Washington assisted living facility license: DSHS rules, fees and steps

Seven residents: where the license starts

Chapter 18.20 RCW defines an assisted living facility as any home or institution that is advertised or kept for “providing housing, basic services, and assuming general responsibility for the safety and well-being of the residents,” and that may also give domiciliary care, “to seven or more residents.”⁠¹ Basic services are housekeeping, meals, nutritious snacks, laundry and activities.⁠¹ A grandfather clause lets a few homes licensed for three to six residents on or before July 1, 2000 keep their ALF license as long as it never lapses. Nobody can get a new three-to-six-bed ALF license today.⁠¹

The DSHS rule makes the trigger more specific. You need the license whenever someone other than a family member provides housing, at least one basic service, and at least one of these:⁠²

• general responsibility for residents’ safety and well-being;
• help with activities of daily living, directly or indirectly;
• health support services; or
• intermittent nursing services.

Running an ALF without a license is a misdemeanor, and each day counts as a separate offense.⁠¹

If you are planning six beds or fewer

If you are planning a house with two to six residents, this is the wrong license. That size is an adult family home under chapter 70.128 RCW, a separate DSHS license that also allows up to eight residents with DSHS approval.⁠¹³ See the Washington adult family home guide.

Independent living and services to nonresidents

Washington lets senior housing operators offer some services without becoming an ALF. Housing under an ordinary landlord-tenant agreement (chapter 59.18 RCW) does not need the license. Neither does a list of services that “nonresident individuals” can request: emergency assistance on an intermittent basis, emergency-response technology, blood pressure checks, nursing assessments to decide on a referral, appointment reminders, medication reminders and container opening, nurse-prefilled insulin syringes, fall assessments, nutrition education, dental services and wellness programs.⁠² Once you start ongoing assessment, care planning or monitoring of someone’s well-being, you need the license.⁠²

A licensed ALF may also run adult day services on its premises for nonresidents, including its own independent-living tenants. The limit is ten continuous hours with no overnight stay.⁠¹⁠²

Home care inside the building

If you plan to bring in personal care or nursing through an agency instead of your own staff, that agency must hold its own license under chapter 70.127 RCW, which the Department of Health administers.⁠² This guide does not cover that license; ask the agency for its license number before you sign a contract.

No certificate of need, but the building is reviewed first

Washington’s certificate of need law covers hospitals, nursing homes, hospices, home health agencies and a few other facility types. Assisted living facilities are not on the list, so you do not need state approval of need before building.⁠⁸

The real gate is the building. The ALF application must include “verification that construction plans have been approved by construction review services.”⁠² Construction Review Services (CRS) is part of the Department of Health. The rules in WAC 388-78A-2821 set the order:⁠²

1. Architect

   Drawings and specifications for new construction must be prepared by, or under the direction of, a Washington-registered architect. A registered engineer can stand in only for limited scopes of work.

2. Presubmission conference

   For projects worth $250,000 or more, you must request and attend a presubmission conference. Plan it for when the construction documents are at least 50% complete.

3. Construction documents

   Send them to CRS within ten days of sending them to the local building department. The package must include a written functional program (WAC 388-78A-2361) covering the services you will offer, any Medicaid contract residents and the care needs of the people you plan to serve. It must also state how many units are designed for staff-assisted movement, bathing and toileting.

4. Authorization to begin

   Do not start construction until CRS has approved the documents or issued an “authorization to begin construction” and the city or county has issued a building permit.

5. Closeout

   No resident may use new or remodeled space until CRS has approved the documents and the local jurisdiction has approved occupancy. You must also send DSHS written notice of completion with the occupancy approval, reduced floor plans and a room schedule.

Meeting the state rules does not excuse you from local building and zoning codes. A newly licensed ALF must meet “all current state and local building and zoning codes.”⁠² Fire safety standards come from the Washington State Patrol’s director of fire protection, not DSHS.⁠¹

If you convert an existing unlicensed building, the fee is based on the value of the existing construction per square foot, run through the same table.⁠⁶ On 2026-10-12, CRS listed an expected review time of 40 days per submission. It warns that most projects take several submissions.⁠⁷

Physical requirements to design around

These WAC 388-78A rules shape the floor plan:⁠²

• Units. A unit can hold no more than two residents. Allowed layouts are a studio, a companion unit, or a one- or two-bedroom unit. Doors need lever hardware and the option of a lockable entry. No resident may walk through another resident’s unit or bedroom to reach their own.
• Bedroom size. At least 80 square feet of usable floor space for one person, and 70 square feet per person in a shared room. Two residents may share a bedroom inside a private apartment of at least 220 square feet (not counting the bathroom) if both agree.
• Shared bathrooms. For residents without a private toilet, provide one toilet and one handwashing sink per eight residents. For residents without a private bathroom, provide one bathing fixture per 12 residents. Every toilet and bathing fixture needs grab bars, and bathrooms need mechanical ventilation to the outside.
• Multiple buildings. One license can cover several buildings only if they sit on the same parcel or on contiguous land that no public street divides. Otherwise, each building needs its own license.
• Nursing home conversions. A converted nursing home must meet the ALF building rules. The exception is when the operator holds an enhanced adult residential care contract. Then the last nursing home inspection can stand in, but bathing and toilet ratios, the call system, room door closures and windows must still meet ALF standards.

