Senior Living Options

Working with a placement agency to determine which setting will be best for your needs, desires, and budget can be a lifesaver. Sometimes it takes a little work to prioritize what is most important and decide which setting will be best. We are standing by to help you.

In-Home Care Agencies & Registries

Helping elderly man find in-home care

For most people, staying home as long as possible is plan A. If this is your plan start gathering your village early. Have conversations with your adult children or others who will be part of your support system and do some research into in-home care.

You have two choices when it comes to hiring in-home care. In-home care agencies and in-home care employment registries.  Both types provide hourly, and 24/7 Live-In Care.  Caregivers are screened, have a background check, and have a Home Care Aide or Nursing Assistant Certification.



In-home care agencies hire caregivers. Some offer paid training and medical insurance and most have Care Coordinators and Supervisors. Supervisors often step in to supply care when a caregiver calls out sick. Agencies monitor care to make sure it is consistent and that both the caregiver and the client are comfortable with each other.  The price range for a caregiver through an agency is approximately $34-44/hour for a 4-hour minimum shift. The price goes up for shorter shifts, 1 to 3-hour shifts are in the $40-$60/hour range depending on the task. Live-in costs range from $400-600/day in King County and surrounding areas. The Department of Health has a complete listing of in-home care agencies in WA and the National Association for Homecare and Hospice has a homecare locator.



An employment service or in-home care registry is another way to find excellent, qualified caregivers. Registries take the work out of the screening and interviewing of caregivers. Most have rigorous standards and minimum years of caregiving experience required. With this model, you pay a placement fee and then hire a caregiver directly. Wages paid go fully to your worker and typically range from $28-35/hour.  Licensed Practical Nurses or Registered Nurses start closer to $50/hour. Most registries let you interview and begin working with a couple of caregivers before settling on the best fit.

If you are on Medicaid and looking for in-home care, the Referral Registry of Washington State and an online platform called Carina links residents who receive publicly funded in-home care services with pre-screened home care workers and Individual Providers. Medicaid can cover up to 20 hours of in-home care per week, excluding weekends.

Key insights

  • Age requirements

    No Age Restrictions

  • Services

    Shower or Bathing Incontinence Care Transfers and Ambulation Medication Reminders Meal Preparation Light Housekeeping and Laundry Transportation to Appointments & Grocery Shopping

  • Accepted Sources of Pay

    Private pay, Long Term Care Insurance, Veterans Benefits, Medicaid (for financially needy).

    Medicare (health insurance for those 65+) does NOT cover in home care.

Retirement Communities

retirement communities near seattle

Why People Move In

Moving to a Retirement Community is really good for your brain! Staying active and socially engaged is an important part of healthy aging.  Basic rent includes one to three nutritious meals a day, utilities, concierge services, planned activities, and transportation. 


How Care is Delivered

In this setting, care is not available in-house but is easily brought in from the outside. Many Retirement Communities partner with in-home care agencies. This can keep the cost of care down. An in-home care company can offer care at a Retirement Community in 15-minute increments for example. One caregiver can see multiple residents, fill their schedule and eliminate their driving time. 


Why People Move Out

When a lot of care is needed, the cost of rent plus the cost of in-home care can become cost-prohibitive. If you begin to need more than 6 hours of care in a 24 hour period, another setting may be more affordable.  A progressing dementia diagnosis, requiring close supervision can not usually be safely accommodated in this setting. Another reason people seek alternative settings is that retirement communities do not accept Medicaid.

Key insights

  • Age requirements

    55 - 62+

  • Services

    Up to 3 meals/day, concierge help desk, utilities, Wifi, life enrichment activities, transportation, and emergency pull cords.

  • Care

    When care is needed it must be brought in from the outside.

  • Accepted Payment Sources

    Private Pay

Assisted Living Facilities

Senior Woman In assisted living

Why People Move In

Becoming a part of a vibrant, social community that can support you as your needs change is the main attraction of Assisted Living.  Many residents are supported through hospice and end-of-life in this setting. Residents are able to maintain their independence and set up their own studio, one or two-bedroom apartments with their own furniture, a kitchenette, and a private bathroom.


How care is provided

You can move into assisted living before needing any care. When care is needed it is delivered right to you 24/7.  Care costs are additional to basic rent.  A customized care plan is created for each person receiving care. Scheduled assistance such as help taking a shower, getting dressed, and medication administration is supported in this setting as well as unscheduled assistance like help to the bathroom. Residents are given a help button to wear as a necklace to push as needed for unscheduled assistance.


