In Washington, the license families see for assisted living is "Assisted Living Facility (ALF)", issued by the Washington State Department of Social and Health Services (DSHS), Residential Care Services. The facility must complete its own preadmission assessment of each prospective resident before move-in, covering medical history, medications, a health professional's diagnosis and personal care needs. The facility must give written notice at least 30 days before a transfer or discharge, and only if the resident's needs cannot be met, others' safety or health is endangered, the resident has not paid, or the facility closes.
Key facts
- The median monthly cost of assisted living in Washington was $7,600 in CareScout's 2025 Cost of Care Survey, or $91,200 a year, $1,400 above the national median of $6,200 a month. (CareScout, 2026)
- Medicaid can pay for services in a Washington assisted living facility only if the facility has a DSHS contract, through the Community First Choice option or the COPES waiver. (WAC 388-106-0015, 2016)
- Washington's assisted living rules require TB screening for staff within three days of employment, and they do not list a TB test for new residents. (WAC 388-78A-2480, 2013)
- Staff who are not nurses or other licensed practitioners may only help residents take their own medicines, such as reminders, opening containers or placing a pill in the hand, unless a nurse delegates a task. (WAC 246-945-714, 2026)
- After July 1, 2026, a facility may not operate memory care in Washington without DSHS certification, which requires awake staff 24 hours a day and a full resident assessment at least twice a year. (RCW 18.20.540, 2025)
Washington calls assisted living an assisted living facility (ALF) and licenses facilities for seven or more residents through the Department of Social and Health Services (DSHS) under chapter 18.20 RCW and chapter 388-78A WAC. A facility that takes Medicaid also needs a DSHS contract for a service package such as assisted living, enhanced adult residential care or adult residential care, and after July 1, 2026 a facility may not offer memory care without a separate DSHS certification. Adult family homes (two to six residents) are licensed separately, and the facts below cover the main ALF license.
Rules change and communities can set stricter policies. Before you sign, confirm the details with the community and the Washington State Department of Social and Health Services (DSHS), Residential Care Services. This page is general information, not legal advice.
The rules at a glance
| Medical assessment before move-in | The facility must complete its own preadmission assessment of each prospective resident before move-in, covering medical history, medications, a health professional's diagnosis and personal care needs. A full assessment is due within 14 days of move-in, and after an emergency move-in the preadmission assessment may be done within five calendar days. [5][6][7] More on this |
|---|---|
| TB test | Washington's assisted living rules require TB screening for staff within three days of employment, and they do not list a TB test for new residents. A facility must report any resident or staff member with TB symptoms or a positive chest X-ray to a health care provider or public health provider. [8][9] More on this |
| Notice before a move-out | The facility must give written notice at least 30 days before a transfer or discharge, and only if the resident's needs cannot be met, others' safety or health is endangered, the resident has not paid, or the facility closes. Shorter notice is allowed for safety or health danger, urgent medical needs, or a stay under 30 days. [10][11] More on this |
| Who may give medications | Staff who are not nurses or other licensed practitioners may only help residents take their own medicines, such as reminders, opening containers or placing a pill in the hand, unless a nurse delegates a task. A registered nurse may delegate insulin injections, but no other injections, to registered or certified nursing assistants and certified home care aides. [12][13] More on this |
| Memory care and dementia | After July 1, 2026, a facility may not operate memory care in Washington without DSHS certification, which requires awake staff 24 hours a day and a full resident assessment at least twice a year. Certified memory care must post a disclosure of its staffing, including awake overnight caregivers. [14][15] |
| Long-term care ombudsman | Washington's State Long-Term Care Ombudsman Program advocates for residents of assisted living facilities, adult family homes and nursing homes, including on transfer and discharge, and can be reached at 1-800-562-6028 or ltcop@mschelps.org. [16] Official page More on this |
| Medicaid help | Medicaid can pay for services in a Washington assisted living facility only if the facility has a DSHS contract, through the Community First Choice option or the COPES waiver. Residents pay for their own room and board and keep a personal needs allowance, and DSHS pays the facility the difference up to its set rate. [17][23][18][19][20] Official page More on this |
What assisted living costs in Washington
The median monthly cost of assisted living in Washington was $7,600 in CareScout's 2025 Cost of Care Survey, or $91,200 a year, $1,400 above the national median of $6,200 a month. [25]
A median is the middle of the rates communities reported, so many charge more or less. Rates differ between regions and by the care a resident needs, so ask each community for its full fee list in writing. More: assisted living costs in every state, a monthly budget and the costs that aren't in the base rate.
How to check a community in Washington
DSHS's Assisted Living Facility Locator lets families search by location or facility name, and filter for facilities that accept Medicaid or are certified for memory care. A facility's reports page lists its inspections, investigations, enforcement letters and fire inspections, and concerns can be reported to DSHS's Complaint Resolution Unit at 1-800-562-6078. Search Washington's records. [2][3][4]
The licensing agency: Washington State Department of Social and Health Services (DSHS), Residential Care Services. [1] Our guide on how to read an inspection report explains what to look for.
Put Washington's paperwork on a date
Parent Move Plan counts every task back from the move-in day, including the medical assessment and TB screening the community will ask for, so nothing lands in the last week.
