Quick Answer
An adult family home is a regular house licensed by Washington State DSHS to provide housing and personal care for up to six adults (up to eight with approval). The term is Washington's; the same small residential care home is an adult foster home in Oregon and Michigan, a board and care (RCFE) in California, a personal care home in Georgia and Pennsylvania, and a family care home in North Carolina.
Every state licenses some version of the same idea: a small number of adults who need daily help living together in an ordinary house, cared for by a provider who lives there or staffs it around the clock. This page maps Washington's term to what each state's regulator actually calls it, with the licensing agency and typical capacity for each.
Adult family home or adult family care (Washington, Wisconsin, Ohio, Florida, New Jersey, West Virginia, New Hampshire, Maine, North Dakota). Adult foster home or adult foster care (Oregon, Michigan, Minnesota, Indiana, Montana, Wyoming, South Dakota, Virginia, Massachusetts). Family care home (North Carolina, Kentucky, Idaho). Personal care home (Georgia, Pennsylvania, Mississippi). Residential care home, facility, or provider (Vermont, Missouri, Oklahoma, Arkansas, South Carolina, New Mexico, Louisiana, California, Hawaii, Tennessee). Assisted living with no separate small-home license (Alaska, Arizona, Utah, Colorado, Texas, Nebraska, Maryland, Illinois, Nevada).
An adult family home is a private house serving up to six (occasionally eight) residents with a live-in or round-the-clock caregiver. An assisted living facility is a licensed building with shift staff and communal dining. In Washington the two are licensed under different laws: RCW 70.128 for adult family homes, RCW 18.20 for assisted living.
An adult family home (AFH) is a regular residential house licensed by Washington State DSHS to provide housing, meals, and personal care to up to six adults who are not related to the provider. DSHS may approve up to eight. The provider or staff live in or staff the home around the clock.
No. It is Washington's licensing term, defined in RCW 70.128. Wisconsin and Ohio also use it, and Florida, New Jersey, West Virginia, New Hampshire, and Maine use "adult family care" or "adult family-care home." Most other states license the same kind of small residential care home under a different name.
An adult foster home, also abbreviated AFH. Oregon adult foster homes are licensed by the Oregon Department of Human Services for up to five residents (up to seven under a 2024 law) and are classified by level of care.
A Residential Care Facility for the Elderly (RCFE), commonly called a board and care home. Small RCFEs serving six or fewer residents are the closest equivalent to a Washington adult family home.
In Washington, yes, for residents who qualify; most adult family homes hold a DSHS Medicaid contract. Other states have their own Medicaid waiver programs for small residential care, with different eligibility and rates.
About the author: David Stein is a Washington State licensed real estate broker (eXp Realty, license #133972) and a Washington State certified residential appraiser (Stein Appraisal, license #1702080), with more than 20 years of experience in both disciplines. More about David.
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