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On December 22, 2017, The Tax Cuts and Jobs Act was signed into law. The information in this article predates the tax reform legislation and may not apply to tax returns starting in the 2018 tax year. You may wish to speak to your tax advisor about the latest tax law. This publication is provided for your convenience and does not constitute legal advice. This publication is protected by copyright.

Eldercare Can Be a Medical Deduction
Article Highlights:
  • Nursing Homes 
  • Meals and Lodging 
  • Home care 
  • Nursing Services 
  • Household Employees 
With people living longer, many find themselves becoming the care provider for elderly parents, spouses and others who can no longer live independently. When this happens, questions always come up regarding the tax ramifications associated with the cost of nursing homes or in-home care.

Generally, the entire cost of nursing homes, homes for the aged, and assisted living facilities are deductible as a medical expense, if the primary reason for the individual being there is for medical care or the individual is incapable of self-care. This would include the entire cost of meals and lodging at the facility. On the other hand, if the individual is in the facility primarily for personal reasons, then only the expenses directly related to medical care would be deductible and the meals and lodging would not be a deductible medical expense.

As an alternative to nursing homes, many elderly individuals or their care providers are hiring day help or live-in employees to provide the needed care at home. When this is the case, the services provided by the employees must be allocated between household chores and deductible nursing services. To be deductible, the nursing services need not be provided by a nurse so long as the services are the same services that would normally be provided by a nurse, such as administering medication, bathing, feeding, dressing, etc. If the employee also provides general housekeeping services, then the portion of the employee's pay attributable to household chores would not be a deductible medical expense.

Household employees, like other employees, are subject to Social Security and Medicare taxes, and it is the responsibility of the employer to withhold the employee's share of these taxes and to pay the employer's payroll taxes. Special rules for household employees greatly simplify these payroll withholding and reporting requirements and allow the federal payroll taxes to be paid annually in conjunction with the employer's individual 1040 tax return. Federal income tax withholding is not required unless both the employer and the household employee agree to withhold income tax. However, the employer is still required to issue a W-2 to the employee and file the form with the federal government. A federal employer ID number (FEIN) and a state ID number must be obtained for reporting purposes. Most states have special provisions for reporting and paying state payroll taxes on an annual basis that are similar to the federal reporting requirements.

The employer’s portion of the employment taxes (Social Security, Medicare, and federal and state unemployment taxes) that relate to the employer’s deductible medical expenses are also allowed as a medical expense.

If you need assistance in setting up a household payroll, please contact this office for additional details and filing requirements.


