Blindsided: Some nursing homes across the country aggressively pursue friends and relatives for a loved one’s unpaid bill

ROCHESTER, New York (InvestigateTV) — Toni Cook opened the letter from her mother’s nursing home and cried in horror.

Lynn Marie Witt dropped to her knees and sobbed when she read the letter from her mother’s nursing home.

Both women — stiff and grief-stricken over the loss of their beloved mothers — learned from those letters that the nursing homes intended to collect their mothers’ unpaid debts from them.

Neither had any financial control over their mother’s bank accounts or assets after their deaths, court records say. They simply were loving daughters who signed paperwork to have their mothers admitted to a nursing home.

But hidden deep in the reams of admission paperwork was a clause claiming financial responsibility.

In Witt’s case, it was explicit, documents show. She was her mother’s financial power of attorney, but that expired upon death.

The paperwork Cook signed was seemingly less clear on that issue. Even so, the nursing home filed a lawsuit against Cook for more than $170,000. She feared she would be forced into bankruptcy.

Witt faced a $9,200 bill, but it might as well have been $1 million because she didn’t have the money. She finally had put her life in order after a bout of homelessness that left her living out of her car or sleeping on the floor of a church near her mother’s nursing home in New York.

“I felt betrayed, which was part of why I, in all honesty, had a pretty bad mental breakdown and had to call one of my friends over just to kind of help get me off the floor,” Witt said of her reaction to the lawsuit.

Across America, consumer advocates and elder care attorneys are sounding alarms about nursing homes attempting to collect unpaid debts from third parties by sending them to debt collection or to law firms for legal action. Friends and relatives have found themselves facing potentially financially devastating lawsuits simply because they signed admission paperwork.

But a building block of federal laws prohibits collection from third parties for their personal financial assets based on signing a nursing home admission agreement. The law does not apply to third parties who have financial control of a resident’s money.

In 1987, Congress passed the federal Nursing Home Reform Act, or NHRA, which, among other things, bans third-party financial guarantees as a condition of a resident’s admission or continued stay in a nursing home. Specifically, a facility must “not request or require a third-party guarantee of payment to the facility as a condition of admission (or expedited admission) to, or continued stay in, the facility.”

The Fair Debt Collection Practices Act, or FDCPA, bans pursuing an unpaid bill based on “any false, deceptive, or misleading representation or means in connection with the collection of any debt.”

In a 2022 letter to nursing homes, federal regulators wrote that “debt collectors, including law firms, who collect on behalf of nursing facilities may violate the FDCPA by misrepresenting that a consumer must pay a debt that arises from a contract provision that is illegal and unenforceable under federal law. Thus, debt collectors may violate the FDCPA by falsely claiming that caregivers are personally liable for residents’ nursing facility bills based on admission agreement terms that violate the NHRA.”

The Fair Credit Reporting Act also plays a role if nursing home debt collectors attempt to have unpaid debt reflected on a third party’s credit report based on the admissions contract.

But those laws have not stopped nursing homes from trying to collect from sons, daughters, grandchildren, neighbors and friends, said Anna Anderson, staff attorney with the nonprofit National Consumer Law Center.

She’s been on the front line of this issue for years as an attorney representing those who have been sued by nursing homes.

“These cases have been ongoing for a number of years. Unfortunately, though, what we have seen is that nursing homes have gotten more and more aggressive in recent years, particularly as Medicaid cuts have made it more difficult for people to get coverage for their care and nursing homes, but also as nursing home care is just getting more and more expensive,” she said.

The true extent of the issue is unknown because these cases are filed in local county courts, and there’s no central court case tracking system for the 3,143 counties or county equivalents in the U.S.

In 2022, the Consumer Financial Protection Bureau and the Centers for Medicare and Medicaid Services held a joint hearing about third-party debt collection by nursing homes and, as a result, instructed nursing homes to stop this practice.

It didn’t help, the consumer law center found.

