Her brother has landed in a nursing home. She was over his bill.

“I thought it was crazy.”

Lucille Brooks

Lucille Brooks, 74, Pittsford, New York

Estimated medical debt: $8,000

Medical problems: None of them. He was billed for his brother’s care.

What happened: Lucille Brooks was shocked to discover a nursing home in Monroe County, New York, sued her. He was not a patient there. Neither was her husband. “I thought it was crazy,” she said, thinking it must be a mistake.

The bill went to his brother, James Lawson, for his care in the summer of 2019. He was hospitalized for complications from diabetes medication. The hospital discharged her to a county-run nursing home, where Brooks visited her several times. No one ever talked to him about the billing, he said. And he was never asked to sign anything.

Brooks and Lawson were part of a large family that moved north from Mississippi to escape segregation in the 1960s. Lawson had a career with the Rochester Parks and Recreation Department. Brooks worked in insurance. They lived on the opposite side of town. “My brother always took care of his own business,” he said.

Lawson spent two months in a nursing home. A year later, Brooks was sued.

The county alleged that Brooks should have used his brother’s assets to pay his bills and was therefore personally liable for his debts. Attached to the suit was an admission agreement with what appeared to be Brooks’ signature.

What’s broken: Admission contracts often designate the signatory as a “responsible party” who will help the nursing home collect payments or enroll the resident in Medicaid, the government safety-net program.

Consumer advocates say nursing homes slip contracts into paperwork that family members sign when an elderly parent or sick friend is admitted. Sometimes people are told they must sign, a violation of federal law. “They are given stacks of forms and told, ‘Sign here, sign there. Click here, click there,” said Miriam Shelain, managing attorney at Pro Senior, a nonprofit law firm in Cincinnati.

Litigation is a frequent byproduct of America’s medical debt crisis, which a KHN-NPR investigation found has touched more than half of all U.S. adults over the past five years.

According to a nationwide KFF survey, 1 in 7 adults with health care debt say they have been threatened with lawsuits or arrest. Five percent said they had been sued.

The nursing home industry has quietly developed what consumer attorneys and patient advocates say is a pernicious tactic of going after family and friends of patients despite federal laws that were enacted to protect them from debt collection.

In Monroe County, 24 federally licensed nursing homes filed 238 debt collection lawsuits from 2018 to 2021 seeking nearly $7.6 million, KHN found. About two-thirds of cases target a friend or relative.

Many were accused — often without documentation — of hiding residents’ wealth. Anna Anderson, an attorney with the nonprofit Legal Aid of Western New York, said the practice can scare people away from paying what they owe. “People see it in a lawsuit and they think they’re being accused of theft,” he said. “It’s getting cold.”

What’s left: Brooks was so worried when Bill arrived that she didn’t tell her husband. He said, “People like us live on a fixed income. “We don’t have money to throw around, especially when you can’t see.”

Brooks has turned to Legal Aid of Western New York, a nonprofit that has represented defendants in such cases. Over time, Monroe County dropped the case against him. Brooks said he thinks the signature on the admission agreement was forged from the nursing home’s visitor log, the only thing he signed.

Now she asks friends or relatives not to sign anything at the old age home. “It’s ridiculous,” he said. “But why would you ever think they’d come after you?”

About this project

“Diagnosis: Debt” is a reporting partnership between KHN and NPR that explores the scale, impact and causes of medical debt in America.

The series draws on the “KFF Health Care Debt Survey,” a poll designed and analyzed by KFF’s public opinion researchers in collaboration with KHN journalists and editors. The survey was conducted online and by telephone in English and Spanish from February 25 to March 20, 2022, among a nationally representative sample of 2,375 US adults, including 1,292 adults with current health care debt and 382 adults who had health care debt. last five years The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race and health status to explore where medical debt is concentrated in the United States and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sample of Chase credit card holders to determine how customers’ balances may be affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke to physicians, health industry leaders, consumer advocates, debt lawyers and researchers; and reviewed scores of studies and surveys about medical debt.

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