Can I Get a Tax Break for Long-Term Care?

The skyrocketing costs of long-term care (LTC) can ruin your retirement savings. The U.S. Department of Health and Human Services found that 27% of Americans turning 65 this year will have at least $100,000 in long-term-care costs, and 18% will require care costing more than $250,000. However, the IRS allows some limited tax breaks on medical expenses and insurance premiums related to long-term care.

Kiplinger’s recent article entitled “Deduct Expenses for Long-Term Care on Your Tax Return” says that if you need LTC, you may be able to deduct a portion of the costs on your tax return. If you purchased a long-term-care insurance (LTCI) policy to cover the costs, you may also be able to deduct some of your premium payments. Since retirement planning includes long-term care, it’s important to know how these tax deductions can help to offset overall costs.

Long-Term-Care Costs

The IRS allows you to deduct unreimbursed costs for long-term care as a medical expense, if certain requirements are met. This includes eligible expenses for in-home, assisted living and nursing-home services. The long-term care must be medically necessary and may include preventive, therapeutic, treating, rehabilitative, personal care, or other services. The cost of meals and lodging at an assisted-living facility or nursing home is also included, if the primary reason for being there is to receive qualified medical care.

The care must also be for a chronically ill person and provided under a care plan prescribed by a doctor. The IRS says that a person is “chronically ill,” if he or she can’t perform at least two activities of daily living. These are things like eating, bathing, or dressing. They must be unable to do these without help for at least 90 days. This condition must be certified in writing within the last year. A person with a severe cognitive impairment, like dementia, is also considered chronically ill, if supervision is needed to protect his or her health and safety.

To get the deduction, you have to itemize deductions on your tax return. However, itemized deductions for medical expenses are only allowed to the extent they exceed 7.5% of your adjusted gross income.

An adult child can claim a medical expense deduction on his own tax return for the cost of a parent’s care, if he can claim the parent as a dependent.

Insurance Premiums

The IRS also allows a limited deduction for certain LTCI premiums. Similar to the deduction for long-term-care services, this has to be an itemized deduction for medical expenses. Again, only premiums exceeding the 7.5% of AGI threshold are deductible. (Note that self-employed individuals may be able to deduct premiums paid for LTCI as an adjustment to income without having to itemize.)

In addition, the LTCI policy is required to satisfy certain requirements for the premiums to be deductible. The policy can only cover long-term-care services, so the deduction only applies to traditional LTCI policies, not “hybrid” policies that combine life insurance with long-term-care benefits. This deduction also has an age-related cap. For 2021, the cap is $5,640 if you’re older than 70, $4,520 if you’re 61 to 70 and $1,690 if you’re 51 to 60. (For those 41 to 50, it’s $850, and for 40 or younger, it’s $450.)

These deductions can be valuable for people in their seventies and older.

Reference: Kiplinger (March 23, 2021) “Deduct Expenses for Long-Term Care on Your Tax Return”

Could a Polar Bear Plunge Help with Dementia?

A “cold-shock” protein has been discovered in the blood of regular winter swimmers at London’s Parliament Hill Lido. The protein has been shown to retard the onset of dementia and even repair some of the damage it causes in mice, according to a report in the BBC’s recent article entitled “Could cold water hold a clue to a dementia cure?”

Professor Giovanna Mallucci, who runs the United Kingdom Dementia Research Institute’s Centre at the University of Cambridge, says the discovery could help scientists with new drug treatments that may help hold dementia at bay. The research, while encouraging, is at an early stage and focuses on the hibernation ability that all mammals retain, which is prompted by exposure to cold.

The link with dementia lies in the destruction and creation of synapses, which are the connections between cells in the brain. In the early stages of Alzheimer’s and other neuro-degenerative diseases, these brain connections are lost. Mallucci saw that brain connections are lost when hibernating animals, like bears, bed down for their winter sleep, but that roughly 20-30% of their synapses are culled as their bodies preserve precious resources for winter. When they awake in the spring, those connections are reformed.

The shock of entering cold water results in a significant increase in heart rate and blood pressure, which can cause heart attacks and strokes in those with underlying illnesses. This also creates a gasp reflex and rapid breathing, which can lead to drowning, if water is inhaled.

Don’t try a plunge without consulting a doctor.

