Is Alzheimer's Care a Tax Deductible Expense?

Over the years I have been asked countless times by residents and families "Are the costs associated with the care they receive tax deductible?" While much of the tax code is subject to varied interpretations, and each individual should seek competent advice from their own professionals, it appears that the answer to this question is "likely."

Section #213 of the publication Selected Federal Taxation Statutes and Regulations states "There shall be allowed as a deduction the expenses paid during the taxable year not compensated for by insurance or otherwise for medical care of the taxpayer, his spouse or a dependent to the extent where that expense exceed 7.5 percent of adjusted gross income." The exact definition of medical care has been further explained in Section 1016 "If an individual in a nursing home or a home for the aged because of his physical condition and the availability of medical care is a principal reason for his presence there, the entire cost of maintenance, including meals and lodging is deductible." The key distinction is the purpose of living there. If it is for personal or family reasons, then only the portion of the cost attributable to medical or nursing cost is deductible. The reason that the deductibility becomes cloudy is that service fees in assisted living facilities bundle the medical care component with room and board, making it difficult to determine or justify what portion of the rent covers the care of the resident. Further, most assisted living facilities go out of their way to advertise that they are not a medical care facility. Officially it is defined as: "Assisted living facilities are a type of living arrangement which combines shelter with various personal support services, such as meals, housekeeping, laundry, and maintenance. Assisted living is designed for seniors who need regular help with activities of daily living (ADLs), but do not need nursing home care." Under this definition the deductibility of costs associated with these facilities may be hard to justify.

Publication 502 by the Department of the Treasury, Internal Revenue Service entitled Medical and Dental Expenses helps to clarify the question. "You can include in medical expenses the cost of medical care in a nursing home or home for the aged for yourself, your spouse, or your dependents. This includes the cost of meals and lodging in the home if the main reason for being there is to get medical care. Do not 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." This means that in an assisted living facility, unless the purpose of the stay is to receive medical care, the cost of lodging and meals may not be deductible.

However, if the individual is chronically ill, as defined under the section entitled Qualified long-term care services all costs associated with the care and supervision of the individual may be tax deductible subject to the 7.5 percent adjustment. Chronically ill is defined in Publication 502: "A chronically ill individual is one who has been certified by a licensed health care practitioner within the previous 12 months as: 1) Being unable for at least 90 days, to perform at least two activities of daily living without substantial assistance from another individual, due to the loss of functional capacity. Activities of daily living are eating, toileting, transferring, bathing, dressing, and continence or 2) Requiring substantial supervision to be protected from threats to health and safety due to severe cognitive impairment." With the enactment of the Kennedy-Kassebaum bill, the law is now clear. Congress stated clearly that the tax code should provide equal consideration for persons with Alzheimer's disease or other irreversible dementia. The only cloudy area remaining is the fee structure of the facility in which they reside.

Another important consideration is the entrance fee, lifecare fee or "founder's fee". "You can include in medical expenses a part of the lifecare fee or founder's fee you pay either monthly or as a lump sum under an agreement with a retirement home. The part of the payment you include is the amount properly allocable to medical care." Many of today's assisted living communities charge an entrance or maintenance fee. This fee is intended to cover administrative processing and maintenance of the property, rendering it a non-tax deductible expense according to the Internal Revenue Service.

Memory Care Units, which are dedicated to caring for people with Alzheimer's disease and related dementia rendering substantial supervision to protect residents from threats to health and safety due to severe cognitive impairment, meet the test. Residents fall under the care of licensed health care practitioners who certify their status. In units specifically designed for the care of those with Alzheimer's disease and related dementia, the care, meals and lodging are in integral part of the complete service plan to constitute "medical care." An entrance fee, if it is intended to cover the cost of the initial assessment, and development of the plan of care for the resident and relates completely to medical care, should qualify it as tax deductible under the definition.

What does all this mean? Well, depending upon your personal income, the deductibility of your monthly fees in a special care unit properly qualified can result in an annual after tax savings of between 15 and 20 percent. If you are looking at several different providers offering similar environments and care, this after tax savings could be a deciding factor on who to choose. So it might be more than worth your while to check this out with your accountant or financial advisor prior to making your decision on where to place your loved one.

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"But I'm Not Ready Yet"

Overcoming the Objections 

Many seniors will feel the decision is premature - they desire to remain where they are more than they desire to move into a senior living community. The decision process to move into a senior living community can involve the psyches of many people (spouse, daughter, son, grandchildren, friends), and it is normally an emotionally charged personal decision. Seniors as well as decision influencers will have their own prospective and biases about senior living according to their experience or knowledge of the business that is all filtered through their personal value system.

" I’m not ready yet." Translation: I'm afraid of giving up my home, independence and lifestyle for an unknown. What if I don't like it? What if they don't like me? What if they raise the rents and I can't afford to live here anymore? Seniors will often look for ways to avoid making the final decision. It is often out of fear or an unwillingness to commit. If an objection can be found they will usually find it, because it is what they are looking for most. When someone says they are not ready yet, what it really means is that perhaps they are afraid or do not understand all the benefits and value Senior living has to offer them personally.

