## Facts

- A patient received skilled nursing care at a facility operated by Health Care & Retirement Corporation of America (HCR) from September 2007 until March 2008, when she left and moved to Greece.
- A substantial portion of the patient’s nursing-home charges remained unpaid, leaving an outstanding balance of $92,943.41.
- HCR presented evidence that the patient’s monthly income was about $1,000, which the court found insufficient to meet her long-term care obligations.
- HCR introduced evidence (including tax returns and testimony) indicating the patient’s adult son, John Pittas, had annual net income exceeding $85,000.
- Pittas asserted he had significant expenses and obligations, but he provided no documentary proof of those expenses at trial.
- HCR sued Pittas under Pennsylvania’s filial support statute, 23 Pa.C.S. § 4603; HCR lost in compulsory arbitration but won after a non-jury trial, resulting in a judgment for $92,943.41.
- Pittas appealed the final judgment to the Superior Court of Pennsylvania.

## Issues

1. Whether the trial court erred by placing on the adult child the burden to prove inability to support an indigent parent after the provider made a prima facie showing under 23 Pa.C.S. § 4603.
2. Whether the trial court erred by imposing liability on one adult child without first considering or requiring pursuit of other potential payment sources (e.g., other relatives or benefits).
3. Whether competent evidence supported the finding that the parent was “indigent” under 23 Pa.C.S. § 4603.

## Decision

- The Superior Court affirmed the judgment for HCR.
- The court held that once HCR established a prima facie case of (1) the parent’s indigence and (2) the child’s apparent financial ability, the burden shifted to Pittas to prove inability to pay.
- The court held the trial court did not have to require HCR to pursue other relatives, assets, or government benefits before seeking recovery from Pittas.
- The court held the indigence finding was supported by competent evidence, including the parent’s limited monthly income compared to the cost of care and the large unpaid balance.

## Legal Principles

- Under 23 Pa.C.S. § 4603, specified relatives, including adult children, may be held liable to support an indigent parent if the relative has sufficient financial ability.
- A care provider may bring an action under § 4603 to recover unpaid charges for necessary care furnished to an indigent person.
- After the plaintiff establishes a prima facie case of indigence and the defendant-relative’s financial capacity, the defendant may bear the burden to prove inability to pay (including through substantiated evidence of expenses and obligations).
- “Indigence” for § 4603 purposes is satisfied by inability to provide adequately for one’s own support; absolute destitution is not required.
- Section 4603 does not require exhaustion of alternative sources of payment before imposing liability on an eligible relative.

## Conclusion

The court affirmed a nursing facility’s recovery against an adult child for an indigent parent’s unpaid care bill, holding that the statute permits direct suit by the provider, does not require pursuit of other payors first, and allows shifting to the child the burden to prove inability to pay once indigence and apparent ability are shown.


Health Care & Retirement Corp. of Am. v. Pittas, 46 A.3d 719 (Pa. Super. Ct. 2012)