More than a hundred operators of adult family homes across Washington convened in Lynnwood on Tuesday to voice concerns regarding state regulations that they argue are undermining their financial viability. These licensed residential facilities, which house between six and eight residents depending on the specific permit, are responsible for providing not only shelter but also meals, laundry services, and daily personal care.
The gathering was organized by Caring Adult Family Homes of the North Sound, an independent coalition of regional providers. Although five lawmakers were originally scheduled to attend, only State Rep. Sam Low, a Republican from Lake Stevens, was present at the meeting. Low shared that his personal connection to the industry dates back to the 1970s, when he would ride a church bus to Everett to visit adults with disabilities residing in these homes. He noted that this experience continued into the early 2000s, making the subject personally significant. Low acknowledged the industry's difficulties, particularly concerning reimbursement levels, and expressed his desire to understand the current challenges faced by providers.
A central point of discussion was a recent ruling by the Washington Supreme Court in July, which declared the long-standing exemption from minimum wage and overtime rules for live-in caregivers unconstitutional. Providers argued that this shift, when paired with low state reimbursement rates, creates an unsustainable financial environment. Damaris Ramirez, a local provider, stated that while fair compensation for essential staff is supported, the state must match increased operational mandates with adequate funding resources to prevent quality homes from failing.
The meeting also addressed licensing capacity. Under the current standard license, homes are permitted to care for up to six residents, provided the space allows. To house eight residents, operators must secure a separate, additional license. Providers contended that allowing eight-bed capacity under the initial license would enhance financial stability, noting that the current process for upgrading to eight beds can take several years. Michelle Simmons, a provider from Clark County, indicated that the group intends to introduce legislation to the state healthcare committee to simplify this procedure. She explained that expanding to eight beds had enabled her to fund extra staff, management, and resident activities, thereby improving the well-being of both caregivers and residents.
Finally, the group highlighted a recent fee increase by the Department of Social and Health Services. In 2025, the agency doubled the annual license fee for adult family homes to $450 per bed, up from the previous $225. Providers pointed out that this rate now exceeds the $381 per bed annual fee charged to assisted living facilities, adding another layer of financial strain to their operations.
Medicaid providers have expressed opposition to a state Health Care Authority plan that would consolidate the procurement of urological and incontinence products for eligible patients under a single vendor arrangement. While the agency estimates the shift could generate annual savings between $4 million and $8 million, local industry representatives argue the consolidation risks degrading product quality and forcing regional suppliers out of business.
JoAnn Adiele, an operator of an adult family home in Shoreline, warned that relying on lower-grade materials would force staff to apply double layers of protection to prevent skin breakdown. She contended that this workaround would likely result in regulatory citations, increased infection rates, and a higher frequency of hospitalizations for residents, effectively raising the overall cost of care in the state.
Representative Low, who serves on the House healthcare committee, stated he intends to present these provider concerns during the upcoming legislative session. Although he sits in the minority, he pledged to communicate the urgency of the issue to the committee chair, emphasizing the matter’s significance to his district and the broader healthcare community.