The NCLC and Justice in Aging surveyed advocates for older Americans across the country. More than half of those advocates from 27 states told the researchers that they had recently seen lawsuits against third parties with some reporting that they had seen as many as 20 cases in their areas.

Last year, KFF Health News did a deep dive into court records in a single county in New York and found 238 debt collection cases from 24 nursing homes between 2018 and 2021. Those two dozen nursing homes were seeking almost $7.6 million from third parties.

The American Health Care Association, which represents the majority of the 15,700 nursing homes in the country, would not agree to an interview.

In emails to InvestigateTV, an association spokesperson wrote that nursing homes suing third parties for unpaid debt is “not a common practice, and we’re urging caution that highlighting it could be very misleading.”

“More people are starting to come forward with these stories of getting sued for these bills,” Anderson said. “And unfortunately, I don’t see the problem slowing down.”

The blindside of an unpaid nursing home debt

Toni Cook and Lynn Marie Witt don’t know one another. They live about 60 minutes apart in upstate New York. Their mothers lived in different nursing homes.

But they share the surprise of an unpaid nursing home debt.

Last year, Cook made the difficult decision to move her mother, Elizabeth Bovenzi, into a nursing home. Her dementia had progressed to a point where Cook couldn’t care for her at home any longer.

When they arrived at the nursing home in Rochester, Cook said she was presented with a packet of papers to sign.

Cook recalled telling the admissions representative for the nursing home that she wasn’t in charge of her mother’s finances.

The representative told her, “You aren’t going to be responsible for anything ... she was admitted with Medicaid and Medicare,” Cook said, referring to the government healthcare insurance programs. “They assured me that her bills were going to be paid by those two insurances.”

Cook’s mother died six months later and, unbeknownst to Cook at the time, neither insurance had approved a nursing home stay for Bovenzi.

Cook learned she had been sued for the unpaid debt months after Bovenzi’s death.

Witt’s mother, Joan Janiszewski, was admitted to the hospice wing of the nursing home in July 2019 as her cancer progressed. She had been staying at an independent living facility.

Witt, who had health care power of attorney for her mother, met with the admissions counselor.

“I remember asking at the time, because I didn’t understand what I was signing ... ‘Does this make me responsible, financially responsible?’” Witt said.

The counselor, according to Witt, replied, “Oh, no, absolutely not, honey, it will be covered.”

Because of a series of life crises, Witt was living in her car with her cat at the time.

A pastor of a church near the nursing home arranged for Witt to sleep there so that she could be close to her mother and have a roof over her head. Witt’s mother died just weeks later.

By December 2024, Witt’s life was back in order until that letter arrived demanding $9,240. The nursing home found her five years after her mother’s death.

Initially paralyzed by the prospect of financial ruin, both women eventually found attorneys to help them using free legal services.

Anderson, who did not represent either woman, said it’s important for anyone who is contacted by a nursing home for a debt that is not theirs should call a lawyer.

“In a lot of cases, people may be eligible for help from their local legal aid organization here,” she said. “But also, what needs to happen is that the government really needs to step up and take a look at these nursing homes that are violating the law.”

The CFPB was examining these debt collection practices until the new administration arrived in January. The agency has since faced the firing of its director, staff cuts and new directives that place little to no emphasis on enforcement.

CMS, which oversees nursing homes, also was poised to take a more aggressive stance by sending guidance to nursing homes of their obligation to follow federal law, but that guidance was pulled from consideration in February, Anderson said.

“I think that what’s happening is that nursing homes are just getting away with this,” she said. “I think that they have filed these lawsuits, and most of these lawsuits don’t actually ever get in front of a judge. They just end up with an automatic default judgment in favor of the nursing home, or the family agrees to settle the case before it ever gets to a judge.”

‘It’s a practice that needs to be stopped’

Anderson’s team has been examining nursing home debt collection lawsuits in four upstate New York counties.

