The issues dominating the dual Hollywood strikes by actors and writers are artificial intelligence, residual payments, and job protections. But one topic that’s often a contentious point in labor negotiations — health insurance — has slipped under the radar.

A-list stars have been out in force snapping selfies on picket lines in the bright California sun, but it’s the people who may have never walked the red carpet who are forgoing a paycheck and potentially their health insurance as the negotiations drag on and work dries up.

The health insurance offered by both unions is predicated on the notion that it is for members who work consistently and lucratively enough to make a minimum amount of money. That makes the insurance difficult first to attain and then to sustain. In exchange, it is very, very good health insurance.

Often referred to in hushed, reverent tones as the “Cadillac of health insurance” by those who have it, the policy offered by the Writers Guild of America, formerly the Screen Writers Guild, feels like a holdover from a bygone age. It has no monthly premiums, costs $600 a year to cover the rest of your immediate family, and has deductibles in the hundreds — not thousands — of dollars.

But the biggest strike in more than six decades in Hollywood threatens that security. The WGA has been on strike since May 2, and the actors’ union, SAG-AFTRA, since mid-July. Together they represent over 170,000 workers, who have refused to perform any part of their job since talks with studios and streamers stalled. Writers and actors could lose their eligibility for insurance simply because they aren’t working while striking.

Filmmaker and Writers Guild member Susanna Fogel said no matter how good her union health insurance is, members are always at risk of losing it. “If we’re this close to not having it, then we’re already on a razor’s edge,” she said, “which is kind of why we’re striking, even though in the short term it sort of just shines a light on the problem.”

A Complicated Formula for Writers

For writers to qualify for health insurance, they must earn a little over $41,700 in covered union work within a year. Residuals don’t count. The income requirement continues to rise, which, coupled with the increasingly uncertain reliability of employment, means even experienced writers can have a hard time qualifying.

Writers can accumulate credits by qualifying for WGA health insurance for 10 years and by earning more than $100,000 in covered work. Top earners can rack up three points per year, which can be cashed in when writers experience a dry spell and can’t make the minimum income requirement, but health coverage ends the quarter after the credits are used up.

For example, a writer who qualifies for health insurance for 10 years but earns less than $100,000 can cash in all their points and continue their insurance for up to a year and a half if they are insuring only themselves.

But insuring dependents uses up more credits, meaning people with families have less of a stopgap to fall back on.

As the strike stretches into another quarter, many union writers are furtively calculating how many credits they have and how long this temporary measure will buy them, if they have credits at all.

Actors’ Good Deal Is Precarious

By contrast, residual payments do count toward the $26,000 per year that members of SAG-AFTRA must earn to qualify for health insurance offered by the actors’ union. So boosting residual payments, especially from streamers like Netflix, which can pay almost nothing, is a high priority for members on the margins.

Plan premiums from SAG-AFTRA are $125 a month for union members. For a family of four or more, the monthly cost rises to $249 a month, or $2,988 a year. That’s less than half of the $6,680 that the average California worker with employer-sponsored health insurance paid for coverage for a family of four in 2022, according to a report by the California Health Care Foundation. (KFF Health News produces California Healthline, an editorially independent service of the California Health Care Foundation.)

Members of both unions say it took them years to make enough money to qualify for the union health insurance, while other union members who have worked in the industry for years never have.

“The moments that I’ve been at risk of or have lost health insurance in the past, pre-strike, were when I was working,” said filmmaker Fogel, who is also a member of the Directors Guild of America. “I was working, but there were particulars to the work that just made it fall short or fall in the wrong month to stay covered. So it was just always a stress.”

Should the unions simply drop the income requirement to a lower amount so more members could qualify? Alex Winter, a longtime member of three industry unions, doesn’t think so.

