Dear Prudence: I don't want to participate in my mother's end of life care

[minoanmiss]

[also, the titular one on that page is a doozy]


Dear Prudence,,

I maintain a distant but polite relationship with my mother, “Amy,” despite living in the same city. When I was a kid, she not only failed to protect me from my abusive father, but sometimes threw me under the bus to protect herself and my younger brothers from him. His alcoholism killed him when I was 14, but the damage had been done at that point. She never apologizes or acknowledges any of this, and through years of therapy the best I’ve managed is a distant coexistence.

Although Amy is still mentally competent, her physical health has been declining steeply, and she’s no longer doing well independently. Amy, my brother, and a social worker all called me after a recent fall landed her in the hospital, looking for me to organize and pay for care. Frankly, although I could afford to help, I have no desire to do it. Ideally, I would make one or two polite holiday visits a year out of a sense of obligation the way I do now, and even that is a big ask.

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How do I politely but firmly refuse to be involved in her care? As my mother and brother brought up, I was heavily involved in my mother-in-law’s end-of-life care (although I doubt they know my partner and I also paid for all of it) but that was different: We loved her in a deep and uncomplicated way and still miss her dearly, and even then it was a difficult time. I don’t want Amy to suffer, but I absolutely do not want to be involved in the life of someone who hurt me so much. My brothers were coddled and neither tends to take on “women’s work,” so I doubt they will step in. I need a script that doesn’t reopen old wounds or get into justification.

—(Trying to Stay) Distant in Ohio

Dear Trying to Stay Distant,

“I want you to know that I’m not going to be involved in Mom’s care.” That’s it, that’s the script! But your actions will be even more important. Your brothers will eventually step up and do this “women’s work,” but only if you don’t do it, or monitor it, or manage it, or even ask about it. It’s great that they already have the support of a social worker. When they realize you’re serious, they’ll figure this out.

Comments

my question is...

[minoanmiss]

Can they force her to?

Re: my question is...

[lannamichaels]

I do have questions about this in terms of financial requirements because many many many years ago I read in a random advice column in the local newspaper that had to do with elder care that there's a way to garnish the adult children's paychecks to force them to pay for nursing homes and the like. It scared the hell out of me. But I don't actually know what the rules/laws on this are and if exists, I would imagine it would vary a lot by location. But I'm still glad I don't live in the same state as that parent anymore.

Re: my question is...

[laurajv]

The rules vary a LOT by location. for example, some US states (MA and PA are two of them) have filial responsibility laws that permit the state to enforce children to help pay for parents' care. Some states that have these laws don't enforce them, some do. (Both MA & PA do.) They can't be enforced across state lines, which is why MA was disappointed when they realized my spouse no longer lived in MA and could not be forced to provide for his estranged father, and also why if my father ever moves back to PA I'm going to leave the state.

Re: my question is...

[movingfinger]

Yes they can!

Re: my question is...

[conuly]

Depends on the jurisdiction.

Re: my question is...

[cereta]

Apparently, yes, in some states, but (a) not if they qualify for Medicare and (b) it's seldom enforced. I would imagine it would be very difficult. Our system can barely manage to get parents to support their kids, and that's an unambiguous legal requirement.

Re: my question is...

[lilysea]

Refusing to be an elder caregiver - thread
https://twitter.com/CZEdwards/status/1215023444720377856

"Per the 1987 Nursing Home Reform Act it’s not legal for an SNF (Skilled Nursing Facility/nursing home) that accepts Medicaid to force a third party to be liable for a resident’s costs.
This doesn’t stop anyone from trying to guilt you into volunteering financial responsibility.

Spend your elder’s assets first. Period. When their assets are gone, it’s time to transfer to Medicaid. A vendor Medicaid application (when the SNF applies for Medicaid for your elder) is almost never denied.
DO NOT pay out of your pocket.

There are special circumstances if you live in a Filial Responsibility state. These are states that have old laws on the books that require adults to support their elderly *parents*. If your person is an aunt, uncle, grandparent? There is no force of law on you.

