Can my elderly mother deduct the entire cost of memory care from her taxes?

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CULater
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Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by CULater » Wed Sep 13, 2017 10:56 am

My elderly mother was in an assisted living facility when she tried to "elope" (leave unescorted without reason). She also threatened suicide when she was retrieved. She requires very little physical care, but has been diagnosed with dementia. She was admitted for observation into a geri psych hospital for several days. The assisted living facility would no longer accept her, nor would several others we checked, and the only recourse was to admit her to a memory care facility, even though she was much higher-functioning than other memory care residents. I am wondering if she meets the IRS criteria to have her entire cost of memory care, including the expensive room and board charge, deducted from her taxes.

As I understand the IRS criteria, she would need to have been diagnosed with "severe cognitive impairment" requiring substantial supervision, and there would need to have been a "plan of care" prescribed by a licensed healthcare practitioner pursuant to her admission into memory care. We have neither.
According to IRS Publication 502, qualified long-term care services include “… maintenance and personal care services that are 1) required by a chronically ill individual, and 2) provided pursuant to a plan of care prescribed by a licensed healthcare practitioner.”

A chronically ill individual includes someone with severe cognitive impairment needing “substantial supervision to be protected from threats to health and safety.” In addition, a taxpayer may “include in medical expenses the cost of meals at a hospital or similar institution if a principal reason for being there is to get medical care.”
http://blog.aicpa.org/2015/06/helping-y ... imers.html

At this point, we do not have in hand a diagnosis of "severe cognitive impairment," nor a written plan of care. She has since left the memory care facility she was in, because we were finally able to find an assisted living facility that would accept her, since she functions at a higher level.

Would I still be able to obtain the necessary documentation in order to qualify her stay in memory care as tax deductible? How should I proceed? She was in that facility for approximately 3 months before moving to an assisted living facility.
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

ResearchMed
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by ResearchMed » Wed Sep 13, 2017 11:03 am

CULater wrote:
Wed Sep 13, 2017 10:56 am
My elderly mother was in an assisted living facility when she tried to "elope" (leave unescorted without reason). She also threatened suicide when she was retrieved. She requires very little physical care, but has been diagnosed with dementia. She was admitted for observation into a geri psych hospital for several days. The assisted living facility would no longer accept her, nor would several others we checked, and the only recourse was to admit her to a memory care facility, even though she was much higher-functioning than other memory care residents. I am wondering if she meets the IRS criteria to have her entire cost of memory care, including the expensive room and board charge, deducted from her taxes.

As I understand the IRS criteria, she would need to have been diagnosed with "severe cognitive impairment" requiring substantial supervision, and there would need to have been a "plan of care" prescribed by a licensed healthcare practitioner pursuant to her admission into memory care. We have neither.
According to IRS Publication 502, qualified long-term care services include “… maintenance and personal care services that are 1) required by a chronically ill individual, and 2) provided pursuant to a plan of care prescribed by a licensed healthcare practitioner.”

A chronically ill individual includes someone with severe cognitive impairment needing “substantial supervision to be protected from threats to health and safety.” In addition, a taxpayer may “include in medical expenses the cost of meals at a hospital or similar institution if a principal reason for being there is to get medical care.”
http://blog.aicpa.org/2015/06/helping-y ... imers.html

At this point, we do not have in hand a diagnosis of "severe cognitive impairment," nor a written plan of care. She has since left the memory care facility she was in, because we were finally able to find an assisted living facility that would accept her, since she functions at a higher level.

Would I still be able to obtain the necessary documentation in order to qualify her stay in memory care as tax deductible? How should I proceed? She was in that facility for approximately 3 months before moving to an assisted living facility.
Have you checked with the previous memory care facility, and any medical staff there, about getting the documentation?
They are probably accustomed to doing this.
It seems that someone did indeed diagnose her with those deficits.

About where she is now... is she really safe? Can she just walk away again?
Just a thought.
Perhaps there is a memory care facility in the area that has a few more higher-functioning residents. Her situation isn't unique, as this illness does progress, and there often isn't a clear/obvious "change". But what you described would seem to be a real and ongoing concern.

RM
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Miakis
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by Miakis » Wed Sep 13, 2017 11:04 am

If she was kept in a memory care unit against her will, there must be some documentation of her impairment. Did she not have a doctor during this time? Wouldn't she be under the supervision of a doctor while in the memory care unit? That doctor should provide the medical records necessary to establish her impairment.

Broken Man 1999
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by Broken Man 1999 » Wed Sep 13, 2017 11:09 am

Was she seen by a doctor, one that stated she suffered "severe cognitive impairment" when she was removed from the ALF?

You stated: She was admitted for observation into a geri psych hospital for several days

Surely she saw a doctor during that time. What did they tell you?

