What this helps with

Most families start looking for a care home in a hurry, after a fall or a hospital stay, with a discharge planner asking for an answer by Friday. It goes so much better when you have looked first, know what things cost and how Medicaid works, and have somebody to call.

This guide gives you all of that for anywhere in Washington. For every county you will find the free local help line, the Medicaid office, the watchdog and the state search that lists every licensed home. For Island and Skagit counties I have also named every licensed adult family home, assisted living and memory care, with which ones take Medicaid.

Sources: the Administration for Community Living, How Much Care Will You Need; the CareScout 2025 Cost of Care Survey for Washington, released March 2026; the DSHS licensing records published on the Washington Geospatial Open Data Portal, read 25 September 2026; and WAC 182-503-0060 on application timelines.

The three kinds of home, side by side

A nursing home is the step beyond all three, for people who need a nurse available around the clock or skilled rehab. Medicare pays for a short rehab stay after a hospital admission. It does not pay for any of the three homes above.

What is usually extra. Incontinence supplies, a higher level of care as needs grow, medication management fees, transport, hair appointments, cable and phone. Ask for every charge in writing.

What it costs, and who pays

From the CareScout 2025 Cost of Care Survey for Washington. Nobody publishes a reliable median for memory care or adult family homes in Washington. In my experience both vary widely, so get every rate sheet in writing and compare them side by side.

• Private pay. Income, savings, or the sale of a home. Most people start here.
• Long-term care insurance. Read the policy for the words adult family home and assisted living, and ask how long the waiting period is before it pays.
• WA Cares Fund. Benefits began on 1 July 2026. Up to $36,500 over a lifetime, rising with inflation, for people who have paid in long enough and need help with three or more daily activities. It can pay adult family homes, assisted living and memory care directly, and it does not count against Medicaid. Call 844-227-3492 (844-CARE4WA).
• Veterans. The VA Pension with Aid and Attendance pays up to $29,093 a year for a single veteran and $18,697 for a surviving spouse, from 1 December 2025. Call the VA on 1-800-827-1000 or ask a county veterans service officer.
• Medicaid. Pays for care in adult family homes, assisted living and memory care that hold a Medicaid contract. The next section explains how.

Medicaid and spend down, plainly

In Washington, Medicaid for long-term care goes by the program names COPES, Community First Choice and Medicaid Personal Care. You do not need to remember them. What you need to know is that Medicaid pays the home a daily care rate, and the person pays toward room and board from their own income. These are the 2026 figures.

• Spend down means paying fair value for real things. Paying the care home privately, paying off debts, repairing the house, buying an irrevocable prepaid funeral, or buying needed things like hearing aids, a wheelchair or clothing. What you cannot do is give money away.
• Gifts cause a penalty. Money given away in the last five years delays Medicaid by about one day for every $462 given. Gifts to a spouse, and some to a disabled child or a caregiver child, are exempt.
• There is no back-dating for adult family homes or assisted living. Medicaid starts on the day the state finds the person eligible, both financially and for care needs. Apply about 45 days before the money will run out.
• Ask every home for its Medicaid policy in writing before you sign. Assisted living must give it to you on a separate page in large print. The real question is: if we pay privately now and later qualify for Medicaid, can my person stay in the same room?
• A little protection exists. If an assisted living leaves the Medicaid program, it cannot use that to evict current Medicaid residents, or residents who paid privately for two years and become eligible within 180 days.
• Estate recovery. After death the state can recover what Medicaid paid for care after age 55 from the estate. It waits while a spouse, a child under 21 or a disabled child survives, and hardship waivers exist.
• How to apply. Online at washingtonconnection.org if the person is 65 or older or on Medicare, or call the Home and Community Services office for your county, listed in your results above. A case manager will then visit to assess care needs.

Figures from the Health Care Authority's income and resource standards effective 1 January 2026, WAC 182-513-1363, RCW 18.20.440 and DSHS publication 14-454. I am not a lawyer or a financial adviser. With a house, a spouse at home or any gifting, please speak to an elder law attorney before you move money.

How to tour a home

Before you go

1. Call first. Ask whether they have an opening for someone with your person's needs, whether they take Medicaid now or later, and what the monthly cost starts at. Three homes that say yes are enough to start.
2. Look the home up on the DSHS search, listed in your results, and read its inspection reports and any enforcement letters. A long clean record is a good sign. One citation is not a reason to rule a home out. Ask them about it.
3. Ask them to email the Disclosure of Services and, for adult family homes, the Disclosure of Charges. These show what care they can and cannot give and what it costs.
4. Book the tour at a mealtime, and bring your worksheet.

On the tour

1. Use your senses. Does it smell clean? Is it calm? Are call lights answered quickly?
2. Watch the staff with residents, not with you. Do they kneel to eye level, use names, knock before entering?
3. Eat the meal if they offer. Look at what is on the plates of people with special diets.
4. Talk to a resident or a visiting family member if you can.
5. Ask the questions below, and write the answers in your notes.

After the tour

1. Go back once more, unannounced, at a different time of day. Evenings and weekends show you the real staffing.
2. Compare rate sheets side by side, including what happens to the price as care needs grow.
3. Read the admission agreement before anyone signs. Deposits, move-in fees and minimum stays must be disclosed in writing to be kept, and refunds are due within 30 days of leaving.
4. If you are unsure, ask for a short respite stay first. Many homes offer one.
5. Call the long-term care ombuds for your county. They cannot recommend a home, but they can tell you what to look out for.

How I can help

Choosing a care home is one of the biggest decisions a family makes, and it is usually made fast and tired. This is the work I do, and I am glad to do all of it or just one piece.

• Sort the list with you. We go through your worksheet together and narrow it to the three homes worth touring.
• Come on the tour, or go for you. A second pair of eyes that knows what to look for, especially helpful when family lives far away.
• Read the paperwork before you sign. The disclosure forms, the rate sheet, the Medicaid policy and the admission agreement, in plain language.
• Keep the Medicaid timing on track. I help you gather documents, work with the Medicaid office and your attorney, and keep the application moving so there is no gap in paying for care.
• A food and nutrition profile. A one page summary of diet needs, textures, allergies, favorite foods and cultural dishes, to hand to the kitchen on day one and check at every care plan meeting.
• The first 30 days. Check-ins after the move, so small problems get fixed while they are small.