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.

But Maryland's filial support law comes into play when a parent is under the care of a state psychiatric hospital, Frank said. If the parent is under age 65, the state can use the law to get children to reimburse the state for the parent's care, Frank said.

Frank said it's unfair, and possibly unconstitutional, to force a child who didn't agree to be liable to pay a parent's care bills.

"How can you be civilly liable for money owed just because you were born?" he said.

Frank said the country doesn't need filial support laws, but rather a solution to long-term care.

AARP, the advocate for those age 50 and older, hasn't taken a position on the issue, said Sally Hurme, an elder-law attorney with the group.

"This topic could be an opportunity for families to have a conversation about the parents' ability to pay for long-term care," Hurme said. "Have they adequately saved? Are they going to need to go on Medicaid?"

And it could cause adult children to consider what they can do now to make sure parents have the resources to pay for nursing home care in the future, Hurme said.

"That's a good family conversation," she said.