Nursing Homes and the Filial Responsibility Trap: Undermining Medicaid Planning

For families planning to safeguard assets through Medicaid planning, a cornerstone strategy is the use of an irrevocable trust to shield resources from the five-year lookback period, ensuring eligibility for long-term care without depleting savings. Yet, a recent New Jersey case, Bartley Healthcare, Inc. v. Ott (No. A-3336-23, N.J. Super. App. Div. Aug. 15, 2025), highlights a troubling trend: nursing homes seeking to enforce filial responsibility (FR) obligations, despite federal law and most states’ reluctance to impose such duties for long-term care costs. This approach threatens to undo careful Medicaid plans, particularly in states like Ohio with nominal FR statutes, and underscores the need for vigilance in elder law.

The Case: A Nursing Home’s Bold MoveRobert Ott resided at Bartley Healthcare, Inc., until his 2022 death. His daughter, Laura Curcione, acting under a power of attorney (POA), signed letters of responsibility during his admission and readmission, agreeing to manage his funds and pursue Medicaid approval for his care costs. She also signed an agreement to pay a balance due. After Robert’s Medicaid application faced a penalty from unappealed nonqualified transfers, allegedly due to Laura’s inaction, Bartley sued her for $19,669.74, claiming she breached her duty to secure full Medicaid coverage.
The trial court dismissed Bartley’s claim, ruling Laura’s POA ended at Robert’s death, leaving no estate liability, and citing New Jersey’s law (N.J. Stat. Ann. § 30:13-3.1(a)(2)) that bars nursing homes from enforcing payment guarantees against family members. Bartley appealed, arguing Laura’s contractual breach, not FR, triggered her liability. The New Jersey Superior Court reversed and remanded, faulting the trial court for lacking specific factual findings under N.J. Ct. R. 1:7-4. The appellate court didn’t uphold or dismiss based on state/federal law but sent it back for clarity on Laura’s contractual obligations versus statutory protections.Filial Responsibility: A Clash with Federal Law and State TrendsFederal law (42 CFR § 483.12) prohibits nursing homes from conditioning admission or continued care on a family member’s financial guarantee, aiming to protect vulnerable seniors and their families from undue burden. Most states, including New Jersey, align with this, refusing to enforce FR for long-term care or Medicaid-related debts—except a handful like Pennsylvania, where FR laws have been controversially applied (e.g., Health Care & Retirement Corp. v. Pittas, 2012, holding a son liable for $93,000). Ohio, technically an FR state under Ohio Rev. Code § 2919.21, relegates it to a criminal statute, applicable only when someone voluntarily assumes care duties (e.g., co-signing a lease), not as a default for nursing home costs or Medicaid recovery. Missouri similarly limits FR to criminal neglect, not civil liability for care debts.
Yet, Bartley shows nursing homes sidestepping this by framing FR as a contractual issue (e.g., Laura’s letters of responsibility). This tactic threatens families who’ve transferred assets to irrevocable trusts, common in Medicaid planning to meet the five-year lookback (42 U.S.C. § 1396p(c)), rendering those assets unavailable for Medicaid eligibility or estate recovery. If successful, Bartley could force Laura to repay from personal funds, unraveling her father’s plan and exposing her own assets.Undoing Medicaid Planning: The Practical ThreatMedicaid planning often involves placing assets (e.g., a home, savings) into an irrevocable trust five years before care needs arise, shielding them from the lookback and ensuring funds for aging in place (e.g., home modifications, caregivers at $4,000–$6,000/month). Nursing homes, facing funding gaps (e.g., Ohio’s $527M Medicaid shortfall in 2024–2025), may target family members to offset unpaid bills, especially when Medicaid penalties arise from unappealed transfers.

• How It Undoes Planning: If Laura loses, her personal assets could cover Robert’s debt, bypassing the trust’s protection. This sets a precedent for nursing homes to pressure POA holders into guaranteeing care, risking families’ financial security.
• Legal Loophole: The remand suggests the court isn’t rubber-stamping lower rulings but also didn’t rule on federal/state law (e.g., 42 CFR § 483.12 or N.J. Stat. Ann. § 30:13-3.1). Bartley’s contract argument, unaddressed here, could exploit gaps if facts favor their narrative.

What This Case DemonstratesThe remand signals judicial scrutiny, not blind approval, indicating the court seeks a robust factual basis to decide Laura’s liability. It’s not a dismissal based on federal preemption or New Jersey’s anti-FR stance, suggesting the outcome hinges on contract specifics (e.g., did Laura’s POA duty extend beyond death?). This ambiguity leaves families vulnerable, especially in FR-leaning states, and highlights nursing homes’ creative attempts to shift costs despite legal protections.Implications for Ohio and Missouri Families

• Ohio: Though FR is criminal (not civil), nursing homes might mimic Bartley’s strategy, targeting POA agents for “breach” of care agreements. Ensure trusts are ironclad and POA terms limit liability.
• Missouri: With no civil FR for care, the risk is lower, but contract pitfalls persist. Review admission agreements with an elder law attorney.
• Planning Tips: Use a Medicaid-compliant trust with a five-year lookback strategy. Register out-of-state POAs (e.g., Tennessee to Ohio) to avoid Norris-like disputes. Monitor Medicaid appeals to prevent penalties.

