The admission agreement is the document that decides what you pay, what care you actually get, and how easily you can leave — and Puget Sound families are usually handed it on the day they are most exhausted.
By Marcus Reyes, LSW · August 31, 2026
Most families in King, Snohomish, and Pierce counties make the decision emotionally on a tour and legally in a conference room a week later. The tour tells you how a building smells and how the staff talk to residents. The admission agreement tells you what happens when your mother needs two people to transfer, when the rate goes up in March, and when the community decides she is no longer a fit. Those are the moments families call us about, and by then the terms are already set.
Washington gives you real footing here. Assisted living communities are licensed under RCW 18.20, adult family homes under RCW 70.128, and residents of both are covered by the long-term care resident rights in RCW 70.129 — which requires the facility to tell you, before or at the time you move in, what services it provides and what they cost. A contract that leaves you guessing on either point is a contract to slow down on.
First, the base rate and exactly what it buys. In the Puget Sound market, assisted living generally runs about $6,000–$8,000 a month, memory care roughly $7,500–$9,500, and licensed adult family homes about $4,500–$7,000. A base rate normally covers the room, meals, 24-hour staffing, housekeeping, and activities — not much else.
Second, the care-level or point system. This is where quoted prices and real bills separate. Ask for the written tier schedule: what triggers a move from level two to level three, how much each step costs, who decides, and how much notice you get. Ask the question directly — what is the most a resident's care charge has increased in one step this year?
Third, the up-front money. Community fees, move-in fees, and deposits are common, and their refundability varies enormously between operators. Get the refund terms in writing, including what happens if your parent is hospitalized in week three and never returns.
Fourth, the annual increase. Ask what the rate went up last year and the year before — not what is projected. Ask how much written notice you receive before an increase takes effect, and make sure that notice period appears in the document rather than in a verbal reassurance.
Every Washington assisted living contract contains language about when the community may ask a resident to leave — usually phrased as needs that exceed what the license or the staffing model can serve. Read it slowly. If your parent has a dementia diagnosis, ask specifically whether exit-seeking, resistance to personal care, or nighttime agitation would trigger it, and whether the community holds a Specialized Dementia Care endorsement that lets it keep serving those needs.
Ask about nurse delegation too. Many Puget Sound adult family homes and assisted living communities rely on a registered nurse delegating specific tasks to trained caregivers. If your parent needs insulin, a catheter, or wound care, the practical question is not whether the building “does” it — it is whether a delegating nurse is currently in place for that task.
Then look for the payment-source clause. If private funds are likely to run out in two or three years, whether the community accepts Washington Apple Health (Medicaid) with the COPES waiver — and how many Medicaid-funded residents it actually serves — matters more than almost anything on the tour. Some communities require a documented number of private-pay years first. That belongs in the contract, not in a hallway conversation.
You are allowed to take the agreement home. You are allowed to bring it to an elder law attorney, and for a contract worth six figures a year that is rarely wasted money. You can also call the statewide Long-Term Care Ombudsman program (waombudsman.org), which advocates for residents free of charge and can tell you whether a term you are being asked to accept is normal.
Before you sign, pull the facility's inspection history from the DSHS Residential Care Services provider lookup at fortress.wa.gov and read the recent findings alongside the contract. A building with repeat medication-administration citations and a vague care-level schedule is a different risk than the same schedule at a clean provider.
And ask for every promise in writing. If the marketing director says the second-floor room will be held, or that the current rate is locked through the calendar year, that assurance is worth what the document says it is worth. Our advisors sit with Puget Sound families through this step at no cost — often catching a refund clause or a care-tier trigger that would have surfaced six months later as a surprise bill.
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