An adult family home is a licensed residence — usually a regular house in a regular neighborhood — where up to six adults live and receive care. In Washington State, AFHs are licensed and inspected by DSHS and represent one of the most personal options on the senior care spectrum. But not all AFHs are alike. Choosing the right one is the most important decision you'll make in this process.
Here's a practical guide, written by people who run one.
1. Start by understanding what level of care your loved one actually needs
Before you tour a single home, get clear on what your loved one needs. Are they mostly independent and need a safe, social place to live? Do they have early dementia and need supervision and reminders? Do they have advanced needs — full assistance with daily living, medication management, mobility help?
An AFH that's great for an independent senior may not be set up for a resident with advanced dementia. The opposite is also true. Match the home to the need.
If you don't know what level of care is appropriate, ask your loved one's doctor or hospital social worker. They've seen this many times. They can tell you whether you're looking at AFH, assisted living, or skilled nursing.
2. Verify the license
Every legitimate adult family home in Washington has a license issued by DSHS. You can look up any AFH at the Washington State DSHS Adult Family Home directory — search by city or by name. The directory shows license number, capacity, current status, and any inspection findings.
If a home can't or won't give you their license number, walk away. This is the single most important verification step.
3. Visit in person — and visit at different times
A tour at 11am on a Tuesday is when every home looks great. Try to visit at a different time, too — late afternoon, when residents are tired; or near a meal, when you can see how the kitchen runs; or on a weekend, when staffing might look different.
Watch the residents during your visit. Are they engaged or are they parked in front of a TV? Are caregivers interacting with them by name, or rushing past? Does the home smell clean, but not sterile? Is there evidence of life — flowers on a table, a half-finished puzzle, music playing?
4. Ask these specific questions
Most tours are designed to put you at ease. Push past that. Here are the questions that reveal what's actually happening:
- What is your caregiver-to-resident ratio overnight? If "one caregiver, on-call from a back room" is the answer for a six-bedroom home with high-need residents, that's not the same as "awake caregiver, on the floor."
- How long has your average caregiver worked here? High turnover means residents experience constant strangers. Two-plus years is good. Less than a year is a yellow flag.
- What do you do when a resident's behavior is challenging? Listen for de-escalation, validation, and patience — not "we ask the family to take them home" or "we use medications to calm them."
- What happens when a resident gets sicker than you can handle? A good home will say "we work with the family and physician to find the right next step, and we hold their room while they figure it out." A bad home discharges quickly.
- Can I talk to a current family? Most homes will set this up. If they refuse, ask why.
- Can I see your most recent inspection report? All AFHs are inspected by DSHS. They should be willing to show you their findings.
5. Pay attention to how the operator talks about residents
This is the soft signal that matters most. Listen to the language. Do they call residents "patients" or "clients"? Do they talk about people by their first names, with stories, with affection? Do they say "this is challenging behavior" or "this is who they are right now and we love them"?
A home that loves its residents shows it in the small phrases. A home that doesn't reveals it in clinical, distancing language.
6. Watch for these red flags
- Strong smell of urine — cleaning standards have lapsed
- Residents who appear over-medicated (sleeping during the day, slurred speech) — possible chemical restraint
- Caregivers who seem stressed, exhausted, or angry — burnout affects care
- The owner is rarely on-site or hard to reach — accountability matters
- You're told you can only visit during certain hours — that's a red flag for any home
- You can't see a sample bedroom or the kitchen — what are they hiding?
- Pressure to commit quickly — good homes know placement is a hard decision and don't push
- Online reviews mention the same complaint repeatedly
7. Trust your gut
You will visit homes that look beautiful on paper and feel wrong in person. Trust that. You'll visit homes that look modest and feel right. Trust that, too.
Your loved one will live in this home. They'll be cared for by these specific people. The brochure won't be there. The website won't be there. The relationships will. Choose the home where you can imagine your mother, your father, your brother, your spouse — actually feeling at home.
8. About cost
AFH costs in Washington vary widely — from around $4,500/month for basic care to $9,000+ for high-level dementia or specialized care. Many homes accept Medicaid (the state's COPES program) for residents who qualify. Some don't. Ask early.
Cost is real, but it's not the most important factor. A great fit at the higher end of your budget is better than a poor fit you can afford.
9. Once you've decided
Move-in is a transition. Most residents have a hard first two weeks — confusion, sadness, sometimes anger. This is normal. Visit often during this period, but resist the urge to take them home unless something is genuinely wrong. Most residents settle in by week three or four, and many begin to thrive.
Stay engaged. Talk to caregivers regularly. Build a relationship with the operator. The best outcomes happen when families and homes work together.
Final thought
Choosing an adult family home is one of the hardest decisions a family makes — and one of the most consequential for your loved one's quality of life. Take your time. Visit several. Ask hard questions. Trust what you feel.
And whatever you decide, know this: making this choice at all is an act of love. Your loved one is lucky to have someone willing to do this work for them.
At Better Life Adult Family Home in Marysville, we're happy to be part of your search — even if you ultimately choose a different home. We'll answer your questions and refer you elsewhere if we're not the right fit. Get in touch.