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Sent to Collection: Joint NPR/Kaiser Investigation Finds Nursing Homes Suing Friends and Family to Collect on Patients’ Bills

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Helping a parent or a loved one with the nursing home admissions process is stressful, emotional, and confusing – just ask anyone who has done it. Apart from the fact that the person being admitted is probably unhappy about it, you as the person handling the details suddenly find yourself faced with questions you can’t answer, policies you don’t understand, and a stack of papers you haven’t time to read. You’re simply told to sign here, here and here.

Imagine the shock you would feel months or even years later when you receive official notice in the mail or via courier that you are being sued because your loved one – for whom you bore no financial responsibility – couldn’t pay their bill. The amounts can run into five or six figures, and the nursing home’s lawyers are alleging that you are on the hook. In many cases, as it turns out, somewhere in those documents you signed was a landmine.

We were shocked, as we read this damning article from the website of NPR, to discover just how common this practice of nursing homes aggressively suing family and friends to collect unpaid resident fees. The NPR article is long and detailed, so we’ll summarize it here. Still, it’s a vitally important story – and another urgent reminder to read the contract before you sign it.

A “Dark Corner” of the Crisis in Medical Debt

The NPR article tells the story of Lucille Brooks of Rochester, who was shocked to discover two years ago that her brother’s nursing home was suing her. Brooks had no control over his money, nor any authority to make decisions on his behalf, and yet she was supposedly on the hook for nearly $8,000.

“Brooks would learn she wasn’t alone,” the article states. “Pursuing unpaid bills, nursing homes across this industrial city have been routinely suing not only residents but their friends and family.” As the NPR story adds, “The practice has ensnared scores of children, grandchildren, neighbors, and others, many with nearly no financial ties to residents or legal responsibility for their debts.”

The stats are staggering. About 1 in 7 adults who have had health care debt report being threatened with lawsuit or arrest, and five percent say they have been sued, according to

nationwide KFF poll conducted for this article. What’s more, according to experts, the level of litigious aggression from nursing homes is increasing, a pernicious strategy of pursuing family and friends of patients, despite federal law standing in their way.

Suits Accuse Friends, Relatives of Stealing and Fraud

The article uses Rochester—Brooks’ city of residence—as its case study, but the effects are nation-wide. “In Monroe County, where Rochester is located, 24 federally licensed nursing homes filed 238 debt collection cases from 2018 to 2021 seeking almost $7.6 million,” the article states. “Nearly two-thirds of the cases targeted a friend or relative. Many were accused — often without documentation — of hiding residents’ assets, essentially stealing. The remaining cases targeted residents themselves or their spouses.”

These are not small suits either: some claims have surpassed $100,000. In many cases, “the people sued didn’t have an attorney, which can be expensive,” the article explains. “In nearly a third, the nursing homes won default judgments because the defendants never responded, a common phenomenon in debt cases. In many cases, lawsuits sought interest rates as high as 18 percent on top of the debt.”

NPR spoke with one attorney who has firsthand experience with this painful issue. “I get calls all the time from people who are served with these lawsuits who had no idea that this was even a remote possibility, who call me crying and frantic,” said Anna Anderson, an attorney at the nonprofit Legal Assistance of Western New York who represented Brooks, among others. “They believe not only that they’re going to lose their own income and their own houses and assets, but also they’re concerned that their loved ones who are still in the nursing home may be potentially kicked out.”

Industry Officials Say Suits are Uncommon – Attorneys Disagree

Naturally, the long-term care industry has their own version of the story. “Long-term care officials and attorneys say they must use the courts when bills go unpaid,” the article states. Spokespeople for the industry are quick to claim that they are simply collecting what is owed them, and that lawsuits against families are “not a common occurrence.”

But the proof is in the paperwork. “The legal strategy is often rooted in admissions agreements, the piles of paperwork that family or friends sometimes sign, not realizing the financial risks,” the article states. As Eric Carlson, longtime consumer attorney, put it, “The world of nursing facilities is a black hole for most people.” And, he adds ominously, “This happens in the shadows.”

Despite the industry’s claims, consumer attorneys say they regularly see these types of lawsuits taking aim at family and friends of residents. Ahmad Keshavarz, New York City attorney, notes that adult children are often the targets of these lawsuits. “Sons or daughters are more likely to have assets,” he said. “They have wages that can be garnished.”

Trapped by Paperwork as “Responsible Party”

Lucille Brooks initially thought that the lawsuit – for a bill of $7,967.05 – was a mistake. For one thing, she had almost zero involvement in her brother James Lawson’s business for most of their adult lives.

“In summer 2019, Lawson was hospitalized after experiencing complications from a diabetes medication,” the NPR article relates. “The hospital released him to the county-run nursing home, and Brooks only found out a few days later. She visited her brother several times. No one talked to her about billing, she said. And she was never asked to sign anything. After two months, Brooks’ brother went home. A year later came the lawsuit.”

Shockingly, “[t]he county alleged that Brooks should have used her brother’s assets to pay his bills and that she was therefore personally responsible for his debt. Attached to the suit was an admissions agreement with what looked like Brooks’ signature.” These agreements—often multiple pages long—have become standard in the long-term care industry.

But many lawyers push back against making a family member financially liable, saying it is unfair. Paul Aloi, an attorney who has represented all sides of this issue, puts it this way: “If you bring your child to a doctor, you should pay for the child’s medical care. But if your adult child brings you to a nursing home and you’re 80, the law doesn’t bind [the child] to pay those bills.”

Federal Laws Protect Friends and Family

There are protections in place, but they have loopholes, and facilities have become increasingly bold about working around the safeguards – or ignoring them altogether. The NPR report says the regulations are unambiguous. “Federal laws and regulations prohibit homes from requiring a resident’s relatives or friends to financially guarantee the resident’s bills. Facilities cannot even request such guarantees,” the article states.

But consumer advocates repeat: look at the paperwork. Admissions agreements assigning financial responsibility are often slipped into paperwork that family members routinely sign when admitting an older parent or sick friend. Often people are told they must sign such forms, which the report states is clearly illegal.

Some facilities outright lie, telling people that the paperwork does not financially tie them to their loved one when in fact it seems to do so. Still, much of the time, no one is there to advise or advocate for the family member or friend at all. They are just told: here’s your paperwork, sign on the dotted line.

Accusations of Stealing Bring Intimidation

Often, says NPR, the claims demanding payment take on an accusatory tone. “Court records show Rochester-area nursing homes also frequently accuse family and friends of hiding residents’ money and property to avoid paying the debts,” the article states. “The allegation is known in debt law as ‘fraudulent conveyance.’ But it is commonly interpreted by those being sued as an accusation of theft, which can be very frightening, consumer attorneys say.”

The fear of being accused of stealing has a strong hold on those being sued, even if there is no documentation or proof that any theft has occurred. But thankfully, the pushback from consumer advocates—and the illumination of this shadowy part of the industry—is having an effect. Many, including Lucille Brooks, are having their cases dropped, thanks to the efforts of advocacy lawyers and other experts in the field.

As for the mystery of Brooks’ signature showing up on a form she didn’t even see? She thinks it was forged from the nursing home’s visitor log, which was the only thing she signed. To this day, the experience still leaves her shaken, and she tells everyone she knows not to sign anything related to long-term care facilities. “It’s ridiculous,” she said. “But why would you ever think they would be coming after you?”

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Photo Credit: Blogtrepreneur on Flickr

(originally reported at www.npr.org)

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