Get your first 3 days freeFrequently asked questions
How much does assisted living cost in Washington?
The median monthly cost of assisted living in Washington was $7,600 in CareScout's 2025 Cost of Care Survey, or $91,200 a year, $1,400 above the national median of $6,200 a month. A median is the middle of the rates communities reported, so many charge more or less, and rates differ between regions and by the care a resident needs.
What medical assessment does Washington require before moving into assisted living?
The facility must complete its own preadmission assessment of each prospective resident before move-in, covering medical history, medications, a health professional's diagnosis and personal care needs. A full assessment is due within 14 days of move-in, and after an emergency move-in the preadmission assessment may be done within five calendar days.
Does Washington require a TB test for assisted living?
Washington's assisted living rules require TB screening for staff within three days of employment, and they do not list a TB test for new residents. A facility must report any resident or staff member with TB symptoms or a positive chest X-ray to a health care provider or public health provider.
How much notice must an assisted living community in Washington give before a move-out?
The facility must give written notice at least 30 days before a transfer or discharge, and only if the resident's needs cannot be met, others' safety or health is endangered, the resident has not paid, or the facility closes. Shorter notice is allowed for safety or health danger, urgent medical needs, or a stay under 30 days.
Who can give medications in assisted living in Washington?
Staff who are not nurses or other licensed practitioners may only help residents take their own medicines, such as reminders, opening containers or placing a pill in the hand, unless a nurse delegates a task. A registered nurse may delegate insulin injections, but no other injections, to registered or certified nursing assistants and certified home care aides.
Who can help with a complaint about assisted living in Washington?
Washington's State Long-Term Care Ombudsman Program advocates for residents of assisted living facilities, adult family homes and nursing homes, including on transfer and discharge, and can be reached at 1-800-562-6028 or ltcop@mschelps.org.
Does Medicaid pay for assisted living in Washington?
Medicaid can pay for services in a Washington assisted living facility only if the facility has a DSHS contract, through the Community First Choice option or the COPES waiver. Residents pay for their own room and board and keep a personal needs allowance, and DSHS pays the facility the difference up to its set rate.
Sources
- Washington DSHS: Assisted Living Facility Professionals, Residential Care Services (2026) (checked October 22, 2026)
- Washington DSHS: Assisted Living Facility Locator (2026) (checked October 22, 2026)
- Washington DSHS: ALF Reports page for a licensed facility, types of reports (2026) (checked October 22, 2026)
- Washington DSHS: Report Abuse and Neglect, Complaint Resolution Unit (2026) (checked October 22, 2026)
- Washington State Legislature (2013 version): WAC 388-78A-2060, Preadmission assessment, 2013 (checked October 22, 2026)
- WAC 388-78A-2070, Timing of preadmission assessment (Washington State Legislature), 2013 (checked October 22, 2026)
- WAC 388-78A-2090, Full assessment topics (Washington State Legislature), 2013 (checked October 22, 2026)
- WAC 388-78A-2480, Tuberculosis, Testing, Required (Washington State Legislature), 2013 (checked October 22, 2026)
- WAC 388-78A-2488, Tuberculosis, Reporting, Required (Washington State Legislature), 2013 (checked October 22, 2026)
- RCW 70.129.110, Disclosure, transfer, and discharge requirements (Washington State Legislature), 2021 (checked October 22, 2026)
- WAC 388-78A-2660, Resident rights (Washington State Legislature), 2025 (checked October 22, 2026)
- WAC 246-945-714, Medication assistance by nonpractitioners (Washington State Legislature), 2026 (checked October 22, 2026)
- RCW 18.79.260, Registered nurse, Activities allowed, Delegation of tasks (Washington State Legislature), 2025 (checked October 22, 2026)
- RCW 18.20.540, Memory care facilities, Certification (Washington State Legislature), 2025 (checked October 22, 2026)
- WAC 388-78A-2385, Certified memory care, Disclosure (Washington State Legislature), 2026 (checked October 22, 2026)
- Washington State Long-Term Care Ombudsman Program: home page (2026) (checked October 22, 2026)
- WAC 388-106-0015, What long-term care services does the department provide (Washington State Legislature), 2016 (checked October 22, 2026)
- WAC 388-106-0285, What do I pay for if I receive CFC services (Washington State Legislature), 2016 (checked October 22, 2026)
- WAC 388-106-0290, What does the department pay towards the cost of care when you are receiving CFC services and live in a residential facility (Washington State Legislature), 2016 (checked October 22, 2026)
- Washington DSHS: Assisted Living Facility Locator for Professionals and Providers, advanced search (2026) (checked October 22, 2026)
- RCW 18.20.020, Definitions (Washington State Legislature), 2025 (checked October 22, 2026)
- Washington DSHS: Assisted Living Facility Service Packages (2026) (checked October 22, 2026)
- WAC 388-106-0305, What services may I receive under COPES if I live in a residential facility (Washington State Legislature), 2019 (checked October 22, 2026)
- Washington DSHS: Long-Term Care Residential Options (2026) (checked October 22, 2026)
- CareScout: Cost of Care Survey 2025, Ranked Median Costs by State (2026) (checked October 22, 2026)