I'm in the process of converting my father-in-law's 403(b) account into a Self Directed IRA. He has Alzheimer's and my wife is POA. His wife passed away last year so she is the sole beneficiary of all his accounts including this 403(b) account. With that said, we can use our new SDIRA to fund a rehab project. But like stated above, all work must be done and documented by 3rd party sources which means invoices from all trades.
Our advantage is that we can as needed pull funds out without penalty to move money under his name to his bank account that we use as needed to care for him. All other retirement funds he has including his social security check, are already taxed with exception to profits from the investments and we use that money as his income.
The penalty for withdrawals from an IRA or 401K are 10% penalty plus ordinary income taxing if taken out before you turn 59 1/2 years old. Having a father-in-law that we take care of and is over 59 1/2 helps us use funds as needed as long as we don't go over his 15% tax bracket at the end of the year.
What we do with the money we take out is put in a Roth IRA periodically. I leaned a lot from these webinars in Dallas:
www.questira.com/all-events/dallas-events/