Adult family home disclosure of charges 2026

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The document is a disclosure form for Adult Family Homes, required by Washington state law (RCW 70.128.280), outlining the charges and services provided by the home. It includes information on Medicaid policies, admission fees, deposits, prepaid charges, daily/monthly rates, personal care services, medication assistance, and additional fees for various items and activities. The form emphasizes the importance of direct communication with the home for potential residents and their families to ensure they understand all costs and services available.
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  1. Click ‘Get Form’ to open the adult family home disclosure of charges in the editor.
  2. Begin by entering the provider’s name and date at the top of the form. This information is essential for identifying the specific adult family home.
  3. Fill in the license number, ensuring that all details are accurate to avoid any discrepancies.
  4. Review each section carefully, starting with Medicaid Information. Clearly state whether your home accepts Medicaid payments and under what conditions.
  5. Proceed to Admission Fees, Deposits, and Prepaid Charges sections. Provide full disclosures as required, including amounts and purposes for each fee.
  6. Complete the Daily and/or Monthly Rates section by indicating both low and high rates for services offered.
  7. Detail Personal Care services, Medication Services, Other Services, Items, Activities, and any Other Charges that may apply. Be thorough to ensure transparency.

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Adult family homes provide living for six or fewer residents and are licensed by the state. They are regular neighborhood homes where staff people assume responsibility for the safety and well-being of the residents. A room, meals, laundry, supervision and varying levels of assistance with care are provided.
In AFC, sometimes called adult foster care or adult family homes, residents live full-time in a house or other small residential setting where they receive assistance with activities of daily living, personal care, and help with medications and other health care tasks, in collaboration with health care professionals.
Introduction. Adult Family Homes (AFH) are regulated through the Washington State Department of Social and Health Services (DSHS). More information about Adult Family Homes and how to obtain a license for an Adult Family Home can be found on their website at: Information for AFH Providers.
AFHs offer a smaller, family-oriented setting for personalized care. Nursing Homes: Best for seniors with advanced health conditions requiring medical supervision.

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