Rhode Island families paying $5,500 to $9,500 a month for care can often deduct a large share of it federally — but only with a certification and a plan of care in hand. Here is what qualifies, what the 2026 thresholds are, and the one thing to ask for before December 31.
By Providence Senior Advisor Care Team · November 1, 2026
Somewhere around the first cold week of November, our phone starts ringing with a version of the same question. A daughter in Cranston has been paying $6,400 a month toward her mother's assisted living bill since March. A son in Barrington wrote checks all year for a home care agency. Both of them want to know the same thing before the year closes: does any of this come back at tax time?
The honest answer is that some of it often does, and more of it than families expect — but only if the paperwork exists. Not paperwork you create in April. Paperwork that has to be in place while the care is being delivered. That is why November is the right month to read this and February is the wrong one.
What follows is a plain explanation of how federal law treats senior care costs, written for Rhode Island families and using Rhode Island numbers. We are senior care advisors, not accountants or tax attorneys. Nothing here is tax advice for your situation, and the dollar thresholds below are the figures published for the 2026 tax year — the return you will file in early 2027. Take this to a preparer who handles elder care cases and let them apply it to your family.
The federal rule is not "assisted living is deductible" or "assisted living is not deductible." The code does not care about the building. It cares about a category called qualified long-term care services, and it has a specific definition of who qualifies to receive them.
Under Internal Revenue Code section 7702B(c), qualified long-term care services are the diagnostic, preventive, therapeutic, curing, treating, mitigating and rehabilitative services, plus maintenance or personal care services, that are required by a chronically ill individual and provided under a plan of care prescribed by a licensed health care practitioner. Those last two conditions are the whole ballgame.
"Chronically ill individual" is not a feeling or a family consensus. It means a person certified by a licensed health care practitioner as either unable to perform at least two of six activities of daily living without substantial assistance from another person, for a period expected to last at least 90 days, because of a loss of functional capacity — or as requiring substantial supervision to be protected from threats to health and safety because of severe cognitive impairment.
The six activities of daily living named in the statute are eating, toileting, transferring, bathing, dressing and continence. Note what is absent from that list: cooking, driving, laundry, managing money, taking medication on schedule. Those are the instrumental activities, and losing them is often what triggers a move — but on its own it does not meet the statutory test. A resident who moved in because the house became unmanageable, and who still bathes and dresses independently, may not clear the bar even though the monthly bill is very real.
The cognitive prong is where most memory care residents qualify, and it is worth understanding on its own terms. It does not require a specific diagnosis. It requires severe cognitive impairment and a need for substantial supervision to stay safe. A Rhode Island resident living in a dementia-designated unit because she had begun leaving the stove on and walking out at night is describing that prong almost word for word.
Here is the step that costs Rhode Island families the most money, and it costs them nothing to fix. The statute requires that the certification have been made by a licensed health care practitioner within the preceding 12-month period, and it requires the care to be delivered under a prescribed plan of care.
A licensed health care practitioner, for this purpose, is not limited to a physician. The statute includes any physician, and also any registered professional nurse or licensed social worker. That matters in practice, because the people who know an assisted living resident's functional status best are usually the residence's nurse and the discharge social worker from the hospital — not the primary care doctor she sees twice a year.
So the action item is small and specific. Before the end of the year, ask your parent's physician, or the registered nurse at the residence, for a dated written certification of chronic illness that states which of the six activities of daily living require substantial assistance, or that states the resident requires substantial supervision due to severe cognitive impairment. Then ask the residence for a copy of the current plan of care or service plan, signed and dated. Rhode Island assisted living residences already write and maintain service plans — the Department of Health requires it as a condition of licensure — so you are asking for a copy of a document that exists, not asking anyone to create one.
Keep both in the same folder as the monthly invoices. If the return is ever questioned, those two pages are the difference between a deduction and a disallowance.
This is where assisted living and nursing home care part company, and where families get the most conflicting advice.
The Internal Revenue Service position, set out in Publication 502, is that the cost of meals and lodging at a nursing home or a home for the aged is includible as a medical expense when a principal reason for being there is to get medical care. If the person is there mainly for personal or custodial reasons, the meals and lodging are not includible — only the portion of the cost attributable to medical or nursing care is.
