The American Catholic

Honor your father and your mother, that you may have a long life in the land the LORD, your God, is giving you. — Exodus 20:12

The Fourth Commandment is most often interpreted as a directive for children to obey their parents and, by extension, for persons of all ages to obey lawful authorities. It has also been interpreted to mean that children remain obligated to respect, honor, and love their parents even after they reach the age of majority and are no longer bound to obey them.

Moreover, other passages in Scripture make it clear that this commandment carries with it a certain level of responsibility to care for parents who have become elderly or disabled:

My son, take care of your father when he is old; grieve him not as long as he lives. Even if his mind fail, be considerate with him; revile him not in the fullness of your strength. For kindness to a father will not be forgotten, it will serve as a sin offering — it will take lasting root. In time of tribulation it will be recalled to your advantage, like warmth upon frost it will melt away your sins. — Sirach 3:12-15

Of course, how this responsibility is fulfilled in any particular case will vary depending on the needs and financial means of the parents and adult children involved, the adult child’s responsibilities to his or her own spouse and minor children, and other factors.

With those caveats in mind, most Catholics and other Christians agree that adult children have a moral responsibility to help care for their parents in some way  if they cannot care for themselves.

But should this responsibility also be legally enforced by the state, in the same fashion that the state compels parents to support children while they are minors? In many parts of the United States, that is legally possible, and there is a movement of sorts to make that the case nationwide.

Currently, 30 U.S. states have “filial responsibility” laws requiring adult children, if possible, to support parents who would otherwise become financially dependent upon the state. The full list of affected states can be found at this link: http://everydaysimplicity.blogspot.com/2006/02/filial-responsibility-laws-list-of.html

The concept of filial responsibility dates back to England’s Elizabethan Poor Law of 1601 which mandated that “every poor, blind, lame, and impotent person”  be supported by his or her parents, grandparents, children or grandchildren to the best of their ability in order to prevent such persons from becoming public charges. Prior to World War II, most states and the federal government had similar laws placing the primary responsibility for support of the poor upon their families first, and only upon the government if the family was unable to meet this obligation.

The advent of Medicare and Medicaid in the 1960s, however, seemed to make such laws obsolete. Federal law [42 USC 1396a (a) (17)(D)] forbids state agencies to consider the ability of any relative other than the applicant’s spouse to support the applicant when determining eligibility for Medicaid. This meant, for example, that an elderly widow with little or no income of her own could qualify for Medicaid even if her children were millionaires who could easily support her financially.

However, the rising cost of long-term care for the elderly and the strain it has placed on Medicaid budgets have prompted some states to institute new filial responsibility laws or revive decades-old laws that had not previously been enforced.

These provisions have been invoked against persons who give away money, property or other assets to their adult children to avoid having to use them to pay for long-term care. In such cases, the children who receive disallowed asset transfers may be ordered to return them or pay the state back in some fashion. But some think these laws need to go even farther. With the federal government tightening restrictions on asset transfers and Medicaid long-term care eligibility via the Deficit Reduction Act of 2005, the likelihood of nursing home residents being temporarily or indefinitely denied Medicaid assistance has increased, making it more likely that adult children may be asked or compelled to take up the slack.

Advocates of filial responsibility laws, such as this writer for the National Center for Policy Analysis (http://www.ncpa.org/pub/ba521) say it would help relieve taxpayers of the burden of caring for people whose own families have the means to contribute to or provide their care. The author also believes it would rekindle the ethic of self-reliance and family responsibility and encourage people to plan ahead for the possibility that they, or their parents, will need long-term care through fiscally responsible measures such as purchase of long-term care insurance policies.

Also, in families that have multiple children, it frequently happens that one or two of them end up doing most of the work of caring for the elderly parent. Sometimes this is done for good reason (e.g., the other siblings live out of state or have families of their own) and is agreeable to everyone involved. At other times, though, there may be a perception (true or not) that the other siblings are not pulling their weight, which triggers considerable resentment and animosity. A filial responsibility law requiring all the siblings in such a scenario to contribute toward the cost of a parent’s care may help ease the burden on the primary caregiving sibling.

Opponents of such laws, on the other hand, point out that while one can freely choose whether or not to assume the responsibilities of marrying or having children, one cannot choose the identity or the character of one’s parents. A strict or sweeping filial responsibility law could potentially saddle a hardworking, responsible adult with demands to “bail out” a financially irresponsible, alcoholic, drug-addicted, abusive, adulterous, or deceitful parent. Throw in the fallout from divorce, single parenthood and real or perceived neglect and the issue becomes even more explosive.

Most of us know people who have chosen to return to or remain in their home community or state, give up lucrative job opportunities, or even set aside prospects of marrying and having families of their own in order to care for disabled or elderly parents. When this is done voluntarily out of love, it is a praiseworthy, even heroic, action. But should it be expected or demanded of everyone, especially when the adult child has the welfare of his or her spouse and own minor children to consider? And even if direct care or financial support of a parent is a moral obligation or a religious duty, does that mean the government should force people to carry it out?

Many of the snowballing fiscal problems facing states and the nation as a whole are the direct result of the unraveling of the family as the primary unit of society. People are increasingly turning to the government for services such as child care and housing that once were provided by relatives and neighbors. Long-term care of the elderly is no exception. Whether or not it is possible or desirable to use the force of law to attempt to restore the fabric of family responsibility in this fashion is another story. What are your thoughts on this topic?