“It seems draconian to turn back to the unions and say, ‘Well, since we have these oligarchs who are hoovering up all the profits, let’s try to take what few squirrel nuts we have and scatter them out amongst whoever survived staying in the industry,’ as opposed to fighting to get equitable pay, which is what we’re doing,” Winter said.

Both SAG-AFTRA and WGA were approached for interviews about their health insurance offerings. SAG-AFTRA declined to be interviewed and WGA sent LAist a link to its FAQ page.

SAG-AFTRA sent members a letter on Aug. 30 saying health insurance would be extended for certain members who would otherwise have lost eligibility on Oct. 1. Members who made at least $22,000 before the strike began will continue to get union health insurance through the end of the year.

A New California Law Could Help Strikers on the Margins

All California workers who lose their employer-sponsored health insurance may be eligible for the state’s Medicaid program, known as Medi-Cal, or qualify to buy health insurance through Covered California, where their costs could be low if they have minimal income. Still, it would be a disruption to lose their low-cost SAG-AFTRA or WGA plans, and an additional expense at a time when striking workers are making much less money.

Writers and actors who lose their union health insurance because of the strike could benefit from a new California law that took effect July 1 aimed at averting just that situation.

AB 2530 received $2 million in funding under the new state budget. To qualify, a union worker must first lose coverage as a result of the strike. According to Covered California spokesperson Craig Tomiyoshi, eligible workers will have their premiums covered as if their incomes were just above the Medicaid eligibility level.

Not all striking workers will enroll in a free plan. Striking workers will be able to pick plans that are more expensive than the benchmark plan. If they do, they will pay the difference in premiums.

“Covered California has seen fewer than 150 applicants who have identified an affiliation to WGA or SAG-AFTRA apply for coverage,” said spokesperson Kelly Green. She added that they expect to see more if the strikes continue and that people who anticipate losing their union health insurance should get in touch.

On Jan. 1, another new law kicks in. Covered California will end deductibles on the middle-tier benchmark plans, meaning a striking worker could receive free premiums under one law and no deductibles in the new year, if the labor dispute lasts that long.

These new rules don’t cover crew members who are not part of the striking unions but have lost health insurance due to the work stoppage.

A new mutual aid group was created to fill that gap.

The Union Solidarity Coalition, known by the acronym TUSC, has raised more than $315,000 to give assistance to International Alliance of Theatrical Stage Employees and Teamsters members, said founding member Winter.

“I don’t know anyone, honestly, in a lot of the primary crew areas who isn’t in danger of losing their health insurance, and I know a lot of people who have lost their health insurance,” Winter said.

The idea for the nonprofit began with conversations between crews and filmmakers, said Fogel, a fellow founding TUSC member.

“Because their coverage is based on the hours that they get within a certain window of time, some of the [crew members] mentioned they or people they knew were at risk for not making their hours due to productions shutting down, or if they opted not to cross a picket line, that could cost them their health insurance,” she said.

TUSC has partnered with the Motion Picture and Television Fund and its Entertainment Health Insurance Solutions, which acts as an insurance navigator for people in the industry.

Fogel said it’s about making sure that everyone in the industry has access to high-quality health care no matter the current industry conditions.

“Every so often, when there’s one group of people that are going on strike, and it’s our turn to strike right now, we just wanted to kind of let the other unions know that we consider ourselves to be part of a collective, and we hope that they feel that love from us,” Fogel said.

Could studios and streamers continue the industry members’ coverage? They could, but it’s unlikely because decision-makers are on the other side of the bargaining table.

Half of the trustees of the Motion Picture Industry Pension & Health Plans are represented by companies involved in the strike. The WGA’s strike FAQ tells members “there is no Health Fund requirement that the Health Plan extend health insurance coverage during a strike, and Trustees are 50% management and 50% Guild.”

In July, Matt Loeb, president of IATSE, the union that represents behind-the-scenes workers, called for studios and streamers to offer an extension of health care benefits to those who may lose them if they fall short of qualifying during the strikes. IATSE is not on strike.