When researching this treatment in mice, scientists found that levels of a “cold-shock” protein called RBM3 soared in the ordinary mice, but not in the others. This suggested RBM3 could be the key to the formation of new connections. Mallucci proved the link in a separate experiment which showed brain cell deaths in Alzheimer’s and prion disease could be prevented by artificially boosting RBM3 levels in mice. This was a major breakthrough in dementia research, and their findings were published in the scientific journal Nature.

Professor Mallucci contends that a drug which prompted the production of RBM3 might help slow—and possibly even partially reverse—the progress of some neuro-degenerative diseases in people. RBM3 hadn’t been seen in human blood, so the obvious next step was to find out whether the protein is present in humans.

It’s hard to get people to become hypothermic by choice, but Martin Pate and his group of Londoners who swim throughout the winter at the unheated open-air London Parliament Hill Lido pool voluntarily made themselves hypothermic on a regular basis, so he thought they’d be ideal subjects of a study.

The tests showed that a significant number of the swimmers had markedly elevated levels of RBM3. All of them become hypothermic, with core temperatures as low as 93.2F. A control group of Tai Chi participants who practice beside the pool but never actually swim, showed no increase in RBM3 levels nor had they experienced very low body temperatures.

The risks associated with getting cold outweigh any potential benefits, so cold water immersion isn’t a potential dementia treatment. The key is to find a drug that stimulates the production of the protein in humans and to show that it really does help delay dementia.

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Reference: BBC (Oct. 19, 2020) “Could cold water hold a clue to a dementia cure?”

Can Bad Thoughts Bring on Dementia?

There is recent research that has shown a link between repeated patterns of repetitive negative thinking (RNT) and signs of dementia. This study suggests a link between the key signs of dementia, the buildup of proteins in the brain and cognitive decline, and RNT.

Medical News Today reported in its recent article entitled “Link between dementia and repetitive negative thinking identified” that this study was published in the journal Alzheimer’s & Dementia. The study set forth the foundation for future research to consider how the link may function, and if psychological therapies that treat RNT can inhibit Alzheimer’s and other dementias.

The CDC explains that dementia is a term that represents a variety of diseases characterized by cognitive decline, which includes trouble remembering, thinking or making decisions that adversely affect a person’s everyday life.

The most common type of dementia is Alzheimer’s disease. This is a degenerative disease, which means it worsens over time. It’s not yet known exactly what causes Alzheimer’s disease. The CDC says that there are likely several factors involved. There is currently no cure for Alzheimer’s.

Prior research has suggested that psychological factors, like depression and anxiety, may also have a connection to Alzheimer’s. This has led researchers to develop the concept of cognitive debt as a risk factor for Alzheimer’s disease, which they believe is acquired by RNT. A large part of RNT are processes of rumination — repeatedly thinking about the past — and worry, being concerned about the future.

The research examined the participants’ RNT, depression, anxiety and cognitive decline levels for up to four years. They also measured the levels of tau and amyloid proteins in the brains of 113 of the participants. Scientists think that the buildup of these structures is key to the development of Alzheimer’s.

The authors of the new research discovered that the higher a person’s RNT, the faster their cognitive decline. They also found these people were more likely to have significant deposits of tau and amyloid proteins. However, although the research found a link between depression and anxiety and cognitive decline, they did not find a connection between depression and anxiety and the buildup of tau and amyloid proteins.

According to the lead author of the study Dr. Natalie Marchant of University College, London, United Kingdom, “[d]epression and anxiety in mid-life and old age are already known to be risk factors for dementia. Here, we found that certain thinking patterns implicated in depression and anxiety could be an underlying reason why people with those disorders are more likely to develop dementia.

“Taken alongside other studies that link depression and anxiety with dementia risk, we expect that chronic negative thinking patterns over a long period of time could increase the risk of dementia. We do not think the evidence suggests that short-term setbacks would increase one’s risk of dementia.

“We hope that our findings could be used to develop strategies to lower people’s risk of dementia, by helping them to reduce their negative thinking patterns.”

The study’s authors say that it’s probable that RNT contributes to Alzheimer’s in some way, possibly elevating an individual’s stress levels. However, they couldn’t discount the possibility that early signs of Alzheimer’s could lead to RNT.

