Financial support for a parent--who's responsible?

Both sets of parents are responsible for their own housing/care cost. Once the money runs out, they would need to qualify for Medicaid. Medicaid will decide how much the State will kick in to help out financially [it depends on the State of residence, each State has it's own rules and regulations].

The grown children are not responsible for the financial support, unless they volunteer to do so.

Children are not financially responsible for their parents.

There's no mess. What's the mess? They should move into assisted living. If A runs out of funds to contribute his/her share, the other should pick it up.

It's not a business transaction. It's a marriage.

Do you have/can you get a copy of the prenup? I'm not sure what's standard, but I think they mainly cover what happens on divorce and maybe death. Even if this one provided that each should be responsible for their own health care/disability costs, I'm not sure it would be upheld if one of the spouses runs out of money and needs assistance. It might depend on the law of the state of residence. I think you really can't know the answer to this without having the prenup evaluated by a qualified elder care lawyer in their state. Generally, adult children are not responsible for parents' expenses, but that also varies by state. Reference the Pittas case in Pennsylvania, where a son was held liable for his mother's rehab hospital costs when she left the country without paying.

No offense intended but I get the impression this is more of a theoretical than urgent situation query. I do think it's a good idea though to get these ideas out in the open and addressed before the issues become more urgent.

Personally, I feel this is primarily a matter between A and B; they're married, they have income, and as long as they do they should be able to manage their affairs, assuming they're physically and mentally capable to do so.

With a combined income of about $6200 a month, I think they could use those funds creatively to continue to have outside help. I can't foresee them being eligible for Medicaid with that income as well as the assets. And relying on paid help might be the best option as long as they're able to stay in their home, as it doesn't seem as if the adult children want to assist with that care.

However, even though you don't mention their specific medical situations, those in my opinion would impact any decisions to move to AL.

It also seems as if the adult children don't want to become involved in any home care, which is part of the family dynamics, as well as one's preference to spend the money on their children's college education.

This is a very personal and biased opinion, but my siblings and I put ourselves through college, whether it was through working (sometimes 2 jobs), or through the GI Bill. I'm not particularly sympathetic to parents' subsidizing a full college education when the kids could work and learn some real life skills, but I know that isn't the prevailing thought.

I don't think the Filial Responsibility laws would come into play, at least not yet, given the income of B.

I'm also not clear on the division of expenses since A would run out of money based on a $1700 monthly SS payment. Is A paying all of the household expenses? Aren't these shared? And I would think that B's $600K would be available for some additional care expenses before A runs out of money.

I would think that this should be resolved first between A and B. If the children don't want to participate in care, I don't see why they would even have a say in how their parents choose to manage their care, whether in A's home or in AL. Third party arbitrators shouldn't be necessary, and I think would possibly make dispassionate decisions not in the best interest of any of the family members.

However, I'm not in that income bracket level and I know that people of higher net worth live and make decisions differently.

Carla, what I found confusing in the Pittas case in Pennsylvania is that neither the mother's husband nor any of the other siblings were held liable for the rehab costs.

FF, that shocked me as well. I haven't read either the lower court or Supreme Court's opinion, so there may be something buried in there. I get shivers up and down my spine every time I read about the filial responsibility laws.

I know one thing - I'll NEVER move to Pennsylvania!

I'm thinking he may have signed something when mom was admitted. I know I was always asked to do so, and always adamantly refused...

Who's responsible. Read the Pre-Nup first and foremost.
The problem as I see it is the Reverse Mortgage in A's name. It will be called when A goes into a nursing home. A will need Medicaid. As long as A did not give away cash, real estate etc for the last five years, A should be OK. BUT if A was too generous to the kids, Medicaid will not pay. Medicaid will expect the gifts to be repaid. In the Pittas case, Medicaid said NO because the five year look back was dirty. It was actually the nursing home who sued ALL the Pittas children. However, the Judge ruled against the son who acquired all the assets, the paper trail pointed in his direction.

Pam, I think you're confusing the Pittas case with something else. Here is a link to the appellate case. It's clear that nobody but the one son was sued, and there was no claim that he'd received any assets from his mother. His mother was deemed to be indigent based on her meager income of around $1,000/month. I don't know why Medicaid was turned down - that wasn't mentioned in the appeals case, but the denial was being appealed at the time the final decision came down. (When the case was first decided, I recall reports saying that the Medicaid filing was never finalized, because the nursing home was counting on the family to pull the documentation together, and they didn't get it done in time. I don't recall any mention of the lookback period or any assets being transferred).