“Make no mistake — if the studios truly cared about the economic fallout of their preemptive work slowdown … they could continue to pay crewmembers and fully fund their health care at any moment, as they did in 2020 during the onset of the COVID-19 pandemic,” Loeb wrote.

This article is from a partnership that includes LAist, NPR, and KFF Health News.

DENVER — Kayce Atencio used to be haunted by a thought while working at a homeless shelter in downtown Denver. “It could have been me,” said Atencio, 30, who lives in a small apartment with his son and daughter not far from the shelter.

It nearly was. Atencio and his children for years slept on friends’ couches or stayed with family, unable to rent an apartment because of poor credit. A big reason, he said, was medical debt.

Atencio had a heart attack at 19, triggered by an undiagnosed congenital condition. The debts from his care devastated his credit score. “It always felt like I just couldn’t get a leg up,” he said, recalling a life of dead-end jobs and high-interest loans as he tried to stay ahead of debt collectors. By 25, he’d declared bankruptcy.

Across the country, medical debt forces legions of Americans to make painful sacrifices. Many cut back on food, take on extra work, or drain retirement savings. For millions like Atencio, the health care system is threatening their very homes.

That’s proven particularly devastating in communities like Denver, where skyrocketing prices have put housing out of reach for many residents and fueled a crisis that’s left thousands homeless and sleeping on the streets.

At the Community Economic Defense Project, or CEDP, a Denver nonprofit that helps people facing eviction or home foreclosure, about two-thirds of clients have medical debt, an informal survey by KFF Health News and the organization suggests. Close to half of the nearly 70 people surveyed said medical debt played a role in their housing issue, with about 1 in 6 saying it was a major factor.

“All day long I hear about medical debt,” said Kaylee Mazza, a tenant advocate who staffs a CEDP legal clinic at the Denver courthouse that offers aid to tenants going through eviction proceedings. “It’s everywhere.”

Nationwide, about 100 million people have some form of health care debt. Of those, about 1 in 5 said the debts have forced them to change their living situation, including moving in with friends or family, according to a 2022 KFF poll.

A growing body of evidence shows that stable housing is critical to physical and mental well-being. Some major medical systems — including several in Colorado — have even begun investing in affordable housing in their communities, citing the need to address what are sometimes called social determinants of health.

But as hospitals and other medical providers leave millions in debt, they inadvertently undermine community health, said Brian Klausner, a physician at a clinic serving homeless patients in Raleigh, North Carolina.

“Many of the hospitals across the country that are now publicly vowing to address health inequities and break down barriers to health are simultaneously helping to create these very problems,” Klausner said. “Nobody likes the elephant in the room, but the reality is that there are thousands of sick Americans who are likely homeless — and sick — because of medical debt.”

A Downward Spiral

Medical debt can undermine housing security in several ways. For some, it depresses credit scores, making it difficult to get a lease or a mortgage. Last year, about 1 in 8 U.S. consumers with a credit report had a medical debt listed on it, according to the nonprofit Urban Institute.

Patients with chronic medical conditions may fall behind on rent or home payments as they scramble to keep medical debts in check to preserve access to health care. Many hospitals and other providers will turn away patients with outstanding bills, KFF Health News found.

Denise Beasley, who also assists clients at CEDP in Denver, said many older people, who typically depend most on physicians and medications, believe they must pay their medical and pharmacy bills before anything else. “The elderly are terrified,” she said.

For others, such debt can compound financial struggles brought on by an accident or unexpected illness that forces them to stop working, jeopardizing their health coverage or ability to pay for housing.

In Seattle, researchers found widespread medical debt among residents in homeless encampments. And those with such debt tended to experience homelessness two years longer than encampment residents without it.

More broadly, people with medical debt are more likely to say the debt has caused them to be turned down for a rental or a mortgage than people with student loans or credit card debt, according to a 2019 nationwide survey of renters, homebuyers, and property owners by real estate company Zillow.

