Washington Assisted Living
Due to its senior-friendly tax laws, a wealth of recreational opportunities, and mild climate, Washington is an excellent place to retire. The state also has a thriving economy and a wide range of cultural attractions, ensuring people have plenty to do during retirement. This guide explains the options available for assisted living in Washington State, covers the costs of different types of care, and provides an overview of state regulations regarding assisted living.
The typical resident population in Washington's assisted living communities is 72% female. Overall, 85% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 55% ages 85 and older.
The Aging and Long-Term Support Administration Department of the Washington State Department of Social and Health Services licenses assisted living facilities (ALFs). ALFs provide room and board and help with activities of daily living (ADLs) to seven or more residents. There are three levels of services provided by ALFs within the state. Any facility contracting with Medicaid must meet additional requirements not specifically required to receive a license, including medication administration and personal care.
As of July 1, 2000, ALFs are permitted to provide, either directly or indirectly, assistance with ADLs, health support services, and intermittent nursing services. ALFs are responsible for providing housing and basic services and are also responsible for the safety and well-being of their residents.
Before admission, the prospective resident will undergo an assessment (see below). The facility must complete a service agreement, an initial service plan, and reassessment information as part of the resident agreement. The case manager must be involved if the resident is a Medicaid client.
This negotiated service agreement must be completed or updated within 30 days of move-in. It must be updated as necessary or whenever the current service agreement no longer addresses the needs and preferences of the resident.
Facilities must disclose the scope of care and services offered, as well as their cost, activities not covered by the facility's rate or benefit program, operating rules of the facility as required by regulations, and information regarding how residents can arrange for outside services.
An ALF cannot admit or retain a resident who requires nursing or medical care that is provided in a nursing facility except in cases where an RN is available. Facilities cannot admit or retain individuals requiring frequent evaluation by an RN except those receiving hospice care or those receiving care for a short-term illness of no more than 14 days.
The facility cannot retain any individual who needs care if there is no available staff to provide for that individual's needs. Residents may be discharged for their own welfare or if the safety of other individuals is endangered.
ALFs assume responsibility for each resident and manage their health, safety, and well-being according to their care plan. ALFs are not required to provide assistance with ADLs, health support services, and intermittent nursing services. If they provide assistance with ADLs, they must provide minimal assistance with bathing, dressing, eating, personal hygiene, transferring, toileting, and mobility.
Facilities can choose to provide any of the following health support services: blood glucose testing, dementia care, mental health care, puree diets, and calorie-controlled diabetic diets. They may also provide intermittent nursing services but must be they must be provided by licensed and credentialled staff. The nursing services include medication administration, administration of health care treatments, diabetic management, tube feeding, and nurse delegation.
The resident's assessment must be performed before moving into the facility. This assessment covers their medical history, necessary medications, a medical diagnosis, any behaviors that may require special care, mental illness, the level of personal care needs, activity and service preferences, and food and daily routines. This assessment is used to develop a personal care plan for each resident. This assessment must be repeated when the condition of the resident changes.
ALFs must permit residents or their representatives to contract with outside agencies to receive care from licensed home health, hospice, or home care agencies for on-site care and services for the resident. The facility is not required to observe the activities of third parties providing care that the resident or their family contracts.
Facilities must provide residents with at least three meals per day with no more than 14 hours between the evening meal and breakfast unless the facility provides a nutritious snack after the evening meal and before breakfast. Facilities must make available prescribed low-sodium, general diabetic, and mechanical soft food diets and nutritional concentrates and supplements when prescribed in writing by a health care practitioner.
All facilities must have an administrator responsible for the facility's day-to-day operations. Any facility that admits and retains residents who require medical care as provided by nursing facilities must have an RN available. At least one staff member with a current CPR and first aid certification must be present and available to assist residents at all times.
All staff must receive orientation prior to any routine interaction with residents. The orientation must be two hours and covers residents’ rights, communication skills, fire and life safety, and general precautions required in the facility.
Administrators and long-term care workers must receive a valid first aid certification and CPR card within 30 days and maintain it during their employment. They must receive three hours of safety training before providing care and 70 hours of basic training within the first 120 days of employment. Both groups must receive 12 hours of continuing education per year.
Basic training includes caregivers' core knowledge and skills to effectively and safely provide care to residents, their specific duties and responsibilities, how to report resident abuse and neglect, and the needs and service preferences identified in the resident service agreements for the residents they will be working with.
