Nursing homes and assisted living in Washington

In Washington State (not to be confused with Washington, D.C.), one option is very common: adult family homes, houses in regular neighborhoods where a small number of older adults live. Here we explain what types of places there are, how Medicaid helps, and who to call.

What care settings are called here

• Adult Family Home (AFH): a house in a residential neighborhood licensed for a small number of residents; DSHS says two to six. It offers a room, meals, laundry, supervision, and personal care. Some provide nursing care or care for people with dementia or mental health needs.
• Assisted Living Facility (ALF): a larger residence with housing, meals, supervision, and help with daily activities. Some offer nursing or specialized care.
• Nursing Home: 24-hour nursing care, therapy, meals, and activities.

Licenses and inspections are handled by Residential Care Services, part of the Department of Social and Health Services (DSHS). Nursing homes are also overseen by the federal Medicare and Medicaid agency (CMS).

DSHS has official search tools where you can check the license and inspection reports: adult family homes, assisted living, and nursing homes.

How Medicaid helps in Washington

In Washington, Medicaid is called Apple Health. Its long-term care programs (Long-Term Services and Supports, or LTSS) can pay for care in a nursing home, personal care at home, assisted living, and adult family homes. In other words, it can help outside a nursing home, as long as the place has a state license and accepts Medicaid.

The main Medicaid waiver for older adults is called COPES (Community Options Program Entry System). It is for people 65 or older, or 18 or older with a disability, who need a nursing home level of care but choose to live at home, in an adult family home, or in assisted living. It works together with another program called Community First Choice (CFC), which covers personal care.

The process has three steps: the application, a review of income and assets, and an assessment of how much help the person needs.

Where to apply: online at Washington Connection or by phone with Home and Community Services Intake: 877-429-7019.

How much care costs in Washington

According to the CareScout Cost of Care 2025 survey (data collected from July to November 2025, published in March 2026), these are the median costs in Washington:

• In-home caregiver (non-medical): $45 an hour.
• Adult day center: $249 a day.
• Assisted living: $7,600 a month.
• Nursing home, semi-private room: $13,155 a month.
• Nursing home, private room: $15,969 a month.

Washington is among the most expensive states for home care. Prices vary by city and by place, so always ask for a written quote.

Who to call

• Community Living Connections: 1-855-567-0252. It is free and gives guidance on public and private long-term care options and services in your area.
• Long-Term Care Ombudsman: 1-800-562-6028. It offers free support to residents of nursing homes, adult family homes, and assisted living, and to their families.
• DSHS Complaint Resolution Unit: 1-800-562-6078, to report a concern about care at a licensed place.
• Eldercare Locator (national): 1-800-677-1116.

Tips for your family

• Consider an adult family home. With only a few residents, it feels more like home. Many are in residential neighborhoods, and you may find one close to family.
• Check the license and inspection reports. The DSHS search tools show each place's license type and reports. They are a normal tool for comparing places calmly. On hogaresparamayores.com you can also see licensed places in Washington.
• Ask if they accept Medicaid. Not every place has a Medicaid contract. If your loved one might need Apple Health later on, ask about it at the first visit.
• Look for Spanish-speaking care. When you call, ask whether the staff or the home's owner speak Spanish, and at what times.
• Start the application early. The assessment and the asset review take time. If you have questions about your income, ask the agency or a professional.