For Atencio, who left home at 16, his struggles with medical debt began with the heart attack. He was working at a gas station and living in Trinidad, a small city in southern Colorado near the New Mexico border.

Rushed to a local hospital, he underwent surgery. The bills, which topped $50,000, weren’t covered by his health plan because he’d unknowingly gone to an out-of-network provider, he said. “I fought it as hard as I could, but I couldn’t afford a lawyer. I was stuck.”

Atencio, who is transgender, has close-cropped dark hair and a large tattoo on his right forearm memorializing two friends who died in a car accident. Sitting on an aging couch in an apartment with bars on the windows, he’s philosophical about his long journey from that medical crisis through years of debt and housing insecurity. “We’ve pulled ourselves out of this,” he said. “But it took a toll.”

When Atencio’s credit score dipped close to 300, the lowest rating, there were few places to turn for help. Atencio’s relationship with his parents, who divorced when he was 2, had been strained for years. Atencio got married at 18, but he and his husband rarely had enough to make ends meet. “I remember thinking, ‘What kind of a start to my adult life is this?’”

They were ultimately taken in by Atencio’s mother-in-law. “If it wasn’t for her, we would have been homeless,” he said. But getting out from the debt was agonizing.

“You end up in this cycle,” he said. “You get into debt. Then you take out loans to try to pay off some of the debt. But then there’s all this interest.” With poor credit, Atencio relied at times on payday lenders, whose high interest rates can dramatically increase what borrowers owe. Many employers also check credit scores, which made it difficult for Atencio to land anything but low-wage jobs.

The job at the shelter was a step up, and Atencio this year got the apartment, which is reserved for single-parent families at risk of being homeless. (Atencio separated from his husband last year.)

Colorado’s Housing Challenges

Atencio’s housing struggles are hardly unique. Jim and Cindy Powers, who live in Greeley, a small city north of Denver, saw their own housing dreams collapse after Cindy was diagnosed with a life-threatening condition that required multiple surgeries and left the couple with more than $250,000 in medical debt.

When the Powers declared bankruptcy, the settlement protected their home. But their mortgage was sold, and the new lender rejected the payment plan. They lost the house.

Lindsey Vance, 40, who moved to Denver five years ago seeking more affordable housing than the Washington, D.C., area where she was from, still can’t buy a house because of medical debts. She and her husband have a six-figure income, but medical bills for even routine care that she’s struggled to pay since her 20s have depressed her credit score, making it difficult to get a loan. “We’re stuck in a holding pattern,” she said.

In and around Denver, elected officials, business leaders, and others have become increasingly concerned about medical debt as they look for ways to tackle what many see as a housing crisis.

“These things are deeply connected,” Denver City Council member Sarah Parady said. “As housing prices have gone up and up, I’ve seen more and more people, especially people with a medical issues and debts, lose housing security.” Parady, who ran for office last year to address housing affordability, is helping lead an effort to get the city to buy and retire medical debt for city residents.

Fueled by skyrocketing prices and rising interest rates, the cost of buying a home more than doubled in Denver from 2015 to 2022, according to one recent analysis. And with rents also surging, evictions are rocketing upward after slowing during the first two years of the pandemic.

Perhaps nowhere is Denver’s crisis more visible than on the streets. The city’s downtown is dotted with tents and encampments, including one that stretches over several blocks near the shelter and clinic where Atencio used to work. By one count, metro Denver’s homeless population increased nearly 50% from 2020 to 2023.

CEDP, which was founded to help residents with housing challenges sparked by the pandemic, this year joined other Colorado consumer and patient advocates to push the legislature for stronger protections for patients with medical debt.

And in June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents’ credit reports or factored into their credit scores, a move that put the state at the forefront of efforts nationally to expand debt protections for patients.

