Families in Pierce County usually narrow their search to two options: an assisted living facility or an adult family home. Both are licensed by Washington State, both provide meals, supervision, and help with daily activities, and both are far less clinical than a nursing home. But they are built on different ideas about what good care looks like, and the right choice depends on the person.
Size and setting
An assisted living facility is a purpose-built community, typically with 50 to 200 apartments, a dining room, common areas, and departments for nursing, dining, housekeeping, and activities. Residents have their own apartment, often with a kitchenette, and move through the building for meals and programs.
An adult family home is a house in a neighborhood with no more than six residents. There is a shared kitchen and living room, bedrooms down the hall, and usually a yard. It looks and feels like someone's home because it is one. Silvergate's homes in Bonney Lake and Buckley are typical: six bedrooms, family-style meals at one table, and caregivers who are in the same rooms as the residents all day.
Staffing and attention
This is the biggest practical difference. In assisted living, staff are organized by department and shift, so the person who helps your mother bathe may not be the person who serves her lunch or the one who notices she seems off. Ratios vary widely, and at night a large building may have one or two aides for dozens of residents.
In an adult family home, the same two or three caregivers see the same six residents day after day. A ratio of one caregiver to three residents is common. Changes in appetite, mood, or mobility get noticed quickly because there is no one else to notice them. In a nurse-owned home, that observation is backed by clinical judgment.
Medical capability
Assisted living facilities in Washington typically have a nurse on staff or on call and can manage medications and routine needs. Many, however, cannot accept residents who need two-person transfers, a Hoyer lift, insulin injections, or hospice-level care, and will require a move when needs increase.
Adult family homes vary. A home's Disclosure of Services, on file with DSHS, spells out exactly what it can do. Some homes, especially those owned by nurses, are equipped for Hoyer transfers, diabetic care, two-hour repositioning, and end-of-life care in coordination with hospice. That can mean a resident stays in one place through the end of life rather than moving as they decline.
Dementia and mental health
Washington requires an adult family home to hold a specialty designation before admitting a resident with a dementia or mental illness diagnosis. Assisted living facilities may operate secured memory care units under their own rules. For a person with moderate dementia, the calm and consistency of a small home often works better than a large building, where wandering and confusion are harder to manage. For someone who is socially active and cognitively well, the programming and community of assisted living may be a better fit.
Cost and how it is charged
Assisted living usually charges a base rent plus care fees that rise in tiers as needs increase, along with a community fee at move-in. The advertised price is rarely what a family ends up paying once care is added.
Adult family homes usually charge a single monthly rate set after an assessment, with a few items such as incontinence supplies and nurse delegation fees billed separately. In Pierce County in 2026, private-pay adult family home rates commonly run from about $6,000 to $10,000 a month depending on care level, which is often less than assisted living at a comparable level of care. Medicaid policies differ home by home; ask before you tour.
Social life and activities
Here assisted living has the edge on paper. Larger communities offer scheduled classes, outings, and a wider circle of neighbors. Adult family homes offer fewer organized programs and a smaller group. Good homes make up for this by tailoring activities to what each resident actually enjoyed before moving in, and many residents prefer a quiet house with a few familiar faces to a busy calendar. Be honest about which your parent would choose.
A short way to decide
- Choose assisted living if your parent is mostly independent, socially active, and would enjoy a community with amenities.
- Choose an adult family home if your parent has dementia, needs hands-on help several times a day, has complex medical needs, or would be overwhelmed by a large building.
- Whichever you choose, verify the license on the DSHS provider lookup, read the inspection history, and tour in person.
If you are weighing an adult family home in Bonney Lake or Buckley, we are glad to answer questions by phone even if you end up choosing somewhere else.
Written by Mary Ndungu, RN, owner of Silvergate Adult Family Homes. General information, not medical, legal, or financial advice.