The court expressly said that there was no obligation on the nursing home to sue the husband or the other children, but that the defendant could have joined them in the suit if he'd wanted to. (There was also no mention of the son having signed anything, in response to Maggie's suggestion).

I agree with the idea of never moving to Pennsylvania (I lived there for a few years right before I moved to Florida). The law is very unfair and was applied very unfairly in the Pittas case.

Here is the link, FWIW (for as long as the website leaves it up).

hollanderlawoffices/CASE%20HCR%20v%20JP%202012.pdf

If parent A sells the house and pays off the home equity loan, how much would that leave him with? If they moved to AL together, between their LTD policies and income, wouldn't they have enough? The $600,000 should be invested to produce income, even at 1% that would provide $500. Per month

that's what I don't understand either; goodness, where's that money going?

CarlaCB, the pdf link doesn't work, and I am unable to locate anything for that law office.

I did find which provides an overview of the case.

MyThreeSons, thanks for the link... this can also backfire on elderly parents.... scroll down to the bottom of the page and click on "Elderly Couple May Be on the Hook for Adult Son's Medical Bills", about a son age 47 who died and now the hospital is looking at the parents to pay the bill.

I missed seeing that link. Is that also Pennsylvania or a view of our world to come? SMH

would never apply to the 1%...

Thanks for these links, MyThreeSons. The link I posted worked at the time I posted it but has since been disabled or corrupted - it doesn't work for me either. And thanks freqflyer for pointing out the link to the story on the bottom.

I think it's equally unfair either way. People have enough trouble paying their own way without being on the hook for anybody else's bad choices and failures, even family members'. I have one sister who almost never worked and an elderly parent who worked but retired before she had accrued a livable retirement income. I don't want their problems landing on me - I had no control over their choices at any point in their lives.

In the US we have a horror of having the taxpayers foot the bill for the indigent or the lazy or incompetent - but actually, studies show that families get along better when the government provides services and assistance and family members aren't dragged into it. I'm sure lots of people on this website can relate to that, given the difficulty of getting family members to participate equitably in a parent's care.

that's strange; I thought I'd be able to copy and paste the link from where I went to it but it won't work for me either now

Sounds like a bad marriage, if at this point in life taking care of each other is not a personal priority to both spouses. I am a huge fan of college and think it is awesome if grandparents can provide such, but your first priority is your own and your spouses care.

The AgingCare website must have software that will remove or shorten outside links so you can't easily click on them. Too bad, as on some of the outside website links we can learn from them.

FF, there is a way to truncate the URLs - it's used on one of the gardening forums I occasionally visit. If it's an issue, I'll collect some info on how to do it and post back here.

Are others still having trouble finding that link on the PA case? I visited the law firm's website for a brief period of time yesterday and found the link, but didn't download it.

Thanks for your feedback and comments so far (although things apparently got a bit off track). It's actually not quite what I expected. So, some more info...
1. This is not theoretical. A is my dad, B is my stepmom. They are in Massachusetts; the rest of the kids are in NJ, MI, WA, CA, and MD.
2. My dad paid for both mine and my brother's college (two very nice schools), so I think that's where our sense of obligation is kicking in. That being said, part of me had always been thinking, "Well, gosh, she married him, why isn't she stepping up?" but then wondering if I was being selfish. I'm thinking if the genders were reversed, I don't think there'd be any question that the husband would take care of the less-financially-well-off wife.
3. As someone pointed out, the marriage at this point is not entirely stable. Dad has Parkinson's, bouts of depression, and some memory issues; I've managed to automate most of his (and the household's jointly paid) bills. Stepmom has cancer (but is doing reasonably well healthwise). Stepmom is acting as caregiver and more or less running the household, but we get occasional calls that she is at the 'end of her rope'. She claims (for example) Dad insists on wearing an ironed shirt every day, and he has a horrible temper and yells at her--things we've never witnessed when we've visited. She also claims Dad is perfectly well-behaved when the outside caregiver visits twice a week (eg, getting up at a reasonable hour, taking meds, etc) but otherwise not. Both I and my stepsister (who works in health care and has experience with depression) think she needs to be more proactive to get some help. And both my brother and I feel there is a risk she will simply walk out on my Dad (although we are not sure where she'd go). Dad's priorities appear to be reading the newspaper, smoking the occasional cigar, and watching football at the neighbors' down the street.

My brother and I will be out visiting in August and hope to make some progress in getting things a bit more stable. Any additional thoughts and ideas would be welcome...