Private rooms or apartments are not required in Washington. No more than two residents may live in an apartment, and both must agree to share a sleeping room. For residents who do not have a private bathroom, the facility must provide a common-use bathroom for every 12 residents. There must be a toilet room on the floor where any resident sleeps.
In ALFs that provide services to Medicaid clients, shared units are not permitted unless the residents are married and both agree and understand that they are entitled to separate apartments. The unit must have a private bathroom that includes a sink, toilet, shower or bathtub, lockable entry door; a kitchen area equipped with a refrigerator, microwave or stovetop, counter or table for food preparation; and a living area wired for telephone and television service.
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility may choose to provide residents with at least minimum assistance with ADLs and must assist all residents with medication services and assess the need for medication attention or nursing services.
In Washington, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 65% of communities providing skilled nursing. Many have health care specialists and on-site services, with 54% of communities offering dental care. In addition, 65% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Washington, 91% of communities conduct depression screenings and 53% offer mental health counseling. Social work programs are also found in 46% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all necessary resources.
Some assisted living residents live with various medical conditions. In Washington, 54% have Alzheimer's disease or another form of dementia. In addition, 48% have high blood pressure, 33% have heart disease, 29% have depression, and 15% have diabetes.
For individuals enrolled in Apple Health, the state Medicaid program's managed care programs offer access to outpatient mental health care, crisis intervention services, and inpatient psychiatric treatment. Older adults in Washington state can also call 211 to ask for referrals to organizations providing mental health services.
Facilities may provide medication services for residents. These services include medication administration, medication assistance, or resident self-administration of medications. The resident service agreement must state whether they will receive administration or assistance services from the facility.
A service that Washington assisted living facilities may choose to provide assistance with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Washington’s assisted living facilities often receive help with their ADLs. In Washington, 31% of residents need help eating. Other commonly used services include bed transfer (43%), toileting (52%), and walking (50%). Caregivers in ALFs help 57% of residents dress, and 71% need help bathing.
The average cost of assisted living care in Washington is $6,000. This is $1,500 higher than the monthly national average of $4,500. The cost of living in Washington is more than the national average by 11.6%, with health care costs more than the national average by 21.2% and housing costs more than the national average by 19.0%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,211 in the Walla Walla area to a high of $6,750 per month in the Seattle area of Washington.
If you live close to Washington’s borders, you may find assisted living in a neighboring state is an affordable option. Seniors in Oregon pay around $5,045 per month, while costs in Idaho average $3,838 per month.
How to Pay for Assisted Living
Washington has more than 100 assisted living facilities across its 39 counties. Each of these facilities is regulated by the Department of Social and Health Services, which is responsible for enforcing laws related to ALF licensing, training, background checks, and services. DSHS maintains a database of ALFs, giving people and their families access to license numbers and inspection reports, which can be helpful for determining if an assisted living community operates according to state guidelines.
The Washington State Long-Term Care Ombudsman Program exists to protect those living in ALFs and other residential communities. This organization investigates complaints and helps people solve problems related to long-term care. Adult Protective Services also protects Washington residents. The agency accepts and investigates complaints about neglect, and physical, financial, and psychological abuse.
The Department of Social and Health Services (DSHS) has strict licensing requirements for assisted living facilities in Washington State. For example, the Washington Administrative Code states that an assisted living administrator must be at least 21 years old and qualified to perform an administrator's duties, which include directing the community's daily operations and ensuring that all residents receive adequate care.
Washington DSHS also requires administrators and ALF caregivers to undergo a national fingerprint background check and a state name and birthdate check to protect residents. A state name and birthdate check are also required for volunteers and students who may spend time with residents without supervision, employees who don't provide direct care, managers who don't provide direct care, and any contractor who has direct contact with an ALF's residents.
No matter how active and vibrant they are, older adults are a target for scammers and abusive individuals. It's unfortunate, but it's critical for people to know how to protect themselves.
WashingtonLawHelp.org, a project of the Northwest Justice Project, offers free information on topics of interest to older adults. These topics include senior health care, estate planning, elder abuse, and financial exploitation. The site also has downloadable forms available to help people handle simple legal issues on their own.
Some counties also have legal aid societies and organizations dedicated to helping older adults with housing and public benefits. These organizations include the Benefits Law Center in Seattle, Benton Franklin Legal Aid in Kennewick, and Clark County VLP Housing Justice Project.