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'); mywindow.document.write(data); mywindow.document.write(' '); mywindow.document.close(); // necessary for IE >= 10 mywindow.focus(); // necessary for IE >= 10 mywindow.print(); mywindow.close(); return true; } function quote_standard() { var miscellaneous=0; var formName = document.ioq; $('#print').show(); /* START GLOBAL VARIABLES ***************************************************************************/ // Federal var form1040 = Math.round(120*1.3); var form1040A = Math.round(100*1.3); var form1040EZ = Math.round(60*1.3); var form1040X = Math.round(200*1.3); // State var form140AZ = Math.round(70*1.3); var form140AZPY = Math.round(90*1.3); var form140X = Math.round(90*1.3); var otherStateIncomeTax = Math.round(80*1.3); // Income var w2 = Math.round(10*1.5); var form1099R = Math.round(10*1.3); var k1 = Math.round(40*1.3); // Schedules var scheduleA = Math.round(110*1.3); var scheduleB = Math.round(20*1.3); var scheduleC = Math.round(120*1.3); var scheduleD = Math.round(40*1.3); var scheduleE = Math.round(200); var scheduleF = Math.round(100*1.3); var scheduleH = Math.round(100*1.3); var scheduleL = Math.round(20*1.3); var scheduleM = Math.round(20*1.3); // Forms var form982 = Math.round(80*1.3); var form2106 = Math.round(50*1.3); var form2441 = Math.round(40*1.3); var form4137 = Math.round(40*1.3); var form4562 = Math.round(30*1.3); var form4684 = Math.round(50*1.3); var form4797 = Math.round(140*1.3); var form5405 = Math.round(80*1.3); var form5695 = Math.round(80); var form6252 = Math.round(80*1.3); var form8283 = Math.round(40); var form8379 = Math.round(40*1.3); var form8396 = Math.round(30*1.3); var form8606 = Math.round(30*1.3); var form8824 = Math.round(150*1.3); var form8829 = Math.round(130); var form8863 = Math.round(50*1.3); // Income documents var incomeDocuments = Math.round(60); var incomeDocumentsAnswer = "Yes"; /* CALCULATES QUESTIONS NUMBER 2 ********************************************************************/ if (formName.DoYouHaveAMortgage_0.checked == true) { var doYouHaveAMortgage = 230; var doYouHaveAMortgageAnswer = "Yes"; } else { var doYouHaveAMortgage = 130; var doYouHaveAMortgageAnswer = "No" } /* CALCULATES QUESTIONS NUMBER 3 ********************************************************************/ if (formName.W2_0.checked == true) { var w2 = parseInt(w2) * parseInt(formName.W2_0_yes.value); var w2Answer = "Yes"; } else { var w2 = 0; var w2Answer = "No"; } /* CALCULATES QUESTIONS NUMBER 4 ********************************************************************/ if (formName.SelfEmployed_0.checked == true) { var selfEmployed = 170 * parseInt(formName.SelfEmployed_0_yes.value); var selfEmployedAnswer = "Yes"; } else { var selfEmployed = 0; var selfEmployedAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 5 ********************************************************************/ if (formName.DidYouLiveOutsideOfArizona_0.checked == true) { var didYouLiveOutsideOfArizona = parseInt(formName.DidYouLiveOutsideOfArizona_0_yes.value * 190); //didYouLiveOutsideOfArizona=Math.round(didYouLiveOutsideOfArizona*1.3); var didYouLiveOutsideOfArizonaAnswer = formName.DidYouLiveOutsideOfArizona_0_yes.value; } else { var didYouLiveOutsideOfArizona = 100; didYouLiveOutsideOfArizona=Math.round(didYouLiveOutsideOfArizona*1.3); var didYouLiveOutsideOfArizonaAnswer = 1; } /* CALCULATES QUESTIONS NUMBER 6 ********************************************************************/ if (formName.DidYouSellInvestments_0.checked == true) { // alert("Your fees could vary significantly depending upon the number and type of transactions. We can give you a firm quote when we meet. This quote is an estimate."); // Captures the quantity value of the drop down and multiplies it times the price. var didYouSellInvestments = (parseInt(formName.ScheduleD.value) * 5) + 50; if (parseInt(formName.ScheduleD.value) > 40) { didYouSellInvestments=didYouSellInvestments+((parseInt(scheduleD)-40)*3); } didYouSellInvestments=Math.round(didYouSellInvestments*1.3); var didYouSellInvestmentsAnswer = "Yes"; } else { var didYouSellInvestments = 0; var didYouSellInvestmentsAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 7 ********************************************************************/ if (formName.DidYouOwnRentalProperty_0.checked == true) { // Captures the quantity value of the drop down and multiplies it times the price. var didYouOwnRentalProperty = parseInt(scheduleE) * parseInt(formName.ScheduleEOwn.value); var didYouOwnRentalPropertyAnswer = "Yes"; } else { var didYouOwnRentalProperty = 0; var didYouOwnRentalPropertyAnswer = "No"; } if (formName.DidYouSellRentalProperty_0.checked == true) { // Captures the quantity value of the drop down and multiplies it times the price. var didYouSellRentalProperty = 250 * parseInt(formName.ScheduleESell.value); var didYouSellRentalPropertyAnswer = "Yes"; } else { var didYouSellRentalProperty = 0; var didYouSellRentalPropertyAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 9 ********************************************************************/ if (formName.ChildCare_0.checked == true) { var childCare = parseInt(form2441); var childCareAnswer = "Yes"; } else { var childCare = 0; var childCareAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 