Considering the demographics, its not surprising that there has been a tremendous amount of research into the lifestyles and values of older adults. While opinions differ, some general conclusions can be drawn. Seniors are interested in being depicted as active, interested, involved and see themselves as at least 10 years younger then their true chronological age. In fact, seniors' anxiety about their age is more closely associated with an aversion to the health complications associated with growing old that will eventually place restrictions on their personal freedom. They are in fact, looking for empowerment so that they can live fuller lives and stay in control longer. They are generally private people, especially about their finances, are comfortable with themselves, more experiential and less materialistic than their children. They see themselves as morally conservative and intellectually liberal, they are more aware and educated and consider learning to be a lifelong experience. It is also a time in their life when they experience a growth in their own spirituality and altruism toward their fellow man. They are among the greatest givers of time to volunteer causes than any other group. They are particularly interested in helping other, less active seniors. They are spouse and family oriented, proud and independent.

So how do you approach this proud and "independent" person who you suspect may not be safe living alone at home? How do you answer them when they say they’re not ready? Overcoming objections is part of any sales process. It helps you to gather more information and clarify needs.

1. Objection - "I'm not ready yet."

Response - "Good, then it's just a matter of working on the timing, isn't it?"

- "I understand how you feel. But tell me, just what do you think would have to happen to you before you felt that you were ready? Wouldn't it be comforting to you and your family that should such an event ever happen to you, you would already be in an environment where you could receive that cushion of care right when you really needed it?"

2. Objection - "I would have to sell the house."

Response - "That's right. Most seniors have sold their homes to finance their senior living and they will tell you it's the best decision they ever made. You can arrange a meeting with a very competent Realtor who will do a comparative market analysis on your home for no obligation. Many people are surprised at how much equity they have tied up in their homes that could be earning interest for them if they sold." As many homes have foreclosed and flooded the market, real estate which was once a good investment, is often outpaced in investment return by securities.

3. Objection - "I'm too old to move now."

Response - "That's interesting. There are many people living in senior living communities who are older than you... I'll bet you're not too old to get more out of life, right? This lifestyle provides you the opportunity of a secure, enjoyable, carefree retirement, and it could be the best years of your life. Statistics prove that people live on the average two to three years longer in a senior living community than in an apartment. There are several good reasons for this. One of them is companionship. One of the saddest things about growing older is that our friends pass away. We meet new friends, of course, but if we are not in a community setting we don’t have the ability to continually expand our friendships. Therefore, they are continually shrinking. If we stop driving in the years ahead, or our friends don’t drive, or the weather is bad, we tend to spend a lot of time within our private residence. Many meals are eaten with their only companion being their television. It’s easy to see how one can slowly become a recluse over a period of time. At a senior living community, companionship is always available."

4. Objection - "I'm just not sure."

Response - "There's some risk involved, isn't there? And you want to be certain you do the right thing. What information would you need to be more comfortable with your decision?"

"I sense that there may be something that you are uncertain about. It is the (fee, moving, apartment, etc., until you zero in). Well, if it weren't for (the objection) do you think this lifestyle here might make sense for you?" "So, if I could (fix the objection) could you at least give it a try?

At some point, and in spite of all their objections, sometimes love gets tough. People who are isolated can become depressed and depression leads to health failure, which puts them at risk. When they were the parent they would not even think of allowing you as a child to be exposed to a potentially dangerous situation regardless of what you wanted. As an adult child, you may have the same decision to make for your parents.


Often when they compare the costs they are incurring on real estate taxes, homeowner’s insurance, food, utilities, transportation,  maintenance, housekeeping, activities and companion services, living in a retirement community where all these costs are included in the monthly rent might very well be cheaper for them. They also see the value of converting their home equity to income producing assets rather than having it remain stagnant while tied up in their home or worse constantly eroded in a soft real estate market.

In the end, overcoming objections is a process of developing a comfort level with the decision. Be patient with your loved one. Listen for other hidden meaning to their objections; they may be using the opportunity for a completely different motivation then to just throw out obstacles. Repeat the objection to clarify your understanding. Sometimes when people hear their objection repeated back to them it sounds worse than they really intend it to be. Confirm the objection by agreeing with them, don’t try to argue with them or pretend to know better. Seniors like to have their objections acknowledged and affirmed. Question their real intent behind the objection and look for common ground. Answer their concerns as best you can without being smart or glib. Confirm the answer by relating the experience to others in their situation that may have had the same objection but ultimately found that it might have been overstated. Finally close on some neutral ground and leave the discussion with something that you both agree on about the situation.

After 30 years of seeing adult children and their parents deal with these tough decisions, I have learned that it’s the process they fear rather than the end result. Most seniors, once admitted to a senior living community readily adapt. After a few months there they will admit that their quality of life has improved, and that’s our ultimate goal anyway, isn’t it?