A few other states are considering similar steps. And in Washington, D.C., consumer and patient advocates are pushing for federal action to limit medical bills on credit reports. In most states — including many with the highest rates of medical debt — patients still have no such protections.

For his part, Atencio is hoping the new apartment marks a turning point.

The home is modest — a small unit in an aging concrete tower. There’s a security guard by the front door and long, linoleum corridors painted institutional blue and brown.

Atencio’s family is settling in, along with four pet rats — Stitch, Cheese, Peach, and Bubbles — who live in a large cage in the living room. “This feels like freedom,” said Atencio.

He’s tried to give his children, who are 5 and 11, a sense of security: home-cooked meals and the space to play or hang out in their own bedrooms. Like parents everywhere, he frets over their screen time and rolls his eyes when they critique what’s for dinner. (They didn’t like the potatoes he put in a pot roast.)

They are all full-time students: Atencio, who left his job at the shelter, is working on a master’s in social work. His son just started kindergarten, and his daughter is in middle school. “I have big plans and big goals,” he said.

And with several thousand dollars of medical debt still to pay off, Atencio said he’s careful not to take his kids to an out-of-network hospital or physician. “I won’t make that mistake again,” he said.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.

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

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past 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.

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

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

ROCHESTER, N.Y. — Lucille Brooks was stunned when she picked up the phone before Christmas two years ago and learned a nursing home was suing her.

“I thought this was crazy,” recalled Brooks, 74, a retiree who lives with her husband in a modest home in the Rochester suburbs. Brooks’ brother had been a resident of the nursing home. But she had no control over his money or authority to make decisions for him. She wondered how she could be on the hook for his nearly $8,000 bill.

Brooks would learn she wasn’t alone. Pursuing unpaid bills, nursing homes across this industrial city have been routinely suing not only residents but their friends and family, a KHN review of court records reveals. The practice has ensnared scores of children, grandchildren, neighbors, and others, many with nearly no financial ties to residents or legal responsibility for their debts.

The lawsuits illuminate a dark corner of America’s larger medical debt crisis, which a KHN-NPR investigation found has touched more than half of all U.S. adults in the past five years.

Litigation is a frequent byproduct. About 1 in 7 adults who have had health care debt say they’ve been threatened with a lawsuit or arrest, according to a nationwide KFF poll conducted for this project. Five percent say they’ve been sued.

The nursing home industry has quietly developed what consumer attorneys and patient advocates say is a pernicious strategy of pursuing family and friends of patients despite federal law that was enacted to protect them from debt collection. “The level of aggression that nursing homes are using to collect unpaid debt is severely increasing,” said Lisa Neeley, a Massachusetts elder law attorney.

In Monroe County, where Rochester is located, 24 federally licensed nursing homes filed 238 debt collection cases from 2018 to 2021 seeking almost $7.6 million, KHN found. Several nursing homes did not file any lawsuits in that period.

Nearly two-thirds of the cases targeted a friend or relative. Many were accused — often without documentation — of hiding residents’ assets, essentially stealing. The remaining cases targeted residents themselves or their spouses.

Nursing homes have gone after some families for tens of thousands of dollars. In a few cases, debts surpassed $100,000.

In Monroe County alone, one nursing home sued the daughter and granddaughter of a former resident. The daughter pleaded with the court to release the granddaughter, promising she would pay the $5,942 debt. Another home sued a woman twice, for her husband’s and her mother’s debts. Yet another claimed a woman owed $82,000 for her mother’s care. The resident was, in fact, a cousin, according to court papers.

“I get calls all the time from people who are served with these lawsuits who had no idea that this was even a remote possibility, who call me crying and frantic,” said Anna Anderson, an attorney at the nonprofit Legal Assistance of Western New York who has represented defendants in such suits, including Brooks. “They believe not only that they’re going to lose their own income and their own houses and assets, but also they’re concerned that their loved ones who are still in the nursing home may be potentially kicked out.”

