Caregiver's Guide to Long-Term Care Settings in Washington State

Long-term care in Washington State includes a range of work settings, from one-on-one care in a client’s home to team-based care in residential and medical facilities. Each setting differs in size, structure, and daily expectations for caregivers.

Some settings involve working independently with a single client, while others require coordination with supervisors, nurses, or other caregivers.

This overview introduces the main long-term care settings in Washington from a caregiver’s perspective. It is made to help you set your expectations, prepare for your caregiving role, and look into work settings you can choose from after completing your HCA training and certification.

Some terms in this overview describe how care is delivered rather than formal licensing categories, but they reflect how caregivers experience these settings in practice.

Home-based care

Home-based care supports adults who need help with daily activities while continuing to live in their own homes. Care is delivered one-on-one and does not involve a facility or resident capacity limit.

Home-based care involves supporting adults who need help with daily activities, but still want to continue to live in their own homes. Their caregivers come to their homes to provide care, which means that care is delivered one-on-one and not in a facility.

What kind of care is provided

• Assistance with activities of daily living (bathing, dressing, toileting)

• Mobility and transfer support

• Meal preparation and light housekeeping

• Safety monitoring and routine support

Where care is provided

• Private homes or apartments

Do HCAs work in home-based care?

• Yes. This is the primary setting for HCAs in Washington

• HCAs provide hands-on personal care and daily support

Community-based services

Community-based services are not residential care, but supportive programs. People do not live or stay at a specific facility. Instead, they live at home and come in for structured care and supervision for part of the day or short periods of time. 

For example, this might be a great option for an adult with mobility issues who lives with their family, but comes to an adult day center for meals, activities, and supervision while family members work. Typical community-based services in Washington state are: adult day health, respite care, and adult day services.

What kind of care is provided?

• Supervision and personal care assistance

• Meals and social or therapeutic activities

• Short-term respite support

Where is care provided?

• Adult day centers

• Community-based program sites

Do HCAs work in community-based services?

• Sometimes

• HCA roles depend on the program and provider

Adult family homes

Adult family homes are licensed residential care settings located in private homes. In Washington State, adult family homes are limited in size and serve up to six residents at a time, creating a small, home-like care environment where residents live on-site and receive daily support.

Adult Family Home may look like a household, but it operates like a care setting. An adult family home is not a family taking someone in. It is a licensed care business operating inside a private home.

However, it can feel much more personal as there is a small number of residents, they share meals and common spaces, and there is usually a consistent home-like daily routine with the same caregivers.

What kind of care is provided?

• Assistance with activities of daily living (bathing, dressing, toileting)

• Help with mobility and transfers

• Daily supervision and routine support

• Assistance with meals and household routines

Where is care provided?

• Licensed private residences

  
  

Do HCAs work in Adult Family Homes?

• Yes

• HCAs often provide most of the day-to-day hands-on care

• Caregivers typically work as part of a small, consistent care team

Assisted living facilities

Assisted living facilities (ALFs) are licensed residential care settings where adults live on-site and receive help with daily activities. Unlike adult family homes, assisted living facilities are designed to serve larger numbers of residents and are not limited to a small household size. Residents typically live in apartment-style or shared units within a larger community.

For example, a person can live in an assisted living community with their own room or apartment. They receive help with bathing, dressing, and medications, eat meals in a shared dining area, and participate in scheduled activities, while care staff are available throughout the day.

What kind of care is provided?

• Assistance with activities of daily living (bathing, dressing, toileting)

• Medication assistance

• Daily supervision and routine support

• Meals and organized activities

Where is care provided?

• Licensed assisted living communities

• Apartment-style units or shared residential spaces

Do HCAs work in Assisted Living Facilities?

• Yes.

• HCAs provide direct personal care as part of a care team

• In some residential settings, caregivers may work under nurse delegation for certain tasks

Memory care

Memory care provides specialized residential support for adults living with Alzheimer’s disease or other forms of dementia.

These settings are designed to support safety, structure, and routine for residents who need ongoing supervision due to cognitive impairment. Memory care may exist as a dedicated facility or as a secured unit within a larger residential setting.

What kind of care is provided?

• Assistance with activities of daily living (bathing, dressing, toileting)

• Supervision to support safety and reduce wandering risks

• Structured routines and daily activities

• Emotional support and redirection as needed

Where is care provided?

• Dedicated memory care facilities

• Secured memory care units within residential communities

Do HCAs work in this setting?

• Yes

• HCAs support daily personal care and routines. Mental Health and Dementia training may be necessary.

• Caregivers work as part of a team and follow dementia-specific care practices

Skilled nursing facilities

Skilled nursing facilities provide 24-hour medical and nursing care for those who require continuous clinical oversight and treatment. For example, a person recovering from surgery or living with serious medical conditions resides in a skilled nursing facility where nurses provide ongoing medical care, monitor health status, and coordinate treatments around the clock.

What kind of care is provided?

• 24-hour skilled nursing care

• Medical monitoring and treatments

• Medication administration

• Rehabilitation and therapy services

Where is care provided?

• Licensed skilled nursing facilities

Do HCAs work in this setting?

• Generally no

• Care is primarily provided by licensed nurses and certified nursing assistants

• HCAs do not typically provide care in these medical settings

How care settings differ for caregivers

Care settings can feel very different depending on where you work. In some roles, caregivers work one-on-one with a single client and manage their day independently. In other settings, care is shared among a team, with responsibilities divided and support available from coworkers. Neither approach is better than the other, but they require different skills and mindsets.

Supervision, structure, and pace also vary. Some settings allow caregivers to work with a lot of independence, while others follow clear routines, schedules, and protocols. The pace may be calm and predictable or fast and demanding, especially in settings where residents have more complex care needs.

Choosing a care setting as a caregiver

Every caregiver brings a different work style to the role. Some people enjoy working independently and building a close relationship with one client, while others prefer team-based environments.

Comfort with structure also matters, as some settings require caregivers to follow detailed procedures, while others allow more flexibility.

It’s also common for caregivers to move between settings over time. Skills learned in one environment often transfer to others, and experience can help caregivers discover where they feel most confident and supported.

Understanding different care settings early on makes it easier to choose roles that fit both personal strengths and long-term goals.

Long-term care settings in Washington State: Key takeaways for caregivers

There is no single “best” care setting for every caregiver. Each environment offers different challenges, routines, and opportunities to learn. What works well for one person may not feel right for another, and that’s normal.

Taking the time to understand how care settings differ helps caregivers know what to expect before starting a role. This understanding builds confidence, supports safer care, and creates a strong foundation for growing and developing as a caregiver over time.