Nursing home residents’ rights

Since 1987, the federal Nursing Home Reform Act has provided a number of important protections for residents of skilled nursing facilities. A few of these are:

            Freedom from restraints. The act provides prohibits the use of “physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms,” as well as “physical or mental abuse, corporal punishment, [and] involuntary seclusion. Restraints may be imposed only to ensure physical safety and only on a written physician’s order.

            Freedom of choice. The act ensures that residents have the right to “choose a personal attending physician, to be fully informed in advance about care and treatment, [and] to be fully informed in advance of any changes in care or treatment.”

            Room change notice. A resident has the right to notice prior to any change in the resident’s room or roommate.

            Confidentiality. The facility must keep a resident’s personal and clinical records confidential, and provide access to current records upon the request of the resident or his or her legal representative within 24 hours.

            Privacy. A resident has the “right to privacy with regard to accommodations, medical treatment, written and telephonic communications, visits, and meetings of family and of resident groups.”

            Protection of resident funds. A facility must “hold, safeguard, and account for” a resident’s personal funds, but “may not require residents to deposit their personal funds with the facility.”

            Grievances. A resident has the right “to voice grievances with respect to treatment or care … without discrimination or reprisal for voicing grievances and the right to prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.

            A complete list and description of resident’s rights under the act may be found in 42 U.S.C. § 1395i-3, which you can read by clicking here.

Help available for caregivers, NBC reports

On last night’s broadcast, NBC News reported on the loneliness and isolation felt by millions of Americans who provide care to elderly relatives.

NBC spotlighted findings from a new AARP study, including the fact that 42 million Americans age 40 to 60 spend time each week caring for an older adult. Of those, 29% devote more than 40 hours a week to caregiving.

The burden on caregivers can be overwhelming at times. AARP has sponsored public service announcements to call attention to the issue, and to let caregivers know there is help available, NBC reported.

AARP provides a Caregiving Resource Center website, with links to an online support group, a place to submit questions to a panel of experts, and basic information for caregivers and their families.


Payments to caregivers found deductible, Tax Court rules

recent decision of the United States Tax Court reminds us that the some of the cost of caregiving for the chronically ill may be tax deductible, but that it is important to get the proper documentation.

It may also help if you file a tax return.

Lillian Baral suffered severe dementia and required assistance and supervision 24 hours a day, her doctor determined. Her brother arranged for caregivers to help her bathe, dress, travel to the doctor, take medications, and transfer to a wheelchair.

Although she had $94,229 in adjusted gross income for 2007, she did not file a tax return, nor did anyone file one for her. The IRS filed a substitute return for her, based on information from third parties, resulting in a tax bill of $17,681.

On her behalf, Lillian’s brother questioned the amount of the tax bill and claimed she could deduct her costs for caregiving, physicians, and supplies. In 2007, she incurred $49,580 for caregiver services, $760 for physicians’ services, and $5,566 for supplies obtained by her caregivers.

IRS rules allow a tax deduction for the medical care of a taxpayer, including “qualified long-term care services” for “a chronically ill individual.” Those services can include “maintenance or personal care services.” A deduction is allowed for the amount of such costs that exceed 7.5% of the taxpayer’s adjusted gross income.

But in this case, the IRS said Lillian had not met the requirements of showing a severe enough impairment, that the services were provided “pursuant to a plan established by a qualified health care professional,” or that the supplies were related to her care.

The Tax Court found that Lillian met the requirements to deduct her caregiver services because her doctor had certified her as being cognitively impaired and “requiring substantial supervision to protect her from threats to her health and safety.” The court also allowed deduction of her physician costs.

However, the court disallowed the deduction for supplies because no one gave the court receipts or other substantiation that they were for medical care.

Medical expense deductions for long-term care services can save thousands in taxes. But as this case shows, you must be able to prove that you have met all the requirements. For example, have a clear plan of care in writing from a licensed heath care practitioner. Keep receipts for supplies and be able to show that they relate to the taxpayer’s care.

Finally, make sure you file a tax return to claim your deduction. Lillian’s deduction may not have been questioned in the first place if it had been claimed on a properly filed return.

Family caregiving in U.S. valued at $450 billion in one year

Family members who provided care to another adult with functional limitations contributed an economic value of approximately $450 billion in 2009, according to a recent report.

The report, issued by the AARP Public Policy Institute, says that family caregivers incur direct out-of-pocket expenses, as well as lost wages and retirement income, lost productivity, higher health care costs, and more stress on their physical and emotional health.

At $450 billion, up from $375 billion in 2007, the economic value of family caregiving is therefore “more than total Medicaid spending in 2009, including both federal and state contributions for both health care and long-term supports and services ($361 billion),” the report says.

The full report, Valuing the Invaluable: 2011 Update; The Growing Contributions and Costs of Family Caregiving is available here.