Adult Family Homes · Pierce County
Small homes. Real care.
A free advisor service for families finding licensed adult family homes across Pierce County and South King County. We visit every home we refer.
What an AFH actually is
A residential home. Up to 6 residents. Licensed under WAC 388-76.
An adult family home (AFH) is a private residence licensed by DSHS to provide 24-hour personal care to up to 6 unrelated adults. Under WAC 388-76, a home can be licensed for 7 or 8 residents only after 24 months of clean operation at 6.
Every caregiver in Washington must be 18+, background-checked, first-aid/CPR certified, and TB-screened. Homes with a Dementia, Mental Health, or Developmental Disability specialty designation have additional training and environment requirements.
The small-home model is structurally different from assisted living. One caregiver per 3 residents during the day. Family members who tell us ‘we want a home, not a facility’ usually mean they want the AFH ratio without knowing they’re asking for it.
When an AFH is the right call
Three signals it's the right setting — and three when it isn't.
Right fit: 24/7 ADL support
Help with bathing, dressing, transfers, meds — in a calm setting smaller than a large facility.
Right fit: hospital recovery
30-day post-hospital recovery where caregiver attention matters more than amenities.
Right fit: small-home preference
Dementia that hasn't progressed to frequent exit-seeking; families prioritizing a caregiver knowing the parent by name.
Not a fit: skilled nursing needs
Ongoing medical instability, IV therapy, or complex wound care — usually routes to a nursing facility.
Not a fit: active elopement risk
Residents with frequent exit-seeking need a secured memory-care environment.
Not a fit: aggressive behaviors
Behaviors that endanger 5 co-residents in shared spaces belong in specialty settings.
Cost & payment
2026 private-pay range: $6,000–$10,000/month.
Four payment paths show up in most Pierce County placements.
Private pay — most common for the first 6–18 months; many families then transition to Medicaid as assets spend down.
Medicaid via COPES — Washington’s Community Options Program Entry System. 2026 asset limit $2,000 (single), income limit $2,901/month, community-spouse allowance up to $162,660.
VA Aid & Attendance — 2026 max: $2,424/mo (single veteran), $2,874 (married), $1,558 (surviving spouse), $3,845 (two married veterans).
Long-term care insurance — five policy terms drive 90% of outcomes. See our LTC insurance page.
Cities we serve
20 cities across Pierce County and South King County.
Common questions
Common questions about AFHs
An AFH is a private residential home capped at 6 residents (occasionally 7 or 8 with DSHS approval). An ALF is a purpose-built community typically serving 40–200 residents. Both are licensed by DSHS, but under different chapters of WAC. AFHs have more personal caregiver ratios; ALFs have broader amenities.
Many do, but only homes with a Dementia specialty designation under WAC 388-76 are licensed for residents with a formal dementia diagnosis and associated behaviors. If the resident has progressed to frequent exit-seeking, a secured memory care home is usually a better fit than a standard AFH.
If there’s inventory in the target area and the family can tour within 48 hours, we’ve moved residents from hospital discharge to AFH move-in in 3–5 days. See urgent AFH placement.
No. Our service is free to families. We’re paid by the receiving home only after a successful placement. Full disclosure.
Yes, through the COPES waiver. The applicant must meet functional eligibility via the CARE assessment plus the 2026 financial criteria: $2,000 asset limit and $2,901/month income for a single applicant.
Start here
Start your AFH search.
Free advisor service. Paid by the homes we place into, never by the family.