Last updated 2026-07-25
TL;DR
Washington requires anyone who manages an assisted living facility to hold a state-issued Assisted Living Administrator (ALA) credential through the Department of Health, which involves specific education, a 90-hour approved training course, an exam, and a separate DSHS facility license for the business itself. The two processes run on different tracks but both must clear before you can legally open.
What is assisted living?
Assisted living is a licensed residential care setting for adults who need help with daily activities like bathing, dressing, medication management, or meals, but who do not need the round-the-clock skilled nursing care of a hospital or nursing home. In Washington, these are formally called "assisted living facilities" and are regulated under chapter 388-78A WAC, the state's assisted living facility rules administered by the Department of Social and Health Services (DSHS) Aging and Long-Term Support Administration [1]. The model is built around supporting independence. Residents typically have their own apartment or room, and staff come to them for personal care, not the other way around like in a hospital ward. Washington's rules describe assisted living as providing "housing and basic services" along with "assessed and negotiated care" to residents who choose to live there [1]. Most residents are older adults, but assisted living in Washington also serves younger adults with physical disabilities who need support with daily living tasks. It is distinct from adult family homes (small licensed homes serving up to eight residents under chapter 388-76 WAC) and from enhanced services facilities for people with more complex behavioral needs.
What is a group home?
"Group home" is a general term, not a specific Washington license category. People use it loosely to describe any small residential setting where a group of unrelated adults live together and receive support, whether that is a home for adults with intellectual or developmental disabilities (IDD), a mental health supported-living residence, or a small assisted living arrangement. In Washington, the closest formal equivalents are adult family homes (up to eight residents, licensed under WAC 388-76) and supported living programs licensed through the Developmental Disabilities Administration. If you hear someone say "group home" and they mean a small assisted living business, check whether they actually need an assisted living facility license or an adult family home license, because the rules, staffing ratios, and administrator credentials differ substantially between the two. If your project fits the smaller, more residential model, read our guide on assisted living to compare it against the adult family home track before you commit to a building or a business plan.
What is an assisted living facility?
An assisted living facility (ALF) in Washington is a licensed building of any size, from a handful of units to over a hundred, that provides housing plus personal care, and in many cases dementia care or nursing services, to seven or more residents (some smaller ALFs are licensed for fewer). The license is issued by DSHS under chapter 388-78A WAC, and every ALF must have a designated administrator who holds the appropriate state credential [1][2]. Washington splits this credential system in two. Anyone managing an ALF that serves seven or more residents needs an Assisted Living Administrator (ALA) license issued by the Department of Health (DOH), separate from the facility license issued by DSHS [2]. This dual-agency structure trips people up constantly: DOH licenses the person, DSHS licenses the building and business. A facility's specialty license type (basic, expanded personal care, or dementia care specialty) changes what services staff can legally provide and what training the administrator and caregivers need. Confirm the exact specialty designation you plan to pursue with your regional DSHS licensor before finalizing your staffing model.
What does assisted living provide?
Assisted living in Washington provides a defined package: private or shared housing, three meals a day, help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication assistance or administration, housekeeping, laundry, and 24-hour staff availability for safety monitoring. Facilities must also offer social and recreational activities and arrange or provide transportation to medical appointments [1]. What assisted living does not automatically include is skilled nursing care. If a resident needs IV therapy, wound care beyond a basic level, or ventilator support, that typically exceeds what a standard ALF license permits, unless the facility holds a specialty endorsement and has nursing staff who can perform delegated tasks under Washington's nursing delegation rules. Each resident gets a negotiated service agreement, essentially a written plan spelling out exactly what care the facility will provide and what the resident (or family) is responsible for. This document matters a lot during inspections; surveyors check whether actual care matches what was promised on paper.
