Adult Day Care Washington

All states: adult day services map

Washington adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Washington?

Washington does not license adult day centers. Instead, the state sets standards in its adult day services rules, WAC 388-71-0701 through 388-71-0776, and applies them through contracts with the Department of Social and Health Services (DSHS) or a local area agency on aging (AAA). The rules recognize two services, adult day care and adult day health, and use adult day services as the umbrella term for both.

Adult day care vs adult day health. Adult day care is a supervised daytime program with personal care, routine health monitoring with a registered nurse (RN) consultant, therapeutic activities, social services consultation, supervision and meals (WAC 388-71-0704). Adult day health provides everything in adult day care plus skilled nursing beyond routine monitoring or at least one skilled therapy (physical, occupational or speech), plus psychological or counseling services (WAC 388-71-0706). It is for adults whose conditions need an RN or a licensed therapist. A center that offers both must meet both sets of rules.

The rules that apply to a Washington center come from these sources:

• Medicaid and contract standards (DSHS ALTSA and AAAs). DSHS's Aging and Long-Term Support Administration (ALTSA) writes the WAC 388-71 adult day rules. They cover eligibility and provider requirements for adult day funded through the COPES waiver, Roads to Community Living, the Residential Support Waiver or other department-approved funding. AAAs handle applications, site inspections and yearly monitoring.
• Medicaid billing (Health Care Authority). Adult day health centers also need a core provider agreement with the Health Care Authority (HCA), Washington's Medicaid agency, and must follow its Apple Health record rules. HCA sets the adult day health daily rate.
• Other funding. AAAs can buy adult day with state Senior Citizens Services Act or respite funds, and the WA Cares Fund pays registered adult day providers. Both use the same WAC 388-71 standards or contracts managed by the AAA.

Because there is no licensing layer, the WAC 388-71 contract standards are the only set of operating rules we found. Within them, adult day health is stricter than adult day care. We did not find a separate dementia or social-model license, or any adult day licensing rule from the Department of Health or DSHS Residential Care Services.

Do you need a license to open an adult day center in Washington?

No. We did not find a Washington license for adult day centers. To serve Medicaid or other publicly funded participants, a center applies for a contract with DSHS or the local area agency on aging, passes an AAA site inspection, and meets the WAC 388-71 standards. The only license the contracting rule mentions is a current business license.

How to get a contract. Under WAC 388-71-0724:

• Get an application from DSHS or your AAA and show that you meet the adult day rules.
• The AAA inspects the site. It sends written notice of any deficiencies within 30 days of the visit, then verifies corrections within 30 days of your notice that they are fixed.
• The AAA sends DSHS a written recommendation on whether to contract with you.
• Adult day health centers must also sign a core provider agreement with HCA to bill for COPES, Residential Support Waiver and Roads to Community Living participants.

What the application includes. Among other items: your mission statement, business structure and current business license, owners and officers, fiscal policies and a budget, program and personnel policies, a floor plan, local building, fire and health reports, food handler permits if they apply, staff TB results, a sample client file, an activity calendar, a menu and certificates of insurance.

Who cannot provide services. A prospective provider convicted of abuse or neglect of a vulnerable adult cannot provide adult day services in any role in the organization.

A contract is not guaranteed. Nothing in the rules requires DSHS or an AAA to contract with any center. When adult day spending exceeds or threatens the state budget for it, DSHS may stop contracting with new centers (a moratorium), limit services by care need or reduce days per week, with at least 30 days' notice for limits (WAC 388-71-0734). Ask your AAA whether it is taking new contracts before you sign a lease.

Monitoring. The AAA or other designee monitors each contracted center at least once a year, gives written notice of compliance or deficiencies, and may require a corrective action plan.

What we did not find. We did not find a certificate of need requirement, application fees, change of ownership rules or a notice period for a sale, a contract renewal period, or a statement on whether each site needs its own contract (the rules do require a program director at each additional site). If you are buying a center, ask DSHS and the AAA early how an existing contract is handled.

What are the staffing rules for adult day centers in Washington?

Washington's adult day rules require at least 1 direct care staff member for every 6 participants, and the ratio must go up as more participants have functional impairments or need skilled nursing or therapy. Whenever even one participant is present, at least two staff must be there. We did not find a separate ratio for participants with dementia.

The ratio is in WAC 388-71-0754, a DSHS contract standard.

• Licensing: no licensing layer, so no ratio from a licensing agency.
• Medicaid and contract standards (DSHS): 1:6 direct care staff minimum, covering nutrition, health monitoring, help with daily activities, activities, transportation assistance, supervision and safety. It must be met for each program the center contracts for.
• AAA-funded programs: must meet the same WAC 388-71 standards, including the 1:6 ratio. We did not find a separate funding-layer ratio.

