3 December 1993 Income Tax Severed Letter 9326607 - Part-Time Attendant Care as a Medical Expense

Please note that the following document, although believed to be correct at the time of issue, may not represent the current position of the CRA.
Prenez note que ce document, bien qu'exact au moment émis, peut ne pas représenter la position actuelle de l'ARC.

Please note that the following document, although believed to be correct at the time of issue, may not represent the current position of the Department. Prenez note que ce document, bien qu'exact au moment émis, peut ne pas représenter la position actuelle du ministère.

                                    December 3, 1993

  WINNIPEG DISTRICT OFFICE          Personal and General
  Public Affairs                       Section
                                    A. Humenuk
                                    (613) 957-2134

  Attention: Jacques Therrien
             Problem Resolution Co-ordinator

                                    932660

Attendant Care as a Medical Expense

We are replying to your memorandum of September 16, 1993, wherein you ask for guidelines as to what type of expenditures qualify as "attendant care" for the purpose of paragraph 118.2(2)(b.1) of the Income Tax Act (the Act).

You have received enquiries from the public asking if the following expenses would qualify as a medical expense under paragraph 118.2(2)(b.1) of the Act, assuming of course that the other conditions set out therein were met:

- home care - maid and cleaning services (i.e. commercial cleaning service) - transportation costs (i.e. Handi-transit, taxis) - meal preparation services (i.e. Meals on Wheels, catering services, a neighbour) - companionship (i.e. recreation, outings) - services for personal needs (i.e. bookkeeping, administration and shopping).

As you have indicated, "attendant care" is not defined in the Act and must therefore be defined in terms of its ordinary meaning. In determining its ordinary meaning, we must consider the context in which the phrase is used, that is, in reference to an individual who has a severe and prolonged impairment which markedly restricts the activities of daily living. In this regard, it is noted that attendant care is less restrictive than is nursing care which implies a degree of medical assistance.

Given that the introduction of this provision was part of the measures taken by the government to enable persons with disabilities to participate more fully in society, we do not believe that we should be overly restrictive in our interpretation of "attendant care". Where an individual is either unable or requires an inordinate amount of time to perform the ordinary activities of daily living, the use of an attendant to assist with those personal activities will generally qualify as attendant care. Thus, the extent to which personal assistance constitutes "attendant care" will depend on the nature and severity of the disability.

It is our understanding that "home care" is the term generally used for the assistance given by a province to individuals who are unable to live in their own homes unassisted but choose to live at home with assistance rather than in a hospital or medical facility. From your letter, we gather that the province of Manitoba has recently announced reductions in the amount of assistance given in these circumstances and as a result, individuals in Manitoba who are in need of such services will now be required to pay for such services personally. Provided that our understanding is correct and the purpose of providing "home care" is to provide the individual with an attendant to perform those personal tasks which the disabled individual is unable to do for himself or herself, it is our view that such services will typically qualify as attendant care.

With respect to the other items on your list, it is our view that when such services are purchased from an individual offering these services to the public at large, the cost of the service does not qualify as an attendant care expense. For example, while an attendant may prepare meals, do laundry, clean the house or provide transportation in the course of his or her duties as an attendant, the cost of such services purchased from an individual operating a restaurant, laundromat, commercial cleaning service or transportation service would not be an attendant care expense. Similarly, while companionship and attendance to personal needs may form a significant part of an attendant's duties, the cost of the items listed in your memorandum under companionship and services for personal needs (recreation, administration, bookkeeping services, personal shopping, etc.) are not intrinsically "attendant care" expenses. The reason for this is that where the disabled individual contracts for a specific service as opposed to attendant care, the primary purpose of the expenditure is the procurement of that particular service rather than the personal care of the disabled individual, notwithstanding that the disabled person may be in attendance while the service is being provided.

Note, however that where an attendant provides a service to the disabled person as part of the overall duties of providing attendant care, it is our view that no part of the amount paid for such care would be denied solely by reason of the fact that one of the duties of that attendant was to provide such a service for the disabled individual.

While in most cases it should be clear as to whether the individual was hired as an attendant or to perform a specific service, we would be pleased to review the particular circumstances of any situation where it is not so clear. In the event that the employment contract is oral, a statement of the duties of the employee as understood by both the disabled individual and the employee would be of assistance in our review.

P.D. Fuoco Section Chief Personal and General Section Business and General Division Rulings Directorate Legislative and Intergovernmental Affairs Branch c.c. Client Assistance Directorate c.c. Assessment of Returns Directorate