Step 1 -- Estimate Continuing Expenses

Household Expenses
Current Monthly Expenses
Mortgage / Rent$ ___________
Second Mortgage / Home Equity Loan___________
Homeowners / Condo Association Dues___________
Real Estate Taxes (if not included in mortgage payment)___________
Homeowners / Renters Insurance___________
Household Supplies___________
Cleaning / Maid Service___________
Yard Care / Pest Control___________
Home Maintenance / Repairs___________
Utilities
Electricity___________
Gas / Heating___________
Water___________
Sewer___________
Garbage / Trash___________
Water Softener / Bottled Water___________
Telephone - Home and Cellular___________
Cable / Satellite TV___________
Groceries / Meals
Food - Home___________
Food - Work___________
Meals Out___________
Transportation
Car Loan / Lease Payments___________
Gasoline___________
Car Repairs / Maintenance / Oil Changes___________
Car Wash___________
Auto Insurance___________
License / Stickers___________
Parking / Tolls___________
Public Transportation / Cabs___________
Insurance Premiums - Other
Life / Accidental Death Insurance___________
Disability Insurance___________
Health / Medical / Dental / HMO, including Medicare___________
Medicare Supplement Insurance___________
Long-Term Care / Home Health Care___________
Other___________
Medical Expenses NOT covered by insurance
Doctors / Dentists / Eye Care___________
Hospitals / Lab Tests___________
Prescriptions and Other Medications___________
Other (including Medical Equipment)___________
Personal Care
Clothing / Shoes___________
Laundry / Dry Cleaning___________
Beauty Shop / Hair Cuts / Hair Care___________
Toiletries / Cosmetics___________
Other___________
Taxes - Other
Income - Federal / State / Local___________
Social Security / Medicare___________
Gifts / Donations
Church / Synagog / Charities___________
Gifts, including Christmas / Hanukkah / Birthdays___________
Other___________
Miscellaneous
Entertainment, except Meals Out___________
Vacations___________
Cigarettes / Cigars / Other Tobacco___________
Education___________
Hobbies / Crafts___________
Legal / Tax Services___________
Membership Dues / Fees___________
Newspapers / Magazines / Books___________
Pet Food / Care___________
Savings / Investments___________
Other (Postage, fees for Checking Accounts, ATMs, etc.)___________
Total Current Monthly Expenses$ ___________ 
Total Continuing Monthly Expenses$ ___________ 


Step 2 -- Calculate Total Available for Assisted Living

Total Current Monthly INCOME $ ___________
PLUS Monthly Benefits from Long-Term Care Insurance + ___________
MINUS Continuing Monthly Expenses - ___________
Total Amount Available for Assisted Living $ ___________


Step 3 -- Add Income from Assets converted into Income

Converted Asset #1: ______________________________$ ___________
Converted Asset #2: ______________________________+ ___________
Converted Asset #3: ______________________________+ ___________
Converted Asset #4: ______________________________+ ___________
REVISED Amount Available for Assisted Living$ ___________ 

These expenses are most likely to continue after moving into an assisted living facility, but may be somewhat lower than current amounts. This is also true for federal income taxes. Our assisted living facility provide some medical services for their residents. 

As a result, a portion of the fees paid for assisted living may qualify as a tax-deductible medical expense even if a resident is not living there primarily for medical reasons.