How does assisted living compare to a nursing home?
| Primary regulator | DSHS, chapter 388-78A WAC [1] | State health department + CMS certification | |
|---|---|---|---|
| Staffing | Caregivers, medication assistants, an ALA administrator | Licensed nurses (RN/LPN) on duty around the clock | |
| Medical intensity | Personal care, medication assistance | Skilled nursing, rehab, complex medical care | |
| Typical setting | Private apartment/room, home-like | Semi-private room, clinical setting | |
| Medicare coverage | Not covered for room and board | Covers short-term skilled stays under specific conditions | The practical difference for a resident's family: assisted living is chosen, nursing home care is usually needed. People move to assisted living for support and lifestyle; they move to a nursing home when their medical needs exceed what non-nursing staff can safely manage. |
Assisted living and nursing homes look similar from the outside sometimes, but they are regulated, staffed, and paid for completely differently. Nursing homes (called skilled nursing facilities federally) provide 24-hour licensed nursing care for people with significant medical needs, and they are certified under federal Medicare and Medicaid rules in addition to state licensing. Assisted living facilities are licensed at the state level and generally do not provide the same level of medical or nursing intensity. | Feature | Assisted Living (Washington) | Nursing Home |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board costs of assisted living, and it does not cover custodial personal care as a standalone benefit. CMS is explicit about this: Medicare covers medically necessary services like doctor visits, therapy, and short-term skilled nursing under specific conditions, but "Medicare doesn't cover room and board when the only care you need is custodial care" in a long-term care setting [3]. Medicare Part A can cover a short skilled nursing facility stay after a qualifying hospital stay, and Medicare Advantage plans sometimes offer limited supplemental benefits, but neither pays ongoing assisted living rent or personal care fees. Medicaid is the more relevant payer for many assisted living residents, but it works through waiver programs, not a blanket entitlement. Washington's Medicaid program, through DSHS, offers home and community-based service options including a Community First Choice state plan benefit, which can help eligible low-income residents pay for services in some licensed assisted living settings, though room and board is often still the resident's responsibility [4]. If your business plan depends on Medicaid-funded residents, confirm the current contract terms and reimbursement rates directly with your regional DSHS Home and Community Services office, because rates and eligibility rules change and vary by year and by contract.
How do you get a Washington Assisted Living Administrator license?
The Washington Department of Health issues the Assisted Living Administrator (ALA) credential, and the requirements sit in chapter 18.20 RCW and its implementing rules. Generally, an applicant needs to be at least 21 years old, hold a high school diploma or equivalent (many applicants also have an associate's or bachelor's degree, though it's not always a flat requirement, confirm current education criteria with DOH), complete DOH-approved administrator training, and pass the state exam [5]. The core training requirement is a 90-hour DOH-approved Assisted Living Administrator training course covering topics like resident rights, care planning, medication management oversight, staffing and supervision, emergency preparedness, and Washington-specific regulatory compliance. After finishing the course, candidates sit for a state exam administered or approved by DOH. Here is the general sequence: 1. Confirm you meet the age and education prerequisites listed in current DOH ALA licensing guidance. 2. Enroll in and complete a DOH-approved 90-hour Assisted Living Administrator training program. 3. Submit your license application, fee, and any required background check paperwork to DOH. 4. Pass the required competency exam. 5. Receive your ALA credential number, which you'll need before you can be named as administrator of record on any DSHS facility license application. Exact current fee amounts and any continuing education renewal hour requirements should be confirmed on the DOH health professions license fee schedule, since these are adjusted periodically.
How do you start a group home in Washington?
