Washington assisted living rules: what you must document about each resident

Most state rules ask for a service plan and an activity calendar. Washington goes further: two of the eleven topics in its full assessment are about the person rather than their diagnoses, meaning what they do with their days and who they are. This page walks the whole chain, from preadmission to the service agreement to activities, with the rule text quoted.

Who these rules cover

Chapter 388-78A WAC governs every licensed assisted living facility in Washington. The licensing statute is chapter 18.20 RCW, and the "department" in the rules is DSHS. DSHS licenses facilities and inspects them.

Since the 2026 amendments (WSR 26-15-066, effective August 15, 2026), a community that markets memory care or specialized dementia care, or that restricts egress for residents with cognitive impairment, is a "memory care facility" or "memory care unit" and must hold a separate certification. The rule is direct:

"After July 1, 2026, an assisted living facility may not operate as a memory care facility or maintain a memory care unit without becoming certified."WAC 388-78A-2383(1)

Step one: the preadmission assessment

Before a resident moves in, the facility must complete a preadmission assessment. Alongside medical history, medications and care needs, it must capture, unless the information is unavailable despite best efforts:²

"(7) Activities and service preferences; and (8) Preferences regarding other issues important to the prospective resident, such as food and daily routine."WAC 388-78A-2060

So the preference conversation starts before move-in. On admission, the facility then writes an initial resident service plan that gives staff direction about "the resident's immediate needs, capabilities, and preferences."⁵

The full assessment: 14 days, eleven topics

The core rule is WAC 388-78A-2090. It opens with the standard the whole assessment is measured against:

"The assisted living facility must obtain sufficient information to be able to assess the capabilities, needs, and preferences for each resident, and must complete a full assessment addressing the following, within fourteen days of the resident's move-in date, unless extended by the department for good cause"WAC 388-78A-2090

Items (1) through (8) and (11) are the clinical and legal backbone: medical history, medications, nursing needs, vision and hearing, communication, behaviors and safety, screening for mental illness, developmental disability and dementia, personal care needs, and who holds decision-making authority. Items (9) and (10) are the ones that set Washington apart:

"(9) Individual's activities, typical daily routines, habits and service preferences. (10) Individual's personal identity and lifestyle, to the extent the individual is willing to share the information, and the manner in which they are expressed, including preferences regarding food, community contacts, hobbies, spiritual preferences, or other sources of pleasure and comfort."WAC 388-78A-2090(9)-(10)

Three details in that wording matter in practice:

• "Typical daily routines" and "habits" means the shape of an ordinary day: waking, coffee, naps, showers.
• "To the extent the individual is willing to share" means the resident sets the limits. You document what they choose to tell you, and you do not have to extract a full biography.
• "Other sources of pleasure and comfort" is open-ended on purpose. Music, a pet, a garden, a grandchild's calls, a faith practice: whatever settles this person belongs here.

The resident has to be part of it. WAC 388-78A-2110 requires the facility to "directly involve each resident or prospective resident, to the extent possible," along with an appropriate representative, in the assessment process.⁴

The negotiated service agreement

Within 30 days of move-in, the facility must complete a negotiated service agreement using the preadmission assessment, the initial service plan and the full assessment.⁵ The people at the table include the resident, their representative, anyone else the resident wants included, and a case manager for Medicaid residents. They must "Discuss the resident's assessed needs, capabilities, and preferences" and agree on the services.

The contents rule, WAC 388-78A-2140, carries the preference thread forward. The agreement must address the resident's "assessed capabilities, needs and preferences," and specifically includes:

"(e) The resident's preferences for how services will be provided, supported and accommodated by the assisted living facility." ... "(4) The resident's preferences for activities and how those preferences will be supported;"WAC 388-78A-2140

That second clause is the bridge between the assessment and the activity calendar. It is not enough to know that a resident loved bridge; the agreement should say how the community will support it. It must be signed at least annually by the resident or their representative and an authorized facility representative.⁶

Reassessment and change of condition

WAC 388-78A-2100 requires a full assessment covering all of the 2090 topics at least annually. The 2026 amendments added a tighter cycle for memory care:

"For residents with dementia living in an assisted living facility certified as a memory care facility or memory care unit, complete a full assessment addressing the elements set forth in 388-78A-2090 for each resident at least semi-annually."WAC 388-78A-2100(2)(b)

A focused assessment is also required after a change of condition, after an injury needing a practitioner, or when the agreement "no longer addresses the resident's current needs and preferences." Note the word preferences: a plan that no longer fits what the resident wants is itself a trigger.

Activities and social programming

WAC 388-78A-2180 requires space and staff support for two kinds of activity. First, each resident's own independent or self-directed activities, "consistent with the resident's assessed interests, functional abilities, preferences, and negotiated service agreement." Second, group activities "at least three times per week," planned around the collective interests of the residents. The facility must also make routine supplies and equipment available.⁷

The phrase "assessed interests" ties the activity program back to items (9) and (10) of the assessment.

