Do you have to pay for your parents care?

Filial Responsibility Laws: Do Children Have to Pay for Elderly Parents’ Nursing Costs

Many states have filial responsibility laws, but few have traditionally enforced them. That may be changing, says Forbes, as nursing home costs increase and residents have less ability to pay them.

“While these laws don’t directly apply to Medicaid recipients, they may force children to pick up their parents’ long-term care costs long before mom is ever eligible for Medicaid,” says the article. “Such a step could still shift significant costs from states to families.”

Some 29 states currently have laws making adult children responsible for their parents if their parents can’t afford to take care of themselves.  These “filial responsibility” laws have rarely been enforced, but six years ago when federal rules made it more difficult to qualify for Medicaid long-term care coverage, some elder law attorneys predicted that nursing homes would start using the laws as a way to get care paid for. 

It looks like this is starting to happen.  In May 2012, a Pennsylvania appeals court found a son liable for his mother’s $93,000 nursing home bill under the state’s filial responsibility law. Health Care & Retirement Corporation of America v. Pittas (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012).  In March 2013 the state’s Supreme Court declined to hear the case, meaning that the ruling is final.

Many of our  readers are caregivers of elderly parents; they have chosen to take responsibility for their parents—whether it be physical responsibility, financial, or other. But what if instead of making that choice, you had responsibility for your aging parents thrust upon you?

“John Pittas’ mother entered a nursing home for rehabilitation following a car crash. She later left the nursing home and moved to Greece, and a large portion of her bill at the nursing home went unpaid. Mr. Pittas’ mother applied to Medicaid to cover her care, but that application is still pending. Meanwhile, the nursing home sued Mr. Pittas for nearly $93,000 under the state’s filial responsibility law, which requires a child to provide support for an indigent parent. The trial court ruled in favor of the nursing home.”

The article points out that many states still have filial responsibility laws on the books, but that those laws are rarely enforced. This ruling by the Pennsylvania Supreme Court does not bode well for Baby-Boomers, many of whom are finding themselves caught between caring for elderly parents and for grown children who have not yet left the nest.

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Perhaps one of the most disturbing things about this case is that the nursing home was given so much leeway. The Pennsylvania Supreme Court found that “the law does not require [the nursing home] to consider other sources of income or to wait until Mrs. Pittas’s Medicaid claim is resolved.” This would seem to condone (if not encourage) a litigious mind-set among nursing homes. As if this weren’t bad enough, the court “also said that the nursing home had every right to choose which boomer members to pursue for the money owed.” If you are one of many siblings you could find yourself involved in a lawsuit merely because you live the closest, are the wealthiest, or called mom more often than your brothers or sisters.

Since Medicaid is an entitlement, not a program everyone pays into like Social Security or Medicare, the Federal government defines eligibility. And Federal law prohibits state Medicaid programs from looking at the finances of anyone other than the applicant or the applicant’s spouse. When the elderly exhaust their assets, individually or as a couple, the government steps in and pays for their long-term care. Adult children are not part of the Medicaid eligibility equation.

But Medicaid is in big trouble — cutting here, squeezing there — and will be inundated when baby boomers reach old age. The staggering cost of long-term care and the explosion in the number of people who will need it has prompted a second look at filial responsibility laws as a way to deal with the impending crisis. The National Center for Policy Analysis, a conservative policy group, identified contributions from adult children as one solution to increasing expenditures and insufficient revenues in a 2005 issue brief. A few law journal articles followed, most recently one earlier this year in The Elder Law Journal.

The more temperate arguments about holding adult children responsible take into account the competing demands on their savings, if they have any, including college tuition and impending retirement. Also, most proponents of enforcing filial responsibility laws would exempt those who were abandoned in childhood and see to it that one sibling doesn’t get stuck while the others skip out. Meanwhile, the best way to ensure that you do not find itself embroiled in a similar lawsuit is to ensure that you (or your elderly parents) have a plan in place to pay for long-term care.

For the full text of the Pennsylvania court’s decision in the Pittas case, go to:

For more on filial responsibility laws, click here.

For an AARP map showing the states with filial support laws and providing citations to the relevant state law, click here.

Having a good heart is not enough, you must learn how to provide elder care.

Employers should pay for caregiving only if the caregiver has been certified to provide quality eldercare.

For a solution to the widespread caregiving problem visit

Contributing authors: Alyssa Gerace, Jane Gross, David Goldman


About Elder Care Advice blog

Get professional elder care giving advice, advocacy, education and tips for those who care for and about the frail elderly at the ElderCareAdvice blog. We are generously sponsored by Most posts are written by Cathleen V. Carr, unless attributed otherwise. We welcome relevant submissions. Submit your article and by-line for publishing consideration (no promises!) to Havi at, our own editor who will ensure submissions are given the best possible treatment and polish before publication, ensuring a professional level of publication. There is a nominal service fee involved ($45). Allow up to 30 days for publishing.
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