Starting what most people call a "group home" in Washington means choosing the right license category first, then building your operation around that category's specific rules. The path differs a lot depending on if you're aiming for assisted living, an adult family home, or a supported living setting for people with developmental disabilities. For an assisted living facility specifically, the general sequence looks like this: 1. Decide on your population and specialty (basic care, expanded personal care, or dementia care specialty) and confirm licensing category requirements with DSHS. 2. Secure a building that meets local zoning and the physical plant standards in chapter 388-78A WAC, including fire and life safety code compliance. 3. Have your designated administrator complete ALA licensure through DOH before or concurrent with your facility application. 4. Submit the facility license application to DSHS, including your policies and procedures manual, staffing plan, and emergency preparedness plan. 5. Pass the pre-licensing inspection conducted by your regional DSHS licensor. 6. Get your license, then maintain compliance through unannounced inspections and complaint investigations going forward. Budget real time for this. Between training completion, application review, inspection scheduling, and any corrections DSHS requires before sign-off, most new operators are looking at a process that runs several months, not weeks. Building out policies and procedures manuals, staffing plans, and required forms from scratch is one of the biggest time sinks; a lot of operators use a prebuilt state-specific packet like the $299 Group Home Licensing Kit at /licensing-kit-builder to skip drafting every document from a blank page, then customize it for their specific facility and county. If you're weighing assisted living against a smaller adult family home model, our overview of assisted living facilities breaks down how the resident capacity and staffing rules diverge.
What does the Assisted Living Administrator exam and training actually cover?
The 90-hour DOH-approved training curriculum for Washington ALAs generally covers resident rights and person-centered care planning, medication management and delegation rules, staff supervision and scheduling, infection control, emergency and disaster preparedness, financial and business operations of a licensed facility, and Washington-specific regulatory requirements under chapter 388-78A WAC. After training, candidates take a competency exam. DOH maintains a current list of approved training providers and exam details, and this list changes as providers gain or lose approval, so check the current roster before enrolling in any course. Renewal isn't a one-time event either. Like most Washington health profession credentials, the ALA license requires periodic renewal with continuing education hours. Confirm the current renewal cycle length and CE hour requirement directly with DOH, since these details are the kind of thing agencies update without much notice.
How is the administrator license different from the facility license?
This is the single most common confusion point for new Washington operators, so it's worth stating plainly. The ALA credential is a personal, portable professional license held by an individual, issued by the Department of Health. The assisted living facility license is a business license held by the entity operating the building, issued by DSHS. You need both, and they are not interchangeable. A facility cannot operate without a DSHS facility license, and it cannot have that license approved (or keep it) without a DOH-credentialed ALA designated as the administrator of record. If your administrator leaves, the facility has to name a new credentialed ALA promptly, usually within a defined grace period specified in DSHS guidance, or risk being out of compliance. If you are the owner but not the day-to-day administrator, you still need someone on staff with an active ALA credential. Many operators either get credentialed themselves or hire a licensed ALA to run daily operations while they handle ownership and business decisions.
What are common mistakes people make with this license?
The most expensive mistake is assuming the ALA credential and the facility license can be pursued in either order without consequence. In practice, DSHS wants to see your named administrator's DOH credential number as part of the facility application, so trying to finalize a facility license before your administrator finishes training and passes the exam just creates delay. Second mistake: underestimating the 90-hour training as a formality. It's a real curriculum with real content on medication delegation and regulatory compliance, and the exam is not a rubber stamp. Third: assuming Medicaid revenue will materialize automatically. Home and community-based Medicaid programs require separate provider agreements and eligibility processes through DSHS Home and Community Services; being licensed as a facility doesn't automatically make you a Medicaid-contracted provider [4]. Fourth: treating the policies and procedures manual as paperwork busywork. Inspectors use it as the baseline against which they check your actual practice. A generic manual copied from another state will not match Washington's WAC citations and will slow down your licensing review.
Frequently asked questions
What is assisted living in simple terms?
Assisted living is licensed housing for adults who need help with daily tasks like bathing, dressing, and medication, but don't need hospital-level medical care. In Washington, it's regulated under chapter 388-78A WAC and residents typically live in their own apartment or room with staff support available around the clock.
What is the difference between an adult family home and an assisted living facility in Washington?
