Washington Regulations

Washington State Long-Term Care Licensing and Regulation: A Comprehensive Guide

The licensing and regulation of long-term care facilities in Washington State is a complex, two-tiered system involving two primary state agencies: the Department of Health (DOH) and the Department of Social and Health Services (DSHS). This dual oversight ensures that facilities providing different levels of care—from skilled nursing to residential assistance—meet stringent state and federal standards for safety, quality of care, and resident rights.

This comprehensive guide details the roles of these agencies, the specific regulations governing each type of long-term care setting, and the critical standards facilities must meet to operate legally in Washington.

The Dual Regulatory Landscape

In Washington, the type of facility dictates which state agency is responsible for its licensing and oversight.

1. Department of Health (DOH): The DOH, specifically its Health Systems Quality Assurance Division (HSQA), is responsible for licensing and certifying Nursing Homes (also known as Skilled Nursing Facilities). This is the agency that ensures compliance with both state and federal (Medicare/Medicaid) regulations [1].
2. Department of Social and Health Services (DSHS): The DSHS, through its Aging and Long-Term Support Administration (ALTSA), is responsible for licensing and regulating Assisted Living Facilities (ALFs) and Adult Family Homes (AFHs). These facilities provide residential care and services, but not the 24-hour skilled nursing care found in nursing homes [2].

Nursing Home Licensing and Oversight (DOH)

Nursing homes in Washington provide the highest level of long-term care outside of a hospital, offering 24-hour skilled nursing, rehabilitation, and medical services. The DOH's oversight is rigorous, focusing on compliance with the federal requirements necessary for Medicare and Medicaid certification.

Governing Regulations and Standards

The primary state regulations for nursing homes are found in the Revised Code of Washington (RCW) 18.51 and the Washington Administrative Code (WAC) 388-97 [3]. These codes cover a vast array of operational standards, including:

• Licensure Requirements: Detailed procedures for initial licensing, renewal, and change of ownership [4].
• Resident Rights: Mandating the protection of residents' dignity, self-determination, and freedom from abuse or neglect.
• Quality of Care: Standards for physician services, pharmaceutical services, dietary services, and specialized rehabilitative services.
• Infection Control: Strict protocols for preventing and controlling the spread of infections.

Staffing Requirements

Staffing is a critical component of nursing home quality. Washington state regulations, in conjunction with federal requirements, mandate minimum staffing levels to ensure adequate care.

• Minimum Staffing Standard: WAC 388-97-1090 requires nursing homes to ensure a sufficient number of qualified nursing personnel are available 24 hours a day, seven days a week [5]. Crucially, the state mandates a minimum of 3.4 hours of direct care per resident day (HPRD), which includes the time provided by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs) [6].
• Enforcement: A nursing home that fails to meet the minimum 3.4 HPRD requirement for any quarter is subject to fines and other enforcement actions [6].

Inspection and Survey Process

The DOH conducts regular, unannounced inspections, known as surveys, to monitor compliance.

• Frequency: Federal law requires that every Medicare/Medicaid-certified nursing home receive a standard survey at least once every 15 months, with the average interval not exceeding 12 months [7]. Washington's DOH adheres to this schedule.
• Scope: The survey team, composed of nurses, social workers, and other professionals, reviews resident care plans, observes care delivery, interviews residents and staff, and examines facility records.
• Complaint Investigations: The DOH also conducts unannounced complaint investigations in response to allegations of abuse, neglect, or regulatory violations [1].

Assisted Living Facility (ALF) Oversight (DSHS)

Assisted Living Facilities (ALFs) provide housing, support services, and personal care to residents who need assistance with Activities of Daily Living (ADLs) but do not require 24-hour skilled nursing care. DSHS is the licensing authority for ALFs.

Governing Regulations and Standards

ALFs are regulated under RCW 70.129 and WAC 388-78A [8]. The regulations emphasize resident choice, dignity, and the provision of services tailored to individual needs.

• Scope of Care: ALFs must admit or retain only those individuals whose needs they can safely and appropriately serve. They are required to provide services such as medication management, personal care, and assistance with self-administration of medication [9].
• Service Agreements: Each resident must have a written service agreement that details the services to be provided, the cost, and the resident's rights and responsibilities.
• Staffing and Training: WAC 388-78A-2450 requires ALFs to provide sufficient, trained staff to furnish the services and care needed by each resident [10]. Staff must meet specific training requirements, including specialized training for residents with dementia or mental health needs [11].

Inspection and Monitoring

DSHS monitors ALFs through a combination of initial licensing inspections, renewal inspections, and complaint investigations.

• Inspections: DSHS conducts unannounced inspections to ensure compliance with WAC 388-78A. These inspections review staffing levels, training records, service plans, and the overall environment of the facility.
• Enforcement: If an ALF is found to be out of compliance, DSHS enforcement actions can range from civil fines and stop-placement orders (prohibiting new admissions) to summary suspension or revocation of the facility's license [12].

Adult Family Home (AFH) Oversight (DSHS)

Adult Family Homes (AFHs) are residential homes licensed to care for a small number of non-related residents, typically up to six [13]. They offer a more home-like setting than larger institutional facilities while providing room, board, and necessary supervision and personal care. DSHS is also the licensing authority for AFHs.

Governing Regulations and Standards

AFHs are regulated under RCW 70.128 and WAC 388-76 [14]. The regulations are designed to maintain the residential character of the home while ensuring professional care standards.

• Capacity and Environment: The small capacity is a defining feature, intended to foster a more intimate and personalized care environment. The physical environment must be safe, clean, and accessible.
• Caregiver Qualifications: The AFH licensee must have a minimum of 80 hours of training in adult family home care before the license is issued [15]. Caregivers must be certified as Home Care Aides (HCAs) unless they hold an exemption (e.g., RN, LPN, or CNA) [16].
• Staffing: WAC 388-76-10200 requires that at least one qualified caregiver be present in the home whenever one or more residents are present [17].

Inspection and Monitoring

DSHS's oversight of AFHs is crucial due to their small, decentralized nature.

• Inspections: DSHS conducts inspections to ensure compliance with WAC 388-76. These inspections focus on the quality of care, the safety of the environment, and the qualifications of the staff.
• Stop Placement Orders: A common enforcement tool for AFHs is the Stop Placement Order, which prevents the home from accepting new residents until identified deficiencies are corrected [18].