In Rhode Island terms, that usually breaks down like this. A resident in a skilled nursing facility, licensed under R.I. General Laws Chapter 23-17, is almost always there principally for medical care, and the whole bill tends to be in play. A resident in an assisted living residence, licensed by the Rhode Island Department of Health under the Assisted Living Residence Licensing Act (R.I. General Laws Chapter 23-17.4) and regulation 216-RICR-40-10-2, is a harder case. If she meets the chronically ill test and the services are under a plan of care, a strong argument exists for the full monthly rate. If she does not, the deductible slice is generally the care and services component, not the rent and the dining room.
Which is why the single most useful phone call you can make this month is to the residence's business office, asking for a year-end statement that separates the base room-and-board rate from the care-and-services charges, by month. Rhode Island residences bill on tiered care levels, so that split already exists inside their system. Most will produce it if asked. Very few produce it if not asked.
None of this helps unless the medical expenses are large enough to matter. Unreimbursed medical and dental expenses are deductible on Schedule A only to the extent they exceed 7.5 percent of adjusted gross income, and only if the family itemizes rather than taking the standard deduction.
For 2026 the standard deduction is $16,100 for a single filer, $24,150 for head of household and $32,200 for a married couple filing jointly. A taxpayer who is 65 or older adds $2,050 if unmarried, or $1,650 per qualifying spouse if married. Separately, and new for tax years 2025 through 2028, there is a $6,000 per-person deduction for taxpayers who are 65 by the last day of the tax year; it phases out above $75,000 of modified adjusted gross income for single filers and $150,000 for joint filers, and the IRS has said it is available whether you itemize or take the standard deduction.
That is a high bar to clear with ordinary medical bills. Senior care costs are not ordinary. Here is what Rhode Island care actually runs in 2026 — New England pricing sits well above the national figures families find online:
| Care type | Typical 2026 Rhode Island range | Annual at the midpoint |
|---|---|---|
| Assisted living | $5,500 - $7,800 / month | about $79,800 |
| Memory care (dementia-designated) | $7,000 - $9,500 / month | about $99,000 |
| Nursing home, private room | $11,000 - $13,500 / month | about $147,000 |
| In-home care | $34 - $40 / hour | about $57,700 at 30 hrs/week |
| Adult day program | $90 - $130 / day | about $28,600 at 5 days/week |
A widow in Providence with $62,000 of income has a 7.5 percent floor of $4,650. If she is in a dementia-designated residence at $8,200 a month and meets the chronically ill test, essentially the entire year of care sits above that floor. Rhode Island's geography shifts the numbers but not the conclusion: the East Side, the East Bay and Newport County run above these ranges, while Woonsocket, West Warwick and the Blackstone Valley run below them, and in all of those places a year of care dwarfs 7.5 percent of a typical retirement income.
If your parent pays premiums on a tax-qualified long-term care insurance policy, those premiums count as medical expenses too — but only up to an age-based cap, set each year by the IRS. For 2026 the amount of eligible long-term care premium that can be counted per insured person is $500 at age 40 or under, $930 for ages 41 through 50, $1,860 for ages 51 through 60, $4,960 for ages 61 through 70, and $6,200 above age 70.
Each spouse uses their own age and the caps add together, so a Rhode Island couple at 68 and 72 can count up to $11,160 of premium between them. Premium paid above the cap is simply not counted. This is also one of the few places where buying early pays twice: a policy bought at 58 locks in a lower premium and, for a while, a cap that covers all of it.
On the benefit side, payments from a per-diem style long-term care policy are excludable up to a daily limit, which for 2026 is in the neighborhood of $430 a day. Benefits above that limit can become taxable unless they are matched by actual costs incurred — and at Rhode Island memory care rates, actual costs usually are there.
Many of the Rhode Island families we work with have a son or daughter paying part or all of the bill. Whether that child can deduct it is a separate question from whether the care qualifies, and it turns on dependency.
