How Admission to an Adult Family Home Works in Washington

Families often assume that moving a parent into an adult family home will take weeks of paperwork. Sometimes it does, especially when Medicaid is involved. But when a family is organized and the home is responsive, admission can happen within a few days, which matters when a hospital is pressing for a discharge date. Here is how the process works in Washington, using the way we do it at Silvergate as the example.

Step 1: The first call

Call the home and describe your parent's situation honestly: diagnosis, mobility, medications, behavior, and what kind of help they need now. A good home will tell you quickly whether it can meet those needs and whether it has a bed. If the answer is no, ask for a referral; small homes know each other. If the answer is yes, schedule a tour or, if time is short, go straight to the assessment.

Step 2: The assessment

Before admission, the provider or a nurse meets the prospective resident in person, at home, in the hospital, or at a rehab facility. At Silvergate, our RN owner does this herself. The assessment covers physical needs, cognition, mood and behavior, medications, diet, sleep, and personal history, including what the person enjoys and what upsets them. This is where the monthly rate is set, because the rate depends on the level of care.

Step 3: The forms Washington requires

State rules require several documents before or shortly after move-in.

• Physician's assessment completed by the resident's doctor or nurse practitioner, usually within the last 30 days, describing diagnoses, medications, and care needs.
• Tuberculosis screening, typically a skin test or blood test, with results in hand.
• Negotiated care plan, written by the home with the resident and family, spelling out exactly what care will be provided, by whom, and how often. It must be completed within 30 days of admission and reviewed regularly.
• Admission agreement, the contract covering the rate, what is included, deposits, the refund policy, and the conditions under which a resident may be asked to leave.
• Advance directives and POLST if the resident has them, along with a copy of any power of attorney.

Hospitals and rehab facilities can usually produce the physician's assessment and TB results quickly. If your parent is at home, ask their doctor's office for a same-week appointment and explain that it is for a care placement.

Step 4: Paying for care

For private pay, the admission agreement sets the monthly rate and the first payment is due at move-in. For long-term care insurance, the home provides the care plan and invoices the policy requires. For VA Aid and Attendance, applications can take months, so families usually pay privately while it is pending.

For Medicaid, the resident must first be found eligible by DSHS Home and Community Services, which involves a financial application and a CARE assessment by a case manager. The home must also hold a Medicaid contract. Silvergate Adult Family Home in Bonney Lake does; Silvergate at Buckley is currently private pay. If you expect your parent to need Medicaid in the future, ask about the home's conversion policy before you sign anything.

Step 5: Move-in day

Bring clothing for a week, toiletries, all current medications in their original containers, glasses and hearing aids, and a few familiar things: photographs, a favorite blanket, a chair if it fits. Bring the medication list and the names of the physician, pharmacy, and any home health or hospice agency. Plan to stay for the first meal if you can, and then let the caregivers take over. The first few days are an adjustment for everyone, and most residents settle in within a couple of weeks.

How fast can it happen?

When a discharge is pending and the family has the documents ready, we can often complete an assessment the same day we receive a referral and admit within two or three days. Medicaid admissions take longer because eligibility must be established first. Either way, the best thing a family can do is start the conversation early, before a crisis forces the decision.

If you have questions about admission to either of our homes in Bonney Lake or Buckley, call (253) 447-8544. We will walk you through each step.