Nursing home costs are tax deductible only if the facility is primarily providing medical care, not just room and board
The IRS allows you to deduct nursing home expenses as medical expenses, but only the portion that covers actual medical care — not the part that covers room, meals, or general living costs. If the nursing home is providing skilled nursing care, rehabilitation, or other medical services as the main reason you are there, you can deduct the full cost. If you are in a facility mainly for custodial care or because you need help with daily living but not medical treatment, you cannot deduct any of it.
The distinction matters because it determines whether your nursing home bill counts toward the medical expense deduction on your federal income tax return. To claim the deduction, your total medical expenses for the year must exceed 7.5% of your adjusted gross income (AGI). If they do, you can deduct the amount above that threshold.
Key Takeaways
- Nursing home costs are deductible only if the primary reason for admission is medical care, not custodial care or information with daily living.
- You can deduct the full cost of a medically necessary nursing home stay, including room and board, because the entire stay is considered medical in nature.
- Medical expenses must total more than 7.5% of your adjusted gross income before you can deduct any of them on your federal tax return.
- You will need documentation from the nursing home and your doctor showing that medical care was the primary reason for admission.
- State and local taxes paid on nursing home care may be deductible separately under the SALT cap, depending on your situation.
How the IRS decides what counts as medical care
The IRS uses a straightforward test: if you are in the nursing home primarily because you need medical care or skilled nursing services, the entire cost is deductible. This includes room, board, meals, laundry, and other services provided by the facility, because they are all part of the medical care arrangement. The key word is "primarily" — the medical need must be the main reason you are there, not just one of several reasons.
If you are in a nursing home mainly because you need help with activities of daily living — bathing, dressing, eating, toileting — but you do not have a medical condition requiring skilled care, the IRS considers this custodial care. Custodial care is not deductible, even if a nurse happens to work at the facility. The difference is whether the nursing home is treating a medical condition or straightforward providing supervision and personal information.
Your doctor's assessment matters here. If your physician documented that you were admitted for skilled nursing care, rehabilitation after surgery, wound care, medication management, or treatment of a specific medical condition, you have evidence that medical care was primary. If the admission notes say you needed help with daily living due to age or general frailty, that points toward custodial care.
What you can and cannot deduct
If your nursing home stay qualifies as medically necessary, you can deduct the full amount you paid — room, board, nursing services, meals, and facility fees. You can also deduct the cost of any medical services provided at the facility, such as physical therapy, occupational therapy, or medications administered by nursing staff. Some facilities itemize these on your bill; others bundle them into a daily rate.
You cannot deduct costs that are purely personal or custodial, even if they are part of your nursing home bill. This includes extra charges for a private room (if a semi-private room would have been adequate), entertainment, telephone service, or personal grooming supplies. If the facility charges separately for these items, ask for an itemized bill so you know what portion relates to medical care.
If you pay for long-term care insurance that covers nursing home stays, the premiums you paid in prior years may also be deductible as medical expenses, subject to age-based limits set by the IRS. These limits change each year, so check the current rules or speak with a tax professional.
Documentation you need to claim the deduction
The IRS does not require you to attach proof to your tax return, but you must keep records in case of an audit. Save your nursing home bills, receipts, and statements showing what you paid. Keep any letters from your doctor or the facility stating that medical care was the primary reason for admission. If the facility provided an itemized bill breaking down medical versus non-medical charges, keep that too.
If the nursing home does not provide an itemized statement, ask for one. Many facilities can separate the medical component from room and board on request. If they cannot or will not, you may need to work with a tax professional to estimate the medical portion based on the services you received.
You should also keep records of who paid the bill — you, a family member, or a third party — because only the person who paid can claim the deduction. If your adult child paid your nursing home bill, your child claims the deduction, not you, unless you can show that you reimbursed them.
How to report nursing home costs on your tax return
Nursing home expenses are reported as medical and dental expenses on Schedule A (Itemized Deductions) on your federal tax return. You add up all your medical expenses for the year, subtract 7.5% of your adjusted gross income, and deduct the remainder. This means if your AGI is $50,000, you must have more than $3,750 in medical expenses before you can deduct any of them.
Most people use tax software or work with a tax professional to calculate this, because the rules around what counts as medical and how to handle other deductions can be complex. If you are over 65 and have significant nursing home costs, it is often worth consulting a tax preparer to make sure you are claiming everything you are may have access to to.
Remember that you can only claim itemized deductions if you choose to itemize rather than take the standard deduction. For many people, the standard deduction is larger, so itemizing does not save taxes even if you have large medical expenses. A tax professional can help you decide which approach is better for your situation.
State and local tax deductions for nursing home costs
Some states allow you to deduct state income taxes paid on nursing home care as part of your state tax return. This is separate from the federal deduction. The rules vary by state, so check with your state's tax authority or a local tax professional to see whether your state offers this benefit.
On your federal return, you can deduct state and local taxes (SALT) up to $10,000 per year as an itemized deduction. If you paid state income tax on nursing home expenses, that counts toward this $10,000 cap. You cannot deduct state taxes on top of the federal medical expense deduction — you choose one or the other depending on what saves you more money.
What happens if the nursing home is primarily custodial care
If the IRS determines that your nursing home stay was primarily custodial rather than medical, you cannot deduct any of the costs. This does not mean you have done anything wrong — it straightforward means the facility was providing personal care rather than medical treatment. Many people legitimately need custodial care and pay for it out of pocket or through long-term care insurance.
If you are unsure whether your situation qualifies, ask your doctor to document the medical reason for your admission and keep that documentation with your tax records. If you are audited and the IRS questions whether the stay was medically necessary, you will have evidence to support your position. In borderline cases, having clear medical documentation often makes the difference.
Frequently Asked Questions
Can I deduct nursing home costs if I am there for rehabilitation after surgery?
Yes. Rehabilitation after surgery is skilled medical care, so the entire nursing home cost is deductible if that was the primary reason for admission. Keep your discharge papers from the hospital and any documentation from your doctor stating that post-surgical rehabilitation was necessary.
What if my nursing home bill includes a charge for "room and board"?
If the nursing home stay itself is medically necessary, room and board are deductible as part of the medical care cost. The IRS considers them part of the medical arrangement, not separate personal expenses. Ask the facility for an itemized bill to confirm what is included.
Can my adult child claim the nursing home deduction if they paid the bill?
Yes, but only if they paid it directly. The person who paid the bill claims the deduction. If you reimbursed your child later, you can claim the deduction instead. Keep records showing who paid and when.
Do I have to itemize deductions to claim nursing home costs?
Yes. Nursing home expenses are claimed on Schedule A as part of itemized deductions. You can only benefit from them if itemizing gives you a larger deduction than the standard deduction. A tax professional can help you determine which approach saves you more.
What if the nursing home cannot provide an itemized bill showing medical versus non-medical costs?
Ask the facility to try. If they cannot separate the charges, work with a tax professional who can help estimate the medical portion based on the services you received and the facility's typical cost structure. Keep all documentation of your request and the facility's response.