A Call to Action

Bartley warns of nursing homes undermining Medicaid plans with filial responsibility claims, even where prohibited. For aging in place, protect your legacy with a trust and legal counsel. For Medicaid planning, seek counsel that will provide ongoing representation to protect the plan- off-the-shelf trusts from online or seminar attorneys that only sell Medicaid trusts, leave you vulnerable.   

For more articles regarding filial responsibility and the efforts of states to circumvent state and federal protections, see the following: 

• Filial Responsibility Rule Means Son, Not Father, Must Pay Legal Bill for Negotiating Medicaid Penalty Reduction
• No Good Deed Goes Unpunished? Caregiver Exemption Does Not Apply When Medicaid Recipient Is Receiving Home Care
• Filial Support Laws Chaos: Pennsylvania and New Jersey Laws Clash
• Three Surprises to Watch Out for When Paying for Long-Term Care
• Maryland Repeals Filial Responsibility Law
• Filial Responsibility Laws Complicate Estate and Financial Planning
• Filial Responsibility In the News
• Filial Responsibility Laws Lead to Chaos
• Man Can't Challenge Discharge of Brother's Debt for Mom's Care under Filial Responsibility Law
• Use of Filial Responsibility to Collect a Nursing Home Debt Survives Federal Challenges
• Elderly Couple May Be Responsible for Adult Son's Unpaid Medical Bills
• California Heir Liable to Reimburse State for Mother's Medicaid Benefits
• Conveyance to Son Was Fraudulent, But His Siblings May Also Be Liable Under Filial Support Law
• Filial Responsibility- Complicating Estate, Retirement and Asset Protection Planning
• Pennsylvania's Filial Support Law Survives Federal Challenge (The Eades Case)
• Conveyance to Son Is Fraudulent, But Siblings May Also Be Liable Under Filial Support Law
• Adult Children Could Be Responsible for Parents' Nursing Home Bills
• Son Liable for Mother's Nursing Home Bill Under Filial Responsibility Law (The Pittas Case)

The following are links to articles describing legal mechanisms by which nursing homes attempt to create filial responsibility even in the absence of filial responsibility statutes: 

• Promissory Note Executed by Nursing Home Resident’s Daughter Is Not Illegal Third-Party Guarantee
• Filial Responsibility- Resident’s Son Not Liable for Breach of Contract Because He Did Not Cause His Mother to Be Ineligible for Medicaid;
• Judge Can Not Impose an ‘Unusual’ Condition on a Reversal of a Default Judgment in a Nursing Home Breach of Contract Lawsuit;
• Tortious Interference With Contractual Relationship Claim Most Recent Possible Remedy Nursing Homes can Employ Against Children of Nursing Home Residents;
• Conservator Owes Duty to Nursing Home to Timely Apply for Medicaid;
• Agent Under Power of Attorney Liable for Damages to Nursing Home for Breach of Contract;
• Conveyance to Son Was Fraudulent, But His Siblings May Also Be Liable Under Filial Support Law;
• Nursing Home May Sue Resident's Daughter for Breach of Contract.

Additional Resources: 

• Losing Loved Ones and Your Livelihood: Re-Evaluating Filial Responsibility Laws
• Filial Support Laws: “A Sleeping Giant”
• Filial Responsibility: Can the Legal Duty to Support Our Parents Be Effectively Enforced?
• A Rational Role for Filial Responsibility Laws in Modern Society?

A Cautionary Tale for Aging in Place Seniors and Their Children - In Re Beam

The recent decision by the Pennsylvania Superior Court in In re Beam, No. 768 EDA 2024 (Pa. Super. Ct. July 1, 2025), serves as a stark reminder of the critical importance of fiduciary responsibility and proactive estate planning, particularly for seniors and their children. This case highlights the consequences of mismanagement under a general durable power of attorney (POA) and the evolving role of probate courts. For seniors and their families, the lessons are clear: failure to plan and document can lead to devastating financial and legal outcomes. For attorneys, the case raises intriguing questions about judicial trends and the balance between traditional probate principles and modern reformist pressures.

