Assisted Living in Washington

Agency: Department of Social and Health Services/Aging and Disability Services Administration
Phone: (360) 725-2300
Website: http://www.adsa.dshs.wa.gov/professional/

A boarding home is any home or institution, however named, that is advertised, announced, or maintained for the express or implied purpose of providing housing, basic services, and assuming general responsibility for the safety and well-being of the residents, and may also provide domiciliary care for seven or more residents after July 1, 2000. However, a boarding home that is licensed for three to six residents prior to or on July 1, 2000, may maintain its boarding home license as long as it is continually licensed as a boarding home. A boarding home does not include any independent senior housing, independent living units in continuing care retirement communities, or other similar living situations including those subsidized by the U.S. Department of Housing and Urban Development.

Facility Scope of Care:
Boarding homes must provide the following basic services, consistent with the resident's assessed needs and negotiated service agreement: (1) Housing; (2) Activities; (3) Housekeeping; (4) Laundry; (5) Meals, including nutritious snacks and prescribed general low sodium diets, general diabetic diets, and mechanical soft diets; (6) Medication assistance; (7) Arranging for health care appointments; (8) Coordinating health care services with the boarding home's services; (9) Monitoring of residents' functional status; and (10) Emergency assistance. Boarding homes may provide the following optional services: (1) Assistance with ADLs; (2) Intermittent nursing services; (3) Health support services; (4) Medication administration; (5) Adult day services; (6) Care for residents with dementia, mental illness, and developmental disabilities; (7) Specialized therapeutic diets; and (8) Transportation services.

Move-In/Move-Out Requirements:
The boarding home may admit and retain an individual as a resident only if: (1) The boarding home can safely and appropriately serve the individual with appropriate available staff who provide the scope of care and services described in the boarding home's disclosure information and make reasonable accommodations for the resident's changing needs; (2) The individual does not require the frequent presence and frequent evaluation of a registered nurse, excluding those individuals who are receiving hospice care or individuals who have a short-term illness that is expected to be resolved within 14 days as long as the boarding home has the capacity to meet the individual's identified needs; and (3) The individual is ambulatory, unless the boarding home is approved by the Washington state director of fire protection to care for semiambulatory or nonambulatory residents.

Resident Assessment:
The boarding home must conduct a preadmission assessment before each prospective resident moves in. The preadmission assessment must include specified information, unless the information is unavailable. The boarding home must complete a full assessment addressing more detailed information within 14 days of the resident's move-in date.

Medication Management:
(1) All boarding homes must provide medication assistance services (differentiated from medication administration). Medication assistance may be provided by staff other than licensed nurses without nursing supervision. (2) Boarding homes have the option to provide medication administration services directly through licensed nurses or through formal nurse delegation. (3) Residents may self-administer medications, or the boarding home may permit family members to administer medications to residents. (4) Residents have the right to refuse medications. (5) Residents who have physical disabilities may accurately direct others to administer medications to them. (6) A boarding home may alter the form in which medications are administered under certain conditions. (7) Residents who are assessed as capable have the right to store their own medications. The boarding home must ensure that residents are protected from gaining access to other residents' medications. (8) Nurses may fill medication organizers for residents under certain conditions.

Physical Plant Requirements:
Resident rooms must be a minimum of 80 square feet for a single occupancy room and shared resident units must provide a minimum of 70 square feet per resident. Boarding homes receiving Medicaid funding under an assisted living contract with the state must provide a private room with a kitchen area and private bathroom. The room must be a minimum of 220 square feet, excluding the bathroom. Boarding homes with other contracts with DSHS/ADSA must meet the licensing requirements for room size.

Residents Allowed Per Room:
A maximum of four residents is allowed per resident unit for boarding homes licensed before July 1, 1989. For boarding homes licensed after this date, a maximum of two residents is allowed per unit. Under an assisted living contract with DSHS/ADSA, only one resident per room is allowed unless the resident requests to share the room with another person, such as his or her spouse.

Life Safety:
All facilities or portions of facilities proposed for licensure as a boarding home that initially submit construction review documents after July 1, 2005 are required to be protected by an automatic fire sprinkler system. All facilities or portions of facilities proposed for licensure as a boarding home are required to be equipped with smoke detectors in each sleeping room, outside each sleeping room, and on each level. The primary power source for these detection systems must be the building wiring system with battery backup. When these new facilities are to be licensed for more than 16 residents, then they are required to be provided with an approved manual and automatic fire alarm system complying with National Fire Protection Association 72. For all boarding homes first issued a project number by construction review services on or after Sept. 1, 2004, the boarding home must provide emergency lighting in all areas of the boarding home. Boarding homes constructed prior to 2004 are required to have emergency lighting or flashlights in all areas of the boarding home. Boarding homes also must have a current disaster plan describing measures to take in the event of internal or external disasters

Alzheimer's Unit Requirements:
Boarding homes must collect additional assessment information for residents who meet screening criteria for having dementia. Additionally, a boarding home that operates a dementia care unit with restricted egress must ensure that residents or a legally authorized representative give consent to living in such units, and: (1) Make provision for residents leaving the unit; (2) Ensure the unit meets applicable fire codes; (3) Make provisions to enable visitors to exit without sounding an alarm; (4) Make provisions for an appropriate secured outdoor area for residents; and (5) Provide group, individual, and independent activities.

Staff Training for Alzheimer's Care:
If a boarding home serves residents with dementia, the boarding home must provide specialized training with specific learning outcomes to staff who work with those residents.

Staffing Requirements:
The boarding home must have a qualified administrator who is responsible for the overall 24-hour operation of the boarding home. The boarding home must have adequate trained staff to: (1) Furnish the services and care needed by each resident consistent with his or her negotiated service agreement, (2) Maintain the boarding home free of safety hazards, and (3) Implement fire and disaster plans.

Staff Education Training:
Caregivers must complete an orientation program before having routine interaction with residents. The orientation provides basic introductory information appropriate to the residential care setting and population served. Caregivers must complete a basic training class and demonstrate competency in the core knowledge and skills that caregivers need in order to provide personal care services effectively and safely. DSHS/ADSA must approve basic training curricula. Caregivers must complete the basic training within 120 days of when they begin to provide hands-on personal care. Until competency in the basic training has been demonstrated, caregivers must have direct supervision when providing hands-on personal care. Caregivers must complete specialty training whenever the boarding home serves a resident whose primary special need is assessed as a developmental disability, dementia, or mental illness. The specialty training provides instruction in caregiving skills that meet the needs of individuals with mental illness, dementia, or developmental disabilities. Certified or registered nursing assistants who accept delegated nursing tasks must complete nurse delegation training. If the nursing assistant will be administering insulin through nurse delegation, he or she must complete the "Special Focus on Diabetes" course and successfully pass an exam with a score of 90 percent prior to assuming these duties. The nurse will continue to meet with the nursing assistant once a week for the first four weeks of delegation.

Medicaid Policy and Reimbursements:
A Medicaid home and community-based services waiver covers assisted living, enhanced adult residential care, and adult residential care contracted services in boarding homes that contract with DSHS/ADSA to serve Medicaid clients. Medicaid payments to boarding homes are based on the assessed needs of the residents. Additionally, boarding homes may contract with DSHS/ADSA to provide specialized dementia care.