Enforcement Actions and Public Information

Both DOH and DSHS maintain public records of enforcement actions taken against licensed facilities. This transparency is vital for consumers researching long-term care options.

DOH Enforcement (Nursing Homes)

The DOH issues civil fines, conditional licenses, and can ultimately suspend or revoke a nursing home's license for serious or repeated violations of state and federal regulations [19]. The DOH Newsroom often publishes summaries of disciplinary actions against health care facilities and providers [20].

DSHS Enforcement (ALFs and AFHs)

DSHS enforcement actions against ALFs and AFHs include:

• Civil Fines: Monetary penalties for specific violations.
• Stop Placement Orders: Prohibiting the facility from admitting new residents.
• Summary Suspension/Revocation: For severe violations that pose an immediate threat to resident health or safety, DSHS can summarily suspend a license, followed by a process for permanent revocation [21].

Consumers can access detailed inspection reports, complaint investigation findings, and enforcement actions for both nursing homes (via the federal Medicare Care Compare website and DOH) and for ALFs and AFHs (via the DSHS website) [22].

Conclusion

Washington State's long-term care licensing system is designed to protect vulnerable residents by establishing clear, enforceable standards for all care settings. The DOH's focus on the medical and skilled care standards of nursing homes, combined with the DSHS's oversight of the residential and personal care provided by Assisted Living Facilities and Adult Family Homes, creates a comprehensive regulatory framework. Understanding the specific regulations (WACs) and the roles of these two key agencies is essential for both providers seeking to comply and consumers seeking quality care.

---

References

[1] Washington State Department of Health. Facilities Licensing. https://doh.wa.gov/public-health-provider-resources/healthcare-professions-and-facilities/facilities-licensing [2] Washington State Department of Social and Health Services (DSHS). Long-Term Care Residential Options. https://www.dshs.wa.gov/altsa/residential-care-services/long-term-care-residential-options [3] Washington State Legislature. Chapter 388-97 WAC: Nursing Home License. https://app.leg.wa.gov/wac/default.aspx?cite=388-97 [4] Washington State Department of Health. Nursing Home Administrator Licensing Information. https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/nursing-home-administrator/licensing-information [5] Washington State Legislature. WAC 388-97-1080: Sufficient nursing personnel. https://app.leg.wa.gov/wac/default.aspx?cite=388-97-1080 [6] Washington State Legislature. WAC 388-97-1090: Minimum staffing requirement. https://app.leg.wa.gov/wac/default.aspx?cite=388-97-1090 [7] Washington State Legislature. RCW 70.97.160: Inspections. https://app.leg.wa.gov/rcw/default.aspx?cite=70.97.160 [8] Washington State Legislature. Chapter 388-78A WAC: Assisted Living Facility Licensing. https://app.leg.wa.gov/wac/default.aspx?cite=388-78A [9] U.S. Department of Health and Human Services (ASPE). Residential Care/Assisted Living Compendium: Washington. https://aspe.hhs.gov/sites/default/files/private/pdf/110636/15alcom-WA.pdf [10] Washington State Legislature. WAC 388-78A-2450: Staff. https://app.leg.wa.gov/wac/default.aspx?cite=388-78A-2450 [11] DSHS. Assisted Living Facilities Training Requirements. https://www.dshs.wa.gov/altsa/training/assisted-living-facilities-training-requirements [12] DSHS. CHAPTER 13: Assisted Living Facilities (ALF). https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/SOP/Chapter%2013%20-%20Assisted%20Living%20Facilities.pdf [13] DSHS. About Adult Family Homes. https://www.dshs.wa.gov/altsa/residential-care-services/about-adult-family-homes [14] Washington State Legislature. Chapter 388-76 WAC: Adult Family Home Licensing. https://app.leg.wa.gov/wac/default.aspx?cite=388-76 [15] Adult Family Home Council. Adult Family Home (AFH) Regulations in Washington. https://adultfamilyhomecouncil.org/articles/adult-family-home-afh-regulations-in-washington [16] DSHS. Information for Adult Family Home Providers. https://www.dshs.wa.gov/altsa/residential-care-services/information-adult-family-home-providers [17] Washington State Legislature. WAC 388-76-10200: Adult family home-Staff. https://www.law.cornell.edu/regulations/washington/WAC-388-76-10200 [18] DSHS. Summary Suspension/Revocation of a License, and Stop Placement. https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/afh/Summary%20Suspension.pdf [19] Washington State Department of Health. Department of Health issues enforcement action on licenses.... https://doh.wa.gov/newsroom/department-health-issues-enforcement-action-licenses-health-care-facilities [20] Washington State Department of Health. DOH Newsroom - Disciplinary Actions. https://doh.wa.gov/newsroom/archive/category/disciplinary-actions [21] DSHS. Residential Care Services Enforcement Policy. https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/AFH-ALF%20Enf%20OPP%20License%20Revocation.doc [22] DSHS. Laws and Regulations. https://www.dshs.wa.gov/altsa/laws-and-regulations

Washington Apple Health (Medicaid) Long-Term Care Programs: A Comprehensive Guide

The state of Washington provides comprehensive long-term care services through its Medicaid program, known as Apple Health. Administered by the Washington State Health Care Authority (HCA), Apple Health is a critical resource for elderly, disabled, and low-income residents who require assistance with daily living activities, whether in a nursing facility, an assisted living setting, or their own home. This guide provides an in-depth look at the eligibility requirements, application process, available Home and Community-Based Services (HCBS) waivers, and the state's Estate Recovery program.

Understanding Washington Apple Health for Long-Term Care

Apple Health is Washington's version of the federal Medicaid program. While it covers a broad range of medical services, its long-term care component is specifically designed to fund the high costs associated with chronic care needs. For long-term care, eligibility is determined by a combination of financial criteria (income and assets) and a functional assessment (level of care needed).

The Role of the Health Care Authority (HCA) and DSHS

The Washington State Health Care Authority (HCA) is the primary agency responsible for administering the Apple Health program. However, the Department of Social and Health Services (DSHS), specifically its Aging and Long-Term Support Administration (ALTSA) and Home and Community Services (HCS) offices, plays a crucial role in determining functional eligibility and managing the delivery of long-term services and supports (LTSS) [1].