Facts and Procedural PostureDorothy Beam, an elderly woman, appointed her great-niece, Vaneeda Days, as her agent under a POA in 2016. In July 2018, Dorothy entered Renaissance Healthcare & Rehabilitation, where she resided until her death in December 2018.  Dorothy dies intestate (without a will), and was survived by Vaneeda and her great-nephew, Shaheed Days. During this period, Vaneeda failed to pay Dorothy’s outstanding nursing home balance of $32,534.28, instead making numerous withdrawals totaling $140,205.95 from Dorothy’s bank accounts, depleting them entirely.
Following Dorothy’s death, David Jaskowiak was appointed administrator of her estate. He petitioned the orphan’s court, alleging Vaneeda’s breach of fiduciary duty through self-dealing and inadequate accounting of the withdrawals. Despite court orders, Vaneeda delayed filing an account, leading to contempt proceedings. When she finally submitted a final account, it acknowledged the Renaissance debt but failed to reconcile the $140,205.95 in withdrawals with documented expenses. David objected, citing misappropriation and lack of transparency.
The orphan’s court, in an unusually lenient ruling, confirmed Vaneeda’s account and imposed a surcharge limited to the $32,534.28 owed to Renaissance, dismissing broader claims due to insufficient evidence and speculating the remaining withdrawals might have been gifts. David appealed, arguing this was an abuse of discretion. 
The Pennsylvania Superior Court reversed, finding Vaneeda’s failure to account, appear at trial, or substantiate her actions constituted clear evidence of fiduciary breach. Inferring self-gifting, the court remanded the case, directing a surcharge of the full $140,205.95. Given the court’s stance, it is highly likely the orphan’s court will now impose this full amount, an obligation that may not be dischargeable in bankruptcy and is unlikely to be fully paid, leaving Vaneeda to face significant asset and income loss.Lessons for Seniors and Their ChildrenThis case underscores the vulnerability of seniors and the critical need for structured planning, especially when long-term care is involved. Here are the key takeaways:

• For Seniors:
  • Specify POA Intent: Dorothy’s POA granted unlimited gifting authority without clear guidance, enabling misuse. Seniors should include specific instructions (e.g., care funding limits) and review documents with an elder law attorney.
  • Deploy Trusts:  Trusts are more capable vehicles for sophisticated planning, specifically planning that spans financial, social, legal, and medical planning.
  • Plan for Care Costs: To avoid spend-down scenarios, consider legal Medicaid planning tools like irrevocable trusts (with the 5-year lookback) or private care agreements to justify asset transfers legally, and consider financial planning techniques such as long-term care or catastrophic needs insurance.
  • Appoint Oversight: Designate a co-agent or successor to monitor POA actions, or with trusts, trust protectors or special trustees, preventing unchecked depletion as seen with Vaneeda.
  • Regular Updates: Revisit estate plans with changing health needs to ensure alignment with wishes, reducing the risk of exploitation.
  • Protect Digital Assets: Sometimes, the digital information necessary to provide context, or indeed to prove a claim regarding use of assets, is lost because digital information is lost for want of proper planning. 
• For Children (POA Agents):
  • Document Transactions: Vaneeda’s failure to provide receipts or explanations led to a $140,205.95 surcharge. Maintain detailed records of all withdrawals, especially for care or gifting, to defend against claims.
  • Seek Legal Counsel: Engage an attorney to navigate POA powers, ensuring compliance with fiduciary duties. A private care agreement could have justified transfers to offset nursing costs.
  • Avoid Self-Dealing: Even with gifting authority, self-transfers must reflect the principal’s intent. Vaneeda’s lack of evidence doomed her defense.
  • Act Transparently: Respond to court orders promptly; Vaneeda’s contempt citations exacerbated her liability.

The likely full surcharge, potentially non-dischargeable in bankruptcy (under 11 U.S.C. § 523(a)(4) for fiduciary fraud), and its uncollectible nature highlight the personal toll. Vaneeda may lose assets or income pursuing payment plans, a cautionary outcome of poor planning.Implications for Attorneys: An Oddity in Probate CourtsFor legal professionals, In re Beam is an anomaly. The court’s initial leniency, limiting the surcharge to $32,534.28 despite uncontested evidence of a $140,205.95 depletion, contrasts with the stricter stance of the Superior Court. This deference or leniency is more familiar in criminal or certain civil courts, where modern reforms sometimes prioritize social or economic justice over traditional legal maxims. Probate courts, historically rooted in protecting vulnerable estates, have been less swayed by such trends, focusing on fiduciary accountability and evidence-based rulings.
The Superior Court’s reversal aligns with this tradition, emphasizing Vaneeda’s breach over speculative gifting. However, the initial ruling raises a question: Could this reflect a creeping influence of reformist leniency, perhaps to avoid overburdening family agents in caregiving roles? If so, might probate courts increasingly adopt a more forgiving approach, balancing justice with practical family dynamics? This case suggests a potential shift, though it remains an outlier given the robust reversal. Attorneys should monitor future cases for patterns, advising clients to rely on documented plans rather than judicial discretion.
Pennsylvania is a filial responsibility state, unlike any other state in many respects.  You can read all of this Blog's articles regarding filial responsibility here. The courts do not mention the filial responsibility law in the consideration and resolution of the case.  One wonders whether the ultimate result is compelled by the filial responsibility law, and the court was as interested in judicial economy, essentially saving the state from the necessity of initiating a separate action against  Vaneeda for recovery under the filial responsibility law.    ConclusionIn re Beam is a sobering lesson for seniors and children, illustrating the perils of unchecked POA authority and the need for proactive estate planning. For Dorothy, a trust or care agreement could have protected her assets; for Vaneeda, transparency might have mitigated her liability. The case also challenges attorneys to consider whether probate courts are evolving, urging vigilance in counseling clients to avoid such pitfalls. Consult an elder law attorney to safeguard your legacy and comply with fiduciary standards.