Washington Medicaid / Apple Health Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Washington, Medicaid is called Apple Health. This article focuses on Washington Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Washington Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Washington Medicaid, more commonly called Apple Health, will cover the cost of long-term care in a nursing home for financially limited Washington seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Skilled nursing care
• Physician’s visits
• Prescription medication
• Medication management
• Mental health counseling
• Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Washington Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $100/month (as of 2023), which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Washington Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Home and Community Based Services (HCBS) Waivers

Washington’s Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Washington seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Washington residents who live in their own home, the home of a loved one, an adult family home (comparable to adult foster care), an assisted living residence or a memory care residence. While Washington’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs.

The HCBS Waivers programs relevant to Washington seniors are:

1. Community Options Program Entry System
2. New Freedom
3. Tailored Supports for Older Adults.

1. Community Options Program Entry System (COPES)
The Community Options Program Entry System (COPES) will provide long-term care benefits to program participants in their own home, the home of a loved one, an adult family home (comparable to adult foster care) or an assisted living residence, but COPES will not pay for room and board in any of these locations.

COPES benefits include nursing services, adult day care, home modifications, meal delivery and non-medical transportation. A licensed care agency will provide these services and supports based on the applicant’s needs and circumstances.

Unlike Nursing Home Medicaid, COPES is not an entitlement. Instead, it has a limited number of enrollment spots (roughly 50,000 in 2023). Once those spots are full additional applicants are placed on a waitlist.

2. New Freedom
New Freedom will provide long-term care benefits to Apple Health recipients who are residents of King County and Pierce County and live in their own home or the home of a loved one. New Freedom will not provide benefits in adult family homes or assisted living residences.

New Freedom benefits can include adult day care, home and vehicle modifications, in-home nursing assistance, meal delivery, transportation, and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Program participants can self-direct their with an individualized budget they can spend on the long-term care services and supports of their choice. This includes hiring friends and family members as caregivers, as long as they are 18 or older, qualified to provide such care and have a contract with the Washington Department of Social and Health Services. Spouses and legal guardians, however, cannot be hired as caregivers.

New Freedom program beneficiaries work with “care consultants” to help them manage their budget and find appropriate care. They also work with a financial services agency to help them with payments to caregivers, tax withholding, and other financial transactions. Program participants who cannot make their own decisions can assign a representative to do so for them, but this representative cannot also be hired as a caregiver.

There are a limited number of enrollment spots for New Freedom (approximately 675 as of 2023). Once those spots are filled, additional applicants are placed on a waitlist.

3. Tailored Supports for Older Adults
Washington’s Tailored Supports for Older Adults (TSOA) program provides long-term care services and supports to Washington residents who are age 55 and over, require a Nursing Facility Level of Care, and live in a private home. TSOA is unique because its beneficiaries are not required to meet regular Medicaid financial limits. Most notably, the TSOA asset limit for an individual is $66,456, while the individual asset limit for the other HCBS Waivers in Washington (COPES and New Freedom) is $2,000. Full financial eligibility details are available below.

TSOA program participants can receive a maximum of about $800/month in long-term care benefits. These can include adult day care, nursing care, meal delivery, homemaker services, and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). For TSOA beneficiaries who live with a caregiver, there are some program benefits for the caregiver such as respite care, support groups, massage therapy, and specialized training. The caregiver can be a spouse or a family member, such as an adult child, but they don’t have to be related to the caregiver.

The TSOA program has a limited amount of funding each year. Once those funds run out, eligible applicants will be placed on a waitlist and will only receive TSOA benefits when the budget allows.

Aged, Blind, and Disabled Medicaid

Washington’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare and long-term care services and supports to financially limited Washington residents who are aged (65 and over), blind or disabled. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

The state will conduct an assessment of Washington ABD Medicaid beneficiaries to determine what type of long-term care services and supports they need and the state will cover. They can receive these long-term care benefits through the following programs:

1. Community First Choice Option (CFC) will provide long-term care benefits to in a program participants who require a Nursing Facility Level of Care but live in their own home, the home of a family member, an adult family home or an assisted living facility.
2. Medicaid Personal Care (MPC) offers long-term care services and supports to beneficiaries who require some help with their Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and live in their own home, the home of a family member, an adult family home or an assisted living facility.
3. Medicaid Alternative Care (MAC) is for ABD Medicaid beneficiaries who are age 55 and over and require a Nursing Facility Level of Care, but live in a private home with an unpaid family caregiver. This program would be ideal for a senior who is living with one of their adult children, for example.
4. The Specialized Dementia Care Program (SDCP) is for ABD Medicaid beneficiaries who have Alzheimer’s disease or a related dementia and live in an assisted living facility or memory care residence.
5. The Program of All-Inclusive Care for the Elderly (PACE) will streamline coverage for all medical and non-medical needs into one comprehensive plan for ABD Medicaid beneficiaries who require a Nursing Facility Level of Care and live in the community. This includes Medicare coverage for PACE program participants who are “dual eligible.” Washington PACE programs are available in Seattle and Tacoma.