Financial Eligibility Requirements (2025)

To qualify for Apple Health long-term care, applicants must meet strict financial limits, which are subject to change annually. These limits differ slightly depending on whether the applicant is seeking institutional care (Nursing Home Medicaid) or Home and Community-Based Services (HCBS) through a waiver.

Income Limits

For a single applicant seeking Nursing Home Medicaid or HCBS waivers, the income limit is typically set at 300% of the Federal Benefit Rate (FBR).

• Single Applicant Income Limit (2025): Under $2,901 per month [4].
• Married Applicant (Both Applying): Each spouse is considered individually, with each having the same income limit.
• Married Applicant (One Spouse Applying - Community Spouse): The non-applicant spouse, known as the Community Spouse, is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA). This allowance permits the community spouse to retain a portion of the applicant's income, ensuring they have sufficient funds to live on. The maximum MMMNA is typically around $3,853.50 per month (2025) [4].

Asset Limits

Assets, or "countable resources," include bank accounts, stocks, bonds, and certain retirement accounts. Non-countable assets typically include the primary residence (up to a certain equity limit, usually $713,000 in 2025), one vehicle, household furnishings, and personal belongings.

• Single Applicant Asset Limit: $2,000 [4].
• Married Applicant (One Spouse Applying - Community Spouse Resource Allowance): The community spouse is allowed to keep a significantly larger portion of the couple's combined assets, known as the Community Spouse Resource Allowance (CSRA). In 2025, the CSRA ranges from a minimum of approximately $30,828 to a maximum of $154,140 [4].

The Look-Back Period and Transfer Penalties

Washington, like all states, enforces a 60-month Medicaid Look-Back Period [4]. This means the state reviews all financial transactions, including gifts and asset transfers for less than fair market value, made by the applicant or their spouse in the five years preceding the application date. Any uncompensated transfers can result in a penalty period of ineligibility for long-term care services.

Functional Eligibility: The CARE Assessment

Financial eligibility is only one part of the equation. To receive long-term care services, an applicant must also demonstrate a medical need for care. In Washington, this is determined through the Comprehensive Assessment Reporting Evaluation (CARE) tool [5].

The CARE assessment is conducted by a social worker or nurse from DSHS/HCS. It evaluates the applicant's ability to perform Activities of Daily Living (ADLs), such as bathing, dressing, toileting, transferring, and eating, and Instrumental Activities of Daily Living (IADLs), such as managing medications, shopping, and housekeeping. To qualify for institutional or waiver services, the assessment must determine that the applicant requires a nursing home level of care [8].

Home and Community-Based Services (HCBS) Waivers

Washington is a leader in providing services that allow individuals to remain in their homes or community settings rather than moving to a nursing home. These services are funded through HCBS waivers, which are authorized under Section 1915(c) of the Social Security Act.

1. Community Options Program Entry System (COPES) Waiver

The COPES Waiver is the primary and most widely used HCBS waiver in Washington for the elderly and disabled. It is specifically designed to provide the necessary support for individuals who meet the nursing home level of care but wish to receive services in a community setting, such as an assisted living facility, adult family home, or their private residence [7] [8].

COPES Services May Include:

• Personal Care Services: Assistance with ADLs and IADLs.
• Case Management: Coordination of all services and supports.
• Adult Day Health: Structured programs in a community setting.
• Environmental Modifications: Changes to the home to ensure safety and accessibility (e.g., ramps, grab bars).
• Assistive Technology: Devices that help maintain independence.
• Respite Care: Temporary relief for unpaid family caregivers.
• Specialized Medical Equipment and Supplies [9].

2. New Freedom (NF) Waiver

The New Freedom Waiver is a participant-directed program, meaning it gives eligible individuals greater control over their care budget and the selection of their service providers [10] [11]. This waiver is available to elderly and disabled residents who require a nursing home level of care.

Key Features of the New Freedom Waiver:

• Participant-Directed: The client manages a budget and hires, trains, and fires their own care providers, including family members (excluding the spouse) [12].
• Flexibility: The budget can be used for a wider range of goods and services that promote independence, such as training, education, and specialized supports, in addition to traditional personal care [10].
• Eligibility: Applicants must meet the nursing home level of care and reside in one of the participating counties (e.g., King, Pierce, Ferry, Pend Oreille) [11].

3. Residential Support Waiver (RSW)

The Residential Support Waiver (RSW) is designed for clients who require a high level of support from trained caregiving staff in a residential setting, such as an Adult Family Home or Assisted Living Facility [13].

Key Features of the RSW:

• Specialized Staff: Services are provided by caregivers who have completed specialized training to support clients with complex needs, often related to behavioral health or significant physical disabilities [13].
• Setting: The waiver primarily funds services within licensed residential settings.
• Eligibility: Eligibility is based on the CARE assessment determining a need for the specialized support provided under this waiver [14].

The Application Process for Apple Health LTSS

Applying for Apple Health long-term care is a multi-step process that requires careful documentation of financial and medical information.

1. Initial Contact and Application: The application can be started online through the Washington Healthplanfinder, or by contacting a local DSHS Home and Community Services (HCS) office [15] [16]. Applicants will need to gather essential documents, including proof of identity, income, assets, and Social Security numbers [17].
2. Financial Review: The HCA reviews the application to determine financial eligibility, including checking for any asset transfers during the 60-month look-back period.
3. Functional Assessment (CARE): A DSHS social worker or nurse will schedule and conduct the in-person or virtual CARE assessment to determine the applicant's level of care needs [15].
4. Service Plan Development: If both financial and functional criteria are met, a case manager works with the client to develop an individualized service plan that outlines the specific services and supports to be provided under the chosen waiver or institutional setting.

Washington Medicaid Estate Recovery Program

Washington State is legally required to seek repayment for certain Medicaid long-term care costs paid on behalf of a recipient after their death. This process is known as Estate Recovery [18].

Services Subject to Recovery

The state seeks recovery for the cost of long-term care services received by individuals who were age 55 or older when they received the services, or who were permanently institutionalized at any age. This includes:

• Nursing facility services.
• Home and Community-Based Services (HCBS) provided through waivers like COPES, New Freedom, and RSW.
• Hospital and prescription drug services received while in a nursing facility [19].

The Estate Definition

For the purpose of recovery, Washington's definition of an "estate" is broader than just the probate estate. It includes any real or personal property and other assets in which the deceased recipient had any legal title or interest at the time of death, to the extent of that interest. This can include assets that pass outside of probate, such as property held in joint tenancy or life estates [20].