FR states:
Alaska
Arkansas
California
Connecticut
Delaware
Georgia
Indiana
Iowa
Kentucky
Louisiana
Maryland
Massachusetts
Mississippi
Nevada
New Jersey
North Carolina
North Dakota
Ohio
Oregon
Pennsylvania
Rhode Island
South Dakota
Tennessee
Utah
Vermont
Virginia
West Virginia

In most of these states, the filial responsibility statutes are *rarely* enforced. In several of these states, the adult child’s responsibility comes after the state’s responsibility (Medicaid), or only applies before the parent is 65.

Pennsylvania is the exception.

Pennsylvania nursing homes & ALFs use the filial responsibility law aggressively. They will sue the adult children for cost of care, regardless of whether the child has a relationship with the adult. They win.

My strong suggestion? If your parents live in PA, don’t live there.

There is no federal Filial Responsibility law, so there is no jurisdiction for a Pennsylvania SNF to sue someone who lives in Kansas or Arizona. And unlike child support, there are no state level filial responsibility reciprocity laws.

The further good news is PA may only recover a maximum of 6 times a person’s annual *disposable* income. They can’t touch your retirement accounts, nor leave you unable to pay your own bills, debts & cost of living, cannot touch your children’s fees or college money.

But you still don’t want to have a full body financial MRI & take the credit hit of a judgement. So Pennsylvania is out if your parents live there! (Or lobby to get the law repealed, but that’s gonna be a hard sell. PA loves FR & anything that pushes social costs to private.)

Filial Responsiblity laws are the very best reason to get & maintain a Long Term Care Insurance policy. (The payout of an LTCI constitutes fulfillment of the filial responsibility in most states.)

If you absolutely can’t, if even supporting yourself is dicey — that is your out.

All Filial Responsibility statutes have an anti-impoverishment clause.

Most states have a reasonable cause clause; they don’t force an abused/abandoned child to pay, but that means documents."

Re: my question is...

[minoanmiss]

Oh wow, thank you for this info!

Re: my question is...

[lannamichaels]

Thanks for this info, this is helpful to my concerns as well! (I was living in PA, and the person in question still does)

Re: my question is...

[librarygeek]

Thank you for this. *I* live in PA, my dad moved from NJ, to TX, to North Carolina by about 2008, after Mom died.

I didn't know about this...

[watersword]

Oh man I feel for this LW ("I don’t want Amy to suffer, but I absolutely do not want to be involved in the life of someone who hurt me so much." is such a good summing up of it.), my family is currently going through end-of-life stuff for a very beloved member and it's emotionally wrecking everyone, and I am dreading the day a abusive bioparent of mine needs end-of-life care, which I will under no circumstances be involved in.

[movingfinger]

Today I learned about filial responsibility law, which you should definitely look up if you are estranged from your family but living in the same state (not clear whether pursuit across state lines is possible). This is a money-grab by states dressed up as enforced child-parent duty.

In the light of this (LW is in Ohio, which is such a state), Prudie's advice sucks flaming bagged dog poop. LW should talk to an attorney about their exposure immediately. Depending on the circumstances, the state or care facilities may pursue even children after death of the (estranged, in this case) parent. Prudie could have run a thirty second search engine skim on this, same as I did. Utterly crap advice!

[xenacryst]

Your brothers will eventually step up and do this “women’s work,”

AHAHAHAHAHAHATHUD. Yeah, you're apparently not familiar with men who dodge "women's work," are you? They have no fucking clue, and they have no clue that they have no clue, and they will cry foul in their whiniest ass voices when the clue bat does actually mess with their faces. This, along with the previous comment about filial responsibility law makes the answer a crapton of bad advice.

You want to know how this will play out if this answer stands? LW will decline to take part in care and her brothers will hem and haw and run out of time and/or money because they don't know shit about how to make Amy's end of life comfortable to their standards, and then someone will stumble across the filial responsibility piece, and come after LW with a vengeance and chase after all her assets. If she's lucky, LW will get a lawyer who's halfway decent when that hits the fan, but she'll already have been dragged into a massive, massive guilt trip. They'll probably all end up hating each others' guts and teetering on the edge of financial ruin.