Minimum staff on site. When one participant is present there must be at least two staff, at least one with current CPR and first aid certification. At least one staff member per shift must hold current CPR and first aid. The administrator must be on site during operating hours.

Who counts toward the ratio. Only staff trained and able to provide direct service count. Volunteers count only if they meet the same standards and job qualifications as paid staff and have designated duties (WAC 388-71-0752).

Required staff for adult day care. An administrator or program director, an activity coordinator, a consulting RN and a consulting social worker (WAC 388-71-0756). The director needs a master's degree plus one year of supervisory experience, a bachelor's degree plus two years, or a high school diploma plus four years of health or social services experience (two of them supervisory). The nurse does not have to be on site at all hours.

Required staff for adult day health. An administrator and a program director (who may be the same person), an RN, an activity coordinator, a physical, occupational or speech therapist, and a social worker, with degree and experience rules for the administrator and director (WAC 388-71-0758). An RN or LPN must be on site when attending participants need nursing services in their care plan. RNs need a valid Washington or multistate license and one year of relevant experience. Each additional site needs its own program director.

Training. Aides must have documented skills tied to their job description before they provide care. The rules set no minimum training hours. Staff learn the center's policies within two weeks of hire and get in-service training at least every quarter (WAC 388-71-0762).

Background checks and health screening. Employees, and volunteers who work as staff or have unsupervised access, need a background check under RCW 43.43.830 and 43.43.832 before any unsupervised access, updated every two years (WAC 388-71-0760). Staff TB testing follows local health authority recommendations. We did not find a required vaccination rule or nurse hours that scale with census.

What does an adult day center in Washington have to provide?

Every contracted center must provide personal care, routine health monitoring with an RN consultant, therapeutic activities, supervision and a meal and snacks every four hours, and must be open at least three days a week for four consecutive hours. Adult day health centers add skilled nursing or therapy and counseling. Each participant needs at least 60 square feet of program space.

Adult day care services. Under WAC 388-71-0704, centers provide on site: help with activities of daily living, consultative social services, routine health monitoring with RN consultation, therapeutic activities, health education, supervision and protection, help arranging transportation, first aid and emergency care, and a nutritious meal and snacks every four hours.

Adult day health services. All of the above, plus skilled nursing or at least one skilled therapy, plus counseling. Skilled nursing must be medically necessary, ordered by an authorized practitioner where nursing law requires (at the start, at a significant change and at least yearly), and reevaluated every 90 days (WAC 388-71-0712).

Hours. Centers under single ownership must operate at least three days a week for four consecutive hours, with at least four hours of programming a day (WAC 388-71-0736).

Remote services. Under the COPES waiver, both adult day care and adult day health may be delivered in person or remotely by phone or other technology, under a remote or hybrid program.

Meals. Each meal supplies one-third of the daily dietary reference intake. Menus may not repeat for at least three weeks and are posted a week ahead. Modified diets or supplements need written practitioner approval (WAC 388-71-0770).

Transportation. Centers must help arrange transportation but are not required to provide it. If a center does transport, driver standards apply.

Space and capacity. Under WAC 388-71-0766:

• At least 60 square feet of multipurpose program space per participant. Lobbies, storage, offices, restrooms, hallways, treatment rooms and therapy-only space do not count. Dining and kitchen areas count only if used for activities other than meals.
• One toilet per 10 participants, or one per 8 when many participants need help with toileting, preferably within 40 feet of activity areas.
• A private rest area with one bed, couch or recliner per 10 participants, and at least one roll-in shower in newly contracted facilities.

The rules set no maximum capacity, so space and toilet ratios limit how many people you can serve. A separate dementia area is not required, but orientation cues and wandering alarms are.

Written policies. WAC 388-71-0738 lists the operating policies a center needs, including:

• Evaluations, reevaluations and negotiated care plans, and staffing schedules that meet the 1:6 ratio.
• Admission and discharge criteria, and grievance and complaint procedures for staff and participants.
• A medication policy, including disposal of wasted or contaminated medications.
• Emergency, evacuation and fire safety procedures approved by the local fire authority and posted.
• HIPAA, confidentiality, nondiscrimination, advance directive, gift and marketing policies.
• A participant bill of rights that is posted, handed out and explained.
• Client record handling, release of information and retention, including what happens if the center closes, and procedures for illness, injury, medical emergency or death.

Policies must show when they were written and revised and be approved by the center's advisory committee at least once a year. That committee meets at least twice a year and includes family members of current or past clients. Personnel policies must cover job descriptions, evaluations, infection control, communicable disease limits and abuse reporting (WAC 388-71-0750).

Safety and quality. Fire drills are held and documented every quarter, and each site needs a written emergency, disaster and earthquake plan and a posted evacuation floor plan (WAC 388-71-0772). Centers also need a yearly quality improvement plan with measurable goals (WAC 388-71-0774).