Exemptions and Hardship Waivers

Estate recovery is subject to certain exemptions and hardship provisions:

• Surviving Spouse: Recovery is postponed indefinitely if the deceased has a surviving spouse. The state cannot recover until the death of the surviving spouse.
• Minor or Disabled Child: Recovery is postponed if the deceased has a surviving child who is under age 21 or is blind or permanently disabled.
• Hardship Waiver: The state may waive recovery if it would cause an undue hardship, such as if the estate is the sole income-producing asset of the survivors (e.g., a family farm or business) [18].

It is crucial for Apple Health recipients and their families to understand the implications of the Estate Recovery program and to seek legal counsel for proper estate planning.

Conclusion

Washington's Apple Health program offers a robust system of long-term services and supports, with the COPES Waiver being the cornerstone for assisted living and in-home care. The state's commitment to participant-directed care through the New Freedom Waiver and specialized support via the Residential Support Waiver provides residents with multiple options for maintaining independence. Navigating the financial and functional eligibility requirements, including the CARE assessment and the 60-month look-back period, is essential for accessing these vital benefits. Families must also be aware of the Estate Recovery program to plan for the future effectively.

---

References

[1] Washington State Health Care Authority. Long-term care and hospice. https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/long-term-care-and-hospice [2] Washington State Health Care Authority. General eligibility for long-term care. https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/general-eligibility-long-term-care [3] Medicaid Long Term Care. Washington Medicaid Programs for Long Term Care. https://www.medicaidlongtermcare.org/eligibility/washington/ [4] Medicaid Planning Assistance. Washington Medicaid Eligibility: 2025 Income & Asset Limits. https://www.medicaidplanningassistance.org/medicaid-eligibility-washington/ [5] Washington State Health Care Authority. Eligibility requirements for LTSS. https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/eligibility-requirements-ltss [6] Lifespan Respite WA. Services and Apple Health Long-Term Supports (LTSS). https://www.lifespanrespitewa.org/wp-content/uploads/2024/06/Long-Term-Services-Medicaid.pdf [7] Washington LawHelp. COPES Program. https://www.washingtonlawhelp.org/en/copes-program [8] Paying for Senior Care. Washington COPES Medicaid Waivers Program. https://www.payingforseniorcare.com/washington/medicaid-waivers/copes-waiver [9] Medicaid Planning Assistance. Washington Community Options Program Entry System (COPES) Waiver. https://www.medicaidplanningassistance.org/washington-medicaid-copes-waiver/ [10] Medicaid.gov. WA New Freedom Waiver (0443.R04.00). https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83491 [11] Medicaid Planning Assistance. Washington State Medicaid New Freedom (NF) Waiver. https://www.medicaidplanningassistance.org/washington-new-freedom-waiver/ [12] Paying for Senior Care. Washington New Freedom Program: Benefits & Eligibility. https://www.payingforseniorcare.com/washington/new-freedom-program [13] DSHS. Residential Support Waiver. https://www.dshs.wa.gov/sites/default/files/ALTSA/hcs/documents/LTCManual/Chapter%207f.docx [14] Washington State Legislature. WAC 388-106-0338. https://app.leg.wa.gov/wac/default.aspx?cite=388-106-0338 [15] DSHS. How to Apply for Medicaid. https://www.dshs.wa.gov/altsa/home-and-community-services/how-apply-medicaid [16] Washington State Health Care Authority. Apply for or renew coverage. https://www.hca.wa.gov/free-or-low-cost-health-care/apply-or-renew-coverage [17] Washington Healthplanfinder. Steps to Apply. https://www.wahealthplanfinder.org/us/en/health-coverage/get-started/steps-apply.html [18] Washington State Health Care Authority. Estate recovery. https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/estate-recovery [19] DSHS. Estate Recovery Information. https://www.dshs.wa.gov/sites/default/files/publications/documents/Estate%20Recovery%20Insert.pdf [20] Washington LawHelp. Estate recovery for long-term care services paid for by the state. https://www.washingtonlawhelp.org/en/estate-recovery-long-term-care-services-paid-state

Washington State Long-Term Care Ombudsman Program and Resident Advocacy

The Washington State Long-Term Care Ombudsman Program (LTCOP) is the cornerstone of resident advocacy for individuals residing in long-term care facilities across the state. Authorized by the federal Older Americans Act and codified in Washington state law, the LTCOP serves as an independent voice, working to resolve complaints, protect resident rights, and promote the dignity and quality of life for those in nursing homes, assisted living facilities, and adult family homes.

This comprehensive guide explores the structure, legal authority, and critical services provided by the LTCOP, as well as the broader landscape of resident rights and other key advocacy organizations in Washington.

The Washington State Long-Term Care Ombudsman Program (LTCOP)

The Washington State LTCOP is administered by the Multi-Service Center (MSC), a non-profit organization that coordinates the activities of all local ombudsmen throughout the state [1]. The program is designed to be a neutral, confidential, and effective mechanism for addressing the concerns of long-term care residents.

Mission and Scope of Authority

The primary mission of the LTCOP is to advocate for the rights and well-being of residents [2]. The program's authority is established in the Revised Code of Washington (RCW) 43.190 and further detailed in the Washington Administrative Code (WAC) [3].

The LTCOP's scope of service covers all residents in:

• Nursing Homes (Skilled Nursing Facilities)
• Assisted Living Facilities (ALFs)
• Adult Family Homes (AFHs)

Core Services Provided by the Ombudsman

The Ombudsman and their trained volunteer representatives provide a range of essential services, all of which are free and confidential:

1. Complaint Investigation and Resolution: This is the most visible function. Ombudsmen investigate complaints made by or on behalf of residents regarding the quality of care, resident rights violations, facility practices, and other issues. They work to resolve these complaints to the satisfaction of the resident [4].
2. Resident Rights Education: Ombudsmen educate residents, their families, and facility staff about the rights guaranteed to residents under state and federal law.
3. Facility Monitoring: Ombudsmen regularly visit facilities to observe conditions, talk with residents, and identify systemic problems.
4. Policy Advocacy: The State Ombudsman works at the legislative and administrative levels to advocate for laws, regulations, and policies that improve the quality of life and care for all long-term care residents [5].
5. Confidentiality: The Ombudsman must protect the confidentiality of the resident and their identity. No action can be taken on a complaint without the express permission of the resident or their legal representative [6].

