Nursing Homes in Washington
Providing comprehensive medical care in the home or an assisted living facility can be difficult. For seniors with significant health needs, nursing home care is often the best choice for senior living. This is also called skilled nursing and can provide medical care to people with complex needs who don’t need to be in a hospital. Professionals on hand include doctors, nurses and nursing assistants. Nursing home communities also provide meals, social activities and assistance with activities of daily living,
Washington is home to 7.7 million people, and 16.2% are aged 65 and over. This is similar to the percentage across the country, which sits at 16.8%. There are 200 nursing home facilities in the state, with 12,527 residents. This guide has information to help seniors and their families make decisions about skilled nursing in Washington, including funding sources and details about the rules and regulations that govern nursing home care in the state.
Cost of Washington Nursing Homes
The average cost of nursing homes in Washington is $266 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Washington?
Washington’s Medicaid program is also called Washington Apple Health or Apple Health. It pays for nursing home care for seniors or disabled people who meet the eligibility requirements and need a high level of care. The state also has a number of waiver programs that fund care in the home or community. In particular, the Community First Choice Option is designed to prevent or delay admission to a nursing home and is available to seniors who need an institutional level of care.
As of the end of 2022, there were more than 2.1 million Washington residents enrolled in Medicaid and the Children’s Health Insurance Program. Washington has expanded Medicaid coverage, which has increased enrollment by 93% since 2013.
Eligibility for Medicaid in Washington
Applicants for Apple Health must meet financial eligibility criteria. This consists of income and asset limits. These differ depending on the type of Medicaid an individual is applying for.
For single applicants applying for nursing home Medicaid in Washington, the income limit is $2,742 per month, or $32,904 per year. They can also have assets of up to $2,000. Married couples can have an income of $5,484 per month and assets of up to $3,000 if both spouses are applying for Medicaid. If just one spouse is applying, the criteria for single applicants apply, however, the nonapplicant spouse can keep $148,620 in assets. It’s important to note that most of a beneficiary’s income goes toward their nursing home care. Individuals can only keep $75.36 for personal needs, the cost of Medicare premiums and a spousal income allowance if required.
There are some belongings that are exempt from the asset count, including personal belongings, irrevocable burial trusts and an automobile. Homes are only exempt if the person intends to return there or if their spouse is still living there.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 |
| Two-Person Household | $65,808 | $3,000 |
*Per year
To meet the other eligibility requirements, the applicant must:
- Be a Washington resident
- Be a U.S. national, citizen, permanent resident or legal alien
- Require a nursing home level of care
Applying for Medicaid in Washington
Seniors can apply for Medicaid online using the Washington Connect website or in person at their local Home and Community Services Office. They can also print Form 18-005 from the Medicaid website and return it via mail or fax to:
Mail: DSHS Home and Community Services
P.O. Box 45826
Olympia, WA 98504-5826
Fax: (855) 635-8305
What Information You Will Need
To process the application, Medicaid may need to see documents showing the applicant's:
- Income
- Assets
- Identity
- Social Security Number
- Residency
- Housing expenses
Additional Medicaid Support & Resources in Washington
There are several resources available to help people with Medicaid in Washington. Government and nonprofit organizations can help seniors apply for benefits and navigate the system.
| Contact | Service | |
|---|---|---|
| Department of Social and Health Services (DSHS) | (877) 501-2233 | DSHS provides help in person or via phone. It can help individuals fill out forms, appeal decisions and translate instructions and communications. |
| Washington Connection | (877) 501-2233 | Washington Connection has tutorials on how to apply for Medicaid online. It also keeps a list of community partners that provide local help to applicants. This includes eligibility reviews, help applying and reporting changes and computer access so people can use the site. |
| Northwest Justice Project | (888) 201-1012 | The Northwest Justice Project offers free civil legal help to qualified people in Washington. This includes assistance with Medicaid and other benefits. It also maintains an online guide to many legal issues, with comprehensive information about public benefits and health. |
Can You Use Medicare to Pay for Nursing Home Care in Washington?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet several specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers several specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Washington
There are numerous government programs that provide Medicare help to residents, including screening for eligibility and choosing plans. There are also nonprofit organizations that offer Medicare assistance.
| Contact | Service | |
|---|---|---|
| Statewide Health Insurance Benefits Advisors (SHIBA) | (800) 562-6900 | SHIBA provides free Medicare assistance to Washington residents. Trained volunteers can answer questions about the program and help people evaluate their options. There are local offices throughout the state that hold regular counseling events. |
| Community Living Connections (CLC) | (855) 567-0252 | CLCs are the Area Agencies on Aging in Washington state. Local CLCs can refer seniors to Medicare assistance in their area. They can also provide help with benefits screening and Medicare fraud reporting. |
| Washington Care Planning Council | (800) 989-8137 | The Washington Care Planning Council maintains a list of organizations that can assist seniors with long-term care. It also has information about Medicare and the companies that provide Medicare plans in the state. |
| Washington Law Help | N/A | Washington Law Help is a legal assistance website. It has comprehensive information about civil legal topics, including Medicare, eligibility, Medicare savings programs and other benefits programs. |
Other Financial Assistance Options for Nursing Home Care in Washington
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Washington
| Licensing Requirements | All nursing homes must be licensed by the Washington State Department of Social and Health Services. Licenses are valid for twelve months and must be displayed in a conspicuous place on the premises. |
| Staffing Requirements | There must be enough staff to provide a minimum of 3.4 hours of direct care daily for each resident. There must also be enough qualified staff on duty around-the-clock to carry out the facility’s programs and responsibilities. |
| Staff Training Requirements | Staff must be properly trained and qualified for the role they’re performing. Except for professionally licensed staff, employees providing direct care must complete a DSHS-approved nursing assistant program and 16 hours of training within four months of starting work as an assistant. |
| Admission Restrictions | Residents who are a danger to themselves or others cannot be admitted to the facility unless the risk can be eliminated with reasonable accommodation. |
| Care Planning Requirements | A care plan must be developed for each resident that details treatment, medication, activities and diet. It should include goals for the resident to accomplish and the people responsible for carrying them out. It must be reviewed at least quarterly. |
| Dietary and Nutritional Services Requirements | Residents must receive three meals per day at regular times. Menus must be planned to ensure varied meals are offered that meet residents' nutritional needs. Medically prescribed special diets must be planned by a qualified dietitian or approved by the attending physician. |
| Specialized Rehabilitative Services | Residents who have rehabilitative services in their care plan must receive these services. Facilities can provide them directly or arrange for them to be provided by qualified outside professionals. The services should aim to maintain and improve the resident’s ability to function independently. |
| Medication and Pharmaceutical Services | Only licensed staff can administer medication to residents. Residents are able to self-administer their medication with a physician’s permission. Medications can only be provided by order of the attending physician, and staff must keep records of any drugs that are administered. |
| Activities Requirements | Facilities must have a staff member qualified to direct group activities to oversee the activities program. This program should encourage residents to maintain normal activity. There must be enough space and supplies to support the program. |
| Infection Control Requirements | Employees with symptoms of a communicable disease can’t work in a nursing home. Facilities must develop an infection control program to prevent the transmission of disease. There must be sufficient equipment and supplies to ensure proper cleaning, sterilizing and disinfecting. |
| Medicaid Coverage | Apple Health covers nursing home care for people who meet all the eligibility requirements. |
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