If you have started looking for care for a parent in Washington, you have probably run into the phrase "adult family home" and wondered whether it is a formal category or just a friendly description. It is a formal category. Adult family home is the official licensing term used by the Washington State Department of Social and Health Services (DSHS) for a specific kind of small residential care home, and it is governed by its own chapter of state law, RCW 70.128, and its own set of licensing rules, WAC 388-76.
The basic definition
An adult family home is a regular house, in a regular neighborhood, that is licensed to provide room, board, laundry, supervision, and personal care to between two and six adults who are not related to the person who runs it. With DSHS approval, a home that has been licensed for at least two years may add up to two more beds, but six is the norm. Silvergate's two homes, in Bonney Lake and Buckley, are each licensed for six.
The person who holds the license is called the provider. State rules require the provider, or a resident manager, to live in the home unless it has 24-hour staffing. Some homes, like Silvergate at Buckley, have the owner living on site. Others, like our Bonney Lake home, are staffed around the clock instead.
What care an adult family home provides
Every licensed home provides help with activities of daily living: bathing, dressing, grooming, toileting, eating, and moving around. Every home helps with medications, from reminders to full administration. Every home is required to provide activities "other than television," in the words of the regulation. Beyond that baseline, homes vary. Some are equipped for Hoyer lift transfers, insulin injections, and hospice care; others are not. The way to find out is to read the home's Disclosure of Services, which we will come back to.
Some nursing care can be provided in an adult family home through a process called nurse delegation, in which a registered nurse trains and supervises a caregiver to perform specific tasks for a specific resident. Homes owned by nurses, as Silvergate is, can generally take on more medically involved residents than homes that are not.
Specialty designations
Washington adds a layer that many families do not know about. A home may not admit a resident who has a formal diagnosis of dementia, mental illness, or developmental disability unless the home holds the matching specialty designation from DSHS. Earning a designation requires additional approved training for the provider and caregivers. When you look up a home, the designations it holds appear on its license record. Both Silvergate homes hold the dementia and mental health designations.
Who lives in adult family homes
Residents are adults of any age who need daily help. Most are older adults, many with dementia. Others are adults with a mental illness, adults recovering after a hospital stay, and people at the end of life who want to stay in a home setting with hospice support. Washington has roughly 4,000 licensed adult family homes with about 22,000 beds, and more than nine in ten accept Medicaid for at least some residents.
How licensing and inspection work
DSHS Residential Care Services licenses adult family homes and inspects each one roughly every 12 to 18 months, plus whenever a complaint is filed. Inspection reports, enforcement actions, license status, capacity, and specialty designations are all public. You can look up any home on the DSHS Adult Family Home Locator by name, city, or license number.
The single most useful document is the Disclosure of Services. Every home must file one, and it lists, in checkbox form, exactly what personal care, medication help, nursing, staffing, and Medicaid policy the home offers. If a home tells you something on the phone that does not match its disclosure, ask why.
How to verify a home before you visit
- Ask for the license number. A home that hesitates is a warning sign. Silvergate's are 755142 for Bonney Lake and 759153 for Buckley.
- Look the number up on the DSHS locator and confirm the status is "Operating."
- Check the specialty designations against your parent's diagnosis.
- Open the most recent inspection report and read any citations.
- Read the Disclosure of Services and note the Medicaid policy.
Then schedule a tour. A license tells you a home meets the minimum. Walking through it tells you whether it is right for your family.
Written by Mary Ndungu, RN, owner of Silvergate Adult Family Homes. General information, not medical, legal, or financial advice.