Contacting the Ombudsman

The Washington State Long-Term Care Ombudsman Program can be reached through the statewide toll-free number. The program is coordinated by the Multi-Service Center (MSC), which directs calls to the appropriate regional ombudsman [1].

• Statewide Ombudsman Phone: 833-727-8900 (Toll-Free)
• Website: https://www.waombudsman.org/

Resident Rights in Washington State

The foundation of the Ombudsman's work is the protection of resident rights. Washington has comprehensive laws that detail the rights of individuals in long-term care settings, primarily codified in RCW 70.129, the Long-Term Care Resident Rights Act [7].

Rights Common to All Long-Term Care Settings

RCW 70.129 establishes a set of fundamental rights that apply to residents in nursing homes, assisted living facilities, and adult family homes:

• Right to Dignity and Respect: The right to a dignified existence, self-determination, and communication with, and access to, individuals and services inside and outside the facility [8].
• Right to Freedom from Abuse and Restraints: The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for discipline or convenience [9].
• Right to Participate in Care: The right to participate in the planning of care and treatment, including the right to refuse treatment and to be fully informed of one's medical condition.
• Right to Privacy and Confidentiality: The right to privacy in treatment, personal care, written and telephone communications, and to confidentiality of personal and clinical records.
• Right to Visitors and Access: The right to receive visitors of one's choosing at any time, and the right to immediate access by the Ombudsman, state surveyors, and the resident's physician [10].
• Right to Grievance: The right to voice grievances without discrimination or reprisal and to have those grievances promptly addressed.

Specific Rights by Facility Type

While RCW 70.129 provides the overarching framework, specific WAC chapters detail rights for each facility type:

• Nursing Homes (WAC 388-97): These regulations include detailed rights regarding transfer and discharge, the right to a free lawyer to respond to a notice of transfer or discharge (subject to appropriation), and the right to manage one's own financial affairs [11].
• Assisted Living Facilities (WAC 388-78A): These regulations emphasize the right to a written service agreement, the right to choose a personal physician, and the right to disclosure of the scope of care and services provided by the facility [12].
• Adult Family Homes (WAC 388-76): These regulations focus on the right to a home-like environment, the right to keep and use personal possessions, and the right to be free from retaliation for voicing complaints.

Other Key Advocacy Organizations

While the LTCOP is the official, federally mandated advocate for long-term care residents, several other organizations in Washington provide crucial legal and systemic advocacy for seniors and people with disabilities.

Disability Rights Washington (DRW)

Disability Rights Washington (DRW) is the federally mandated Protection and Advocacy (P&A) system for Washington State [13]. Its mission is to advance the rights and opportunities of people with disabilities.

• Scope: DRW provides legal representation, advocacy services, and education to people with disabilities, including those in long-term care settings. They often focus on systemic issues, such as ensuring access to community-based services and preventing abuse and neglect in facilities [14].
• Focus Areas: DRW's work often intersects with the LTCOP, particularly in cases involving involuntary discharge, denial of services, or systemic rights violations affecting large groups of residents.

Legal Services Organizations

Various non-profit legal aid organizations across Washington provide free or low-cost legal assistance to low-income seniors and people with disabilities. These organizations can offer legal counsel on issues such as:

• Medicaid Eligibility and Appeals: Assisting clients with denials or terminations of Apple Health (Medicaid) benefits.
• Guardianship and Power of Attorney: Providing legal guidance on decision-making authority.
• Housing and Eviction: Addressing issues related to tenancy in residential care settings.

The Washington State Council on Aging (WSCOA)

The WSCOA is a governor-appointed body that advises the Governor and the Legislature on issues affecting older adults. While not a direct advocacy service, it plays a vital role in systemic advocacy by promoting policies that support the health, independence, and well-being of seniors, including those in long-term care [15].

Conclusion

The Washington State Long-Term Care Ombudsman Program, coordinated by the Multi-Service Center, is an indispensable resource for residents of nursing homes, assisted living facilities, and adult family homes. By providing confidential complaint resolution, education on resident rights (codified in RCW 70.129 and various WAC chapters), and facility monitoring, the LTCOP ensures that the voices of the most vulnerable are heard. Complementary organizations like Disability Rights Washington further strengthen the advocacy network, ensuring that all residents have access to the protection and legal support necessary to live with dignity and respect.

---

References

[1] Washington State Long-Term Care Ombudsman Program. About Us. https://www.waombudsman.org/about/ [2] Washington State Long-Term Care Ombudsman Program. Home Page. https://www.waombudsman.org/ [3] Washington State Long-Term Care Ombudsman Program. Laws and Regulations. https://www.waombudsman.org/laws-and-regulations/ [4] Washington State Legislature. WAC 365-18-060: Duties of the state long-term care ombudsman. https://app.leg.wa.gov/wac/default.aspx?cite=365-18-060 [5] National Long-Term Care Ombudsman Resource Center (NORC). State Long-Term Care Ombudsman Programs. https://ltcombudsman.org/uploads/files/support/ads-ombudsman-report-2024.pdf [6] Multi-Service Center. Multi-Service Center/ Long-Term Care Ombudsman Program. https://volunteer.wwu.edu/agency/detail/?agency_id=121301 [7] Washington State Legislature. Chapter 70.129 RCW: LONG-TERM CARE RESIDENT RIGHTS. https://app.leg.wa.gov/rcw/default.aspx?cite=70.129 [8] Cornell Law School. Wash. Admin. Code § 388-97-0180 - Resident rights. https://www.law.cornell.edu/regulations/washington/WAC-388-97-0180 [9] Washington State Long-Term Care Ombudsman Program. Resident Rights. https://www.waombudsman.org/resident-rights/ [10] Washington State Legislature. WAC 388-97-0520: Access and visitation rights. https://app.leg.wa.gov/wac/default.aspx?cite=388-97-0520 [11] Washington State Legislature. WAC 388-107-0281: Right to legal counsel. https://app.leg.wa.gov/WAC/default.aspx?cite=388-107-0281 [12] Washington State Legislature. WAC 388-78A-2660: Resident rights. https://app.leg.wa.gov/wac/default.aspx?cite=388-78A-2660 [13] Disability Rights Washington. Home page. https://homepagedisabilityrightswashington.wpcomstaging.com/ [14] Disability Rights Washington. Long-Term Care Facility Poster. https://homepagedisabilityrightswashington.wpcomstaging.com/drw-facility-poster/ [15] Washington State. Rights and Self-Advocacy. https://wa.gov/people-with-disabilities/rights-and-self-advocacy

Washington State Long-Term Care Complaint Process: A Comprehensive Guide to Reporting and Resolution

Ensuring the safety, dignity, and quality of care for residents in long-term care facilities is a paramount concern for Washington State. The state has established a multi-layered system for reporting and investigating complaints against nursing homes, assisted living facilities (ALFs), and adult family homes (AFHs). This system involves two primary regulatory bodies—the Department of Health (DOH) and the Department of Social and Health Services (DSHS)—along with the independent advocacy of the Long-Term Care Ombudsman Program (LTCOP).

