One of the frequent questions that we hear at Okura & Associates is: “Will I be responsible to pay for my mother’s (or father’s) nursing home expenses?” This can be a scary thought for a working adult who can’t physically provide care for her aging parent, and who is looking at options for her parent’s care—especially if she has children of her own whom she is financially supporting as minors or through college. In some cases, you WILL BE responsible to pay for your parent’s nursing home expenses, but with proper guidance and planning, you don’t have to be responsible for parent’s medical expenses under the laws of the State of Hawaii.

Nursing home costs in Hawaii have skyrocketed over the past 20 years. It used to be that the average cost of nursing homes in Hawaii was approximately $3,000 to $4,500 per month. Now a nursing home on Oahu starts at $10,000 per month and on the outer islands it’s usually at least $13,000 per month. We even had one client in the State-run Leahi hospital who was paying $23,000 per month ($276,000/year) for her long term care needs! Even though there are some private care homes that only cost about $6,000 to $8,000 per month, at these rates the costs will exceed $100,000 per year in most cases. This can use up an elderly person’s entire lifetime savings very quickly. Then what?

In most States there are still “filial responsibility” laws on the books. These old laws are based on the Elizabethan Poor Laws of 1601, and require adult children to pay for their impoverished parents’ basic needs such as food, clothing, shelter, and medical expenses.

Most of these States have not enforced these laws for many years—not since Roosevelt’s New Deal, the advent of Social Security, and especially since the enactment of Medicaid in 1965. However, with rising health care costs, there has been a trend recently to have these old laws enforced. In Pennsylvania, an appeals court held that John Pittas was responsible to pay for his mother’s $93,000 nursing home bill, even though he did nothing wrong. In some states, refusing to pay under these filial responsibility laws is actually a criminal offense and you can be put in prison for it!

Thankfully, Hawaii doesn’t have a filial responsibility statute, but that doesn’t mean we’re completely in the clear. You have to be careful when filling out the nursing home admission paperwork. Often nursing homes include language in their admission contracts that name a “Responsible Party” who is also asked to sign the admission contract. Although it is usually presented to the family of the patient that the “responsible party” is the one in the family who will be the main point of contact with the nursing home on behalf of the patient, what may not be apparent is that these contracts often place financial responsibility for paying the bill on the responsible party as well! This means that if you sign this type of admission contract to get your parent placed in the nursing home, they can come after your assets and garnish your wages to pay their bill.

Federal law prohibits nursing homes from requiring a family member or friend to assume financial responsibility as a condition of admitting the patient or expediting the admission. However, if you don’t read the fine print and just sign the standard admission contract, you might be volunteering to be financially responsible for your parent’s nursing home expenses. Once you’ve signed a contract like this or as a guarantor, you will be legally obligated to assume the financial costs of your parent’s nursing home expenses.

Finally, there is another way that you could lose your assets to your parent’s medical expenses. If you have your parents as a joint owner of your bank account, or the title to your home, or any of your other assets, those assets become legally available to pay for your parents’ medical expenses. Although it can be quick and easy to add a parent as a joint owner for convenience in managing your finances, it is almost never the recommended way to do it. You’d be much better off giving or having access to bank accounts and other assets by using a power of attorney, a trust, or as an authorized signatory—NOT as a joint owner.

So in most cases, it’s best to restructure the way you hold your assets and your parent’s assets to not be joint owners. Also, remember to carefully review the terms of any contract before you sign it, and if you need help understanding it, don’t be afraid to have your lawyer review it for you. A few hundred dollars of preparation can be worth hundreds of thousands of dollars in savings in the long run!



Honolulu Office (808) 593-8885

Hilo Office (808) 935-3344


Ethan R. Okura received his Doctor of Jurisprudence Degree from Columbia University.

Carroll (Cary) D. Dortch received his Doctor of Jurisprudence Degree from the University of New Hampshire School of Law, and clerked for the Honorable Judge David G. Campbell in Arizona.

The lawyers at Okura & Associates focus their practice on Estate Planning to protect assets from nursing home costs, probate, estate taxes, and creditors.

This column is for general information only. The facts of your case may change the advice given. Do not rely on the information in this column without consulting an estate planning specialist.