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What portion of nursing home costs can I deduct for spouse with dementia who permanently resides there?

My mother-in-law is in an awful situation right now and I'm trying to help her figure out the tax implications. Her husband (my father-in-law) has late-stage dementia and is completely bedridden. He can't speak anymore and has to be fed through a tube. He's been permanently placed in a nursing home since his condition requires 24/7 care that she just couldn't provide at home anymore. They've always filed their taxes as married filing jointly and itemize their deductions. The nursing home bills are astronomical - around $9,800 per month. About $7,200 is for the "room and board" portion, and then there's a separate bill of about $2,600 for the medical care (when nurses, doctors, etc. provide specific treatments). I've been trying to understand Publication 502, which says something about deducting nursing home costs if the "principal reason" for being there is medical care. Well, he's definitely there because of his medical condition - he physically cannot care for himself at all. The doctor is in the process of certifying him as incapacitated so she can get power of attorney. My question is: Can they deduct the ENTIRE nursing home bill (including the room and board portion) as a medical expense, or just the separate medical treatment charges? They're paying completely out of pocket, no Medicare coverage for the stay. This deduction would make a huge difference for their finances.

Something important that hasn't been mentioned - if your father-in-law has long-term care insurance that's covering any portion of the nursing home costs, you cannot deduct those portions that are reimbursed. You can only deduct the out-of-pocket expenses. Also, look into whether he might qualify for Medicaid. Depending on your state and his assets, he might be eligible, which could significantly reduce the out-of-pocket costs. Though there are lookback periods for asset transfers to be aware of.

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Yara Nassar

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Thank you for bringing this up! They don't have long-term care insurance unfortunately. They looked into Medicaid but were told they have too many assets to qualify right now. They're spending down their retirement savings at an alarming rate with these nursing home bills. Do you know if the medical expense deduction applies to withdrawals from retirement accounts that are used to pay for the nursing home?

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Yes, you can still claim the medical expense deduction even if the money comes from retirement account withdrawals. The source of the funds doesn't affect the deductibility of the medical expense. However, be aware that withdrawals from traditional retirement accounts (like a traditional IRA or 401k) are generally taxable income, which will increase your AGI. This could potentially reduce the benefit of the medical expense deduction since you can only deduct expenses that exceed 7.5% of your AGI. It creates a bit of a circular problem - you withdraw money to pay medical bills, which increases your income, which raises the threshold for deducting those same medical bills.

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A tip from someone who's been through this - make sure you're keeping track of ALL qualifying medical expenses, not just the nursing home. Transportation costs to medical appointments (including gas and parking), prescription drugs, medical equipment, vision care, dental work, hearing aids, etc. all count toward that 7.5% threshold. For my mom with similar issues, we were able to deduct things like: - Special food for her feeding tube - Incontinence supplies - Medical alert system - Portion of utilities for medical equipment at home (before nursing home) - Modifications to bathroom for accessibility

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Is there a good way to track all this? I've been keeping receipts in a shoebox but it's getting overwhelming.

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StarStrider

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I've been using FreeTaxUSA for the past 3 years and have been super happy with it. Federal is completely free no matter what forms you need (including HSA, self-employment, investments, etc). They only charge $15 for state filing. Their interface isn't as slick as TurboTax or TaxSlayer but it gets the job done without the sneaky charges. And direct deposit is included at no extra cost because that's how a normal tax service should work lol.

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Zoe Stavros

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Do they let you pay the state filing fee out of your refund or do you need to pay upfront with a credit card?

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StarStrider

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You need to pay the state filing fee upfront with a credit card or PayPal. They don't offer the option to pay from your refund - that's actually one of the ways other tax services justify charging those extra "processing fees." The $15 state fee is straightforward with no hidden charges. And honestly, paying upfront rather than from your refund usually saves you money since many services charge $35-50 to use your refund for payment.

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This happened to me too! But protip: if you start over and go to the IRS Free File page and click through to TaxSlayer from there, you actually get the truly free version. The "Simply Free" on their regular site is different from the IRS Free File version. It's super shady marketing but there are actually two completely different "free" products - one with tons of gotcha upgrades and one that's actually free because it's part of the IRS program. Companies intentionally make their regular "free" version limited so they can upsell you.

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Sofia Torres

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This is the real answer! The IRS Free File program requires participating companies to provide truly free filing if you meet the income requirements (usually under $73,000). Going directly to TaxSlayer's website means you get their commercial "free" version with all the upgrade traps.

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Zoe Stavros

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Wow that's incredibly misleading of them! I had no idea there were two different versions. I'll definitely try the IRS Free File portal next time. Thanks for the tip!

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Paolo Rizzo

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9 My mom is in the same situation, but she just went to her local Social Security office and got a printout of her 1099 on the spot. Took about an hour of waiting, but she walked out with the document in hand. Might be worth considering if you're in a hurry and there's an office near you.

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Paolo Rizzo

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12 Do you know if she needed to bring anything specific with her? ID or anything like that? I might try this approach instead of waiting.

