John Pittas' mother spent six months in a Pennsylvania facility recovering after an auto accident, then moved to Greece to be with her other children.

Left behind: $93,000 in unpaid care bills.

The facility sued to collect — from John Pittas. A court sided with the care facility last year and ordered the son, who runs a diner in Schnecksville, Pa., to pay up.

The basis of the lawsuit is a so-called filial support law, which requires adult children to be responsible for the care of indigent parents. Twenty-nine states, including Maryland, have such laws, although they vary and can be overridden by other statutes. Maryland, for instance, bars nursing homes from saddling children with their parents' bills, but the filial support law can apply under other circumstances.

The Pittas case has generated lots of chatter, particularly as the nation grapples with a growing elderly population, rising long-term-care costs, and shrinking state and federal budgets. "In desperate financial times, these kind of laws hold a new fascination," said Katherine Pearson, a law professor at Pennsylvania State University who has studied filial support laws.

Though the laws have mostly been ignored in many states, there are new reasons courts might be asked to start enforcing them, Pearson said. Baby boomers are getting up in years and approaching a time when many of them will need expensive long-term care, she said. That care will have to be paid somehow.

"With the economic climate, all options are back on the table," she said.

Joseph DeMattos Jr., president of the Health Facilities Association of Maryland, said that's not an option his members are pursuing.

But, he added, "any time there is a reduction in resources for treatment and care, whether it comes from a federal cut in the rate or state cut in the rate or through bad debt from residents who are unable to pay, it reduces, obviously, the total resources available for quality care. And that's a problem."

Filial support laws go back centuries, and nearly all states had them at one time, Pearson said. States began repealing the laws after the creation of Medicare and Medicaid in the 1960s, the latter of which pays for long-term care for the poor.

But the laws are about more than just creditors and have been used in recent years to rescue destitute parents whose assets have been diverted to an adult child, Pearson said. This can happen when a parent transfers a house or other assets to an offspring, who promises to provide care and then reneges. The filial support law is a tool to help recover the parent's assets, she said.

Generally, though, filial support laws are rarely enforced, and most families are unaware of them.

"A lot of people would be surprised," said Kenneth Aneckstein, an estate planning lawyer in Baltimore. "A lot of lawyers would be surprised."

That's why the Pittas case has grabbed so much attention. An application for Medicaid had been made, but ultimately it was denied, said Pittas' attorney, John P. Karoly III in Allentown. The case is further complicated by a legal dispute over the mother's care.

But the bottom line is that Pittas, whose net income exceeds $85,000 a year, according to court documents, was ordered to pay the $93,000 in a lump sum. He appealed the decision to the Pennsylvania Supreme Court, which late last month declined to hear the case.

Karoly said his client faces a few options: He can try to negotiate a settlement with the care facility; file for bankruptcy; or take his case before a federal court and argue that Pennsylvania's filial support law is unconstitutional.

Pittas hasn't made a decision, said Karoly, who also is handling two other filial support cases in Pennsylvania.

What happened to Pittas generally can't occur in Maryland.

Another Maryland statute prohibits nursing homes from going after an adult child to pay a parent's unpaid bill, unless the offspring agreed in writing to be financially responsible, said Jason Frank, an elder-law attorney in Lutherville. He is participating in a webinar Monday with Pearson on filial support laws for the American Bar Association.

A Maryland nursing home, though, can ask the court to force a child acting on behalf of a parent to file an application for Medicaid, Frank said. The child faces up to a $10,000 civil fine for not doing so, he said.