Frequently Asked Questions

Maximum facility capacity is the maximum number of individuals that the assisted living facility may serve at any one time, as determined by the department. The maximum facility capacity includes all residents, all respite care residents, and all adult day care clients. Refer to WAC 388-78A-2020 for calculating maximum facility capacity.

The Nurse Delegation Program, under Washington State law, allows nursing assistants working in certain settings to perform certain tasks--such as administration of prescription medications or blood glucose testing--normally performed only by licensed nurses. A registered nurse must teach and supervise the nursing assistant, as well as provide nursing assessments of the patient's condition.

Any nurse registered in Washington State may delegate, but s/he may only do so according to the laws (RCW 18.79.260) and regulations (WAC 246-840-910 to 970) written by the Nursing Commission.

Some registered nurses contract with DSHS to provide this service. They agree to see Medicaid clients living in adult family homes, and are paid directly by the state to provide this service.

The court has the ultimate authority in all guardianship related issues, including approval of all fees and costs. Courts review a guardian’s actions to ensure the guardian always acts in the best interests of the client. The courts also act as a final decision maker when the state and a guardian disagree on guardianship issues.

Adult residential care (ARC) is a package of services provided by an assisted living facility that is licensed under Chapter 18.20 RCW and that has a contract with the department under RCW 74.39A.020 to provide personal care services.

Enhanced adult residential care (EARC) is a package of services provided by an assisted living facility that is licensed under Chapter 18.20 RCW and that has a contract with the department to provide personal care services, intermittent nursing services, and medication administration services in accordance with Parts I and III of Chapter 388-110 WAC.

Assisted living services is a package of services provided by an assisted living facility that has a contract with the department under RCW 74.39A.020 to provide personal care services, intermittent nursing services and medication administration services in accordance with Parts I and II in Chapter 388-110 WAC. Assisted living services include housing for the resident in a private apartment-like unit.

Personal care services means the same as personal care services defined in WAC 388-72A-0035. Personal care services do not include assistance with tasks that must be performed by a licensed health professional.

The license fee is $116 per licensed bed. The fee is calculated by multiplying the number of licensed beds by $116. For initial applications, this fee is due when the application is submitted.

A person gives informed consent when he/she provides health care authorization for a person not competent to do so themselves. HCS/APS staff are not able to make these decisions for their clients. You should first work with the health care provider and explain the situation and give an honest assessment of the ability of the adult to make this decision. If the hospital refuses to treat a client due to concerns with his/her ability to consent to treatment, state law lists those persons authorized to make the decision for them. They are:

  • Legal guardians;
  • Someone holding a durable power of attorney for health care;
  • A spouse;
  • Children of the adult at least 18 years old;
  • Parents;
  • Adult brothers or sisters.

You should contact these people in the order above since the decisions of those listed first take priority over the others. If it is an emergency and the hospital or facility won’t act, APS/social work staff and the Attorney General’s Office can petition the court for appointment of a guardian ad Litem to make the decisions.

  • Guardianship of Estate: responsible for financial and estate matters only.
  • Guardianship of Person: responsible for non-financial decision making.
  • Guardianship of Person and Estate: a full guardianship of person and estate.

Limited guardianship: the court can choose to let an incapacitated person retain any rights it feels he/she is capable of exercising on his/her own.

Co-guardianship: can be of person, estate, or both. This is when two persons share the decision making responsibility equally.

Training is scheduled every month except October and December. Trainings are held in locations where delegating nurses are needed. See the current training schedule.

  • A guardianship may be established only if the person is legally “incapacitated.” A person is deemed incapacitated when “the individual has a significant risk of personal harm based upon a demonstrated inability to adequately provide for nutrition, health, housing, or physical safety.” A person is deemed incapacitated as to his/her estate when “the individual is at significant risk of financial harm based upon a demonstrated inability to adequately manage property or financial affairs.” Merely because a person makes poor decisions does not necessarily mean he/she will be found legally incapacitated. A person with capacity is free to make poor choices of his/her own accord.
  • Standby guardian: this person has no decision making authority unless the primary guardian is unavailable (usually when emergency health care decisions must be made).
  • Resident Agent: This is a Washington resident chosen to receive service of process on guardianship matters for a guardian who lives out of state. This person has no decision making authority.
  • Parent: After a client is 18 years old, he/she is an adult and his/her parents are no longer the client’s legal guardians. Parents do retain the ability to make informed consent decisions if no legal guardian has been appointed. Parents must petition the court if they want to remain the legal guardians.

To be a guardian you must be 18 years or older, of sound mind, not convicted of a felony or gross misdemeanor involving dishonesty or immorality, and found suitable to perform a guardian’s duties by the court. The Court may consider other factors as well. If you are not a Washington resident, you must designate an in-state agent for service of process. A corporation can be a guardian if it is authorized to act as a fiduciary. If you are being paid to be guardian for three or more persons who are not your family members, you cannot be a guardian unless you are certified. Current DSHS employees should not be paid guardians without complying with Administrative Policy 18.18 on outside employment. If an employee wants to be an unpaid guardian for a person who is a DSHS client, consult with your supervisor in order to ensure no conflicts of interest will arise between your duties as a guardian and your responsibilities as a DSHS employee.

Information regarding the assisted living facility application process can be obtained by writing to the Business Analysis and Application Unit, P.O. Box 45600, Mail Stop: 45600, Olympia, WA 98504-5600 or calling (360) 725-2420. WAC and RCW information is available at

The guardian and the incapacitated person work together to protect and enhance that person’s life. In most instances, the guardian has the final say on issues involving the incapacitated person. The guardian is directed in his or her decision making by what the incapacitated person would have done in such instance, were he or she not incapacitated. Consequently, it is important for the guardian to consider the incapacitated person’s expressed wishes, if the incapacitated person has that ability. When disputes arise, case managers may try to work together to craft a compromise that protects the client’s best interests. If this is unsuccessful a court will hear the dispute and decide the issue. The dynamics of this relationship can vary depending on the capacity of the client and where he/she is living.

For application purposes, background check authorization forms are required for individual applicants, entity owners, partners, officers, directors and managerial employees, group or association members, and the administrator.

It is the licensee’s responsibility to require and submit background check authorization forms on all individuals associated with the assisted living facility who have unsupervised access to residents, including, but not limited to, employees, managers, volunteers who are not residents, contractors, and students.

The application must be signed by the individual applicant, or by an officer, director, member, partner, or owner of 5% or more of the entity applicant who has signature authority. The signature of the administrator does not meet the requirements if the administrator does not have 5% or more ownership in the entity.