For families · Last reviewed October 2026
How to Choose an Adult Family Home in Washington
Build a shortlist from the state's licensing records, read each home's DSHS inspection record, then visit your top two or three, ideally at a mealtime. On the tour, ask who is on duty overnight, which specialty designations the home holds, whether it has a Medicaid contract, and exactly what your parent's care would cost. Ask for the home's Disclosure of Services and its last three years of inspection reports, and compare the homes on the same points before you decide.
1. Build a shortlist
An adult family home is a licensed private house caring for two to six residents, or up to eight with DSHS approval. Washington has thousands of them, so start by narrowing on the things that rule a home in or out:
- Location. Close enough that family can visit often. Visits are how you see the care.
- Care needs. If your parent has dementia, a mental health condition or a developmental disability, look for a home with that specialty designation, which means its staff completed the DSHS training for it.
- How care will be paid for. If Medicaid pays now, or may within a few years, the home needs a Medicaid contract.
This site's directory of licensed homes lists every home by city and county with its capacity, specialty designations and Medicaid status from DSHS records, and the DSHS Adult Family Home Locator is the state's own search. Then call: openings change week to week, and a five-minute call tells you whether a visit is worth it.
2. Read the record before you visit
Every licensed home's inspections, complaint investigations and enforcement letters are public. The DSHS Locator shows limits and enforcement from the previous three years, and the home itself must keep its last three years of inspection reports available for anyone to read. A citation is not automatically a red flag: look at how serious it was, whether it was repeated, and how the home corrected it. How to look up and read a home's DSHS record.
Ask each home for its Disclosure of Services (DSHS form 10-508). It is the home's own statement of what it does: personal care, medication help, nursing and nurse delegation, specialty designations, staffing, languages, Medicaid and activities. What it says the home does not do matters as much as what it does.
3. What to ask on the tour
Washington law requires the provider or a qualified resident manager to live in the home, and a qualified caregiver to be on site whenever a resident is there. Everything else varies from home to home, which is why these questions matter.
Who lives here, and who cares for them
- How many residents live here now, and how many is the home licensed for?
- Does the provider live here, or a resident manager? Who is in charge when they are away?
- How many caregivers are on duty during the day, and how many overnight? Are they awake at night?
- Which specialty designations does the home hold: dementia, mental health, developmental disabilities?
- What languages do the caregivers speak?
Care and health
- Can the home meet my parent's needs today, and what happens as those needs grow?
- Does the home work with a delegating nurse, so caregivers can help with tasks such as insulin or wound care?
- How are medications handled, and who manages refills?
- How does the home respond to a fall, and to a return from the hospital?
- Has the home cared for residents on hospice, and which hospice agencies has it worked with?
Money
- What is the private-pay base rate, and what does each care level add? Which level would my parent start at?
- What raises the rate, and how much notice do you give before it changes?
- Is there a deposit or move-in fee, and when is it refundable?
- Does the home have a Medicaid contract? If my parent's savings run out, can they stay on Medicaid?
Daily life
- What does a normal day look like? Can we visit at a mealtime?
- Can my parent bring their own furniture, keep their routines and have visitors when they like?
- What activities are offered, and how often do residents get outside?
Paperwork to ask for
- The home's Disclosure of Services (DSHS form 10-508).
- The last three years of DSHS inspection reports, which the home must have available.
- A copy of the admission agreement to read before signing, including the rate sheet and the discharge terms.
On money, get it in writing. Many homes charge private-pay residents a base rate plus a care-level charge, and each home defines its own levels, so "Level 3" at one home tells you nothing about Level 3 at another. Ask for the total monthly cost at your parent's level of care. What adult family homes cost.
4. Compare two homes side by side
After the visits, homes blur together. Fill in the same facts for each one while they are fresh, then talk it through with your parent and whoever will share the visiting.
| What to compare | Home A | Home B |
|---|---|---|
| Location and drive time for the family | ||
| Residents now / licensed capacity | ||
| Provider or resident manager living in the home | ||
| Caregivers on duty day / night (awake at night?) | ||
| Specialty designations | ||
| Nurse delegation available | ||
| Medicaid contract; can a private-pay resident stay on Medicaid? | ||
| Private-pay base rate + care level for my parent | ||
| Deposit or fees; notice before rate changes | ||
| DSHS record, last three years: what was cited, how corrected | ||
| What the Disclosure of Services says the home cannot do | ||
| Languages spoken | ||
| What we saw at the mealtime visit | ||
| How my parent felt there |
A home with one old, corrected citation and an owner who explains it openly may be a better choice than a home with a clean page and vague answers. Trust what you saw at the mealtime visit, and how your parent felt there.
5. After the move: your parent's rights
Residents of adult family homes have the rights set out in Washington's long-term care residents' rights law. A home may move a resident out only for set reasons, such as needs the home can no longer meet, a danger to others, unpaid charges or the home closing, and normally with at least 30 days' written notice. Read the admission agreement's discharge terms before signing.
If something is wrong: call 911 in an emergency. Concerns about care go to the DSHS Complaint Resolution Unit at 1-800-562-6078 (TTY 1-800-737-7931); every home must post the complaint number where residents and visitors can see it. The Long-Term Care Ombudsman Program offers free, independent help to residents and families.
Sources: RCW 70.128.010 (capacity); RCW 70.128.130 (provider or resident manager in the home; caregiver on site); RCW 70.128.080 (inspection reports available); RCW 70.128.200 (complaint number posted); RCW 70.128.280 (Disclosure of Services); RCW 70.129.110 (transfer and discharge). This site does not rate, rank or recommend individual homes.