1. Community First Choice (CFC) Option
Washington ABD Medicaid beneficiaries who require a Nursing Facility Level of Care  can receive long-term care services and supports through the Community First Choice Option, which is also known as CFC or CFCO. CFC beneficiaries can live in their own home, the home of a family member, an adult family home (comparable to adult foster care) or an assisted living facility, including enhanced residential care facilities. While CFC will provide benefits in any of those settings, it will not cover room and board costs.

CFC program benefits include nursing assistance, personal emergency response systems, assistive technology, respite care for primary caregivers, and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). The state can assign a licensed caregiver to provide these benefits, and CFC program participants also have the option to self-direct their care, meaning they can hire a caregiver of their choice to provide certain benefits, like personal care help. This includes friends and certain family members, as long as they are 18 or older, qualified to provide such care, and have a contract with the Washington Department of Social and Health Services. Spouses and legal guardians, however, can not be hired as caregivers.

The Community First Choice Option, like ABD Medicaid itself, is an entitlement program. This means that eligible applicants are guaranteed to receive benefits without delay once their application has been processed and accepted.

2. Medicaid Personal Care (MPC)
The Medicaid Personal Care (MPC) program provides long-term care services and supports to Washington ABD Medicaid recipients who require some help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), but don’t require a Nursing Facility Level of Care. MPC program participants must need extensive assistance with one of the Activities of Daily Living, or minimal assistance with at least three of them. The state of Washington uses the Comprehensive Assessment Reporting Evaluation tool to make this determination.

MPC benefits include select nursing services and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (cleaning, shopping, cooking, transportation, communication). MPC program participants can receive these benefits while living in their home, the home of a loved one, an adult family home, or an assisted living facility, but MPC will not pay for room and board in any of these locations.

The Medicaid Personal Care program, like ABD Medicaid itself, is an entitlement. This means that eligible applicants are guaranteed to receive benefits, without delay, after their application has been processed and accepted.

3. Medicaid Alternative Care (MAC)
Washington ABD Medicaid recipients who have a “family” caregiver, live in a private home, are age 55 or older and require a Nursing Facility Level of Care can receive long-term care services and supports through the Medicaid Alternative Care (MAC) program. For MAC program purposes, “family” includes friends as well as relatives, like spouses and adult children. “Family” caregivers must be age 18 or older, but they do not need to be Washington state residents.

MAC program benefits include adult day care, minor home modifications, durable medical equipment, meal delivery, homemaker services, and training and respite care for the caregiver.

Washington ABD Medicaid recipients who are enrolled in the MAC program cannot be simultaneously enrolled in the Community First Choice Option, Medicaid Personal Care, Community Options Programs Entry System or New Freedom programs.

The MAC program has limited funding, and once that limit has been reached for the year, the program does not accept new applicants, even if they are eligible. Instead, those eligible applicants are placed on a waitlist and will then be accepted into the MAC program once funds are available.

4. Specialized Dementia Care Program (SDCP)
Washington ABD Medicaid beneficiaries who have been diagnosed with Alzheimer’s Disease or a related, irreversible dementia such as Lewy body dementia, Creutzfeldt-Jakob disease, Pick’s disease or vascular dementia can receive long term care services and supports through the Specialized Dementia Care Program (SDCP). Program applicants must also require a Nursing Facility Level of Care to be eligible for this program, and the state of Washington uses the Comprehensive Assessment Reporting Evaluation (CARE) tool to determine if this level of care is necessary. Applicants must also receive a minimum score of three (out of six) on the cognitive performance portion of the Comprehensive Assessment Reporting Evaluation. Plus, applicants must exhibit at least one behavior that demonstrates cognitive impairment, such as taking items that don’t belong to them, wandering, disrobing in public, delusions, yelling, inappropriate toileting or being resistant to care.

Each SDCP participant receives an individualized service package tailored to their needs. Available benefits include 24/7 supervision, dementia-trained staff, medication management, intermittent nursing services and personal care help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

SDCP benefits are only available to Washington residents who live in an assisted living facility, including memory care units, but SDCP will not pay for room and board costs in these settings. The memory care unit can be a standalone residence, or a section of an assisted living facility designed for dementia-specific care. Not all assisted living facilities in Washington participate in this program. Since there are a limited number of spaces in participating facilities, there are a limited number of spaces in this program.

5. Program of All-Inclusive Care for the Elderly (PACE)
Washington residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and non-medical personal needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Washington’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs, and regular health checkups and services to program participants. Washington has two PACE programs in Seattle (Providence ElderPlace Seattle and International Community Health Services) and one in Tacoma (Pacific Northwest PACE Partners). To learn more about PACE, click here.

Eligibility Criteria For Washington Medicaid Long Term Care Programs

To be eligible for Washington Medicaid, which is called Apple Health, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Apple Health, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers, or Aged, Blind, and Disabled (ABD) Medicaid.

