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Lifestyles over 50

Can a Nursing Home Require Friends or Family Members To Pay for a Resident’s Care?

Apr 18, 2023 10:59AM ● By Stanley M. Vasiliadis, Esq., CELA
If your loved one is entering a nursing home, you may worry about whether you could be required to pay for his or her care. Under federal law, a facility that accepts Medicaid as payment for the cost of a resident’s care after the resident goes broke (almost all facilities do) cannot require a family member or friend to co-sign an admission agreement and take on personal liability. However, most, if not all, nursing home contracts do impose certain obligations upon the person who signs the agreement on behalf of the resident. Typically, the signer is obliged to ensure that the resident’s funds are used to pay the nursing home and to apply for Medicaid on behalf of the resident when the funds run out. If the resident incurs an unpaid nursing home bill because Medicaid eligibility is delayed, the signer can and will be held personally liable.

The relevant nursing home contract provision deceptively implies that the signer may not permit a resident to take measures to protect assets and then qualify for Medicaid. On the contrary, federal law provides that a Medicaid-participating skilled nursing facility “may not seek additional payment from a resident for covered items or services. It must accept … Medicaid as payment in full.” Courts interpret this statutory provision to mean that a facility may not prohibit a resident or the resident’s agent under power of attorney from implementing estate planning measures that enable the resident to qualify for Medicaid without first having to pay over all of his or her money to the nursing home.

Beware of the Filial Support Trap
Unfortunately, some family members DO in fact incur financial liability on another basis—namely, state “filial support” laws. Pennsylvania’s law is perhaps the most onerous in the country. Under these so-called “filial support” laws, adult children are obliged to financially support their indigent parents. In Pennsylvania, this means that a nursing home resident’s son or daughter can and will be sued for the parent’s unpaid nursing home bill. That typically occurs when someone’s Medicaid eligibility is delayed and there is an unpaid nursing home bill that pre-dates eligibility for Medicaid benefits. Moreover, this financial obligation applies even if the child received none of the parent’s assets and even if the child did not sign the nursing home admission agreement or have any involvement with the parent’s care or placement.

How To Avoid the Filial Support Trap and Still Protect Assets
The good news is that filial support liability will not be incurred with proper planning. If the nursing home resident qualifies for Medicaid to pay for care immediately upon exhaustion of assets, everyone is happy—no unpaid nursing home bill and no lawsuit against the children.

STANLEY M. VASILIADIS is a Certified Elder Law Attorney as accredited by the Pennsylvania Supreme Court. He is a member of the National Academy of Elder Law Attorneys, the Academy of Special Needs Planners, and member and Past-President of the Pennsylvania Association of Elder Law Attorneys. Vasiliadis successfully litigated the landmark elder law case, Mertz v. Houstoun, and has received numerous awards in his field. He is of counsel to the law firm Vasiliadis Pappas Associates, located in Bethlehem, PA.
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