What rules protect participants in Washington adult day centers?

Washington's rules set firm timelines for new participants: a written reply to a referral within 2 working days, a preliminary service plan within 10 paid service days, and a signed care plan within 30 calendar days. Centers keep daily attendance records, must give written reasons and appeal information for a discharge, and must report suspected abuse to adult protective services.

Who can enroll under Medicaid. Medicaid adult day care requires COPES enrollment and an unmet need for personal care, routine health monitoring, therapeutic activities or supervision. People living in nursing homes, assisted living or adult family homes are not eligible (WAC 388-106-0805). Skilled services in adult day health need practitioner orders.

Care plan timelines. Under WAC 388-71-0718 and 0722:

• A written response to a referral within 2 working days.
• A preliminary service plan within 10 paid service days of first attendance.
• A signed negotiated care plan within 30 calendar days of acceptance.
• Adult day care plans updated yearly and at a significant change. Adult day health services reviewed every 90 days.
• DSHS reassesses clients at least yearly, and a break of more than 30 days in adult day health requires a reassessment.

Reporting to the case manager. Centers report unplanned absences of more than three scheduled days in a row, and changes in a participant's condition, to the case manager within one week.

Discharge. A participant may be discharged by choice, for not meeting conduct standards in the center's policy, or for losing eligibility. Unless the case manager starts the discharge, the center gives written reasons to the participant, their representative and the case manager, with appeal and hearing information. The rules set no number of days' notice.

Attendance and records. Centers record each client's dates and hours of attendance daily and keep a permanent registry of all clients with admission, attendance and discharge dates (WAC 388-71-0746, 0748). Electronic records are backed up daily, with full weekly backups stored off site. Apple Health providers keep records that support billed services for six years from the date of service (WAC 182-502-0020). Employee files are kept for the length of employment plus at least seven years.

Incidents and abuse. Suspected abuse, neglect or exploitation must be reported to adult protective services (or law enforcement for adults who are not vulnerable) under chapter 74.34 RCW. Centers must write incident reports for illness, injury or death, but the adult day rules do not set a deadline for reporting incidents to DSHS. Ask your AAA what it expects.

What we did not find. We did not find a required physician exam or TB screening for adult day care enrollment, or a discharge notice period in days. Families should ask the center for its admission and discharge criteria and its participant bill of rights.

How does Medicaid pay for adult day in Washington?

The main payer is the COPES waiver, run by DSHS ALTSA, which covers both adult day care and adult day health. A day of four or more hours is billed at a daily rate, and shorter adult day care and remote services are billed in 15-minute units. As of July 1, 2026, adult day care pays $86.01 or $78.28 per day and adult day health pays $129.65 or $121.17 per day, depending on cost area.

COPES waiver. The Community Options Program Entry System (COPES) is a federal 1915(c) waiver (WA.0049, renewed effective January 1, 2024) that pays for home and community services for adults who would otherwise need nursing home care. Services must be in the client's approved plan of care and authorized before billing. Codes come from ALTSA's Long-Term Care Manual, Chapter 7d (last revised May 2026), and rates from the ALTSA Home and Community Services rate table, as of July 1, 2026 (high cost area / standard cost area):

• Adult day care, 4 or more hours: S5102 HQ, $86.01 / $78.28 per day.
• Adult day care, under 4 hours: S5100, $5.38 / $4.90 per 15 minutes.
• Remote adult day care: S5100 U1, $5.13 / $4.66 per 15 minutes, with a minimum claim of one hour (4 units) per visit.
• Adult day health, 4 or more hours: S5102 TG, $129.65 / $121.17 per day. HCA sets this rate.
• Remote adult day health: S5100 U2, $7.32 / $6.83 per 15 minutes, minimum 4 units per visit.
• Intake evaluation: $137.43, billed once per attendance cycle (S5102 UA for adult day care, S5102 CG for adult day health).

The rate table does not say which counties fall in the high cost and standard cost areas, so ask ALTSA or your AAA which rate applies to you. Chapter 7d also prints a 15-minute unit label next to S5102 HQ, which conflicts with the daily rate in the rate table; confirm the unit with ALTSA before you set up billing.

Other Medicaid programs.

• Residential Support Waiver (RSW). A 1915(c) waiver (WA.1086) that covers adult day health but not adult day care. We did not confirm which codes RSW uses.
• Roads to Community Living (RCL). Named in the adult day rules as a funding source. We did not confirm its billing unit.
• Medicaid Alternative Care (MAC) and Tailored Supports for Older Adults (TSOA). Part of Washington's 1115 Medicaid Transformation waiver. Adult day health is listed as a health maintenance and therapy support, and adult day care is listed under TSOA personal assistance for people without an unpaid caregiver (WAC 388-106-1915).
• PACE. The Program of All-Inclusive Care for the Elderly is offered through a contracted plan that provides long-term services, medical and behavioral health care under a personal plan (WAC 182-513-1230). PACE is paid a set amount per enrollee, not by the unit. The rule does not mention adult day centers, so we did not confirm how adult day fits into PACE in Washington.

