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Qualifying for Care

Richard Connor

A NEIGHBOR WAS recently telling me about the increasing amount of care he and his wife have to provide to his 90-year-old mother-in-law, and the challenges and expenses he expects in the near future.

I was able to offer some advice—because this is an area where my wife and I have significant experience. Together, we took care of her parents and mine, both medically and financially. If this is something you’re experiencing, or may soon, you would do well to learn about the six activities of daily living. The six ADLs are generally recognized as:

  • The ability to clean yourself and perform grooming activities like shaving and brushing teeth.
  • The ability to get dressed by yourself without struggling with buttons and zippers.
  • The ability to feed yourself.
  • Being able to either walk or move from a bed to a wheelchair and back again.
  • The ability to get on and off the toilet.
  • The ability to control your bladder and bowel functions.

Long-term-care (LTC) providers use ADLs as a measure of whether assistance is required and how much help is needed. To qualify for Medicaid nursing home benefits, the state may do an assessment to verify that an applicant needs assistance with ADLs. Other state programs may also require that an applicant be unable to perform a certain number of ADLs before qualifying for assistance. In addition, LTC insurance usually uses the inability to perform two or more ADLs as a trigger to begin paying on a policy.

On top of all that, ADLs play a significant role in determining whether you can take a tax deduction for the costs of an assisted living facility, such as a nursing home or a continuing care community. To deduct assisted living expenses, the resident must be considered “chronically ill.” This means a doctor or nurse has certified that the resident either can’t perform at least two ADLs or requires supervision due to a cognitive impairment, such as Alzheimer’s disease or another form of dementia.

In addition, for a resident of an assisted living facility to qualify for a tax deduction, personal care services must be provided according to a plan of care prescribed by a licensed health care provider. This means a doctor, nurse or social worker must prepare a plan that outlines the specific daily services the resident will receive. For further details, check out IRS Publication 502.

Usually, only the medical part of assisted living costs is deductible, while ordinary living costs—such as room and board—are not. If the resident meets the criteria above, however, room and board may be considered part of medical care and the cost may be deductible. The assisted living facility should provide you with a breakdown of costs.

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What if you choose care at home rather than at an institution? Again, IRS Publication 502 provides the answer. In the “nursing services” section, the IRS says that nursing services at home are deductible, potentially including “certain maintenance or personal care services provided for qualified long-term care.”

In my mother-in-law’s case, she had dementia and needed help with several ADLs. Luckily, she had the resources to afford a safe and comfortable facility. Her income included a small pension, Social Security, and dividends and interest. But given the huge costs of long-term care, her itemized deductions each year were roughly $40,000 higher than her taxable income.

Thanks to that $40,000 of “extra” itemized deductions, we were able to withdraw that sum from her remaining IRAs for a number of years and not owe any federal taxes. When her IRAs were drained, we sold taxable-account investments and realized some long-term capital gains—and again, thanks to her “extra” itemized deductions, there was zero federal tax. One caveat: A parent may still owe state taxes if the state government taxes retirement income or capital gains.

Planning for our own, or our parents’, elder years is one of the more challenging aspects of financial planning. My wife and I learned how important it is for adult children to talk openly with their parents about their wishes. Equally important, seniors should talk with their children while they still have all their faculties. Engaging an expert in elder law, especially for the nightmare that a Medicaid application presents, is also a great idea.

Richard Connor is a semi-retired aerospace engineer with a keen interest in finance. He enjoys a wide variety of other interests, including chasing grandkids, space, sports, travel, winemaking and reading. Follow Rick on Twitter @RConnor609 and check out his earlier articles.

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Ying Chen Axt
Ying Chen Axt
1 month ago

Hi Richard,
I am new to this topic. A family member was diagnosed stage III cancer last month. Our family is putting together a care plan. Very glad to read your article!

I have a question on the “institution” or “facility” you mentioned in this article, does it have to be Medicare approved providers (listed on Medicare.gov)? There is a senior living community near our house, they combine all three levels of care – independent living, assisted living, and nursing home in one setting. This facility is not listed on the Medicare website. Would Medicare cover some of the costs in this facility if our parent meets the ADL requirement? Would the medical component of the costs qualify for tax deductions?

Thanks a lot,

Ying

Andrew Forsythe
Andrew Forsythe
2 months ago

Excellent article, Richard. We’ve been going through a similar situation with a family member and your summary and advice are spot on.

Rick Connor
Rick Connor
1 month ago

Thanks Andrew. Best of luck with your family.

parkslope
parkslope
2 months ago

Thanks for this informative article. I would add those who purchase an apartment/room in a Lifetime Care facility qualify for medical deductions regardless of their disability status. The deduction includes the share of the apartment purchase price the facility charges to guarantee lifetime care in the first year as well the annual resident per capita fee that the facility charges for long-term care.

Last edited 2 months ago by parkslope
Rick Connor
Rick Connor
1 month ago
Reply to  parkslope

Thanks. Great info on the Lifetime. I have no background with one.

Newsboy
Newsboy
2 months ago

Richard -a timely article for many HD readers. Thanks for sharing your extensive hands-on experience in this space.

One item worth researching for those who have purchase LTC Insurance: The requirement for an inability to perform at least 2 of the 6 ADLs that you reference (standard in most LTCI contracts) is typically superseded / subordinate in many policies to the presence of “physician-certified cognitive impairment”. In other words, the presence of a doctor-verified cognitive impairment as a standalone (dementia and / or Alzheimer’s) may trigger benefits for a covered person by itself. It’s worth reading the fine print found in the LTCI contract on this.

Last edited 2 months ago by Newsboy
Rick Connor
Rick Connor
1 month ago
Reply to  Newsboy

Thanks. My mother-in-law qualified with a diagnosis of dementia.

Don Southworth
Don Southworth
2 months ago

Thanks for a great article. Your parents and in-laws were fortunate for your support and wisdom. Sadly, most of us won’t have enough of either but your willingness to share your experiences helps.

Rick Connor
Rick Connor
2 months ago
Reply to  Don Southworth

Thanks Don.

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