If you want Medicaid residents under the “assisted living services” contract, design for that from the start. That contract requires private apartment-style units of at least 220 square feet, a private bathroom, a lockable door and a kitchen area with a refrigerator, a cooking appliance and a sink.⁠¹⁰

Memory care: a second approval since July 1, 2026

Since 2025, chapter 18.20 RCW has required certification of memory care. After July 1, 2026, no one may operate a memory care facility or memory care unit without a DSHS certification.⁠¹ The definition is broad. It covers any ALF that markets or represents itself as giving memory or dementia care, whatever its name. It also covers any facility where part of the building has restricted egress that keeps residents with cognitive impairment from leaving without staff.⁠¹ If your design includes a locked or alarmed secure unit, plan on certification.

To be certified, the ALF must:⁠¹⁠²

• hold a valid ALF license, with no pattern of uncorrected serious citations or significant civil fines, and no stop placement or care-related license conditions;
• have permanent infrastructure for residents with dementia, including elements to prevent elopement;
• have a staffing plan with awake staff 24 hours a day, and at least one awake staff member in each separate building or cottage;
• have policies on residents who wander, missing residents, and the clinical consultants (such as psychologists, psychiatrists or psychiatric nurse practitioners) it will use for behavioral challenges.

To keep the certification, the facility must do full assessments of memory care residents at least every six months. Each worker serving those residents needs six hours of dementia continuing education a year. Residents must get daily individual, group and self-directed activities and access to common areas, at least one of them outdoors.⁠¹ Using terms like “memory care facility” without a certificate can bring civil penalties of up to $10,000.⁠¹

A new ALF applies for certification together with its license application, at least 90 days before the proposed certification date.⁠²⁠¹¹ A DSHS provider letter dated February 26, 2026 sets the initial certification fee at $331, due when the application is submitted, and annual recertification at $676 per memory care facility or unit. The April 2026 draft application repeats the $331 fee and tells new facilities to send the certification application and fee with the ALF application.⁠¹²⁠¹¹

Who can hold the license and who can run the building

The licensee

DSHS treats every person named in the application as an applicant, “separately and jointly.” It can review inspection and complaint records for any facility tied to the applicant or to any partner, officer, director, managerial employee or owner of 5% or more.⁠² Applicants must pass a Washington name and date-of-birth background check and a national fingerprint check before they are licensed.⁠² Form 10-591 also asks whether anyone named has been excluded from Medicare or Medicaid, has been barred by court order from caring for vulnerable people, has faced professional discipline, or has a finding for abuse, neglect or exploitation.⁠⁵

A financial attestation, signed under penalty of perjury, must state that the applicant is not insolvent or bankrupt and will run the facility lawfully “despite any limitation or insufficiency of funds.” An officer, director or 5%+ owner must sign it. A management company or the administrator may not.⁠⁵

Liability insurance

From licensure onward, the facility must carry commercial general (or business) liability insurance. It must cover employees and volunteers, with limits of at least $1 million per occurrence and $2 million in aggregate.⁠² If the licensee holds a professional license or employs licensed staff such as nurses, professional liability (errors and omissions) insurance is also required, with the same $1 million / $2 million minimums.⁠² Proof of insurance is one of the application attachments.⁠⁵

The administrator

The administrator must be at least 21 and may not live in the facility. They must also meet one of these qualification routes:⁠²

“Certification of training” means a recognized administrator course of at least 24 hours, or a passed administrator exam from or endorsed by a national organization. The rule lists the American College of Health Care Administrators, the American Health Care Association and NAB as examples.⁠²

The “qualifying administrator training program” is an apprenticeship. You notify DSHS before it starts. It then runs at least six months. The trainee works full-time in an ALF and spends at least 40% of that time on administrator duties. The supervising administrator works on site and logs at least 100 direct contact hours with the trainee.⁠² The administrator must also complete the long-term care worker training in chapter 388-112A WAC.⁠²

The application packet (DSHS 10-591)

Before you fill in the form, DSHS expects three registrations: a federal EIN (a copy of the IRS SS-4 is accepted), a Washington Unified Business Identifier, with a business license showing the facility’s trade name, and a Certificate of Formation or Incorporation from the Secretary of State.⁠⁴⁠⁵

