Frequently Asked Questions

Yes. Guardians are subject to the jurisdiction of the court that appointed them. They can be removed for not acting in a client’s best interests or not following the court’s reporting procedures. Guardianships can be modified for a number of reasons, including a change in the client’s medical status or financial circumstances. Guardians can also be removed or limited in their duties if they become incapacitated in some way themselves. Legal action to remove a guardian is a serious step and may be appropriate. In some cases it may be suitable to explore other avenues to work with that person or agency.

You should not make specific recommendations about who would be a good guardian or attorney. Such recommendations can cause a conflict of interest or it can look like the state is penalizing guardians it doesn’t recommend. It is best to refer them to a local advocacy organization.

Yes.  Beginning 7/1/2012, DSHS must approve all instructors and curriculum for CE. You must have at least one DSHS approved CE instructor even if you will be using DSHS approved online CEs. Any CE that is not taught by a DSHS approved instructor with DSHS approved materials is invalid after 7/1/2012. 

Guardians are required to provide notice of a fee request to the HCS Regional Administrator or designee. HCS has the opportunity to object to the request at a hearing. After the court has reviewed and approved the fees they send an order to DSHS to adjust the client’s participation. The amount of money the client pays for his/her cost of care is then reduced by the monthly amount the court directed. This allows the client to use his/her income to pay the guardianship fees (by law, guardianship fees cannot be paid directly by the state).

If a guardianship was established by a tribal court, only that court has the authority to modify it. Each individual tribe has its own rules and regulations which it applies to guardianship issues. Because there are special rules governing who can appear before a tribal court, it is a good idea to work with the tribe’s social services staff when researching a guardianship issue. They may be able to bring the matter to the tribe’s attention informally and work with the state to solve the problem. You should consult your guardianship contact when any tribal issues arise.

APS staff should refer to Chapter 6 of the Long-Term Care manual, under Legal Protective Services and Remedies for the process APS must follow.

Registered nurses who wish to contract with the state are required to attend a free, all-day training session provided by the state. You must also complete a contract packet which you will receive at the class and provide the necessary documents (such as business license and proof of insurance) prior to being contracted.

For initial license applications, fill out and submit a completed Assisted Living Facility License Application – Initial License, along with the applicable license fee.

If you were licensed to operate an assisted living facility within the past 12 months, send a letter stating the assisted living facility name, assisted living facility license number and the type of contract(s) requested to the Business Analysis and Applications Unit (PO Box 45600, Olympia, WA 98504). An application is not required. If you already have an assisted living facility license but no contracts, fill out and submit a completed Assisted Living Facility Contract Application.

If you have at least one contract and want to apply for additional contracts, fill out and submit a completed Assisted Living Facility Contract Application – “Mini”. No fee is required for either contract application.

Licensed bed decreases can be requested by filling out and submitting a “Change in Status to the Assisted Living Facility Licensed Resident Bed Capacity or Licensed Rooms” form. The form is available at There is no fee to decrease the number of beds.

DSHS doesn't provide clients; you must market your services yourself. DSHS does distribute the current list of contracted delegating nurses to the case managers who authorize Nurse Delegation services for their Medicaid clients.

The business that sponsors the event must send in information to DSHS and get the conference, or seminar approved as a CE.  More information for business sponsors can be found in the CE - Curriculum Developer section of this site.

See a list of current conferences or seminars that have been approved for use as CE.

Send all CE curriculum to DSHS for approval.  The instructions for what to do and submit are included in the new CE Approval form.  This form cannot be submitted alone.  It must be submitted with a training program application, training program update form or a curriculum developer - CE application depending on your situation.

DSHS has to be notified of and approve all instructors of CE. You must have at least one DSHS approved CE instructor even if you will be using DSHS approved online CEs. This is done through the training program application or training program update form.  These forms have a CE instructor attestation where you confirm that instructors meet the required CE instructor qualifications.

Licensed bed increases can be requested by filling out and submitting a “Change in Status to the Assisted Living Facility Licensed Resident Bed Capacity or Licensed Rooms” form, along with the fee of $116 per additional bed. The fee may be prorated. The form is available at

Before the licensed bed capacity may be increased, you must: (1) obtain from Department of Health, Construction Review Services a review and approval of additional rooms or beds, and related auxiliary spaces, if not previously reviewed and approved; and (2) ensure the increased licensed bed capacity does not exceed the maximum facility capacity as determined by the department.

Once DSHS approves a CE, it is assigned a unique DSHS CE approval code.  This code is given to the curriculum developer/training program/conference sponsor that submitted the CE for approval.  It is the responsibility of the curriculum developer/training program/conference sponsor to ensure that the DSHS CE approval code is on the training certificate or transcript given to the worker that documents the CE is completed.

Without a DSHS CE approval code on the certificate or transcript, the CE cannot be used to meet the 12 hour CE requirement after 7/1/2012 except in the following case.

There are special cases where the hours taken from some required LTC worker courses can be applied towards CE.  When this is possible, the original course certificate serves as the required written documentation that the CE is approved by DSHS.  In these cases only, there will be no DSHS CE approval code required.   Learn more about when and how  LTC worker courses can be used as CE.  

You may obtain an assisted living facility license or contract application by calling the Business Analysis and Application Unit at (360) 725-2420. Assisted living facility license and contract applications are available at this website.

Guardianships are normally perpetual as long as the client remains legally incapacitated and as long as the guardian remains competent and meets the statutory requirements. Only an order of the court that initially established the guardianship can terminate it. If a guardian does not report regularly to the court the guardianship can become delinquent. Reports occur on a one, two, or three year basis and allow the court to ensure the guardian is making appropriate decisions and managing the client’s money properly. A guardianship can be inactivated by the court if the reporting requirements are not followed.

Once the guardian is appointed, they receive “Letters of Guardianship”. Often, the Letters terminate upon a date, which coincides with the date when the guardians’ next report is due. If the guardian fails to report and obtain renewed letters, and the previous letters expire, the guardian no longer has Court authority to act on behalf of the incapacitated person, although they remain legally liable for their actions. Consequently, when DSHS is informed that a guardian has been appointed for a client, it is a good idea for DSHS to obtain a copy of the order and most recently issued Letters of Guardianship.

Each assisted living facility application is unique. Because of this, it is impossible to predict how long the licensing process will take. Currently, the application process may take as long as 4-6 months.

State law gives DSHS the ability to set the maximum amount of fees it will allow for guardians and attorneys. In the WAC the Department set the maximum amount as $175/month for guardians and $600 for costs and attorney fees over a three year period. In order to pay guardians for occasionally performing “extraordinary” services, the WAC gives the court discretion to award “just and reasonable” fees in excess of the $175/$600 amounts.