[author: Scott Alan Mitchell]
In this issue of McNees Insights, I will take a brief detour from the ongoing series, “Planning and Paying for Long-Term Care,” to discuss a recent and significant Pennsylvania case that has generated a great deal of discussion in legal and health care communities and has led to numerous articles being published not only in Pennsylvania but throughout the country. In May of this year, the Pennsylvania Superior Court issued a decision in Health Care & Retirement Corporation of America v. Pittas, holding that a son is liable for his mother’s nursing care bill of nearly $93,000.
According to the facts of the case, in September 2007, Mr. Pittas’ mother entered a skilled nursing facility following an automobile accident. She remained in the facility until March 2008, at which time she moved to Greece. Unfortunately, most of the charges incurred by the mother were unpaid at the time of moving to Greece.
As a result, the facility filed a lawsuit against the son under Pennsylvania’s filial support law (23 Pa.C.S.A. § 4603). This law generally provides that a spouse, child, and/or parent “have the responsibility to care for and maintain or financially assist an indigent person, regardless of whether the indigent person is a public charge” provided that the spouse, child, and/or parent “have sufficient financial ability to support the indigent person.”
Because the son had net income in excess of $85,000, and because the son did not otherwise establish that he lacked the ability to financially support his mother, the Superior Court affirmed the lower court’s determination that the son was liable for his mother’s outstanding charges of $92,943.41.
The Court also determined that the statute does not require a facility or court to look to other possible sources of income before proceeding against any one of the relatives listed in the statute. Specifically, the Court suggests that there is joint and several liability under the statute, meaning that a facility or other claimant can proceed against any one of the relatives listed in the statute, regardless of the (perhaps greater) financial ability of any other relative listed in the statute (but other relatives can be joined in the action by the relative against whom the action is filed). Also, the Court finds that a claim against a relative can proceed even when there is a pending Medical Assistance application for the person’s care (but a subsequent approval of the application likely relieves the relative of the support obligation).
In addressing the meaning of “indigent,” the Court found that such term “includes, but is not limited to, those who are completely destitute and helpless.” The term “also encompasses those persons who have some limited means, but whose means are not sufficient to adequately provide for their maintenance and support.”
The duty of “filial support” certainly is not new in Pennsylvania. The above statute was enacted in 2005. However, prior thereto, a former filial support statute existed at 62 P.S. § 1973, which initially was enacted in 1937. This statute provided, “The husband, wife, child . . . father and mother of every indigent person, whether a public charge or not, shall, if of sufficient financial ability, care for and maintain, or financially assist, such indigent person at such rate as the court of the county, where such indigent person resides shall order or direct.”
In fact, in the 2003 case of Presbyterian Medical Center v. Budd, the Pennsylvania Superior Court allowed for a facility to proceed against a daughter for approximately $68,000 of outstanding charges of the mother. As has occurred recently with the Pittas decision, after Budd was decided, numerous articles and commentaries were written sounding the alarm that children could suddenly be found liable for a parent’s nursing home bills (even though the statute underlying Budd existed in one form or another since 1937).
After the decision in Pittas, it remains to be seen what impact this case will have in the future – and whether health care facilities or other creditors will begin to institute support actions against spouses, children, and parents of individuals who have outstanding bills. Budd certainly did not open the floodgates to spouses, children, and parents being sued for filial support, and so one certainly could argue that Pittas also will not lead to a wave of such lawsuits.
However, it should be noted that Budd involved a situation where a daughter clearly engaged in fraud, which resulted in the large balance due the facility. In Pittas, the opinion of the Superior Court references no fraud or culpability on the part of the son, and so a seemingly innocent son is held liable for $93,000 of nursing care expenses of his mother. However, statements made by the facility to the media suggest that there was some culpability on the part of the son in not cooperating with the facility in applying for Medical Assistance benefits for the mother.
In sum, while the future impact of Pittas remains uncertain, families need to be aware that Pennsylvania law presently provides (and historically has provided) that the spouse, children, and parents of an indigent person have a duty to financially assist the person. One lesson we clearly learn from Pittas (and from Budd) is that when a person’s nursing home bill is not paid, when a large balance begins to accumulate, and when there is fraud or negligence or some lack of cooperation or diligence by families, facilities can and often will look to the family under this financial duty. Thus, when a person is receiving care in a facility, families should ensure that the facility’s bill is being paid each month and that the person’s assets are not being improperly diverted elsewhere. Additionally, when the time comes for the person to apply for Medical Assistance benefits, families need to cooperate in providing necessary documentation in the application process so that the person can be approved for benefits in a timely manner. Finally, Pittas (and Budd ) also underscores the need for families to work with an experienced elder law attorney as early as possible when a loved one has entered or is soon to enter a long-term care facility.
In the next issue of McNees Insights, I will return to the ongoing series, “Planning and Paying for Long-Term Care,” to continue the discussion of how a family’s “excess” assets are addressed in the Medical Assistance context.