For a stay of three months at the memory care facility, I should think prior to admitting her they developed a plan. Maybe these type facilities aren't as heavily regulated as ALFs and nursing homes.

My caregivers work for Bayada, and I receive an annual care plan, plus usually a visit from a registered nurse monthly.

Broken Man 1999

ETA: Did she receive a "care plan", ie suggestions for future care when she left the psych hospital?
Last edited by Broken Man 1999 on Wed Sep 13, 2017 11:13 am, edited 1 time in total.
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bsteiner
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by bsteiner » Wed Sep 13, 2017 11:12 am


CULater
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by CULater » Wed Sep 13, 2017 1:30 pm

Ideally, my mother would have been under the direct care of a doctor who monitored her condition and supervised her treatment. But the American Medical System is a mess these days.

(1) She had a primary care physician whom she visited periodically at his office and he attended to her physical medical treatment.
(2) She also had a psychiatrist, whom she visited periodically at her office who prescribed psychotropic meds.
(3) In the ALF, she was under the care of a nurse (LPN I believe) who basically administered her meds according the the "Care Plan" that was formulated by the Director of Medical Care at the ALF, which was basically the prescriptions given to them by her primary and her psychiatrist. There was no physician at the ALF.
(4) When the elopement occurred, she was required by the ALF to seek medical treatment immediately and could not be retained in her room, so she was taken to the hospital ER, and they sent her to a psychiatric hospital with a geriatric wing.
(5) Neither her primary nor her psychiatrist were involved with her diagnosis or treatment at the geri psych hospital in any way.
(6) She was discharged from the geri psych hospital with no specific diagnosis or treatment plan.
(7) She returned to the ALF and was informed that she had to move immediately into their locked memory care wing.
(8) No physician at the facility, her primary, her psychiatrist, or any physician at the geri psych hospital ever provided a specific diagnosis or a recommended treatment plan. With so many moving parts and pieces, the left hand never knew what the right hand was doing -- so there was no coordinated medical management of her condition.

I'm sure there are a lot of folks out there caring for elders who have seen this movie themselves. It is a mess, it keeps getting messier, relatives are largely left on their own to figure their way around this screwed-up system. It is a disgrace.
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

dbr
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by dbr » Wed Sep 13, 2017 1:59 pm

CULater wrote:
Wed Sep 13, 2017 1:30 pm
Ideally, my mother would have been under the direct care of a doctor who monitored her condition and supervised her treatment. But the American Medical System is a mess these days.

(1) She had a primary care physician whom she visited periodically at his office and he attended to her physical medical treatment.
(2) She also had a psychiatrist, whom she visited periodically at her office who prescribed psychotropic meds.
(3) In the ALF, she was under the care of a nurse (LPN I believe) who basically administered her meds according the the "Care Plan" that was formulated by the Director of Medical Care at the ALF, which was basically the prescriptions given to them by her primary and her psychiatrist. There was no physician at the ALF.
(4) When the elopement occurred, she was required by the ALF to seek medical treatment immediately and could not be retained in her room, so she was taken to the hospital ER, and they sent her to a psychiatric hospital with a geriatric wing.
(5) Neither her primary nor her psychiatrist were involved with her diagnosis or treatment at the geri psych hospital in any way.
(6) She was discharged from the geri psych hospital with no specific diagnosis or treatment plan.
(7) She returned to the ALF and was informed that she had to move immediately into their locked memory care wing.
(8) No physician at the facility, her primary, her psychiatrist, or any physician at the geri psych hospital ever provided a specific diagnosis or a recommended treatment plan. With so many moving parts and pieces, the left hand never knew what the right hand was doing -- so there was no coordinated medical management of her condition.

I'm sure there are a lot of folks out there caring for elders who have seen this movie themselves. It is a mess, it keeps getting messier, relatives are largely left on their own to figure their way around this screwed-up system. It is a disgrace.
Yes, I have and am personally experiencing exactly this with a relative. The only glue that holds the tangle together is you and me and people like us who are there all the time, every time.

ResearchMed
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by ResearchMed » Wed Sep 13, 2017 2:20 pm

CULater wrote:
Wed Sep 13, 2017 1:30 pm
Ideally, my mother would have been under the direct care of a doctor who monitored her condition and supervised her treatment. But the American Medical System is a mess these days.