Their preliminary findings, which she shared with InvestigateTV, are stark.

Nursing homes there have filed 159 lawsuits against relatives and friends in 2022, 2023 and 2024.

In 31 cases, a default judgment was entered against the relative or friend because he or she did not respond to the lawsuit. In one case, a brother-in-law now owes nearly $190,000. In another, a son must pay more than $66,000.

The data also shows lawsuits against stepchildren who have been sued for more than $65,000.

The nursing home that sued Witt has also filed four lawsuits between 2022 and 2024, collectively seeking more than $156,000 from relatives.

But the issue is not isolated to New York, according to InvestigateTV research and the NCLC report.

A woman in Cleveland, Ohio was sued for $80,000 for her mother’s nursing home bill even though the daughter had checked a box on the admission form that she was not financially responsible for her mother.

A man in Illinois has spent years fighting the $10,000 lawsuit a nursing home filed against him for his grandmother’s care.

An 81-year-old woman living on Social Security was sued for more than $21,000 for her deceased friend’s unpaid nursing home stay.

These types of cases also have been documented in Alabama, Indiana, Kentucky, New Jersey and Washington D.C.

These all are cases where the relative or friend has no control over the nursing home residents’ finances.

“That’s just unfair. But it’s also really deceptive. And we think it’s a practice that needs to be stopped,” Anderson said.

She said this begins with a heartstring tug — or a veiled threat — when a loved one is admitted to a nursing home.

“Where the loophole comes in, though, is that nursing homes are not allowed to have that person who’s signing the agreement to then be financially on the hook,” Anderson said. “But in reality, what we see is that the nursing homes will say, ‘If you don’t sign it, we’re not going to give your mom a bed today.’ And that is really, really troubling because that means that that person won’t be able to get the care that they need for their loved one. And so, they end up signing them.”

The only people that can be held responsible for covering a nursing home stay are the resident or the third party in charge of that resident’s bank account and assets. A nursing home cannot deny admission because someone refused to sign an admission contract.

But nursing homes sometimes win these cases because the third party doesn’t show up for court resulting in a default judgment against them or they settle even though federal law is on their side.

“There are a lot of players out there that could do more work on enforcement to make sure that these nursing homes are not bringing these lawsuits,” Anderson said. “Absolutely CMS could be doing more work here to ensure that nursing homes are abiding by the federal nursing home protections and federal nursing home laws, but also state entities and attorneys general could be doing more work here as well.”

An unpaid debt takes its toll

Cook and Witt each are grateful for the help of legal aid attorneys who took their cases and made those lawsuits disappear even as no judge ruled on the legality of the issues of because the cases were not adjudicated.

In Cook’s case, the nursing home eventually filed for and received reimbursement from Medicaid and Medicare.

Witt’s attorneys showed that she never could pay off such a debt, and the nursing home dropped the lawsuit.

“I live with a chronic autoimmune disorder and, life is hard on a daily basis. And this financial stress that now was thrust upon me and, not knowing, what was going to happen,” Witt said.

The ordeal thrust her into a dark place again, taking a physical and emotional toll until the case was resolved.

Cook said she felt paralyzed.

“You can’t function. The stress level was horrible. It was hard to work. It was hard to even go to the grocery. It was hard to function. All I wanted to do is when I woke up in the morning, just find a hole and crawl into it, not talk to anybody,” she said.

It paused the grieving process as both women struggled to understand how they ended up in this precarious financial situation and how to escape it.

They wanted to cherish their happiest memories with their mothers — Cook and Bovenzi at the state fair, Witt and her mother building sandcastles at the beach.

Instead, they were forced back to the devastating end.

“I miss her hugs the most,” Witt said. “I just miss that support in my life.”

Cook has vowed to never allow another family member to go into a nursing home.

“It will never happen again,” she said. “It was holy hell what I went through.”

The daughters’ feelings have run the gamut from betrayal to despair because they were blindsided simply for helping their mothers.