This guide provides a detailed, step-by-step overview of the complaint process, including how to report concerns, which agency to contact for specific facility types, the investigation timeline, and the legal protections afforded to residents and complainants.

The Critical First Step: Reporting Vulnerable Adult Abuse and Neglect

The most serious complaints, particularly those involving abuse, neglect, abandonment, or financial exploitation, are handled through the state’s Vulnerable Adult Protection Act (VAPA). Washington law mandates that certain professionals report suspected abuse, but any citizen can and should report concerns immediately.

DSHS Adult Protective Services (APS)

The Department of Social and Health Services (DSHS) operates Adult Protective Services (APS), which is the central intake point for all reports of abuse, neglect, or exploitation of vulnerable adults, regardless of where they live (in a facility or in the community) [1].

• Vulnerable Adult Definition: In Washington, a vulnerable adult includes any person aged 60 or older who has a functional, mental, or physical inability to care for themselves, or any person aged 18 or older who has a developmental disability, is receiving services from DSHS, or is a resident of a long-term care facility [2].
• The APS Hotline: The most direct way to report is through the statewide, toll-free hotline.
• DSHS APS Hotline: 1-866-363-4276 (1-866-END-HARM)
• Emergency Situations: For immediate danger, always call 9-1-1 first.

Complaint Process for Nursing Homes (DOH)

Nursing Homes (Skilled Nursing Facilities) are licensed and regulated by the Washington State Department of Health (DOH), specifically the Health Systems Quality Assurance (HSQA) Division [3]. Complaints against these facilities are investigated by DOH surveyors who ensure compliance with state and federal (Medicare/Medicaid) regulations.

How to File a Complaint with DOH

1. Gather Information: Before filing, collect as many details as possible, including:

• The full name and address of the nursing home.
• The name of the resident (if applicable).
• Specific dates, times, and locations of the incident(s).
• Names of staff involved or witnesses.
• A clear description of the alleged violation or injury.

1. Filing Methods:

• Online: Use the DOH's online complaint form.
• Phone: Call the DOH Complaint Intake Line.
• Mail: Send a written complaint to the HSQA Complaint Intake office.

The DOH Investigation Process and Timeline

Once a complaint is received, DOH staff triage it based on the severity and potential for immediate harm.

• Immediate Jeopardy: Complaints alleging immediate jeopardy to a resident's health or safety are investigated within two working days [4].
• High Priority: Complaints that allege actual harm but not immediate jeopardy are typically investigated within ten working days.
• Standard Complaints: Less severe complaints are investigated during the facility's next scheduled annual survey or within a longer timeframe.

Investigation Timeline: DOH investigations are thorough and can be lengthy. While some simple cases may be resolved in a few weeks, complex cases can take six months or more [5]. The DOH's general target for completing an investigation is 170 days [6].

Outcomes of a DOH Investigation

If the DOH investigation finds that the nursing home violated state or federal regulations, the facility will receive a Statement of Deficiencies (Form CMS-2567). Enforcement actions can include:

• Civil Fines (Monetary Penalties): Fines are assessed based on the severity and scope of the violation.
• Directed Plan of Correction: The facility is required to implement specific actions to correct the deficiencies.
• Denial of Payment: Federal payments (Medicare/Medicaid) for new admissions may be denied.
• Termination of Certification: In the most severe cases, the facility's Medicare/Medicaid certification can be terminated, effectively forcing it to close or operate without public funding.

Complaint Process for Assisted Living and Adult Family Homes (DSHS)

Assisted Living Facilities (ALFs) and Adult Family Homes (AFHs) are licensed and regulated by the Department of Social and Health Services (DSHS), through its Residential Care Services (RCS) Division [7].

How to File a Complaint with DSHS (RCS)

DSHS provides two primary methods for reporting concerns about ALFs and AFHs:

1. DSHS Complaint Hotline: The dedicated hotline is the most common method for reporting general concerns about care quality, staffing, or facility conditions.

• DSHS Complaint Hotline: 1-800-562-6078

1. Online Incident Reporting: DSHS also offers an online portal for submitting incident reports, which is often used by facility staff but is available to the public [8].

The DSHS Investigation Process

DSHS RCS staff, including Licensors and Complaint Investigators (CIs), follow detailed Standard Operating Procedures (SOPs) for complaint investigations [9].

• Triage and Priority: Complaints are triaged based on the risk to residents. High-priority complaints, such as those alleging immediate danger or serious harm, trigger an unannounced on-site investigation, often within 24 to 48 hours.
• On-Site Investigation: The investigator will visit the facility unannounced, interview the resident, family, staff, and witnesses, and review relevant records (e.g., care plans, staffing logs, medication records).
• Documentation: The investigator documents any deficiencies found by citing the specific Washington Administrative Code (WAC) section that was violated (e.g., WAC 388-78A for ALFs or WAC 388-76 for AFHs).

DSHS Enforcement Actions

If a complaint is substantiated, DSHS RCS has a range of enforcement tools to ensure compliance:

• Civil Fines: Monetary penalties are issued for serious or repeated violations.
• Stop Placement Orders: This is a severe action that prohibits the facility from admitting any new residents until the deficiencies are corrected and DSHS approves the removal of the order.
• Conditional License: A facility may be placed on a conditional license, requiring heightened oversight and a strict timeline for correction.
• License Revocation: For egregious or persistent non-compliance that endangers residents, DSHS can move to summarily suspend or permanently revoke the facility's license [10].

The Role of the Long-Term Care Ombudsman Program (LTCOP)

While DOH and DSHS are the regulatory and enforcement agencies, the Long-Term Care Ombudsman Program (LTCOP) provides a crucial, non-regulatory avenue for complaint resolution and advocacy [11].