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Reference:  Medical News Today (June 11, 2020) “Link between dementia and repetitive negative thinking identified”

How Did Alzheimer’s Impact the Estate Planning of These Famous People?

Forbes’ recent article, “Top 7 Celebrity Estates Impacted By Alzheimer’s Disease” looks at seven celebrity estates that were affected by Alzheimer’s disease.

  1. Rosa Parks. The civil rights icon died at 92 in 2005. She was suffering from Alzheimer’s disease. Legal battles over her estate continue to this day. Her estate plan left her assets to a charitable institution she created. However, her nieces and nephews challenged the validity of her will and trust, due to her mental deficiencies and allegations of undue influence. That claim was settled, but there have been fights over broken deals and leaked secrets, claimed mismanagement of her estate and assets, allegations of bribery and corruption and a battle over Rosa’s missing coat that she wore at the time of her famous arrest at the Alabama bus stop in 1955.
  2. Gene Wilder. Wilder’s widow–his fourth wife, Karen–and his adopted daughter didn’t fight over Gene’s estate after he died, which shows good estate planning. Wilder makes the list because of how his widow used her husband’s struggle—which she kept private while he was alive—to bring attention to the terrible disease, including permitting his Willy Wonka character to be used in a campaign to raise awareness.
  3. Aaron Spelling. The Hollywood producer left behind a reported fortune worth $500 million. His death certificate listed Alzheimer’s disease as a contributing factor. Spelling changed his estate plan just two months before he died, reducing the share to his daughter, actress Tori, and his son, Randy, to $800,000 each.
  4. Etta James. Legendary blues singer Etta James passed away in 2012, at 73. Her family said she had been struggling with Alzheimer’s disease for several years, and her illness ignited an ugly court battle between her husband of more than 40 years and her son from a prior relationship, over the right to make her medical and financial decisions, including control of her $1 million account. Her husband, Artis Mills, alleged that the power of attorney she signed appointing her son as decision-maker was invalid, because she was incompetent when she signed it. Mills sued for control of the money to pay for Etta’s care. After some litigation, Etta’s leukemia was determined to be fatal, which led to a settlement. Mills was granted conservatorship and permitted to control sums up to $350,000 to pay for Etta’s care for the last few months of her life.
  5. Peter Falk. The Lieutenant Columbo actor died at 83 in 2011, after living with Alzheimer’s disease for years. His wife Shera and his adopted daughter Catherine fought in court for conservatorship to make his decisions. Shera argued that she had power of attorney and could already legally make Peter’s decisions for him, which included banning daughter Catherine from visits. The judge granted Shera conservatorship, but ordered a visitation schedule for Catherine. However, a doctor, who testified at the hearing, said that Falk’s memory was so bad that he probably wouldn’t even remember the visits.
  6. Tom Benson. The billionaire owner of the New Orleans Saints and Pelicans was the subject of a lengthy and bitter court battle over control of his professional sports franchises, and hundreds of millions of dollars of other assets. Prior trusts, that he and his late wife established, left the sports franchises and other business interests to his daughter and two grandchildren. One of granddaughters operated the Saints as lead owner, until she was fired by her grandfather. Tom decided to take the controlling stock of the teams out of the trust and substitute other assets in their place, taking over control of the teams. However, his daughter and grandchildren fought the move. A 2015 court ruling declared Benson to be competent, despite allegations he suffered from Alzheimer’s disease. Benson then changed his will and trust and left everything to his third wife, Gayle. They all settled the dispute in 2017, leaving other assets to the daughter and grandchildren—but ultimately leaving Gayle in control of the Saints and Pelicans, after Benson’s death in 2018 at age 90.
  7. Glen Campbell. Campbell’s 2007 estate plan left out three of his adult children. They sued to challenge their disinheritance after he died. They dropped the case in 2018, without receiving a settlement. The fact that Campbell’s final will was drafted several years prior to his Alzheimer’s diagnosis was a critical factor in the outcome of the lawsuit.

The estate planning of these celebrities show the importance of proper estate planning, before it is too late. Wills and trusts that are created or changed after someone is diagnosed with Alzheimer’s disease, dementia, or similar conditions are more apt to be challenged in court.

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Reference: Forbes (November 25, 2019) “Top 7 Celebrity Estates Impacted By Alzheimer’s Disease”