The typical resident population in Washington's assisted living communities is 72% female. Overall, 85% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 55% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Aging and Long-Term Support Administration Department of the Washington State Department of Social and Health Services licenses assisted living facilities (ALFs). ALFs provide room and board and help with activities of daily living (ADLs) to seven or more residents. There are three levels of services provided by ALFs within the state. Any facility contracting with Medicaid must meet additional requirements not specifically required to receive a license, including medication administration and personal care.
As of July 1, 2000, ALFs are permitted to provide, either directly or indirectly, assistance with ADLs, health support services, and intermittent nursing services. ALFs are responsible for providing housing and basic services and are also responsible for the safety and well-being of their residents.
Resident Agreements and Disclosures
Before admission, the prospective resident will undergo an assessment (see below). The facility must complete a service agreement, an initial service plan, and reassessment information as part of the resident agreement. The case manager must be involved if the resident is a Medicaid client.
This negotiated service agreement must be completed or updated within 30 days of move-in. It must be updated as necessary or whenever the current service agreement no longer addresses the needs and preferences of the resident.
Facilities must disclose the scope of care and services offered, as well as their cost, activities not covered by the facility's rate or benefit program, operating rules of the facility as required by regulations, and information regarding how residents can arrange for outside services.
Assisted Living Admission and Retention
An ALF cannot admit or retain a resident who requires nursing or medical care that is provided in a nursing facility except in cases where an RN is available. Facilities cannot admit or retain individuals requiring frequent evaluation by an RN except those receiving hospice care or those receiving care for a short-term illness of no more than 14 days.
The facility cannot retain any individual who needs care if there is no available staff to provide for that individual's needs. Residents may be discharged for their own welfare or if the safety of other individuals is endangered.
Assisted Living Services and Service Planning
ALFs assume responsibility for each resident and manage their health, safety, and well-being according to their care plan. ALFs are not required to provide assistance with ADLs, health support services, and intermittent nursing services. If they provide assistance with ADLs, they must provide minimal assistance with bathing, dressing, eating, personal hygiene, transferring, toileting, and mobility.
Facilities can choose to provide any of the following health support services: blood glucose testing, dementia care, mental health care, puree diets, and calorie-controlled diabetic diets. They may also provide intermittent nursing services but must be they must be provided by licensed and credentialled staff. The nursing services include medication administration, administration of health care treatments, diabetic management, tube feeding, and nurse delegation.
The resident's assessment must be performed before moving into the facility. This assessment covers their medical history, necessary medications, a medical diagnosis, any behaviors that may require special care, mental illness, the level of personal care needs, activity and service preferences, and food and daily routines. This assessment is used to develop a personal care plan for each resident. This assessment must be repeated when the condition of the resident changes.
ALFs must permit residents or their representatives to contract with outside agencies to receive care from licensed home health, hospice, or home care agencies for on-site care and services for the resident. The facility is not required to observe the activities of third parties providing care that the resident or their family contracts.
Assisted Living Food and Dietary Provisions
Facilities must provide residents with at least three meals per day with no more than 14 hours between the evening meal and breakfast unless the facility provides a nutritious snack after the evening meal and before breakfast. Facilities must make available prescribed low-sodium, general diabetic, and mechanical soft food diets and nutritional concentrates and supplements when prescribed in writing by a health care practitioner.
Assisted Living Staffing Requirements
All facilities must have an administrator responsible for the facility's day-to-day operations. Any facility that admits and retains residents who require medical care as provided by nursing facilities must have an RN available. At least one staff member with a current CPR and first aid certification must be present and available to assist residents at all times.
Assisted Living Staff Training Requirements
All staff must receive orientation prior to any routine interaction with residents. The orientation must be two hours and covers residents’ rights, communication skills, fire and life safety, and general precautions required in the facility.
Administrators and long-term care workers must receive a valid first aid certification and CPR card within 30 days and maintain it during their employment. They must receive three hours of safety training before providing care and 70 hours of basic training within the first 120 days of employment. Both groups must receive 12 hours of continuing education per year.
Basic training includes caregivers' core knowledge and skills to effectively and safely provide care to residents, their specific duties and responsibilities, how to report resident abuse and neglect, and the needs and service preferences identified in the resident service agreements for the residents they will be working with.
Assisted Living Housing Requirements
Private rooms or apartments are not required in Washington. No more than two residents may live in an apartment, and both must agree to share a sleeping room. For residents who do not have a private bathroom, the facility must provide a common-use bathroom for every 12 residents. There must be a toilet room on the floor where any resident sleeps.
