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The admission packet is 40 pages long, and the nursing home wants it signed today. Mom needs a bed. On page 12 there’s a line that says “Responsible Party,” and the admissions coordinator has already put your name next to it.
Let’s say you’re Janet, 61, and your mother, Dorothy, 87, is moving into a nursing home after a fall. Janet isn’t a real person.
She’s a composite of a situation many families face, and the question she’d ask is a good one: If I sign, am I on the hook for Mom’s bill?
I’ve been a CPA since 1981, and I was executor of my parents’ estate. Here’s my answer: read that page very carefully before you sign anything, because federal law is on your side.
Under federal rules, a nursing home “must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility.” (1) That rule covers nursing homes that participate in Medicare or Medicaid. (2)
In a 2022 report, the Consumer Financial Protection Bureau found that many facilities include clauses in admission contracts that require caregivers to be a “responsible party” for the resident’s costs of care. (3)
The stakes are real. The national median cost of a semi-private nursing home room hit $114,975 a year in 2025, according to CareScout. (4) And Medicare “does not provide long-term care coverage or custodial care unless medical care is needed.” (5)
Here are five things Janet, and you, should know before signing.
1. A nursing home can’t make you guarantee Mom’s bill
The rule above enforces the federal Nursing Home Reform Act. The CFPB puts it bluntly: “The nursing home can’t make you promise to pay for the resident’s care with your own money.” (6)
That’s true whether the home is asking as a condition of getting in, getting in faster or staying. (1)
If an admissions office tells you Mom can’t have the bed unless you personally guarantee payment, that’s a red flag, not a formality.
2. Watch for two phrases in the contract
The CFPB tells caregivers to look out for “responsible party” and “joint and several liability.” (6)
Either phrase can be an attempt to make your money answer for your mother’s bill. If you see one, ask the facility in writing what it means for you personally, and don’t sign until you understand the answer.
The CFPB says caregivers have faced wage garnishment and have even lost their homes over nursing home debt. (3)
3. Here’s what they can legitimately ask you to do
Federal rules do allow one thing.
If you have legal access to your mother’s money, say as her agent under a power of attorney, the facility may ask you to sign a contract to pay the bill from her income or resources, “without incurring personal financial liability,” as the regulation puts it. (1)
That’s a big difference. You’re agreeing to write checks from Mom’s account, not yours.
If you don’t yet have that legal authority, my advice is to get it now, while your parent is still able to sign one. Many basic estate plan packages include a financial power of attorney.
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4. If a collector comes after you, push back
Even with the law on your side, the CFPB warns that collectors may report a resident’s debt to credit bureaus as your debt and file lawsuits. (6) Its advice: “If you are sued for a loved one’s nursing home debt, contact an attorney immediately.” (6)
You also have places to complain. The CFPB says you can report Nursing Home Reform Act violations to your state nursing home survey agency or file a complaint with your state attorney general. (6)
You can submit a debt collection complaint to the CFPB, and a long-term care ombudsman can help residents and caregivers resolve nursing home problems. (6)
5. Plan for the real bill, which is Mom’s
Knowing you aren’t personally liable doesn’t make the bill go away. At roughly $115,000 a year, the bill can drain savings fast. Medicaid can step in for people who meet their state’s eligibility rules. (5)
For Dorothy’s daughter, the job is to make sure Mom’s own money, benefits and paperwork are organized, and that someone with legal authority is paying the right bills on time.
For the rest of us, the lesson is to plan before a fall forces the decision. One option is coverage designed for exactly this bill.
According to government data, about 7 in 10 people turning 65 will need some form of long-term care. And Medicare doesn’t cover custodial care — the day-to-day help with things like bathing and dressing — which can leave families facing six-figure bills that eat into retirement savings.
Long-term care insurance helps fill that gap, covering services like home care, assisted living, and help with daily tasks. Rates are typically lowest if you buy in your 50s or early 60s, couples often qualify for discounts, and premiums may even be tax-deductible.
See a list of the best LTC insurance companies — takes 2 minutes.
If you have $100,000 or more saved and want help working out how you’d pay for care, a service like SmartAsset can match you with up to three fiduciary advisors, legally required to put your interests first. It’s free to use.
The questionnaire takes about 10 minutes and asks for a phone number near the end, and you decide whether and when to respond to anyone.
SmartAsset only makes the match; the advice comes from the advisor. See if you qualify for a free match.
My take
Admission day is the worst possible day to read a contract. Mom’s scared, you’re exhausted, and the person across the desk handles these contracts all the time.
So slow down. Take the packet home if you can. If anything in the contract tries to make you personally responsible, don’t sign until you understand it, and have a lawyer read it if you’re unsure. If something feels off, call the ombudsman before you sign, not after.
You’re signing up to help your mother. You’re not signing up to pay her bill.
Sources: 1. Electronic Code of Federal Regulations (42 CFR 483.15); 2. Electronic Code of Federal Regulations (42 CFR 483.1); 3. Consumer Financial Protection Bureau (2022); 4. CareScout via Business Wire; 5. Medicare.gov; 6. Consumer Financial Protection Bureau (Know Your Rights)
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