Filial-ResponsibilityA few years ago, the U.S. Census Bureau published a report called “The Next Four Decades,” showing how elder demographics are expected to change between 2010 and 2050. In short? They’re expected to grow. (A lot.)

Today, for every 100 people of traditional working age, there are 22 seniors: this is called the dependency ratio. By 2030, that number is projected to hit 35, at which point elders will represent 19% of the total population.

This explosion of non-working elders brings with it certain obligations. Who will care for those who cannot care for themselves? Usually, the answer falls along family lines.

What is filial responsibility?

Filial responsibility is the obligation that adult children have to care for their aging parents.

In the U.S., some thirty States have laws about filial responsibility on the books, stipulating that if parents can’t pay their medical bills, the debt will transfer to the children. In about two-thirds of these States, says Life Health Pro, providers of long-term care have the right to sue family members to recover their costs.

This type of law is not a new phenomenon. There were filial responsibility laws in England up to 400 years ago; closer to home, in the U.S. they’ve been part of the system for decades. Their purpose is to lighten the load on the State, lifting costs off the welfare system by placing them back on the family.

When does it become an issue?

Most of the time, these laws are not enforced. When they are, often they take the child’s ability to pay into account. And there are federal laws that prohibit care providers from going after children (source).

That doesn’t mean, however, that your clients are universally off the hook. According to Life Health Pro:

“A Pennsylvania state appeals court has ruled that the adult son of a nursing home resident is responsible for her unpaid $93,000 bill. And the decision has some elder care lawyers wondering if this is just the beginning of a trend.”

What about Medicare?

Filial responsibility laws apply only to patients who don’t qualify for Medicare. Elders in the Medicare system are covered by Medicare.

So, that means their long-term care needs are taken care of, right?

Wrong. Remember that Medicare doesn’t cover long-term care. These expenses are the patient’s responsibility. If the patient can’t pay, they fall under the umbrella of filial responsibility.

Educate your customers

We encourage you to talk to your customers about filial responsibility. Educate them on their parents’ need for long-term care insurance, and brainstorm ways to resolve any concerns they may have about broaching the subject with their parents.

Make sure they understand their risks, too. Nolo says that adult children are most likely to be held accountable for their parents’ long-term care expenses if the following criteria apply to them: 

  • The parent received care in a state that has a filial responsibility law
  • The parent did not qualify for Medicaid when receiving care
  • The parent does not have the money to pay the bill
  • The child has the money to pay the bill
  • The caregiver chooses to sue the child

Remember to add to this list: 

  • The parent received long-term care in a state that has a filial responsibility law, whether or not they qualify for Medicaid or Medicare

To help your customers find answers or create a long-term care plan, you may also want to direct them to

Most of all, make sure they understand what long-term care is, and what this type of insurance covers. Here’s an overview.  Also, our LTCI Fact Sheet #1 is an invaluable tool to share with clients.


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