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Paolo Rizzo

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9 She brought her photo ID (driver's license), Social Security card, and a piece of mail showing her current address just to be safe. The agent only ended up asking for the photo ID, but it's probably good to have all of it with you. I think they just need to verify your identity before printing out tax documents. She said the office was pretty busy with other people there for the same reason, so going early in the morning might help cut down on wait time.

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Paolo Rizzo

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5 For what it's worth, mine just arrived yesterday (Feb 16th), so they seem to be coming out later than usual this year. I've received them for several years and they typically arrive in early February. This is definitely the latest I've ever gotten one.

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Paolo Rizzo

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1 That's somewhat reassuring to hear. Maybe I'll wait another week before trying any of the other solutions mentioned here. Did you receive any other tax forms on time (like W-2s or other 1099s), or were those delayed too?

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Paolo Rizzo

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5 My W-2s and 1099-INT from my bank came right on time in mid-January, so it seems to be specific to the SSA forms being delayed. I've heard from a couple of friends who also receive social security, and they were in the same boat - got their SSA-1099s much later than usual this year. My theory is that the Social Security Administration is just overwhelmed with all the new beneficiaries from the baby boomer generation retiring. Every year the system seems to get a little more strained.

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I found a workaround! Instead of giving physical gifts, I set up a formal "Employee Achievement Program" where exceptional work is recognized with awards. If you follow the IRS guidelines in Publication 15-B, you can give non-cash achievement awards worth up to $1,600 tax-free if they're "qualified plan awards." The key is having formal, written criteria for the awards, making them for length of service (minimum 5 years) or genuine safety achievements, and giving them as part of a meaningful presentation. Can't just hand over an iPad and call it a day. Also can't do it for things like production or sales targets. We've been doing this for 3 years and our accountant says it's legit as long as we have proper documentation and don't exceed the dollar limits.

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Ellie Perry

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This is helpful but I'm confused about the "qualified plan" part. Do I need to file something official with the IRS to set this up? And does it need to be available to all employees or can I choose who gets awards?

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A qualified plan award means it's part of an established written plan that doesn't discriminate in favor of highly compensated employees. You don't need to file the plan with the IRS, but you should have it documented in your employee handbook or as a separate written policy. The plan needs to be available to all employees - you can't just create it for specific people. However, the criteria can be based on genuine achievements that not everyone will meet. The key is that everyone theoretically has the opportunity to earn the award if they meet the established criteria. Also, you can't give more than $1,600 per employee per year for qualified plan awards, and no more than $400 per employee for non-qualified awards.

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Has anyone actually tried giving gift cards instead? My accountant told me small-value gift cards (under $25) can sometimes qualify as "de minimis" fringe benefits and avoid being taxable. But anything over that amount is definitely taxable.

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Teresa Boyd

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I tried this approach and got burned during an audit. The IRS agent specifically told me that ALL gift cards, regardless of amount, are considered cash equivalents and are therefore always taxable. They only allowed actual tangible gifts of minimal value (like company t-shirts, coffee mugs, or occasional meal) to qualify as de minimis.

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Tyler Murphy

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I think these guidelines are really needed. I've seen so many posts where people confidently state "Starting in 2025, the standard deduction will be cut in half" or "The child tax credit is definitely increasing to $5,000 per child" without any sources. The reality is that with the TCJA provisions sunsetting, we know certain aspects of the tax code will change unless Congress acts, but the exact details of any new legislation are impossible to predict with certainty. Even tax professionals should be careful about making definitive statements about future tax policy. We can discuss the scheduled changes under current law and the historical patterns of Congress, but should be transparent about the limits of our knowledge.

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Sara Unger

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Slightly off topic but how do you stay updated on tax law changes? I tried subscribing to irs.gov updates but the emails are overwhelming and filled with jargon. Is there a more user-friendly resource that's still accurate?

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Tyler Murphy

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I find that the IRS Tax Professional page has more targeted updates than the general subscription, so that might be worth checking out even if you're not a tax pro. For a more digestible format, I actually rely on a few trusted sources: the Journal of Accountancy has good summaries of major changes, and the Tax Foundation puts out clear analyses of both existing and proposed legislation. Just be careful with any source that has a strong political leaning, as they sometimes present analysis with a particular slant. I always try to verify anything important by checking the actual text of laws or IRS notices.

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Has anyone noticed that a lot of the misinformation seems to be coming from social media "tax experts" who are really just trying to sell courses or get followers? I saw a TikTok yesterday claiming the 2025 capital gains taxes are "definitely doubling" which is completely unsubstantiated!

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Freya Ross

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Absolutely! I've noticed this trend too. Some of these accounts have hundreds of thousands of followers and make these dramatic claims about tax changes to drive engagement. The worst part is when they're selling courses based on "strategies" for tax changes that haven't even happened yet!

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Exactly! I'm glad I'm not the only one noticing this. The engagement-driven nature of social media rewards the most alarming or exciting claims, not the most accurate ones. I've started immediately checking any tax policy claim against the actual IRS website or Congressional Budget Office reports. The reality is usually much more nuanced than what these "experts" claim.

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