Certified memory care: daily, individual activities

The 2026 amendments added a memory care subsection to the activities rule. It is the most individualized activity requirement in the chapter:

"The assisted living facility certified as a memory care facility or memory care unit must provide daily activities consistent with functional abilities, interests, habits, and preferences of the individual residents."WAC 388-78A-2180(3)

Daily, residents must have access to independent activities, individual activities "in which a staff person or volunteer engages the resident in a planned or spontaneous activity of interest," group activities, and options that fit "variations in a resident's mood, energy, and preferences." The rule adds that activities must match each resident's own schedule: "a resident up at night must have access to staff support, food, and appropriate activities."

Certification itself (WAC 388-78A-2383) also requires a staffing plan with 24-hour awake caregivers adequate to each resident's needs, "including waking and sleeping patterns," and physical features that support the daily activity requirements.⁸ Knowing someone's lifelong sleep pattern is not a nice extra in memory care. The rules assume you know it.

What surveyors tend to look for

Going only by what the rule text says to document, a reviewer can reasonably check:

• A dated full assessment within 14 days of move-in (or a department extension) that actually addresses items (9) and (10), not a blank box or "N/A."
• A negotiated service agreement within 30 days that states the resident's preferences for how services are given and for activities, and how the community will support them.
• Consistency: the activity preferences in the agreement show up in the resident's actual activity options.
• Annual full reassessments, semi-annual ones in certified memory care, and focused assessments after changes.
• In memory care, daily activities, including individual ones, that line up with each resident's recorded interests, habits and schedule.

Gathering personal identity and comfort well

Items (9) and (10) are hard to fill in from an intake form. A few practices help:

• Use the first two weeks. The 14-day window allows two or three short conversations instead of one long interview on a tiring move-in day.
• Ask open questions. "Tell me about the house you grew up in." "What did a good Saturday look like when you were forty?" "Who do you like to hear from?" Stories reveal routines, food, faith and comfort far better than "List your hobbies."
• Bring in family, with the resident's consent. The rule limits item (10) to what the resident is willing to share. Family can fill gaps, especially for residents with dementia, but the resident's own view comes first.
• Write down what to avoid. A topic that brings grief, a food they refuse. That matters as much as what soothes.
• Write it in their words. "Likes music" is weak. "Sings along to Patsy Cline; her late husband played guitar" gives staff something to say.
• Revisit at every reassessment. Preferences change. The annual (or six-month) full assessment is a natural time to ask what is new and what no longer fits.

How Porchlight can help

Porchlight is a life-story tool built for exactly this part of the job. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and they talk; the answer is recorded and transcribed. There are more than 800 human-written questions organized by life chapter, the resident or staff can choose a topic, any question can be skipped, and nothing is scored. Staff can record profile facts, including topics to avoid. Family get a private page to listen, leave voice replies, and add their own questions and photos. Staff get a "Know Your Resident" briefing with conversation starters, story highlights, a printable life-story biography and a weekly Monday email digest.

It helps you gather and keep the routines, preferences and personal-identity material that WAC 388-78A-2090 asks about, in the resident's own words. The assessment itself, and compliance with chapter 388-78A WAC, remain your community's responsibility.

Frequently asked questions

How long does a Washington assisted living facility have to complete the full assessment?

WAC 388-78A-2090 requires the full assessment within fourteen days of the resident's move-in date, unless the department extends it for good cause. The negotiated service agreement is due within thirty days of move-in under WAC 388-78A-2130.

Does Washington require assisted living to document a resident's life history?

Not under the words life history. WAC 388-78A-2090 requires the assessment to cover the resident's activities, typical daily routines, habits and service preferences, and their personal identity and lifestyle, to the extent they are willing to share, including food, community contacts, hobbies, spiritual preferences and other sources of pleasure and comfort.

How often must a Washington assisted living resident be reassessed?

At least annually for a full assessment under WAC 388-78A-2100. For residents with dementia in certified memory care, at least semi-annually. A focused assessment follows a change of condition, an injury needing a practitioner, or a service agreement that no longer fits.

How many group activities does WAC 388-78A-2180 require?

Group activities at least three times per week, plus space and staff support for each resident's independent activities consistent with their assessed interests and preferences. Certified memory care facilities and units must offer activities daily, including individual activities, suited to each resident's interests, habits and preferences.

Do the federal nursing home rules apply to Washington assisted living?

No. The federal nursing home requirements in 42 CFR Part 483 apply to certified nursing facilities, not to assisted living. Washington assisted living facilities are regulated by the state under chapter 18.20 RCW and chapter 388-78A WAC.

Does Porchlight complete the WAC 388-78A-2090 assessment for us?

No. Porchlight helps residents and families share routines, preferences and life stories in the resident's own voice, and gives staff a briefing built from them. Your team still conducts the assessment and writes the negotiated service agreement.