Adult family homes and assisted living facilities are often grouped together — and for good reason. Both provide housing, personal care, and medication management for seniors who need help with daily life. But in Washington, they are distinct settings with real differences that matter for your family.
Size and atmosphere
- Adult family home (AFH): licensed for 2–6 residents, operated out of a single family-style home. Care is intimate and consistent — residents know their caregivers, and the setting feels like a home.
- Assisted living facility: typically licensed for 7 or more residents (many much larger), with a more apartment- or campus-style layout and shared common areas.
Care approach
Both settings use unlicensed caregivers supported by RN delegation for medication administration and other clinical tasks. The practical difference is scale:
- In an AFH, one caregiver may be responsible for only a handful of residents, so care is highly personalized.
- In assisted living, caregivers often serve more residents, and the model is more like a community.
Neither provides 24-hour skilled nursing — that's the role of a nursing home. For that comparison, see AFH vs Nursing Home.
Cost
Costs vary by region and level of care, but generally:
- Adult family homes: roughly $5,000–$10,000/month
- Assisted living: typically $4,500–$8,500/month, with memory care units at the higher end
Assisted living can be somewhat cheaper for lower-acuity residents because the care ratio is spread across more people. For higher needs, an AFH's lower resident-to-caregiver ratio often justifies the price.
Regulation in Washington
Both settings are licensed by DSHS, but under different chapters:
- Adult family homes operate under Chapter 388-76 WAC
- Assisted living facilities operate under Chapter 388-78A WAC
Both must comply with Washington's nurse delegation rules (WAC 246-840-910), and both benefit from working with a licensed RN delegator. Seattle Nurse Delegation serves both AFH operators and assisted living administrators with assessments, caregiver training, and supervisory visits.
Which is right for your parent?
Choose an adult family home if you want:
- The smallest, most homelike environment possible
- A low resident-to-caregiver ratio
- Care that feels personal and family-run
Choose assisted living if you want:
- A community with more residents and social activity
- Apartment-style living with some independence
- A larger facility with more staff on rotation
The assessment step applies to both
Before a new resident moves into an AFH in Washington, a licensed RN must complete a pre-placement assessment to confirm the home can safely meet their needs. The same comprehensive evaluation helps assisted living facilities plan for new admissions.
Our adult family home assessment — a flat $450 with a written report within 48 hours — is the standard families and facilities use to make placement safe. Learn more about the service, or explore adult family home alternatives to see the full landscape of options.