Why People Move Out

Unfortunately, each year we receive calls from people needing to move out of their assisted living home for unanticipated reasons. If you are seeking care in an assisted living facility please carefully review the Disclosure of Services for each place you are considering. The Disclosure of Services is often handed out during a tour, and always available by request.  It’s one thing to know prior to moving in that you’ll have to move out if you start needing pureed food, it’s another story altogether to have to leave your friends when you didn’t realize ahead of time that your facility couldn’t puree food.

Care for people with dementia varies greatly in assisted living communities.  Some have a lot of built-in support for people with memory loss and secure memory care units and others do not.

Another common reason people move out is that they can no longer afford it and the facility does not accept Medicaid.

Key insights

  • Age requirements

    Most are 62+

  • Services

    3 meals/day, concierge, utilities, life enrichment activities, housekeeping, transportation, and a personal help button to call caregivers.

  • Care

    All Assisted Living Facilities (ALFs) provide 24/7 care. Some ALFs accommodate high levels of care such as insulin injections and two-person transfers. Others are geared more toward independent residents.

  • Accepted Payment Sources

    Long Term Care Insurance,  Veteran’s Aid and Attendance Benefit, Medicaid (if the facility accepts Medicaid pay).

Adult Family Homes

Adult family homes search

Adult Family Homes are private residential homes licensed to care for up to eight people.  They are heavily regulated in WA and can be owned and operated by Registered Nurses, Nursing Assistants, or Home Care Aides. Some have private rooms with private bathrooms, most offer a combination of shared and private rooms. Owners often feel a calling to open their homes and provide high-quality, loving care. Finding out why they opened and what keeps them going is an important part of our screening process.

Why People Move In

The adult family homes setting offers a smaller more intimate environment than larger assisted living facilities. For people who have more complex medical needs and need close monitoring or for those who thrive in the consistent presence of other people (it’s harder to disappear for long periods of time in your room here), this setting can be just right.

How care is delivered

Adult Family Homes are usually better equipped to handle unscheduled needs with higher caregiver to resident ratios. Care and activities are able to be more customized in this setting.  A little bit of checking in each hour is naturally easier in this smaller setting. Each home is a microculture. Some specialize in care for people with Dementia and Alzheimer’s, others focus on Mental Health, Developmental Disabilities, or a combination of the three. Many people live out their last days under the care of a loving adult family home care team that has become like family to them.

Why People Move Out

Just like other settings, we get calls each year from people needing to move out of adult family homes too. An unexpected change in condition that cannot safely be accommodated is the most common reason for a move-out. Other reasons include disagreements between owners and residents or their representatives that cannot be resolved with the help of an Ombuds or the need to move because a person’s funds have run out and the facility does not accept Medicaid.

We hope that you will enlist our help as you search for the best place for yourself or a loved one. We feel that our service especially shines when our clients are seeking care in an adult family home. For 14 years, we have been taking insider notes on the capability and character of hundreds of homes in King and Snohomish County.

If you are a do it yourselfer, get started with your search by visiting The Department of Social Health Services (DSHS) Adult Family Home Locator or the Adult Family Home Council websites. Both have listings of adult family homes in Washington. Here is a guide to Choosing Care in an Adult Family Home.

Adult family homes are paid for privately, with Long Term Care Insurance, Veteran’s Aid and Attendance, or Medicaid when accepted (not to be confused with Medicare).

Key insights

  • Age requirements

    Some homes specialize in care for younger people. The majority focus on elder care.

  • Services

    3 meals/day plus snacks, 24-hour care, medication management, customized activities, and a warm, homelike atmosphere.

  • Care

    AFHs excel at 24 hour personalized care with a caregiver to resident ratio that typically can't be found in other settings.

King and Snohomish County Senior Living Breakdown

There are over 2500 communities in King and Snohomish counties. The vast majority of these are adult family homes, yet many people have never heard of them. We can help you understand which type of community makes sense for you.

Featured Community

Adult Family Home

Premier Gentle Care

What we like about them

Veronica and Julian Mart live on-site with their residents. Their home feels like a country cottage, with incredible vegetable and flower gardens, a huge backyard, a green belt view, and a big deck for lounging in the sun.

We’ve helped a few people move here over the years and witnessed the love and attention they have for their residents firsthand. They have great staffing and a proactive and preventative approach to care.


What families are saying

“I am so thankful we found Veronica and Julian at Premier Gentle Care. We had to move my mom there in a hurry, but from the day she moved in, I no longer had to worry about her.  After being there for only a couple of weeks, we saw marked improvement in her condition. They take time for the little things that make a difference like hot tea, nutritious snacks, and a gentle touch on the shoulder. They engaged with her every day to make her smile. My dad ended up moving there too to be with my mom. It was tremendous peace of mind having them close to my home and knowing they were clean and safe.”  – Ami R

Premier Gentle Care

Have more questions about Senior Care?

Check out our Frequently Asked Questions page or contact us!