11 ********************************************************************/ if (formName.EnergyCredit_0.checked == true) { var energyCredit = parseInt(form5695) * parseInt(formName.EnergyCredit.value); var energyCreditAnswer = "Yes"; } else { var energyCredit = 0; var energyCreditAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 12 ********************************************************************/ if (formName.DonateNonCash_0.checked == true) { var donateNonCash = parseInt(form8283); var donateNonCashAnswer = "Yes"; } else { var donateNonCash = 0; var donateNonCashAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 13 ********************************************************************/ if (formName.BusinessUseOfHome_0.checked == true) { var businessUseOfHome = parseInt(form8829) + ((parseInt(formName.BusinessUseOfHome_0_yes.value) * 80) - 80); var businessUseOfHomeAnswer = "Yes"; } else { var businessUseOfHome = 0; var businessUseOfHomeAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 14 ********************************************************************/ if (formName.BusinessUseOfHome_0.checked == true) { var businessUseOfHome = parseInt(form8829) * parseInt(formName.BusinessUseOfHome_0_yes.value); var businessUseOfHomeAnswer = "Yes"; } else { var businessUseOfHome = 0; var businessUseOfHomeAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 15 ********************************************************************/ if (formName.CollegeTuition_0.checked == true) { var collegeTuition = parseInt(form8863) * parseInt(formName.Tuition_0_yes.value); var collegeTuitionAnswer = "Yes"; } else { var collegeTuition = 0; var collegeTuitionAnswer = "No"; } /* CALCULATES QUESTIONS NUMBER 16 ********************************************************************/ if (formName.IncomeDocuments_0.checked == true) { var incomeDocuments = parseInt(incomeDocuments); var incomeDocumentsAnswer = "Yes"; } else { var incomeDocuments = 0; var incomeDocumentsAnswer = "No"; } // Calculate the subtotal var subtotal = parseInt(doYouHaveAMortgage + w2 + selfEmployed + didYouLiveOutsideOfArizona + didYouSellInvestments + didYouOwnRentalProperty + didYouSellRentalProperty + childCare + energyCredit + donateNonCash + businessUseOfHome + collegeTuition + incomeDocuments); // create answer text var doYouHaveAMortgageAnswer = "2. Mortgage? " + doYouHaveAMortgageAnswer + " $" + doYouHaveAMortgage; var w2Answer = "3. W-2, 1099-R, SSA-1099, K-1 forms? " + w2Answer + " $" + w2; var selfEmployedAnswer = "4. Self-Employed? " + selfEmployedAnswer + " $" + selfEmployed; var didYouLiveOutsideOfArizonaAnswer = "5. State Returns: " + didYouLiveOutsideOfArizonaAnswer + " $" + didYouLiveOutsideOfArizona; var didYouSellInvestmentsAnswer = "6. Sold Investments? " + didYouSellInvestmentsAnswer + " $" + didYouSellInvestments; var didYouOwnRentalPropertyAnswer = "7a. Owned Rental Property? " + didYouOwnRentalPropertyAnswer + " $" + didYouOwnRentalProperty; var didYouSellRentalPropertyAnswer = "7b. Sold Rental Property? " + didYouSellRentalPropertyAnswer + " $" + didYouSellRentalProperty; var childCareAnswer = "8. Child Care? " + childCareAnswer + " $" + childCare; var energyCreditAnswer = "9. Energy Credit? " + energyCreditAnswer + " $" + energyCredit; var donateNonCashAnswer = "10. Donated more than $500? " + donateNonCashAnswer + " $" + donateNonCash; var businessUseOfHomeAnswer = "11. Business-use-of-home? " + businessUseOfHomeAnswer + " $" + businessUseOfHome; var collegeTuitionAnswer = "12. College Tuition? " + collegeTuitionAnswer + " $" + collegeTuition; var incomeDocumentsAnswer = "13. Earned Income Credit " + incomeDocumentsAnswer + " $" + incomeDocuments; // Check if existing client box is checked if (formName.ExistingClient_0.checked == true) { var existingClientAnswer = "1. Existing client? Yes"; var discount = parseInt(subtotal * .10); } else { var existingClientAnswer = "1. Existing client? No"; var discount = parseInt(subtotal * .20); } // Dependent discount check if (formName.DependentDiscount_0.checked == true) { var dependentDiscount = parseInt(subtotal * .5); var dependentDiscountText = "
Dependent Discount: -$"+ dependentDiscount; } else { var dependentDiscount = 0; var dependentDiscountText = ""; } var breakdown = existingClientAnswer + "
" + doYouHaveAMortgageAnswer + "
" + w2Answer + "
" + selfEmployedAnswer + "
" + didYouLiveOutsideOfArizonaAnswer + "
" + didYouSellInvestmentsAnswer + "
" + didYouOwnRentalPropertyAnswer + "
" + didYouSellRentalPropertyAnswer + "
" + childCareAnswer + "
" + energyCreditAnswer + "
" + donateNonCashAnswer + "
" + businessUseOfHomeAnswer + "
" + collegeTuitionAnswer + "
" + incomeDocumentsAnswer; var quote = breakdown + "
--------------------
Subtotal: $" + parseInt(subtotal) + "
Discount: -$" + parseInt(discount) + dependentDiscountText + "
--------------------
Total Only $" + parseInt(subtotal - discount - dependentDiscount + miscellaneous) + "! "; document.getElementById('quotearea').innerHTML=quote+'

If you have other transactions not mentioned above, your fees will be higher. This quote is an estimate. Please print this quote and bring it with you to your appointment. You must have a completed tax organizer to get the discount.'; return false; }