When looking at placing your loved one into an Adult Family Home, often one of the first concerns is, how much will it cost? As with most things in life, this has the disappointing answer of, “it depends”.
As of November 2025, a typical starting rate for a Private Pay resident in an Adult Family home in Western Washington is $7,500 and that typically goes up based on care needs to around $13,000 per month. Most clients I work with end up paying an average of $9,000 per month. Some being a little more or a little less, others being significantly more or significantly less. If you’re early Dementia and a low care needs individual, your rate is going to be substantially less than the resident that requires 2 person assist, Hoyer Lift, Active Trach tube, Enteral Feeding, Suctioning, Colostomy Care, Oxygen Care, etc.
The Real Budget
Ultimately, what tends to make the biggest difference for those looking for an AFH is Spend Down or how long the Provider will require you to be Private Pay before transitioning over to Medicaid. Often people will look at $9k or whatever the number is and get stuck on that, when their loved one has $100,000 in total assets and every indication they are going to be around to spend it all. In that case $8k, $9k, $10k…it’s really not that important. What matters is that the Provider will keep them on after they transition over to Medicaid after their Private Pay runs out. If the Provider would prefer to charge $8k and that lasts 12.5 months, great. If they charge $9k and it lasts 11 months, great. If they charge $10k and it lasts 10 months, great. In the end, this is their forever home and you’re planning out past when they run out of money, not getting caught up on how quickly, this isn’t an Assisted Living Facility, you won’t get kicked out when you can no longer pay.
When you’re looking at an AFH, the real budget is total cash assets + Social Security Payments or whatever other Payments they get. You’re typically looking at how long you are Private Pay and then you can determine which AFHs are willing to accept that. I generally recommend clients assume around $100k per year or $9k per month and calculate out from there. Then we can bring you options that will work for that situation.
Adult Family Homes on a budget
Not everyone can afford $9k per month or has $100K+ in cash assets or even $50k. Some folks are on a fixed income with multiple income streams, maybe they are hitting $5k-$6k per month, is there an AFH that will accept that? Maybe….
In situations like this, I go straight to Medicaid AFHs. They are Adult Family Homes that are already willing to accept Medicaid, so a lower end Medicaid client in King, Snohomish or Pierce would probably come in at around $4.5k, a higher care needs client at around $6.5k. Being Private Pay, the Provider will have to pay for Nurse Delegation out of pocket, so they’ll need a little more than Medicaid pays to make it make sense.
There are typically Providers that are willing to go under market rate for the right client. If you are on a limited budget, there’s still a chance we can find something for you.
What about Medicaid?
If you or your loved one is on Medicaid, good news, there are lots of AFHs that accept Medicaid clients. As one might expect, this tends to be geographically consistent with housing prices. Expensive area, not very many Medicaid AFHs and what you will find are usually shared bedrooms. Cheaper areas, lots of Medicaid AFHs.
The most important thing when it comes to Medicaid is to get approved for Long Term Care Benefits through DSHS. You can do that here Washington Connection (Your Link to Services). Please be sure you qualify, the program requires the applicants to be very poor before applying. Once you’ve been approved then you’ll need to request an “Adult Family Home Assessment” from the Case Manager assigned to you or your loved one.
If you try shopping around without this, it won’t do you much good. The assessment gives the Provider the daily rate that Medicaid is willing to pay in addition to a detailed report on medical diagnosis, care needs, etc. This is always the first step when you are on Medicaid, get the assessment!
What are Typical Spend Downs for Adult Family Homes?
For a Private Pay AFH, the most typical Spend Down requirements you’ll find is between 1-3 years. Some require more, some less, some don’t accept Medicaid at all and some accept Medicaid right away. It just depends on the home and depends on the situation and the market.
Why are some Adult Family Homes more expensive?
Lots of reasons, but in no particular order.
-Longer History – If you’ve been in business for 20 years, you’ve got lots of people recommending you and you can be pickier in which clients you accept, including amount of Private Pay. Newer Providers don’t have that same luxury
-Location – If you’re in an area where an AFH cost $2 million, it’s going to cost more to operate than one that cost $500k, just basic math on that one.
-Nicer Home – Homes come in many different shapes and sizes. More affordable Adult Family Homes tend to be simpler conversions, more expensive homes tend to be much fancier with Private Bathrooms, wider hallways, taller ceilings, views, etc.
-Food – Pricier Adult Family Homes put a huge emphasis on the freshness and quality of food they offer to their clients. This isn’t to say that more affordable Adult Family Homes don’t offer delicious and nutritious meals to their residents, but it’s typically not at the same level.
-Staffing – Some Adult Family Homes run 2 Caregivers during daytime hours and 1 awake at night. That’s a lot of staff for 6 residents and it costs a lot of money to maintain. For that you are getting a 1:3 ratio, which is excellent, but that excellence comes at a price. Staffing definitely affects price.
-Availability – The more often you stay full, the pickier you’ll be about who you take.
How do I know if an Adult Family Home has a Spend down that works for us?
Many AFHs that list with us do post their Spend Down in their vacancy info. I would warn you that those numbers tend to be more aspirational than hard policy. I’ve got 2 year spend downs that will take as 8 month Spend Down client without blinking.
The easiest way is just to ask a Care Advisor at Local Care Homes. We’ll send you options that will accept you or your loved one with whatever your financial situation is. We work with these Providers every day, so we know who is more flexible and what will be the best fit for your situation. Not to mention, we can also take all other criteria into account. From care needs to social needs, we can ensure that AFH has what your looking for so all you need to do is tour them and pick your favorite, as you’ll already know they are reputable Providers as we only refer clients to Providers that pass our stringent screening process.
If your looking to find an Adult Family Home for yourself or a loved one
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