[purlewe]

THIS.

[tielan]

I hope someone noted this in the letters column. Eesh.

[cereta]

I agree with a great deal of this, but I would be very, very surprised if the brothers ever stumbled across the filial responsibility thing. The idea that such a thing might exist had never even occurred to me, and (as you know, Bob) I spend a great deal of time around legal types, and have had several reasons to investigate elder care. Also, I'd be very surprised if Amy didn't qualify for Medicare, which seems to obviate filial responsibility (which is probably why so few people know it exists).

[beable]

The brothers might not, but I expect the social worker would.

[cereta]

They might, but everything I've read (admittedly, in the last hour or so) says they're almost never enforced, that they're a relic from before Medicare and Medicaid. And I've been through the eldercare process in Ohio for my grandmother, and no one ever brought up my mother's assets. I just asked her. It didn't happen, and she was right there through the whole process. The deal made was that my grandmother's assets would all be used to pay for her care, and if/when they ran out, the facility would continue the same standard of care for what Medicare, her pension, and Social Security paid.

That said, having a lawyer is a very good idea, because (a) facilities will wring every last cent from a parent's assets, and caregivers usually have a right to have things like gas or the cost of an auction service covered, and (b) what you really have to watch for are care facility contracts, which might include a promise on the part of an adult offspring to cover bills Medicare/Medicaid/the parent's assets don't. Having a lawyer is pretty much always a good idea.

And to be clear, I'm not saying that there's no chance the LW will encounter these laws, or that she shouldn't take steps to protect herself. But the overall impression here that the government and/or private entities are tracking down uninvolved adult offspring to make them pay for eldercare just does not appear to be reflective of current practice.

[xenacryst]

That’s good to know, though also going through my head was just if the brothers ever got it into their heads to see if they could wring any money out of LW, by whatever means. And if they could find any legal leg to stand on, they might use that, just as an attempt to cover for whatever inadequacies they’ll likely perpetuate.

[cereta]

Oh, it certainly could. And maybe I'm projecting, here, because while I have zero doubt that my own brother (the older, not the younger) would try to pull some kind of shite like that (fortunately, they don't seem to cross state lines; also, we have scarier lawyers), he's also...okay, there's no kind way to put it: not the sharpest bulb in the chandelier about stuff like that. I get the feeling that for LW's brothers, actually researching laws and finding lawyers and showing up for hearings, etc, would be, like, effort, you know? I'd be more concerned about a care facility trying something, but again, it's a lot of work that could very, very easily end up costing them more than they can get out of LW. There's a reason so many parents give up trying to collect child support, and that's with the government actively pursuing it (when they do). Legal stuff is slow and messy and costly and work.

[minoanmiss]

is relieved

You know one of the reasons this letter made me curious, after all.

[cereta]

Oh, indeed. It's also worth noting that they can't exactly take assets you don't have, and that, again, if the legal costs outweigh what they're likely to recoup, they're not going to bother.

[minoanmiss]

Yeah, that's what I worry about for LW's sake.

[seascribble]

The part I don’t understand is why would LW be more on the hook under filial responsibility than the brothers. Just for being the eldest?

[conuly]

I got a hint in there that LW might have the highest income after expenses.

[resonant]

That's a tough one. I think the letter writer is 100% morally justified but is going to have a rough time on the practical side.

A lawyer would be the right place to start, and then she should probably look for a support group of people estranged from their parents, where she might find others who have been through the same thing and can give advice.

It's going to suck regardless, though.

[lemonsharks]

I feel for this LW. So much. My mom and I have a good relationship now, but when she finally left my abusive dad ten years after I left it stung that she couldn't have done it when it would have done me some good.

So that's why I'm 100 on the LW's side, here. I think she should tell her brothers and social workers exactly what she wrote:

"[Amy] not only failed to protect me from my abusive father, but sometimes threw me under the bus to protect herself and my younger brothers from him."

Plus: "I'm done here. You deal with her end of life care, because I'm not going to."

The advised script works, too, but I suspect telling them how she really feels could be cathartic, especially since she's looking at pressure and guilt from her brothers either way.