The 10-591 checklist asks for numbered attachments, including:⁠⁵

• the per-bed license fee, or a letter from the current licensee transferring the rest of its fee (change of ownership);
• the Individuals Affiliated with Applicant form, an organizational and chain-of-ownership chart, and compliance history;
• the financial attestation;
• background check authorizations for everyone with possible unsupervised access, the DSHS fingerprint result letter, and any “agreement not to have unsupervised access”;
• property ownership proof, or the real property, lease or operating agreement attestations with a copy of the lease (a draft is accepted);
• a management agreement attestation with the agreement (a draft is accepted), if a management company will run the building;
• your Disclosure of Services (DSHS 10-351) and your resident agreement;
• proof of liability insurance;
• the Policies and Procedures Attestation (DSHS 16-197).

Do not send your policy manual. DSHS asks only for the signed attestation that your policies exist and comply with the listed laws.⁠⁵ Mail the packet to HCLA Finance and Contracts, PO Box 45600, Olympia, WA 98504-5600. Send questions to the Business Analysis and Applications Unit (BAAU) at (360) 725-2573 or [email protected].⁠⁵

Use the revision of form 10-591 currently posted on the DSHS page. DSHS announced that from May 1, 2026 it would reject applications whose revision date does not match the one it names, and that notice still names Rev. 03/2026, while the form posted on 2026-10-12 was Rev. 07/2026. Confirm the accepted revision with BAAU before you mail the packet.⁠³⁠⁵

Fees as published on 2026-10-12

The statute does not fix the per-bed fee. Since July 1, 2011, the legislature has set it in the biennial omnibus appropriations act, capped at DSHS’s licensing and oversight costs.⁠¹ For example, an 80-bed building would owe $30,480 a year at the $381 rate.

From empty lot to license: the order that works

1. Form the entity and register

   Get the Secretary of State certificate, the UBI and trade name, and the EIN. BAAU wants all three before you apply.⁠⁴

2. Design with CRS

   Hire a Washington-registered architect, write the functional program, and request the presubmission conference if the project is $250,000 or more.⁠²

3. File plans with CRS and the local building department

   File with CRS within ten days of the local filing. Pay the CRS fee and start construction only after both CRS authorization and the local permit.⁠²⁠⁶

4. Line up the people

   Choose a qualified administrator. Start fingerprint checks for every applicant and for the administrator. Bind the required liability insurance.⁠²⁠⁵

5. File DSHS 10-591 at least 90 days before opening

   The rule minimum is 90 days, but the form warns that processing “may take as long as four (4) to six (6) months.”⁠²⁠⁵ On 2026-10-12, BAAU said it was processing applications received in June 2026.⁠⁴ If you plan a secure dementia unit, include the memory care certification application.⁠¹¹

6. Answer DSHS requests quickly

   DSHS may treat an application as void if you do not answer a request for missing information within 60 days. If the application sits for more than a year, you must update it.⁠²

7. Close out construction

   Send DSHS written notice of completion with local occupancy approval, reduced floor plans and a room schedule.⁠²

8. License issued

   DSHS may issue a full license or, if you are not fully compliant, a provisional license for up to 12 months that cannot be renewed.⁠¹ If you are denied, you have 28 days to request a fair hearing.⁠⁵

If you also want Medicaid residents, a separate contract application must reach DSHS at least 90 days before the requested contract start (see below).⁠¹⁰

Staffing and caregiver training

Washington sets no fixed staff-to-resident ratio for ALFs. The rule requires “sufficient, trained staff” to deliver each resident’s negotiated service agreement, keep the building free of hazards and carry out fire and disaster plans.⁠² The firm minimums are:⁠²

• At least one caregiver aged 18 or over, with current CPR and first-aid cards, present at all times when any resident is on the premises, and during off-site facility activities.
• Written job descriptions, verified references and verified credentials before hire.
• Weekly staffing schedules, as planned and as worked, kept for 12 weeks.

Washington’s long-term care worker training system applies to administrators (or their designees) and caregivers hired on or after January 7, 2012. That means orientation and safety training, basic training, specialty training for dementia, mental illness or developmental disabilities when you serve those residents, CPR and first aid, and continuing education. These workers must also get the home care aide certification.⁠² The entry-level requirement is 75 hours of DSHS-approved training within 120 calendar days of hire. Five of those hours must be done before the worker gives any care.⁠⁹ Registered nurses, LPNs and certified nursing assistants are exempt from basic training but not from all continuing education.⁠²

Administrators and caregivers hired after January 7, 2012 need both the Washington name and date-of-birth check and the national fingerprint check. Other staff, volunteers and students with unsupervised access need the name and date-of-birth check.⁠²