Adult family homes serve up to eight residents in a converted residential house under chapter 388-76 WAC. Assisted living facilities are usually larger, often apartment-style buildings, licensed under chapter 388-78A WAC, and require a DOH-credentialed Assisted Living Administrator, which adult family homes generally do not.
How long does it take to get an Assisted Living Administrator license in Washington?
There's no single fixed timeline because it depends on how quickly you complete the 90-hour approved training course, schedule and pass the exam, and how fast DOH processes your application. Realistically, budget a few months from enrollment to credential issuance, and confirm current processing times directly with DOH.
Does Medicare pay for assisted living in Washington?
No. Medicare doesn't cover room and board or custodial care in assisted living. CMS states Medicare covers medically necessary services but not long-term custodial care costs. Some residents use Medicaid home and community-based programs through DSHS to help cover service costs, but room and board is often paid separately by the resident.
Can one person hold both the ALA license and own the facility?
Yes. Many small assisted living operators in Washington are both the owner and the credentialed Assisted Living Administrator. There's no rule against it. You still have to complete the same 90-hour training and exam as anyone else seeking the DOH credential, ownership doesn't exempt you from it.
What happens if a facility's administrator quits?
The facility needs to name a new DOH-credentialed Assisted Living Administrator promptly. DSHS guidance specifies allowable timeframes for a facility to operate under an interim or acting administrator before it's out of compliance; confirm the current grace period and notification requirements with your regional DSHS licensor.
How do I start a group home for adults with disabilities in Washington?
If you mean a home for adults with intellectual or developmental disabilities, that typically falls under Developmental Disabilities Administration supported living licensing, not the assisted living or adult family home tracks. The application process, staffing requirements, and administrator credentials differ from assisted living, so confirm the correct program category with DSHS before building a business plan.
What is the 90-hour training requirement for?
It's the DOH-approved Assisted Living Administrator training course covering resident rights, medication management, staffing, emergency preparedness, and Washington regulatory compliance. Completing it is a prerequisite to sitting the state competency exam and obtaining the ALA credential under chapter 18.20 RCW.
Is assisted living the same as a nursing home?
No. Assisted living provides housing plus personal care support for people who don't need constant medical supervision. Nursing homes provide 24-hour skilled nursing care and are certified under federal Medicare and Medicaid rules in addition to state licensing, serving residents with more intensive medical needs.
What services does assisted living provide in Washington?
Washington-licensed assisted living facilities provide housing, meals, help with daily activities like bathing and dressing, medication assistance, housekeeping, laundry, social activities, and 24-hour staff availability, all defined in a negotiated service agreement specific to each resident under chapter 388-78A WAC.
Do I need a college degree to become an Assisted Living Administrator in Washington?
Requirements can include a high school diploma or equivalent as a baseline, though many candidates hold additional post-secondary education. Exact current education prerequisites are set by DOH under chapter 18.20 RCW, so confirm the specific requirement in effect before enrolling in a training program.
How much does it cost to get licensed as an assisted living administrator in Washington?
Costs include the DOH application and credential fee plus the cost of the 90-hour approved training course, which varies by provider. Current DOH fee amounts are adjusted periodically, so check the current published fee directly with the department rather than relying on older figures.
Sources
- Washington State Legislature, WAC 388-78A: Definition and regulation of assisted living facilities in Washington, including housing and negotiated service agreements
- Washington State Legislature, RCW 18.20.020: DOH issues the Assisted Living Administrator credential, requiring approved training and exam
- Medicare.gov, Nursing Home Care coverage: Medicare does not cover room and board when only custodial care is needed
- Washington State Health Care Authority, Community First Choice (CFC) program: Washington Medicaid home and community-based programs help eligible residents pay for services in licensed community settings
- Washington State Legislature, RCW 18.20.090: Statutory basis for assisted living facility licensing and administrator credentialing in Washington
- Washington State Legislature, WAC 388-76: Adult family homes are licensed to serve up to eight residents under a separate chapter from assisted living facilities