The Nurse Delegation Program in Washington State: What Families Need to Know

The Nurse Delegation Program in Washington State: What Families Need to Know

For older adults in Washington who need nursing-level care but want to stay home — or in a smaller residential setting — the Nurse Delegation Program opens a door many families don't know exists.

There is a gap in senior care that frustrates families across Washington State. On one side is an older adult who needs help with medical tasks — insulin injections, wound care, medication management — but who is otherwise stable and does not need a nursing home. On the other side is the assumption that only a licensed nurse can perform those tasks, which makes staying home, or staying in an adult family home, feel impossible.

Washington's Nurse Delegation Program was designed to close that gap.

What Is Nurse Delegation?

Nurse delegation is a formal process where a registered nurse trains and authorizes a credentialed caregiver — a registered or certified nursing assistant, or a certified home care aide, who has completed nurse delegation training — to perform specific nursing tasks for a specific client.

This is not a workaround or a compromise. It is a legally recognized, carefully regulated practice, governed by state nursing law (RCW 18.79.260) and Nursing Commission rules (WAC 246-840-910 to -970). The Washington State Department of Social and Health Services (DSHS) provides caregiver training and pays for delegation for Medicaid clients. The delegating nurse retains clinical oversight and responsibility. The trained caregiver performs the tasks under that nurse's supervision. The client receives the care they need in the setting they prefer.

Who Can Benefit From Nurse Delegation in Washington?

Nurse delegation is available to adults receiving care at home, in an adult family home, or in an assisted living facility who need assistance with tasks that would otherwise require a licensed nurse. (It is not used in nursing homes, which have licensed nurses on staff.)

To be eligible, the client's condition must be stable and predictable. The nursing tasks must be ones that can be safely taught to and performed by a trained nursing assistant or home care aide. And the registered nurse overseeing the delegation must determine that the arrangement is appropriate for that specific individual.

Common tasks that can be delegated include insulin administration, oral medication management, wound care and dressing changes, catheter care, and monitoring of specific health conditions such as blood pressure or blood glucose levels.

Washington law says some tasks can never be delegated: injections other than insulin, sterile procedures, central line care, and any task that requires a nurse's judgment — situations where the nature of the task changes based on the client's condition in ways that require a nurse's real-time assessment.

How the Program Works in Practice

The process begins with a registered nurse — typically a community nurse working with DSHS or a home health agency — conducting an assessment of the client's needs and the proposed caregiver's capability.

If the nurse determines that delegation is appropriate, they provide hands-on training to the caregiver for each specific task. The caregiver must demonstrate competency before performing the task independently. The nurse then documents the delegation formally and establishes a plan for ongoing oversight — including regular visits, at least every 90 days, to monitor the client and check in with the caregiver.

The delegation is client-specific and task-specific. A caregiver delegated to administer insulin for one client is not automatically authorized to perform that task for another. Each delegation is its own formal arrangement.

Nurse Delegation in Adult Family Homes

Adult family homes are one of the primary settings where nurse delegation makes a meaningful difference. Because adult family homes are smaller residential settings — licensed for two to six residents, or up to eight with DSHS approval — they are not required to have a nurse on staff around the clock. Without delegation, residents who develop nursing-level care needs may face a difficult choice: move to a higher level of care, or go without.

Nurse delegation allows adult family home providers to meet those needs legally and safely — keeping residents in a familiar, home-like environment rather than requiring a disruptive transition to a nursing facility.

For families considering an adult family home for a loved one with medical needs, asking whether the provider works with a delegating nurse is one of the most important questions to raise during the evaluation process.

Nurse Delegation and Medicaid in Washington State

Washington State's Medicaid program covers nurse delegation services for eligible clients. For older adults and individuals with disabilities who qualify for Medicaid long-term care services, the cost of the delegating nurse's assessments, training, and oversight visits is covered — not paid out of pocket by the family.

This makes nurse delegation not just clinically valuable but financially accessible. For families navigating the intersection of medical need, residential preference, and limited resources, it can be one of the most practical tools available.

What Families Should Know

If a loved one has medical care needs that have made staying home — or staying in a smaller residential setting — feel uncertain, nurse delegation is worth exploring. The program is not widely advertised, and many families discover it only after being told that a nursing home is the only option. It often isn't.

A conversation with a DSHS case manager, a home health agency, or an Aging Life Care Manager can help determine whether nurse delegation is appropriate for a specific situation. An Aging Life Care Manager is particularly well-positioned to assess the full picture — medical needs, living situation, caregiver capacity — and help families understand what is actually possible.

The goal of the Nurse Delegation Program is the same goal most families share: to help an older adult receive the care they need, in the place they want to be, with as much dignity and continuity as possible.

Real Property Planning is a free educational resource for Washington families navigating senior care decisions. Explore the full library of resources or learn what an independent Aging Life Care Manager does to start the conversation.