Advocacy vs. Regulation

The Ombudsman's role is distinct from that of the state regulators:

• Advocacy: The Ombudsman acts solely on behalf of the resident, focusing on the resident's wishes and the resolution that satisfies them.
• Confidentiality: The Ombudsman's services are strictly confidential. They will not disclose the resident's identity or take action without the resident's express permission.
• Mediation: Ombudsmen often resolve complaints through mediation and negotiation with facility staff and administration, which can be a faster and less adversarial process than a regulatory investigation.

When to Contact the Ombudsman: The LTCOP is an excellent resource for issues that may not be regulatory violations but still impact a resident's quality of life, such as dietary concerns, roommate disputes, communication problems, or concerns about resident rights. They can also assist residents and families in navigating the formal DOH or DSHS complaint process.

• LTCOP Statewide Phone: 833-727-8900

Protections for Complainants and Residents

Washington law provides strong protections to ensure that residents and staff feel safe reporting concerns without fear of reprisal.

Protection Against Retaliation

The Long-Term Care Resident Rights Act (RCW 70.129) explicitly prohibits retaliation against a resident who files a complaint or participates in an investigation [12].

RCW 70.129.100 - Right to voice grievances:

"The resident has the right to voice grievances and recommend changes in policies and services to the facility staff and to outside representatives of the resident's choice, free from restraint, interference, coercion, discrimination, or reprisal."

Any facility found to have retaliated against a resident, family member, or staff member for filing a complaint is subject to severe penalties, including fines and enforcement actions.

Confidentiality of the Complainant

Both DOH and DSHS maintain the confidentiality of the complainant's identity. When filing a complaint, the reporter can choose to remain anonymous. However, providing contact information can be beneficial, as it allows the investigator to follow up for additional details or clarification, which can strengthen the investigation.

Navigating the Complaint Process: A Summary

The process of filing a complaint in Washington requires the complainant to first identify the type of facility and the nature of the concern.

Conclusion

The Washington State long-term care complaint process is a robust system designed to hold facilities accountable and protect vulnerable residents. By understanding the distinct roles of DOH (Nursing Homes) and DSHS (ALFs/AFHs), and by utilizing the confidential advocacy services of the Long-Term Care Ombudsman, residents and their families are empowered to report concerns effectively. The state's commitment to investigating all reports and enforcing strict anti-retaliation laws ensures that the act of reporting is a protected right, leading to better quality of care for all long-term care residents.

---

References

[1] Washington State Department of Social and Health Services (DSHS). Report Abuse and Neglect. https://www.dshs.wa.gov/report-abuse-and-neglect [2] DSHS. I need to report abuse or neglect of a vulnerable adult. https://www.dshs.wa.gov/node/32315 [3] Washington State Department of Health (DOH). Healthcare Agencies and Facilities Complaint Process. https://doh.wa.gov/licenses-permits-and-certificates/file-complaint-about-provider-or-facility/facility-complaint-process [4] DOH. Complaint Process: Hospitals and Hospital Staffing. https://doh.wa.gov/sites/default/files/2024-12/346-172-ComplaintProcessHospitalsAndHospitalStaffing.pdf [5] DOH. The Complaint and Disciplinary Process. https://doh.wa.gov/licenses-permits-and-certificates/file-complaint-about-provider-or-facility [6] Disability Rights Washington. How to File a Complaint Against a Health Care Provider or Facility. https://homepagedisabilityrightswashington.wpcomstaging.com/publications/how-file-complaint-against-health-care-provider-or-facility/ [7] DSHS. Report Concerns Involving Vulnerable Adults. https://www.dshs.wa.gov/altsa/home-and-community-services/report-concerns-involving-vulnerable-adults [8] DSHS. Residential Care Services Online Incident Reporting. https://www.dshs.wa.gov/altsa/residential-care-services/residential-care-services-online-incident-reporting [9] DSHS. SOP Chapter 20 – Complaint Investigations. https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/SOP/Complaint%20Investigations.pdf [10] DSHS. SOP Chapter 7 - Enforcement. https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/SOP/Chapter%207%20-%20Enforcement.pdf [11] Washington State Long-Term Care Ombudsman Program. File a Complaint. https://www.waombudsman.org/file-a-complaint/ [12] Washington State Legislature. RCW 70.129.100: Right to voice grievances. https://app.leg.wa.gov/rcw/default.aspx?cite=70.129.100

Washington State Veterans Benefits: A Comprehensive Guide to Long-Term Care and Financial Assistance

The state of Washington, through the Washington State Department of Veterans Affairs (WDVA), offers a robust and comprehensive suite of benefits, services, and financial assistance programs designed to support its large population of veterans, service members, and their families. These benefits are critical for veterans seeking long-term care, housing, and financial stability.

This guide provides an in-depth look at the WDVA's long-term care facilities, state-specific financial aid, and key tax exemptions available to Washington veterans.

The Washington State Veterans Homes

The cornerstone of Washington's long-term care commitment to its veterans is its network of four State Veterans Homes. These facilities provide a high level of care in a setting that honors the service of its residents.

Overview of the Four State Veterans Homes

Washington operates four State Veterans Homes, all of which are Medicare and Medicaid certified and provide 24-hour skilled nursing care, medical services, and pharmacy services [1].

Eligibility and Admission

Admission to a Washington State Veterans Home is open to veterans, their spouses, and Gold Star Parents (parents of a service member who died while serving).

• Veteran Eligibility: Generally, a veteran must have been discharged under honorable conditions and meet the residency requirements of the state [2].
• Clinical Need: Admission is based on a clinical need for the level of care provided (e.g., skilled nursing or assisted living/domiciliary care).
• Cost of Care:
• Service-Connected Disabled Veterans: Veterans with a service-connected disability rating of 70% to 100% are eligible for nursing home care at no cost [3].
• Other Veterans: For veterans with lower or no service-connected disability, the cost of care is determined on a sliding scale based on income and assets. However, the homes are Medicare and Medicaid certified, meaning most veterans can utilize their existing benefits (VA Aid & Attendance, Medicare, or Washington Apple Health/Medicaid) to cover the cost of care [1].