Who you can admit and keep

An ALF may admit or keep a resident only if the facility can safely serve them within the services it has disclosed. The resident must also not need the “frequent presence and frequent evaluation of a registered nurse.” The exceptions are hospice patients and short-term illnesses expected to resolve within 14 days.⁠² Residents must be ambulatory unless the state director of fire protection has approved the building for semi-ambulatory or non-ambulatory residents.⁠² This approval affects construction, so decide early whether you will serve wheelchair users who cannot evacuate on their own. The statute also bars admitting or keeping anyone who needs the level of care given in a nursing home or hospital.⁠¹

You must disclose the scope of your care and services on the standardized DSHS disclosure form (DSHS 10-351). Give it to residents and their representatives, and to interested consumers on request.⁠¹⁠³ Each ALF must also keep a comprehensive disaster preparedness plan. It must cover fires, earthquakes, floods, extreme heat and cold, infectious disease outbreaks and loss of power or water. Review it every year and train every employee on it when they start.⁠¹

Getting paid through Medicaid

Washington pays for Medicaid residents through DSHS contracts under chapter 388-110 WAC, not through a separate license. There are three contract types: assisted living services, enhanced adult residential care (with a specialized dementia care variant), and adult residential care.⁠¹⁰ To apply, you need an ALF license or a pending application. Submit the contract application at least 90 days before the requested start and list every licensed care facility that owners of 5% or more, officers, directors or managers have been tied to in the past ten years.⁠¹⁰ DSHS must also weigh “funding from the legislature available” when it decides, so a contract is not guaranteed.⁠¹⁰

Since January 1, 2026, ALFs must give residents who have Medicaid as a payer a written residency agreement. The agreement must give eviction and appeal protections comparable to the Residential Landlord-Tenant Act. Discharge notices to these residents must state their right to legal assistance and the long-term care discharge defense screening line, (888) 437-0017.⁠³ The licensing rules and the 10-591 application do not state Medicaid daily payment rates, and the DSHS contract page could not be read for this guide. Ask DSHS for the current daily rate for each contract type before you build a budget around Medicaid residents.

Inspections, renewals and changes after opening

DSHS inspects each ALF at least every 18 months, with an annual average of 15 months. After three inspections in a row with no violations and no violations from complaints, it can stretch the interval to 24 months. Unannounced inspections can happen at any time.⁠¹

The license lasts at most 12 months. Send the renewal application at least 30 days before it expires, with the annual per-bed fee.⁠² To add beds, submit a request at least one day before the change and pay the prorated fee within 30 days. Before that, CRS must approve any rooms it has not already reviewed.⁠² If you change how a room is used, give CRS 30 days’ written notice and get its approval.⁠² In a change of ownership, the buyer must submit a change of ownership application before the change date, with evidence of control of the real estate. The seller writes a letter relinquishing its license and may let the buyer use the rest of its fee.⁠²⁠⁵

What changed recently

• Memory care certification (2025 law, in force July 1, 2026). RCW 18.20.540 to .560 and WAC 388-78A-2383 to -2389 created the certification. For facilities already running memory care that applied by July 1, 2026, DSHS may treat them as compliant from the application date while it processes the application, and may grant conditional exemptions.⁠¹⁠²
• Medicaid residency agreements (January 1, 2026). New rules apply federal home and community-based settings requirements to ALF residents with Medicaid.⁠³
• Application form revisions (2026). DSHS has updated form 10-591 twice in 2026 and rejects outdated versions.⁠³⁠⁵

Sources

1. 1
   Washington State Legislature, Chapter 18.20 RCW (Assisted living facilities) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Washington State Legislature, Chapter 388-78A WAC (Assisted living facility licensing rules) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Washington State Department of Social and Health Services, Assisted Living Facility Professionals Checked 12 Oct 2026 · Back to text ↑
4. 4
   Washington State Department of Social and Health Services, BAAU Application Processing Timeline Checked 12 Oct 2026 · Back to text ↑
5. 5
   Washington State Department of Social and Health Services, Assisted Living Facility License Application (DSHS 10-591, Rev. 07/2026) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Washington State Department of Health, Plan Review Fees (Construction Review Services) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Washington State Department of Health, Construction Review Services Checked 12 Oct 2026 · Back to text ↑
8. 8
   Washington State Legislature, RCW 70.38.025 (Certificate of need definitions) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Washington State Legislature, RCW 74.39A.074 (Long-term care worker training requirements) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Washington State Legislature, Chapter 388-110 WAC (Contracted residential care services) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Washington State Department of Social and Health Services, Certification of Memory Care Services application (DSHS draft, April 2026) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Washington State Department of Social and Health Services, Certification of Memory Care Services Application (DSHS provider letter ALF #2026-009) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Washington State Legislature, RCW 70.128.010 (Adult family home definitions) Checked 12 Oct 2026 · Back to text ↑

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