The legal strategy is often rooted in admissions agreements, the piles of paperwork that family or friends sometimes sign, not realizing the financial risks. “The world of nursing facilities is a black hole for most people,” said Eric Carlson, a longtime consumer attorney at the nonprofit Justice in Aging. “This happens in the shadows.”

In most cases reviewed by KHN, the people sued didn’t have an attorney, which can be expensive. In nearly a third, the nursing homes won default judgments because the defendants never responded, a common phenomenon in debt cases. In many cases, lawsuits sought interest rates as high as 18% on top of the debt.

Long-term care officials and attorneys say they must use the courts when bills go unpaid. “It would be a disservice to the hospital’s residents, and to Monroe County’s taxpayers, to allow residents who have assets not to pay what is owed,” said Gary Walker, a spokesperson for Monroe County, which operates Rochester’s largest nursing home, Monroe Community Hospital.

From 2018 to 2021, the county filed 60 debt collection cases, including the lawsuit against Brooks, KHN found.

Nationally, Beth Martino, a spokesperson for the American Health Care Association, the largest nursing home industry group, said lawsuits against families are “not a common occurrence.”

But consumer attorneys in California, Illinois, Kentucky, Massachusetts, New York, and Ohio said they regularly see lawsuits against family and friends.

In 2020, Washington, D.C., secured an agreement with two nursing homes to stop what authorities called “deceptive billing practices.” The homes had sued at least 15 family members, the attorney general found.

Ahmad Keshavarz, an attorney who documented debt lawsuits around New York City, said nursing homes see adult children as more appealing targets than older residents. “Sons or daughters are more likely to have assets,” he said. “They have wages that can be garnished.”

In Ohio, Robyn King, a former teaching assistant from Cleveland, was sued for more than $70,000 by a nursing home where her mother had been a resident. “The lawsuit made no sense to me since I told them I would not be personally responsible for my mom’s medical expenses,” King told a U.S. Senate committee in March. “The stress was unbearable. I thought, ‘I will not be able to afford my mortgage.’”

Trapped by Paperwork

In upstate New York, Brooks faced a smaller yet shocking bill: $7,967.05.

“People like us live on a fixed income,” Brooks said. “We don’t have money to throw around, especially when you don’t see it coming.” She was so worried that she didn’t tell her husband at first.

Brooks initially thought there had been a mistake. She and her brother, James Lawson, were part of a big family that moved north from Mississippi to escape segregation in the 1960s. Lawson, who was a gifted athlete despite losing an arm as a child, spent his career at the Rochester Parks and Recreation Department. Brooks worked in insurance. They lived on opposite sides of the city. “My husband is somewhat disabled, and that keeps me pretty busy,” said Brooks, who is also active in her church. “My brother always took care of his own business.”

In summer 2019, Lawson was hospitalized after experiencing complications from a diabetes medication. The hospital released him to the county-run nursing home, and Brooks didn’t find out for a few days. She visited her brother there several times. No one talked to her about billing, she said. And she was never asked to sign anything.

After two months, Brooks’ brother went home. A year later came the lawsuit.

The county alleged that Brooks should have used her brother’s assets to pay his bills and that she was therefore personally responsible for his debt. Attached to the suit was an admissions agreement with what looked like Brooks’ signature.

View note

Such agreements, which can run multiple pages, have long been standard in the long-term care industry. They often designate whoever signs as a “responsible party” who will help the nursing home collect payments or enroll the resident in Medicaid, the government safety-net program.

Many lawyers say making a family member financially liable is unfair. “If you bring your child to a doctor, you should pay for the child’s medical care. But if your adult child brings you to a nursing home and you’re 80, the law doesn’t bind you to pay those bills,” said Paul Aloi, a Rochester attorney who has represented all sides — patients, hospitals, and nursing homes — in debt collection cases.

Federal laws and regulations prohibit homes from requiring a resident’s relatives or friends to financially guarantee the resident’s bills. Facilities cannot even request such guarantees.