Thanks for the explanation. From your second post, I think your stepmother clearly needs some assistance, not just for the caring of your father but for her own respite. Battling cancer, regardless how well someone is coping, is emotionally and physically draining.

Often those who aren't present on a daily basis don't see how disabling caregiving can be - the carers try to put on a good face and manage things, and the visitors go away thinking things are on a pretty good level. I'm not suggesting that you and your siblings aren't realistic, only that what you see and are aware of from conversations and visits may only be the tip of the proverbial iceberg.

And I suspect there are many unspoken questions in stepmom's mind how or if the cancer will go into remission, what her short and long term future may be, and who will care for her husband if that future becomes more challenging or ends more quickly than expected. That's a tremendous burden and challenge for anyone, let alone someone taking care of a spouse with some dementia and apparent personality change.

BTW, answers very frequently go off topic; in this case I think it was helpful because the issue of filial responsibility is a delicate but explosive one if other states become as aggressive as PA has.

Since you raised the issue of sibling responsibility, I personally thought that a potential legal bombshell was a related subject.

As to suggestions:

1. How much and what tasks does the caregiver do? Think about the tasks your mother still does and how to get outside assistance to perform them. Relieving her of her own obligations will allow her more time to rest, which anyone battling cancer needs.

2. Perhaps you or your stepmother can arrange to have your father spend more time bonding with the neighbor watching football games. Make it an event - your father can bring food and the guys can enjoy sports activities while your mother gets another rest.

3. Check on local hospital's support groups. If there's one for those with cancer, and if your stepmother would go, make arrangements. Typically there are small bus or dial-a--ride door-to-door services in metropolitan areas if she's not able to drive. (In SE metro Michigan the dial-a-ride only costs $1.00 from home to a destination if it's within 10 miles.)

Check Gilda's Club website to determine if there's a facility in their area. GC in my area has an outstanding range of activities ranging from pot luck get-togethers to meetings for specific types of cancers to meditation type events.

4. Think of other ways, such as senior centers, book clubs, free musical events, or other cultural or social events that your parents can attend. Socialization would be helpful for both of them.

5. Contact the local senior center and find out what services they have, including meals on wheels. It would relieve your stepmother of some of the obligation to cook, especially if it's on a day when she's had chemo or radiation, if that's part of her regimen.

After seeing how debilitated my sister was after both, I can't imagine anyone even having the energy to cook meals or take care of someone else.


I'm sure others will stop by and offer more suggestions.

Adam, I see from your profile that your Dad is 90 years old, curious how old is your StepMom, even if she is 25 years younger that would still put her into the senior citizen category. I can't imagine anyone who is dealing with cancer trying to care for a spouse who has general age decline and starting to have memory issues.

I agree with GardenArtist when she posted "Battling cancer, regardless how well someone is coping, is emotionally and physically draining".... I know, I have the t-shirt and am in remission. There would have been no way I could successful cared for my aging parents or even a spouse during that time frame if any needed help. Cancer is very draining, I remember spending time just staring out the window because I had zero energy.

Yes, your StepMom needs a professional Caregiver to come in to help... but that is where the problem starts when one has elderly parents. The parent(s) refuse to open the front door to any strangers.... they feel they can take care of themselves, thank you very much. No matter how how common sense you toss at them, they will dig in their heels. They are desperately trying to hang onto their independence.

My parents are in their 90's and really need to hire a cleaning crew to clean the house... but there is no way that my mother will allow that. So now I am just a bystander when it comes to home maintenance.... sadly looking at all the dirt, grim, spots on the rug, hand prints everywhere, etc. I can't imagine when the time comes that either one of my parents need hands-on care.

GardenArtist--very, very helpful stuff and good questions. To provide additional clarity...
1. I think the caregiver focuses primarily on my Dad, including at-home stuff like managing meds and driving him to doctor appointments. Stepmom still insists she can do laundry, etch, despite what I (and, at the very least, one of her stepsons) has said.
2. During football season, Dad goes down the street to watch football with "Todd" every weekend. Not sure he necessarily wants to impose more than that.
3. Not sure what she's looked into, local-support-wise (although she may be reluctant to leave Dad alone for extended lengths of time).
4. Dad is a member of the Kiwanis, has a local seniors' 'coffee club', a monthly Civil War roundtable, and helps out with the local baseball league, so he does have contacts (although, to hear Stepmom tell it, it's not enough).
5. Great idea, but she loves to cook--it's a challenge to get her step away from the kitchen when the family visits (and if my partner and I take over dinner for one night).

