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What is an Adult Family Home or AFH?

Adult Family Homes (commonly abbreviated to AFH) are residential homes licensed to provide personal care for up to six non-related individuals (commonly called “residents”). They provide room, board, laundry, supervision, and necessary help with activities of daily living, medication management, personal care, and limited social services. Sometimes people will refer to them as Adult Care Homes, Adult Foster Homes, and Residential Care Homes but in Washington State an AFH is specifically licensed to care for frail seniors, Developmentally Disabled (DD) or Mental Health persons .

Of all options available to seniors, an AFH is the least restrictive, and least expensive place, to care for the aging population. The appeal for most is that a family setting offers residents a familiar, real home setting that is comfortable and secure. The staff-to-resident ratio is 1:6 at minimum, compared to a nursing home where 1 caregiver may routinely be assigned 10 to 14 residents, and sometimes more!

Care Setting

Settings can vary from very luxurious million dollar homes with views, to small run-of-the-mill houses. Homes offer private rooms, rooms with baths, or shared rooms. Some homes offer larger spaces with more privacy but they may only be accessible by stairs; such spaces are most appropriate for residents who are ambulatory and more physically able. Don’t assume that a “fancy” home or high cost reflects the skills and abilities of the provider or the staff, as this is often not the case. In Washington State alone, there are over 2,800 State registered Adult Family Homes, so as you can imagine they come in all shapes and sizes.

As long as state requirements are met (WAC 388-76), providers are free to offer as much or as little care as they are capable or qualified to provide. However, homes that are owned and operated by nurses are typically able to provide care to higher acuity residents. There are also many ‘average-looking’ homes owned by excellent caregivers who are able to provide higher levels of care. Many providers will opt to coordinate skilled oversight with Visiting Nurse Services, Occupational Therapy, Physical Therapy, or hospice care providers. Mental Health Therapy can also be brought into the home when necessary.

What are the Personal Care Services Provided?

  • Daily assistance with bathing, grooming and dressing, toileting and walking.
  • Assistance with Medication
  • Continence Care and Management.
  • Escorts and assistance with walking and Transfer Assistance.
  • Array of Menus: Three delicious meals & snacks.
  • Dining assistance and special diets.
  • Behavior Management.
  • Assistance with reminders and redirection.
  • Access to health & medical services. Medical care and assistance within the guidelines of Nurse Delegation state law and Physician orders.
  • Housekeeping and Personal Laundry services.
  • Social and recreational activities.
  • Health promotion and exercise programs. Our caregivers follow Physical Therapist's discharge orders.

Many AFH's are also experienced Hospice Homes; Residents may transition into Hospice without having to move!

Type of Residents

Because Adult Family Homes are small family settings, residents who are noisy, disruptive, or aggressive may not be appropriate for some homes, but some providers are able to accommodate such resident if they specialize in this type of care. If a resident poses a safety risk to himself or others, he/she is usually not a good candidate for this type of setting.

Generally speaking however, residents in adult family homes should be stable and predictable. Residents with more complex medical issues should be admitted to homes owned and operated by an RN or LPN providers who have the necessary training and experience to deal with more acute and complicated medical issues.

About Providers

Washington State has some of the most stringent licensing requirements in the nation ensuring that our seniors receive some of the best care available. Adult Family Home providers must be licensed by DSHS (Department of Social Health Services) and adhere to strict rules and regulations as described in WAC 388-76. Licensed homes/providers are inspected by DSHS licensors on a yearly basis, and these inspections occur without prior notice – licensee must be in compliance at all times.

Additionally, the Washington Residential Care Council (WSRCC) recently introduced a professional certification program with training provided by the UW’s Northwest Geriatric Education Center. After obtaining this additional 52 credits including over 20 geriatric-related health topics, a provider will become a “Certified Adult Family Home Provider”. This new program greatly raises the quality of care for seniors in Washington State and gives providers yet more skills to deal with the ever-increasing complexity of their residents’ health needs.

General requirements to become a provider include: DSHS orientation course; fundamentals of care (20hrs); nurse delegation course (10hrs); first aid; CPR; administrator course (48hrs); ten hours of continuing education yearly; and a criminal background check. Many providers also have specialty training in dementia care, mental health, or developmental disability.

Who are the Owners/Providers?

Many Providers have nursing degrees; ARNP's, RN's, LPN's, as well as nursing assistant certificates; CNA's and NAR's. We take continuing education every year to renew our licenses. Larger numbers of us are furthering our education and have returned to school to become nurses or earn Geriatric accreditation. Many started out by caring for one of our own family members (father, mother, aunt, etc.) and continue on in this line of work because we've become attached to the Residents we care for. It's about the care! We care about Quality Assurance and hold ourselves to a higher standard! And, we consider it an honor and privilege to serve you and your families just as if you were our own!


Adult Family Homes are a great alternative to a nursing home environment and can even save you money! But with so many options available it’s hard to find the right one for you or your loved one. For a list of Adult Family Homes that are also members of Washington State Residential Care Council, visit Type in the zip code or city nearest you and you will find a list of those homes in your area.

Adult Family Homes/Assisted Living Facilities


Nursing Homes

Perhaps the number one disadvantage of nursing home care is the cost. Simply put, nursing homes are very expensive, and might actually be beyond the realm of possibility for many families.