Transportation. The ALTSA rate table lists no separate adult day transportation code. We did not confirm whether transportation to adult day is billed separately under current rules, so ask ALTSA or your AAA.

Attendance documentation. The hours a participant attends decide whether you bill the day code (4 or more hours) or 15-minute units. Centers must keep daily records proving the 1:6 ratio was met for each contracted program, listing staff names, titles and hours worked and participant names and hours attended (WAC 388-71-0754). HCA requires records showing the level, type and extent of each service billed, the dates and who provided it (WAC 182-502-0020). We did not find a required electronic sign-in or sign-out system.

Can a private-pay adult day center operate in Washington without Medicaid?

Yes. Washington has no adult day license, so no state license is needed to open a private-pay center. The adult day rules say they also apply to privately owned centers paid directly by clients, but we did not find any process that registers or inspects a center without a public contract. Ask DSHS ALTSA how it expects private-pay centers to meet WAC 388-71.

What still applies. Under the adult day rules, centers must keep a fee schedule showing private pay rates and any extra charges (WAC 388-71-0740), have a nondiscrimination policy and post a participant bill of rights. We did not find state limits on what a non-contracted program may do, such as personal care or medication help. Nursing is governed by Washington's professional practice laws.

Other funding.

• Area agencies on aging. AAAs may pay for adult day with state Senior Citizens Services Act (chapter 74.38 RCW) or respite (chapter 74.41 RCW) funds. Centers must meet WAC 388-71-0736 through 0774, and these funds may serve only people not eligible for, or not getting, Medicaid adult day because of funding limits. There is no entitlement (WAC 388-71-0730).
• WA Cares Fund. Washington's long-term care insurance benefit is now available statewide. Adult day providers register with DSHS, and the local AAA processes applications and manages contracts. Services cannot be provided or billed until a pre-authorization is approved, and claims are due within 60 days after it ends (WA Cares provider page).
• Veterans Affairs. The VA offers Adult Day Health Care to enrolled veterans who meet clinical criteria, where available, at VA medical centers, State Veterans Homes or community organizations. We did not find Washington-specific VA adult day contracts.

The market. We did not find a state count of DSHS-contracted adult day centers, and we did not find a currently active Washington adult day association. Your local area agency on aging can tell you which centers it contracts with in your area.

What is changing next for adult day in Washington?

As of our last check on October 21, 2026, we did not find an upcoming change to Washington's adult day rules or Medicaid adult day payment. Several recent changes matter for operators, and all are already in effect.

• New rates and cost areas, July 1, 2026. ALTSA replaced its three county tiers (King, metropolitan and non-metropolitan) with high cost and standard cost areas. The adult day care day rate rose from $78.19 (King County) to $86.01 (high cost), and adult day health from $117.86 to $129.65 (ALTSA rate table).
• WA Cares Fund benefits available. WA Cares benefits are now available statewide, and adult day centers can register as providers through DSHS, with contracts managed by the local AAA.
• Staff qualification update, September 1, 2024. WAC 388-71-0752 was amended, including recognition of multistate nurse licenses.
• Adult day health rate increase, July 1, 2024. The adult day health daily rate was set to rise by a weighted average of $18.64, about 20 percent (WSR 24-14-015). The fee schedule was later updated again under a state plan amendment approved in May 2025 (SPA WA-25-0011).

Washington adult day sources

• WAC 388-71-0702: Adult day services rules, scope (Washington State Legislature)
• WAC 388-71-0724: Contracting requirements for adult day centers
• WAC 388-71-0754: Direct care staffing ratio
• WAC 388-71-0766: Space and facility requirements
• DSHS ALTSA Long-Term Care Manual, Chapter 7d (COPES), revised May 2026
• DSHS ALTSA Home and Community Services rate table (rates as of July 1, 2026)
• WAC 388-106-0805: Medicaid adult day care eligibility
• WAC 182-502-0020: Apple Health provider record requirements (HCA)
• WAC 388-71-0730: Adult day funded by area agencies on aging
• WA Cares Fund: information for providers

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Podcast: How Adult Day Services Let You Serve 50 Clients with Just 8 Staff
• Podcast: Adding Adult Day Services to Home Care Brings Synergy and Margins
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

Alabama, Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Dakota, Ohio, Oregon, South Dakota, Vermont, West Virginia, Wisconsin. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.