But consumer advocates say nursing homes slip the admissions agreements into papers that family members sign when an older parent or sick friend is admitted. Sometimes people are told they must sign, a violation of federal law. Sometimes there is barely any discussion. “They are given a stack of forms and told, ‘Sign here, sign there. Click here, click there,’” said Miriam Sheline, managing attorney at Pro Seniors, a nonprofit law firm in Cincinnati.

When Chris Ferris helped admit his mother to Kirkhaven nursing home in Rochester in 2019, he said, he asked the staff whether any papers he had signed made him financially liable for her care. “They said ‘no,’” he said.

Ferris, who was estranged from his mother, had no legal control over her finances. She had been managing her own affairs. Nevertheless, the nursing home sued Ferris two years later for nearly $11,000. “It’s not right,” said Ferris, who is no longer speaking with his mother.

In more than a third of the cases that nursing homes filed in Monroe County against friends and relatives, the people sued had no power of attorney, limiting their access to residents’ money to pay bills.

Accused of Stealing

Court records show Rochester-area nursing homes also frequently accuse family and friends of hiding residents’ money and property to avoid paying the debts. The allegation is known in debt law as “fraudulent conveyance.” But it is commonly interpreted by those being sued as an accusation of theft, which can be very frightening, consumer attorneys say.

The practice can intimidate people with means into paying debts they may not even owe, said Anderson, the legal assistance attorney. “People see that on a lawsuit and they think they’re being accused of stealing,” she said. “It’s chilling.”

Families do sometimes prey on older relatives, taking their bank cards or selling their property, advocates for seniors say. But nursing home lawsuits in Rochester contain almost no documentation to support these claims.

Monroe County provided supporting records in only three of the 29 lawsuits it filed that included a fraudulent conveyance claim against a friend or relative of a resident. And Underberg & Kessler, a Rochester law firm that has represented the county and other nursing homes, attached documentation in only five of the 70 actions it filed with such claims. The firm has filed the most nursing home debt cases in Monroe County.

Anna Lynch, a partner, said the firm always has “factual and legal grounds” to file. “The fact that the complaint does not make reference to the specific evidence does not mean there is not evidence,” she said. “When we do institute legal action on behalf of a nursing home, the firm reviews the agreements between the parties and the facts to make sure there are grounds for claims against the persons who are legally responsible for payment.”

Barbara Robinson, an 81-year-old widow who lives alone outside Rochester, said that wasn’t her experience. She was sued by Monroe County three years ago for $21,000.

Robinson, who lives on a fixed income, signed papers for an older friend who was admitted to the county home, and she said she helped staff gather information to enroll her friend in Medicaid.

“As far as I knew, that was that,” Robinson recalled. After the friend died, however, the county accused Robinson of taking her friend’s assets. The county provided no documentation.

View note

Robinson said there was no money to take, noting that her friend “had spent every single dime.” A court ultimately dismissed the case, first reported by WHEC-TV in Rochester. Judge Debra Martin admonished the county for the lack of evidence. “Plaintiff must allege some facts to support its claims,” she wrote, noting that the county’s case “does not meet the bare minimum requirements.”

Ferris, who was sued over his estranged mother’s debts, had his case dropped by the nursing home. Valerie King Hoak, a spokesperson for the Kirkhaven nursing home, said the facility “cannot discuss private resident information or potential litigation with third parties.”

Brooks is now in the clear, too, after the county dropped its case against her. She said she thinks the signature on the admissions agreement was forged from the nursing home’s visitor log, the only thing she signed.

The experience left her shaken. She now tells anyone with a friend or relative in a nursing home not to sign anything. “It’s ridiculous,” she said. “But why would you ever think they would be coming after you?”

About This Project

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

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.

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

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KHN on a survey of its clients to explore links between medical debt and housing instability.

KHN journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past 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.

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