In broad terms, a child may be able to include a parent's medical expenses on their own return if the parent qualifies as a dependent, or qualifies as a dependent except for the gross income test — which is the common situation, because Social Security and a modest pension often push a parent over the income limit while the child is still providing more than half of their support. There is also a multiple support agreement available when several siblings each pay a share and no one pays more than half; one sibling can be designated to claim, with the others filing the consent form.
This is genuinely technical, the rules interact with who claims the parent as a dependent, and getting it wrong across multiple siblings' returns is expensive to unwind. If more than one person is paying, decide in December who is claiming what, and have a preparer confirm it before anyone files.
Here is the part that surprises nearly every family we explain this to. Rhode Island does not allow itemized deductions on the state personal income tax return. The state eliminated that option effective with the 2011 tax year as part of its tax reform, and the RI-1040 uses a Rhode Island standard deduction instead.
The practical consequence: a large medical expense deduction can meaningfully reduce your federal tax and do nothing at all for your Rhode Island tax. Families who assume the federal savings will be mirrored at the state level build their budget on a number that does not exist.
That does not mean Rhode Island offers nothing to older taxpayers — the state has its own modifications and credits aimed at retirees and at property tax burden, and they operate through different lines on the return rather than through deductions. Which ones apply, and in what amounts for this year, is exactly the question to put to the Rhode Island Division of Taxation or to a preparer who files RI returns regularly. Do not guess at it, and do not assume the federal answer carries over.
Two intersections are worth naming, because they change the math.
First, only unreimbursed costs count. Once Rhode Island Medicaid Long-Term Services and Supports begins paying — administered through EOHHS and DHS, delivered for most members through Neighborhood Health Plan of Rhode Island, and covering care services rather than room and board — the portion Medicaid pays is not your expense and is not deductible. What a resident pays as patient share, and the room-and-board piece that LTSS does not cover, remain out of pocket. The same logic applies to long-term care insurance reimbursements: the policy's payment reduces what you can count.
Second, veterans benefits run on their own track. VA Aid and Attendance, an increased monthly pension for wartime veterans and surviving spouses who need help with daily activities, is not taxable income — and notably, unreimbursed medical expenses are what drive the Aid and Attendance calculation in the first place. The same care invoices often do double duty: supporting the VA claim and supporting the federal medical expense deduction. Providence VA Medical Center can start the claim, the Rhode Island Veterans Home in Bristol is a separate state-run option with its own eligibility, and the VA Caregiver Support Line at 1-855-260-3274 is the fastest route to a human who does this daily.
A note on hospital discharge, since that is when most of these decisions get made under pressure. If the conversation is happening at Rhode Island Hospital, The Miriam or Newport Hospital, you are inside Brown University Health. At Kent or Women & Infants, Care New England. At Roger Williams or Fatima, CharterCARE Health of Rhode Island. At Landmark in Woonsocket, Prime Healthcare. Ask the case manager for the functional assessment in writing before discharge — it is often the cleanest contemporaneous documentation of activities of daily living you will ever get, and it is free.
Five things, none of which take long:
Ask the residence or agency for a year-end statement that separates room and board from care and services, month by month. Ask the physician, the residence's registered nurse, or the hospital social worker for a dated certification of chronic illness naming the specific activities of daily living involved, or the cognitive impairment and supervision need. Get a signed copy of the current plan of care or service plan. Total the premiums paid on any long-term care policy and note the insured's age at year end. And if siblings are splitting the bill, settle in writing who is claiming the parent before anyone files.
Then hand the folder to a preparer. The families who get this right are not the ones with the best accountant; they are the ones who walked in with the certification and the itemized statement already in hand.
If you are not yet sure which level of care your parent needs, or what a particular Rhode Island residence actually charges once care levels are added, that is our job and it costs you nothing. Call us at (844) 735-1766. For free, unbiased public help, THE POINT at the Rhode Island Office of Healthy Aging is at 401-462-4444, and Adult Protective Services, if you are worried about a senior's safety, is at 401-462-0555.
Free, no pressure, and no one rushing you. We answer to families, not to facilities.
Or call (844) 735-1766