Washington Medicaid Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Washington residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid through Apple Health (Washington Medicaid). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash, and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Washington Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $100/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Nursing Home Medicaid is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in Washington is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. The state of Washington considers a Nursing Facility Level of Care to be necessary if the applicant needs daily nursing care, or if they need substantial assistance with at least two Activities of Daily Living (mobility, bathing, dressing, eating, toileting) or some assistance with at least three Activities of Daily Living. To determine if an applicant requires that level of care, Washington uses the Comprehensive Assessment Reporting Evaluation tool.

Washington Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Washington residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for most HCBS Waivers in Washington is $2,000, which means they must have $2,000 or less in countable assets. The only exception to this is the Tailored Supports for Older Adults (TSOA) waiver program, which has a $66,456 asset limit for single applicants (as of 2023). Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Washington for a single applicant is $2,829/month, with the exception of TSOA, where the individual income limit is $3,656/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Washington is a combined $3,000, and the income limit for married applicants with both spouses applying is a combined $5,658/month. For TSOA, the asset limit for a married couple with both spouses applying is a combined $132,912 (as of 2023) and the income limit is $3,656/month per spouse.

For a married applicant with just one spouse applying for HCBS Waivers in Washington, the 2024 asset limit is $2,000 for the applicant spouse and $68,301 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted. For married TSOA applicants with just one spouse applying, the asset limit is a combined $132,912. The income limit for the applicant spouse is $3,656/month and the income of the non-applicant spouse is not counted.

HCBS Waiver beneficiaries in Washington may not be entitled to keep all of their income. Instead, they may only be allowed to keep a small personal needs allowance depending on where they live, their marital status and any Medicare or spousal allowance expenses they may have.

Most HCBS Waiver applicants in Washington are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Washington has a “Look-Back Period” of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets. The Look-Back Period does not apply to TSOA applicants. However, TSOA applicants should be careful about giving away their assets. They might eventually need another HCBS Waiver, or Nursing Home Medicaid, and those programs will deny or penalize the applicant for giving away assets.

There are alternative pathways to eligibility for Washington HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers in Washington is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. The state of Washington considers a Nursing Facility Level of Care to be necessary if the applicant needs daily nursing care, or if they need substantial assistance with at least two Activities of Daily Living (mobility, bathing, dressing, eating, toileting) or some assistance with at least three Activities of Daily Living. To determine if an applicant requires that level of care, Washington uses the Comprehensive Assessment Reporting Evaluation tool.

Washington Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Washington residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Washington ABD Medicaid for a single applicant is $943/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants, the 2024 asset limit for Washington ABD Medicaid is a combined $3,000, and the income limit is a combined $1,415/month. These limits are used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.

Functional Requirements
The only functional requirements for receiving basic healthcare coverage through Washington ABD Medicaid is being aged (65 or over), blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, the state of Washington will use the Comprehensive Assessment Reporting Evaluation tool to conduct an evaluation of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long-term care benefits the state will cover.

How Medicaid Treats the Home

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

• If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $1,071,000 (as of 2024) then the home is exempt.
• If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
• If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $1,071,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Washington Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Washington and how you can protect your home from it, click here.

Applying For Washington Medicaid Long Term Care Programs

The first step in applying for an Apple Health (Washington Medicaid) Long Term Care program is deciding which of the three programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Apple Health (Washington Medicaid) when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Apple Health applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Washington residents can apply for Apple Health online at Washington Connection. They can also call the Department of Social and Health Services (DSHS) at 877-501-2233. Or they can print out an application here, and return it to their local DSHS office.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Choosing a Washington Medicaid Nursing Home

After being approved for Nursing Home Medicaid through Apple Health (Washington Medicaid), seniors have to choose which Medicaid-accepting nursing home best meets their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available space. Finding the right residence can be a challenge, especially if you’re looking in a specific location.

Washington has about 200 nursing homes, and all of them accept Medicaid. There are roughly 60 facilities in the Seattle area and about another 25 around Tacoma. Spokane has nearly 20 nursing homes that accept Medicaid within 25 miles. Outside of those cities, the clusters dwindle. There are 10 nursing homes around Yakima, but just five in the Pasco/Kennewick/Richland area.

Residents in some Washington communities regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, someone with Apple Health would not be covered for nursing homes in Oregon, for example.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in Washington.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS reveals that some nursing homes in Washington are seriously lacking when it comes to health standards. Washington nursing homes averaged 54.4 health deficiencies per facility from 2019-2022, while the national average was 25.7. Washington nursing homes also fared poorly when it came to fire safety. They averaged 22.3 fire deficiencies per facility from 2019-2022, while the national average was 13.5. This doesn’t mean that all Washington nursing homes have health or fire safety issues, but it does mean you should be sure to research those areas before making a final decision on nursing homes. Again, the search tool on Nursing Home Compare provides information about health inspections and quality measures for every nursing home in Washington and the country.