(1) She had a primary care physician whom she visited periodically at his office and he attended to her physical medical treatment.
(2) She also had a psychiatrist, whom she visited periodically at her office who prescribed psychotropic meds.
(3) In the ALF, she was under the care of a nurse (LPN I believe) who basically administered her meds according the the "Care Plan" that was formulated by the Director of Medical Care at the ALF, which was basically the prescriptions given to them by her primary and her psychiatrist. There was no physician at the ALF.
(4) When the elopement occurred, she was required by the ALF to seek medical treatment immediately and could not be retained in her room, so she was taken to the hospital ER, and they sent her to a psychiatric hospital with a geriatric wing.
(5) Neither her primary nor her psychiatrist were involved with her diagnosis or treatment at the geri psych hospital in any way.
(6) She was discharged from the geri psych hospital with no specific diagnosis or treatment plan.
(7) She returned to the ALF and was informed that she had to move immediately into their locked memory care wing.
(8) No physician at the facility, her primary, her psychiatrist, or any physician at the geri psych hospital ever provided a specific diagnosis or a recommended treatment plan. With so many moving parts and pieces, the left hand never knew what the right hand was doing -- so there was no coordinated medical management of her condition.

I'm sure there are a lot of folks out there caring for elders who have seen this movie themselves. It is a mess, it keeps getting messier, relatives are largely left on their own to figure their way around this screwed-up system. It is a disgrace.
Is it possible that one of the people (supervisor type) at one of these facilities would be able to complete the appropriate paperwork, at least to get things started?

Is there an Elder Care Service in her town? Is there someone who can help with this?
If not, or perhaps even if so, what about having an attorney who specializes in elder care help out with getting the proper paperwork.
There should be (!?) some combination of docs, including from the psych facility especially, that would suffice.

RM
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Gnirk
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by Gnirk » Wed Sep 13, 2017 10:28 pm

Do you have medical Durable Power of Attorney for your mother?. If I were you, I would consult with her primary care physician, and tell him all of your concerns. Also, consult with her psychiatrist, if necessary. They should be willing and able to make a formal diagnosis, and recommend a care plan. If at all possible, have your mother sign a HIPAA waiver so you can discuss her care directly with her doctor.

My mother suffered from Alzheimers for 12 years, and I managed her medical care, living situation, and financials. I took her to her doctors appointments, and prior to her appointment I faxed him my concerns and any changes I had noticed so he would have the information before her appointment. And I never discussed anything or contradicted her answers to his questions in front of her. We would always consult n privately after her appointment.

Once she was in an assisted living home that specialized in dementia care, her CPA deducted the costs on her tax returns as Long Term Care. As a licensed care home, they are required to have a written care plan which is updated annually or as care needs change.

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Pajamas
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by Pajamas » Thu Sep 14, 2017 1:11 am

I think you are making this too complicated because the language in that blog post that you linked to focuses on individuals with severe cognitive impairment. Your mother doesn't have to fall into that category for her long-term inpatient care to be tax deductible.

If you look at p. 11 of IRS Pub. 502, it says:
Long-Term Care
You can include in medical expenses amounts paid for
qualified long-term care services
and premiums paid for
qualified long-term care insurance contracts.

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.



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).
https://www.irs.gov/pub/irs-pdf/p502.pdf

I don't see any problem with your mother meeting these criteria since she was admitted to a locked ward for safety supervision. You are not required to have the documentation in your hand. Can't imagine that this would even be questioned by the IRS. I would deduct it and not worry at all about doing so.

If you are worried about the meals and lodging, on page 12 it says:
Nursing Home
You can include in medical expenses the cost of medical
care in a nursing home, home for the aged, or similar institution,
for yourself, your spouse, or your dependents. This
includes the cost of meals and lodging in the home if a
principal reason for being there is to get medical care.
Don't include the cost of meals and lodging if the reason
for being in the home is personal. You can, however,
include in medical expenses the part of the cost that is for
medical or nursing care.
That also seems very clearcut. She was diagnosed with dementia and admitted to that locked ward after a stay in a geri psych hospital because she had cognitive impairment that was so severe that it was deemed not to be safe for her to be in the general assisted living area because she required supervision behind locked doors to prevent wandering. It isn't required to have a specific definitive diagnosis or meet some specific cognitive impairment test or to receive well-coordinated medical management or similar. It's enough that a ("a" not "the") principal reason for the stay is for medical care. Again, I think you are overthinking this.


Here is an earlier thread on the same issue except that it was a short-term stay and safety supervision wasn't an issue:

viewtopic.php?t=165332
Last edited by Pajamas on Thu Sep 14, 2017 1:48 am, edited 1 time in total.

mouses
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by mouses » Thu Sep 14, 2017 1:40 am

Whenever I've been in the ER, when I've left they're given me paperwork with a diagnosis.

grandmacassie
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Re: Can my elderly mother deduct the entire cost of memory care from her taxes?

Post by grandmacassie » Thu Sep 14, 2017 8:11 am

To your original question about taxes. Dear MIL is in a specialized Alzheimer's unit. Her annual income is about $50K. Her health and care expenses, net of reimbursement by LTCI, are about 90K. The 40K difference is paid from her assets. She pays no federal tax. An enrolled agent prepares her tax return.

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