Long-term care facilities provide a range of services to support individuals who need assistance with daily living tasks as a result of aging, chronic illness, cognitive functioning, or disability. Individuals may reside in the facility for several weeks, months, or years. The Department of Social and Health Services (DSHS) oversees licensing and regulatory compliance for long-term care facilities in Washington State. Additionally, facilities may be subject to federal regulations and over sight. The facility size, services offered, and regulations vary by provider type.
Adult family homes are residential homes licensed to care for up to eight residents. They provide room, board, laundry, necessary supervision, and necessary help with activities of daily living, personal care, and social services.
Assisted living facilities are community-based residences that provide housing and basic services to seven or more residents. Each assisted living facility provides a range of services which may include housekeeping, meals, laundry, activities, assistance with activities of daily living, health support services, and intermittent nursing services.
Enhanced services facilities are targeted towards individuals with behavioral needs and are licensed to care for up to 16 individuals. They offer behavioral health, personal care services and nursing, at a level of intensity that is not generally provided in other licensed long-term care setting.
Skilled nursing facilities, also referred to as nursing homes, provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, social services, room, board, and laundry.
Certified community residential services and supports are provided in a home-like setting to individuals with developmental disabilities. It may include supported living, group homes, group training homes, and state operated living alternatives.
Continuing care retirement communities are communities that offer independent living, assisted living, and skilled nursing on one campus.
An epidemic is a widespread occurrence of an infectious disease in a community at a particular time. On February 29, 2020, one of the first detected COVID-19 outbreaks in the United States was at a skilled nursing facility in Kirkland, Washington. As of January 5, 2021, the Department of Health (DOH) reports there have been 13,870 COVID-19 cases and 1765 COVID-19 deaths—51 percent of the state's total deaths—associated with long-term care facilities. In response to COVID-19's impact on long-term care facilities, the Governor has issued a number of proclamations. The proclamations waived certain licensing and credentialing requirements, restricted resident visitation, and mandated testing for residents and staff. DSHS and DOH have created a Safe Start Plan for long-term care facilities that consists of four phases. Each phase has different requirements for visitation, testing and screening, personal protective equipment, and group activities. The long-term care facility is allowed to move into the next phase when DOH approves their respective county eligible to move into the next phase. The local health jurisdiction or DOH have authority to return a long-term care facility to more restrictive operations when there is an infectious disease and/or COVID-19 outbreak. There are 35 local health jurisdictions representing the 39 counties in the state.
DOH is required to consult with interested stakeholders to develop epidemic disease preparedness and response guidelines for long-term care facilities. The stakeholders DOH must consult with include DSHS' Aging and Long-Term Support Administration, local health jurisdictions, advocates for consumers of long-term care, associations representing long-term care facility providers, and the State Long-Term Care Ombuds.
The guidelines must include containment and mitigation strategies for controlling infection in long-term care facilities. At a minimum, the guidelines must address visitation, admission and discharge policies; timely and priority access to personal protective equipment and other infection control supplies; and rapid and accurate testing to identify outbreaks. In developing the guidelines, DOH must work with stakeholders to:
By December 1, 2021, DOH must finalize the guidelines and provide them to the health care committees of the Legislature. Beginning December 1, 2022, DOH must annually review the guidelines with DSHS, make any necessary changes, and provide the updated guidelines to the health care committees of the Legislature.
Long-term care facilities include licensed skilled nursing facilities, assisted living facilities, adult family homes, and enhanced services facilities; certified community residential services and supports; and registered continuing care retirement communities.