The average nursing home cost in Washington for a shared room is $255 per day (over $90,000 per year!) and around $275 for a private room. According to MetLife, the 2008 National average for a nursing home private room is $212. This is more than many people in the United States make with dual incomes, working full time. The problem with this cost is that it is expected to nearly double within the next 20 years, making it difficult if not impossible for many older people to afford nursing home care without supplemental or long term care insurance.

In contrast, an Adult Family Home/Assisted Living costs around $155 per day (about $56,000 a year) and being privately owned small homes have much more flexibility in working with a family’s budget.

Another drawback of living in a nursing home is that you lose a lot of your independence. Even though you have certain rights and privileges, you are still forced to live within an institutionalized environment. You have to conform your schedule and lifestyle to the schedules, food choices and activities that the nursing home offers.

“Every AFH understands that just because a resident can’t live independently, that doesn’t mean all of their independence should be sacrificed.”

In contrast an Adult Family Home is small scale (with a maximum of 6 residents) so the residents have much more freedom to pick when they wish to get up in the mornings, meal times, activities, etc. The care given is conformed to the resident, NOT the other way around.

The third drawback of living in a nursing home is that you have to deal with the noises and problems of the other residents in the facility. You have to listen to them talk, scream, moan and you have to deal with their invading your privacy. This can be a hard fact of life to deal with when first moving to a nursing home.

Adult Family Homes however feel much more like the name implies, a FAMILY home. With a maximum of 6 resident (and an average of 4 per home) these homes are much more selective when taking new residents. Residents who are noisy, disruptive, or aggressive are not found in most Adult Family Homes, rather they go to an Adult Family Home that specifically provides this type of care.

While there are some very nice nursing homes in the country, many nursing homes are forced to meet the needs of far more residents than they have the funding for. This means that in some cases care is less than perfect. The cleanliness of the facility can be lax, the food can be subpar, mistakes can be made in regards to the distribution of medications and residents can be left alone for long stretches of time.

Adult Family Homes have a much smaller environment which means more care is given to residents and more supervision. The staff-to-resident ratio is 1:6 at minimum, compared to a nursing home where 1 caregiver may routinely be assigned 10 to 14 residents, and sometimes more!

How Do I Talk To My Parents About Senior Care Options?

I’m sure all can agree that one of the hardest decisions a child will ever have to make is moving their parents to a nursing home or assisted living facility. One of the main reasons being that most seniors have an unrealistic view that they are able to care for themselves for the rest of their life. This is where children or other family members can help in identifying the problem and work collectively to instigate change.

One of the best ideas is to start talking about future plans early on. By opening the lines of communication in the early stages, words like Adult Family Home begin to lose their sting in future conversations. Experts say that all too often children do not make it their problem and instead make it their parents’ problem. By talking about it and letting your mother or father know your concerns about them living alone you will achieve better results rather than telling them what they will or will not do.

“Tip 1: Start talking about future plans early on!”

Most parents do not want to burden their children and as a result will often respond to this honest communication method. It is common for some parents to hide things from their children in an effort to avoid scaring them. But if their children come across as being an advocate and showing their genuine concern about their parents it will make making the hard decisions much easier.

Dealing With a Resistive Parent

Psychologists who counsel individuals in situations of having to move an elderly loved one, know the difficulties all too well. They however, conclude that while there are no tricks or magic strategies in persuading an elderly loved one to move, by having children ask their parent or loved one to indulge them in visiting an Adult Family Home or assisted living facility, it will greatly decrease the tensions for all.

When placed under duress, the majority of us will resist regardless of how sound a plan or another person’s arguments are. With that said, psychologists believe that by encouraging parents to visit Facilities, they will more than likely move to a different location and/or change their lifestyle if they feel that they have done this on their own accord.

If a loved one is refusing to even entertain the idea of moving, then psychologists suggest that the child back off and seek out other opportunities to bring the issue up in non~confrontational ways.

In many instances, psychologists believe that things may have to get worse before they get better. It may take a parent, falling, being spooked by burglars or even having the electricity turned off as they simply forgot to pay the bill. While this is not always the case, it can wake up a stubborn parent who is refusing to move. However, it may also be necessary for healthcare providers or other family members to encourage the parents to move to an assisted living facility.

Creating a Care-giving Team

The truth is that care-giving is a family responsibility and needs to include all siblings and immediate family members such as aunts and uncles. It is important for all of these family members to address the ailing loved ones situation, by initially coming together and discussing the problem without the loved one being present.

It is important during this meeting to address financial issues, who will act as the elders Durable Power Of Attorney for healthcare issues, and one individual should be delegated to make critical decisions. While experts agree that this needs to be a family approach, they advised that one person should be the primary advocate for the loved one in need of care. This individual, regardless of who they are needs to be able to make final decisions and act as the Durable Power Of Attorney for health care needs.

“It’s up to the family to decide which person should be the primary advocate for the loved one in need of care.”

Regardless of how smooth the move of a loved one to a care facility goes, many children retain guilt for moving their parents into such a facility. Even though a child may have promised their parent or loved one that they would never put them in such a place. At this point the decision needs to be based on what is best for the loved one to maintain a quality of life.

Thankfully with so many great a viable options in Washington State there are many facilities for your parents that you will feel proud to help them move into.

We at Aspen Quality Care would love to be that perfect home for your loved one,

a home that eases your mind and ensures not only quality care, but also a greater quality of life. Many of our clients (much to their surprise) find that their loved ones thrive within the Adult Family Home environment.