FreqFlyer: Stepmom just turned 87; she was good friends with my mom from years' back, and she and her late husband were good friends with my parents. There is actually not an issue letting a stranger into the house (although we had an issue last year with a guy who convinced Dad to put "a few things" onto his credit card)-- it's what Stepmom is willing to give up doing.

To an extent, it does get back to the notion that she's got decent income and a newly-acquired lump sum of $600K (less taxes) and should be willing to spend it so she and Dad can be comfortable--but I don't know how to bring that up without sounding selfish.

adambravo, being your Dad and Stepmom are the children of the Great Depression, any large sums of money they have they will guard with their life.

My parents do that, and it is so frustrating trying to get Dad to hire people to do handyman work around the house, as Dad use to do it all. And my parents can easily afford to hire someone.

Dad is in denial that he can no longer safely climb ladders or deal with electrical outlets. Right now he is messing up more things. Mom believes that Dad can do all the fixing. My gosh, Dad is 93, his eyesight isn't all that good, and he can barely move around even using a walker. They both act like they are back in 1955 where they can still do everything.... must be great thinking you are still that young :)

I gave up trying to get my parents to blow the dust off the wallet and enjoy their later years, but if falls on deaf ears [sorry for the pun].

For Pittas, the mom – MaryAnn - who was under 65, entered a HCR (Healthcare and Retirement Corporation of America) owned facility (Liberty Nursing & Rehab) after an auto accident for rehab. At rehab from 9/07 – 3/08 (6 months / 92K bill). She applied for Medicaid & was “Medicaid Pending”. Under 65, so no Medicare. 3/08 she left rehab – against medical advice - & moved to Greece. Now the son – upon being billed 92K for his mom’s care - took it to an arbitration hearing. (I bet arbitration was required to be done as per the admissions contract.) In arbitration, it was ruled in the son’s favor. He won. HCR appealed the arbitration ruling in son’s favor to a Pennsylvania trial court (judges only, no jury).

From WestLaw: “ As a result, on or about May 12, 2008, HCR instituted a filial support action against Appellant. Pursuant to 23 Pa.C.S.A. § 4603, entitled “Relatives' liability,” HCR sought to hold Appellant liable for the outstanding debt incurred as a result of his mother's treatment and care.
The parties submitted the case to arbitration, whereupon a three-member arbitration panel found in favor of Appellant. HCR appealed the arbitration award to the trial court. The trial court held a three-day non-jury trial, after which it entered a verdict in favor of HCR in the amount of $92,943.41. Appellant filed post-trial motions, which the trial court denied on January 13, 2011.”

In reading the transcripts, my thought is that he & his attorney did a poor job for the trial court. He did not substantial his bills; did not provide documentation; did not join his father or his sisters to share the support-burden (if he had, his share would have been 23K). He did not show an attempt at completing Medicaid application or pursuing auto accident litigation. HCR just had to show the trial court he had income and bills due. If the Pittas & his attorney’s thought was that he did not have to do anything because he won in arbitration, that was a huge costly mistake.

NH bills for elderly parents are not going to be what Pittas was. There is going to be Medicare or other health insurance. If their admitted to NH rehab, Medicare is going to pay for 100% of first 21 days and possibly up to 100 days @ 80%. If rehab is due to accident, someone is gonna get sued & followed up to pay. If they need NH after rehab days over, family will complete the Medicaid application. And Momma is not going to leave rehab AMA & move to Greece!
The situation posed for Pittas is very very unique.

BTW HCR was taken private in 2007 with The Carlyle Group ($ 185B in assets under management in 2013) as the majority owner.

If I could post the link from WestLaw, I would but WL is paid subscription only

I agree that Pittas is a very unusual situation. Still, it's alarming that the nursing home was successful against a son who warning and no say in his mother's treatment. If he had known this outcome, maybe he would have arranged care at home, or moved her to a cheaper place. IMO he was totally blindsided.

The more likely application with the elderly is the one Pam initially suggested - where the parent needs to go to a nursing home but the Medicaid application is denied or delayed. For example, when the 5-year lookback rule an issue.

Another likely case is when the parent goes into the NH for rehab but the treatment lasts longer than 21 days. That $110/day copayment after 21 days can add up fast.

There are many ways an elderly person can run up expenses that they can't pay, for health care costs or otherwise. It makes me very, very nervous.

Sorry, the $110/day copayment is now $157/day after day 21 and up to day 100. After that, unless Medicaid kicks in, you're on your own.