In ALFs that provide services to Medicaid clients, shared units are not permitted unless the residents are married and both agree and understand that they are entitled to separate apartments. The unit must have a private bathroom that includes a sink, toilet, shower or bathtub, lockable entry door; a kitchen area equipped with a refrigerator, microwave or stovetop, counter or table for food preparation; and a living area wired for telephone and television service.
What Is Included With Assisted Living Care In Washington?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility may choose to provide residents with at least minimum assistance with ADLs and must assist all residents with medication services and assess the need for medication attention or nursing services.
Health Care Services
In Washington, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 65% of communities providing skilled nursing. Many have health care specialists and on-site services, with 54% of communities offering dental care. In addition, 65% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Washington, 91% of communities conduct depression screenings and 53% offer mental health counseling. Social work programs are also found in 46% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all necessary resources.
Some assisted living residents live with various medical conditions. In Washington, 54% have Alzheimer's disease or another form of dementia. In addition, 48% have high blood pressure, 33% have heart disease, 29% have depression, and 15% have diabetes.
Mental Health Resources
For individuals enrolled in Apple Health, the state Medicaid program's managed care programs offer access to outpatient mental health care, crisis intervention services, and inpatient psychiatric treatment. Older adults in Washington state can also call 211 to ask for referrals to organizations providing mental health services.
Medication Provisions
Facilities may provide medication services for residents. These services include medication administration, medication assistance, or resident self-administration of medications. The resident service agreement must state whether they will receive administration or assistance services from the facility.
Activities of Daily Living (ADLs) Assistance Services
A service that Washington assisted living facilities may choose to provide assistance with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Washington’s assisted living facilities often receive help with their ADLs. In Washington, 31% of residents need help eating. Other commonly used services include bed transfer (43%), toileting (52%), and walking (50%). Caregivers in ALFs help 57% of residents dress, and 71% need help bathing.
Cost Of Assisted Living Care In Washington
The average cost of assisted living care in Washington is $6,000. This is $1,500 higher than the monthly national average of $4,500. The cost of living in Washington is more than the national average by 11.6%, with health care costs more than the national average by 21.2% and housing costs more than the national average by 19.0%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,211 in the Walla Walla area to a high of $6,750 per month in the Seattle area of Washington.
How Costs Compare In Nearby States
If you live close to Washington’s borders, you may find assisted living in a neighboring state is an affordable option. Seniors in Oregon pay around $5,045 per month, while costs in Idaho average $3,838 per month.
How to Pay for Assisted Living
Washington Assisted Living Oversight
Washington has more than 100 assisted living facilities across its 39 counties. Each of these facilities is regulated by the Department of Social and Health Services, which is responsible for enforcing laws related to ALF licensing, training, background checks, and services. DSHS maintains a database of ALFs, giving people and their families access to license numbers and inspection reports, which can be helpful for determining if an assisted living community operates according to state guidelines.
Quality and Safety of Assisted Living Facilities in Washington
The Washington State Long-Term Care Ombudsman Program exists to protect those living in ALFs and other residential communities. This organization investigates complaints and helps people solve problems related to long-term care. Adult Protective Services also protects Washington residents. The agency accepts and investigates complaints about neglect, and physical, financial, and psychological abuse.
The Department of Social and Health Services (DSHS) has strict licensing requirements for assisted living facilities in Washington State. For example, the Washington Administrative Code states that an assisted living administrator must be at least 21 years old and qualified to perform an administrator's duties, which include directing the community's daily operations and ensuring that all residents receive adequate care.
Washington DSHS also requires administrators and ALF caregivers to undergo a national fingerprint background check and a state name and birthdate check to protect residents. A state name and birthdate check are also required for volunteers and students who may spend time with residents without supervision, employees who don't provide direct care, managers who don't provide direct care, and any contractor who has direct contact with an ALF's residents.
Legal Resources
No matter how active and vibrant they are, older adults are a target for scammers and abusive individuals. It's unfortunate, but it's critical for people to know how to protect themselves.
WashingtonLawHelp.org, a project of the Northwest Justice Project, offers free information on topics of interest to older adults. These topics include senior health care, estate planning, elder abuse, and financial exploitation. The site also has downloadable forms available to help people handle simple legal issues on their own.
Some counties also have legal aid societies and organizations dedicated to helping older adults with housing and public benefits. These organizations include the Benefits Law Center in Seattle, Benton Franklin Legal Aid in Kennewick, and Clark County VLP Housing Justice Project.
