Nursing Homes, Caregivers and Debt Collection

In the United States, one in six adults supports an older adult’s health and well-being through illness or disability.1 As the population ages, the challenges faced by caregivers are likely to become increasingly acute. Nursing homes play a critical role in caring for older Americans. For caregivers, placing a family member or friend in a nursing facility is often difficult. Choice constraints, costs, and limited availability can leave individuals seeking a nursing facility with few options.

During the nursing home admission process, caregivers are often required to sign lengthy admission agreements and many other documents during the admission process. Typically, the caregiver has little to no opportunity to negotiate the agreement even if the caregiver has the time, attention, and ability to read and understand it.

Often these agreements include terms that claim to hold a third party personally liable for the resident’s nursing facility costs. For example, some agreements claim to hold both residents and their caregivers personally liable for payment. Other agreements assert the caregiver as a “responsible party,” holding them personally liable for the resident’s unpaid bills if the resident’s Medicaid application is deemed inaccurate, untimely, or incomplete.

Under the Nursing Home Reform Act (NHRA), nursing facilities that participate in Medicaid or Medicare may not request or require any third party, including family members or caregivers, to personally guarantee payment of the costs of the resident’s stay as a condition of admission, expedited admission, or continued stay in the facility. Despite this law, a recent Consumer Financial Protection Bureau (CFPB) report found that family and friends of nursing home residents are frequently pursued by nursing homes and collection agencies for debts owed by residents.2

As a result of these findings, the CFPB, along with the Centers for Medicare and Medicaid Services (CMS), issued a notification letter to nursing facilities and debt collectors on September 8, 2022.3 The letter warned nursing homes that “[w]hen a nursing facility claims that a non-resident is personally financially responsible for a resident’s bill and engages a third-party debt collector to collect the debt, the debt collector may violate the FDCPA [Fair Debt Collection Practices Act] by attempting to collect debts that are invalid under the NHRA.”4

Debt collectors who violate the FDCPA may be subject to private actions brought by consumers. If you or someone you know is being held financially liable for a nursing home resident’s bill, you may be a victim of consumer fraud. The attorneys at Finkelstein, Blankinship, Frei-Pearson & Garber, LLP have successfully represented consumers misled by deceptive debt collection practices and look forward to discussing this matter with you.

1 Approximately 19 percent of U.S. adults are caregivers for an adult with health or functional limitations, and 16 percent of U.S. adults (41.8 million) are caregivers for someone ages 50 and older. See AARP & Nat’l Alliance for Caregiving, Caregiving in the U.S. 2020, at 4 (May 2020), available at: 2Fppi.00103.001.pdf.
2 CFPB, Issue Spotlight: Nursing Home Debt Collection, at 3 (September 8, 2022), available at:
3 CFPB & CMS, Notification Letter, (September 8, 2022), available at: