My question is about deducting the home care costs for Mom's 24/7 coverage. Upon discharge from a rehab facility(2 years ago) after the brain injury in April, 2014, the facility doctors said my Mom needed 24-hour care permanently, and told us a residential care home was their recommendation. We looked at about 10 residential care homes and could not find one that seemed like a good place for Mom, so the rehab Discharge Coordinator said they would instead discharge her to her home as long as we ensured she would have 24-hour caregivers at home daily.

Without in-home, round-the-clock care, Mom would not remember to take her medications and would be likely to have another health crisis as a result. Though the caregivers are not nurses, they do provide critical assistance throughout every day. For the first year they were in her home, her fall risk was high and she needed assistance walking with her walker constantly. She has improved a little but is still considered a high fall risk due to the 2014 brain bleed. The caregivers also check her BP and pulse 3 times/day and do withhold doses of two of her regular medications if either of those readings are too low. They also call me, her daughter, or 911, if either her BP or pulse rates increase to certain levels and she has any additional symptoms of weakness, numbness, chest pain, or feels very sick.

I believe the full amount of Mom's care giving costs fall in the category of medical deductions for the IRS, because of the medical necessity voiced by her neurologist and GP for the last few years, especially since the brain bleed in April 2014. And in light of the need for this high level of care voiced by her rehab doctors at discharge. 24/7 care in-home is a substantial expense, so I would like to know what I would need to verify that these costs are medically necessary under IRS rules.

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GardenArtist, thank you so much for the great advice. I will work on the physicians statements, and also do the IRS inquiry to get a written response from them. Had thought about some of these ideas, but not all, and your answer gives me very good ways to back up the medical deduction!
Helpful Answer (1)

Michlaz, if you do see an elder law attorney, he/she needs to also have a practice area that includes taxation, and not just gift or estate taxation issues.

What I've done when I've had questions that might lead to misinterpretation later is e-mail the IRS. I haven't done this in a few years, so I don't offhand have the URL for the "contact the IRS". It may take a few weeks for it to answer, especially now since it's tax season.

Download IRS Publication 502 and become familiar with it before you e-mail the IRS, so you can understand how an issue is presented and addressed.

Be sure to state that 24/7 care was ordered by a physician. That's an essential issue in the qualification of "medically necessary."

But the benefit of doing this by e-mail is that you have in writing, a statement from the IRS as to the taxability of specific issues. If there are any questions or challenges later, you present a copy of the e-mail to the IRS so it can be aware that you relied on an IRS staffer for determination of whether items are or are not deductible.

And BTW, if you don't have the statement/recommendation of medical necessity for 24/7 care from the physicians, I would ask for it now, in writing, so it's available if you're challenged by the IRS.
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Thank you, freqflyer for your suggestions! I did hire a CPA last year to help me file my Mom's taxes (including a large living Trust). He did not have any clear answers, so think I do need to try and find another CPA or an Elder Care attorney. The hard part is finding a good one!
Helpful Answer (0)

Your best bet is to contact an Accountant/CPA to see what is deductible. Or to call the IRS hot-line number for your State.

Otherwise, you will need to wait until there is a caregiver who is an expert in current tax laws to come on line here to give information.
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