When a parent needs more care than the family can provide, the first decision is usually the biggest one: an adult family home or a nursing home?
The two settings are often confused, but they serve very different needs — and in Washington State, they're regulated very differently. Here's how to think about the choice.
The short answer
- Adult family home (AFH): a small, homelike facility (up to 6 residents) where a resident lives with caregivers who provide daily support and, with RN delegation, medication administration and other clinical tasks. Best for seniors who need hands-on help but not 24-hour skilled nursing.
- Nursing home (skilled nursing facility): a larger, medical facility with licensed nurses on staff around the clock. Best for people who need continuous medical care, rehabilitation, or management of complex, unstable conditions.
Cost
Cost is often the deciding factor.
- Adult family homes in Washington typically range from $5,000 to $10,000 per month depending on location and level of care.
- Nursing homes are significantly more expensive, commonly $9,000 to $14,000+ per month for a private room.
For many families, an adult family home provides a comparable standard of care at a meaningfully lower cost — which is one reason AFHs have become so popular in Washington.
Environment and staffing
- AFHs are licensed for up to six residents, so care is small-scale and consistent. Residents form close relationships with caregivers, and there's no institutional feel. Staff are unlicensed caregivers, supported by an RN delegator.
- Nursing homes house dozens or hundreds of residents. They have licensed nurses on every shift and are built around medical care, but they are inherently more institutional.
Level of care
This is where the decision becomes clear:
- An AFH is appropriate when a parent needs assistance with daily living, medication management, and supervision — but is medically stable.
- A nursing home is appropriate when a parent needs 24/7 skilled nursing, IV therapy, wound care beyond routine dressings, or rehabilitation after surgery or illness.
The mandatory assessment
Here's what makes Washington unique: before a resident can move into an adult family home, a licensed RN must complete a pre-placement assessment to confirm the facility can safely meet the person's care needs. This protects everyone — the resident, the family, and the facility.
If you're choosing an AFH, that assessment is a required step in the process. Our adult family home assessment is a flat $450 with a written report within 48 hours, so it doesn't hold up a move-in.
How to decide
Ask these three questions:
- Does my parent need licensed nursing care around the clock? If yes, lean toward a nursing home.
- Could my parent thrive in a small, homelike setting? If yes, an AFH is worth serious consideration.
- Is cost a major factor? If so, the AFH is usually the more affordable path.
Also worth comparing: AFH vs assisted living, and the broader options in our guide to adult family home alternatives.
If you've decided on an adult family home, the next step is scheduling the mandatory pre-placement assessment. Families across Washington use it to confirm a home is safe before move-in day.