Services Provided

The State Veterans Homes offer a comprehensive range of services, including:

• 24-Hour Skilled Nursing Care: Provided by Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).
• Medical and Pharmacy Services: On-site medical care, medication management, and pharmacy services.
• Rehabilitation Services: Physical, occupational, and speech therapy.
• Dementia and Memory Care: Specialized units and programs for residents with cognitive impairments.
• Social and Recreational Activities: Programs designed to promote social engagement and quality of life.

Financial Assistance Programs (WDVA)

The WDVA administers several state-funded programs designed to provide direct financial relief to veterans and their families facing economic hardship.

Veterans Innovations Program (VIP)

The Veterans Innovations Program (VIP) is a key state-level financial assistance program. It is designed to provide temporary, emergency financial assistance to veterans who have served on or after September 11, 2001, and are experiencing financial hardship [4].

• Purpose: VIP funds can be used to cover essential needs such as rent, utilities, food, and medical expenses.
• Eligibility: Applicants must be Washington residents, have served on or after 9/11, and meet specific income and hardship criteria. The program is intended to be a short-term bridge to stability.

Veterans Assistance Fund (VAF)

Many Washington counties operate a Veterans Assistance Fund (VAF), often managed by the County Veterans Assistance Program (CVAP). While not directly administered by the WDVA, these funds are a critical resource for local veterans.

• Purpose: VAFs provide emergency financial assistance for food, shelter, utilities, and medical expenses to indigent veterans and their families.
• Administration: Veterans must typically apply through their local County Veterans Service Officer (CVSO) [5].

Veterans Transitional Housing Program

The WDVA also manages and supports transitional housing programs across the state, aimed at providing temporary shelter and supportive services to homeless veterans and their families, helping them transition to permanent housing and self-sufficiency [6].

State Tax Exemptions and Fee Waivers

Washington State offers several significant tax exemptions and fee waivers that can substantially reduce the financial burden on veterans, particularly those with service-connected disabilities.

Property Tax Exemption for Disabled Veterans

This is one of the most valuable state benefits. The Washington State Property Tax Exemption is available to veterans with a service-connected disability and is administered by the Department of Revenue (DOR) and local county assessors [7].

• Eligibility: To qualify, a veteran must:

1. Be a Washington resident.
2. Own and occupy a primary residence in Washington.
3. Have a 100% service-connected disability rating from the U.S. Department of Veterans Affairs (VA), OR be rated as 80% or higher for both compensation and pension purposes.
4. Meet a specific income threshold, which is adjusted annually and varies by county [8].

• Benefit: Qualified 100% disabled veterans are exempt from all regular property taxes on their primary residence. Veterans with lower disability ratings may qualify for a partial exemption based on a sliding scale [9].

Tuition and Fee Waivers

Washington offers tuition and fee waivers at state colleges and universities for eligible veterans, their spouses, and children.

• Waiver for Veterans: Veterans who are Washington residents and meet certain service requirements may be eligible for a waiver of all or a portion of tuition and fees at state-supported institutions of higher education [10].
• Waiver for Dependents: Spouses and children of 100% disabled veterans or those who died as a result of military service may also be eligible for tuition waivers.

Other Fee Waivers

• Driver's License and ID Card: Veterans with a service-connected disability rating of 80% or higher are exempt from the fee for a Washington State driver's license or identification card [11].
• Vehicle License Plates: The state offers a variety of specialized military and veteran license plates, with some fees waived for disabled veterans.

WDVA Veterans Service Officers (VSOs)

The WDVA does not process federal VA claims directly but employs and partners with Veterans Service Officers (VSOs) who are accredited by the VA.

• Role of VSOs: VSOs are experts in federal and state benefits. They provide free assistance to veterans and their families in:
• Filing claims for federal VA disability compensation, pension, and healthcare.
• Appealing denied claims.
• Connecting veterans to state and local resources, including the State Veterans Homes and financial assistance programs [12].

Veterans are strongly encouraged to utilize the services of a WDVA-accredited VSO to ensure they receive all the benefits they have earned.

Conclusion

Washington State demonstrates a strong commitment to its veteran community through the WDVA. The four State Veterans Homes provide essential, high-quality long-term care options, which are accessible through Medicare, Medicaid, and VA benefits. Furthermore, state-specific programs like the Veterans Innovations Program and the significant property tax exemption for disabled veterans provide crucial financial security. By leveraging the expertise of WDVA-accredited Veterans Service Officers, Washington veterans and their families can effectively navigate the complex landscape of federal and state benefits to secure the care and support they deserve.

---

References

[1] Washington State Department of Veterans Affairs (WDVA). Veterans Homes. https://www.dva.wa.gov/veterans-service-members-and-their-families/veterans-homes [2] WDVA. Washington Veterans Home Port Orchard. https://www.dva.wa.gov/veterans-service-members-and-their-families/veterans-homes/washington-veterans-home-port-orchard [3] WDVA. Washington State Veterans Homes Frequently Asked Questions. https://www.dva.wa.gov/sites/default/files/2021-07/FAQ%20Washington%20State%20Veterans%20Homes.pdf [4] WDVA. Veterans Innovations Program (VIP). https://www.dva.wa.gov/node/1383/veterans-innovations-program-vip [5] MyArmyBenefits. Washington Military and Veterans Benefits. https://myarmybenefits.us.army.mil/Benefit-Library/State/Territory-Benefits/Washington [6] WDVA. Veterans Benefits. https://dva.wa.gov/veterans-service-members-and-their-families/veterans-benefits [7] Washington State Department of Revenue (DOR). Property tax exemption for seniors, people retired due to disability, and veterans with disabilities. https://dor.wa.gov/taxes-rates/property-tax/property-tax-exemption-seniors-people-retired-due-disability-and-veterans-disabilities [8] Vets Guardian. Veteran Benefits for Washington. https://vetsguardian.com/veteran-benefits-for-washington/ [9] Veterans United. Disabled Veteran Property Tax Exemptions By State. https://www.veteransunited.com/futurehomeowners/veteran-property-tax-exemptions-by-state/ [10] Washington State Legislature. RCW 28B.15.621: Waiver of tuition and fees—Veterans and national guard members. https://app.leg.wa.gov/rcw/default.aspx?cite=28B.15.621 [11] Washington State Department of Licensing (DOL). Disabled Veteran Driver's License/ID Card. https://www.dol.wa.gov/driverslicense/disabledveteran.html [12] WDVA. Financial Assistance. https://www.dva.wa.gov/node/1383