Are home health aides a deductible medical expense

[orion31662]

My mother in law has 24-7 home health aides.  Are their costs deductible on her return.  They are not nurses, but do cooking, cleaning, transportation, and keep her safe (no unattended falls, proper nutrition, and assistance in toileting and hygiene).  They follow a plan designed by the agency.  Her doctor wrote a note requiring 24-7 care.  So can the fees be processed in the medical expense area?

[Howard1948]

From IRS Publication 502 re medical expenses:

Qualified long-term care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal care services (defined later) that are:

1. Required by a chronically ill individual, and

2. Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

Chronically ill individual.   An individual is chronically ill if, within the previous 12 months, a licensed health care practitioner has certified that the individual meets either of the following descriptions.

1. He or she is unable to perform at least two activities of daily living without substantial assistance from another individual for at least 90 days, due to a loss of functional capacity. Activities of daily living are eating, toileting, transferring, bathing, dressing, and continence.

2. He or she requires substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.

Maintenance and personal care services.    Maintenance or personal care services is care which has as its primary purpose the providing of a chronically ill individual with needed assistance with his or her disabilities (including protection from threats to health and safety due to severe cognitive impairment).

[LEM2017]

I have a similar question, but I cannot find enough information to find out how the amount you can deduct determined.  I am assuming the entire amount cannot be deducted.  My mother is 95, filing single.  She was left with sufficient funds to cover the costs so she is, in essence, filing for herself so it is not a dependent / child.   She cannot be left alone, and I work.  How do we determine how much can be deducted?  Is it a percentage of the total cost?  I have found nothing that speaks to this.

[VictoriaD75]

Generally, only the amount spent for nursing services is a medical expense. If the attendant also provides personal and household services, amounts paid to the attendant must be divided between the time spent performing household and personal services and the time spent for nursing services.

For example, because of your medical condition you pay a visiting nurse $300 per week for medical and household services. She spends 10% of her time doing household services such as washing dishes and laundry. You can include only $270 per week as medical expenses. The $30 (10% × $300) allocated to household services can't be included. However, certain maintenance or personal care services provided for qualified long-term care can be included in medical expenses. See Maintenance and personal care services under Long-Term Care, earlier.

Additionally, certain expenses for household services or for the care of a qualifying individual incurred to allow you to work may qualify for the child and dependent care credit. See Pub. 503.

[Leica Lover]

We have a part time caregiver-three days a week for my wife who has dementia. She basically relieves me,

She assists with incontinence, medication, dressing etc. How much of her wage if anything can I deduct.

[Opus 17]

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@Leica Lover wrote:

We have a part time caregiver-three days a week for my wife who has dementia. She basically relieves me,

She assists with incontinence, medication, dressing etc. How much of her wage if anything can I deduct.

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That depends.

Generally, you can only deduct the cost of nursing care.  Nursing care does not have to be provided by a nurse, but must be the kind of services that a nurse usually provides, such as assisting with eating, bathing, going to the toilet, or taking medications.  If the aide performs other services, you will have to allocate the cost based on the amount of time spent performing nursing services.

However, there is a special rule for chronically ill individuals.  You can deduct the entire cost of the aide if you meet three tests:

1. the individual is chronically ill as certified by a doctor (has a long term illness that is permanent, or will last at least one year, or will lead to death.

2. the person requires assistance with 2 or more activities of daily living (ADLs are eating, dressing, bathing, toileting, transferring, and managing continence) OR the person requires assistance to prevent them from being a danger to themselves or others, due to cognitive impairment.

3. the care is provided according to a written care plan that is prepared by a qualified medical professional or social worker that is reviewed and updated at least once a year.

I suspect you don't have a written care plan, most caregivers don't know about this part.  That would mean you have to determine what percentage of the time the aide performs nursing services, and that percentage of the cost is a deductible medical expense. 

However, if you can get a visiting nurse or a social worker who specializes in dementia care to create a simple written care plan that includes the use of an aide, then the entire cost of the aide would be a deductible medical expense starting on the date the care plan is written.  

https://www.irs.gov/publications/p502#en_US_2020_publink1000178977

Qualified Long-Term Care Services

Qualified long-term care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal care services (defined later) that are:

1. Required by a chronically ill individual, and

2. Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

Chronically ill individual.

An individual is chronically ill if, within the previous 12 months, a licensed health care practitioner has certified that the individual meets either of the following descriptions.

1. He or she is unable to perform at least two activities of daily living without substantial assistance from another individual for at least 90 days, due to a loss of functional capacity. Activities of daily living are eating, toileting, transferring, bathing, dressing, and continence.

2. He or she requires substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.

[ritchb]

We used Home Instead Senior Care both for me and my now deceased wife.  Is all or part of the expense tax deductible?

[Opus 17]

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@ritchb wrote:

We used Home Instead Senior Care both for me and my now deceased wife.  Is all or part of the expense tax deductible?

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You posted to an old topic that already has a long detailed answer to this question.  Did you read the answer or did you skip it?  If you read it, what part are you still unclear about?

You can only include as a medical expense, in-home care that qualifies as nursing care.   Nursing care does not have to be provided by a nurse, but must be the kind of services that a nurse usually provides, such as assisting with eating, bathing, going to the toilet, or taking medications.  If the aide performs other services, such as housekeeping, cooking or companionship, you will have to allocate the cost based on the percentage of time spent performing nursing services.

If you or your spouse meets the tests for chronically ill individual, you can deduct the entire cost of in-home care.  These tests are:

1. the individual is chronically ill as certified by a doctor (has a long term illness that is permanent, or will last at least one year, or will lead to death.

2. the person requires assistance with 2 or more activities of daily living (ADLs are eating, dressing, bathing, toileting, transferring, and managing continence) OR the person requires assistance to prevent them from being a danger to themselves or others, due to cognitive impairment.

3. the care is provided according to a written care plan that is prepared by a qualified medical professional or social worker that is reviewed and updated at least once a year.

Even if you or your spouse are chronically ill, if you don't have a written care plan, you can only deduct the percentage of the time the aide spends performing nursing services.

However, if you can get a visiting nurse or a social worker who specializes in long term care to create a simple written care plan that includes the use of in-home services, then the entire cost of the aide would be a deductible medical expense starting on the date the care plan is written.  

[ThomasM125]

@ritchb The portion of the care that is associated with medical care, as opposed to household chores, would be allowed as a medical itemized deduction. As such, it is deductible to the extent the amount is over 7.5% of your adjusted gross income. Also, you need to be able to benefit from itemizing your deductions for the deduction to help you.

You add the costs in the Deductions and Credits section of TurboTax, and then Medical and then Medical Expenses.