Moving Into an Adult Family Home or Assisted Living? You May Need a Pre-Admission Assessment First
You found a care home or assisted living community you like.
You toured it.
You talked with the provider.
They have an opening.
Your family is ready to move forward.
Then someone says:
“Before your loved one can move in, we need an assessment.”
For families paying privately for care, this can come as a surprise.
Why is an assessment necessary?
Who performs it?
Does insurance pay for it?
Does the care provider arrange it?
And does every state require the same thing?
The short answer is no.
Pre-admission assessment requirements vary by state and by the type of residential care setting you’re considering.
Washington and Oregon are a good example. Both states require providers to evaluate a prospective resident’s needs before admission in many residential care settings, but they don’t use exactly the same process or require the same person to conduct the assessment.
Here’s what families should know before choosing a care provider.
What Is a Pre-Admission Assessment?
A pre-admission assessment is designed to answer a very important question:
Can this provider safely meet your loved one’s needs?
The assessment gives the care provider a more complete understanding of the prospective resident before admission.
Depending on the state and care setting, it may look at things such as:
• Medical history and diagnoses
• Medications
• Mobility and transferring
• Bathing and dressing
• Toileting and continence
• Eating and nutrition
• Cognitive abilities
• Dementia or memory concerns
• Behaviors or mental-health needs
• Communication
• Nursing needs
• Nighttime care
• Fall risk
• Personal preferences and routines
• Other assistance the resident may require
The goal isn’t simply to create paperwork.
The provider needs enough information to determine whether it has the staffing, experience, services, and capabilities necessary to care for that person safely.
Is a Pre-Admission Assessment the Same as a Nursing Assessment?
Not necessarily.
Families often hear the terms assessment, nursing assessment, care assessment, and preadmission assessment used interchangeably.
But legally and practically, they aren’t always the same thing.
A state may require an assessment without requiring that the assessment be performed specifically by a registered nurse.
That’s an important distinction — especially in Washington.
Washington Adult Family Homes Require an Assessment Before Admission
If your loved one is considering an adult family home in Washington, state rules generally require the home to obtain a written assessment of the prospective resident’s current needs and preferences before admitting the resident, except in a genuine emergency.
You can read the requirement directly in the official Washington Adult Family Home Resident Assessment Rule.
The assessment helps the adult family home determine what the prospective resident needs and whether the home can safely provide that care.
Washington also requires adult family homes to admit only people whose needs the home can safely meet with qualified staff and appropriate accommodations.
Families can review that requirement in Washington WAC 388-76-10545.
Does a Nurse Have to Perform the Washington Adult Family Home Assessment?
This is where the terminology can get confusing.
Not necessarily.
Washington requires the assessment to be performed by a qualified assessor. For residents whose care is paid for by the state, an authorized department case manager may perform the assessment.
For other residents — including private-pay residents — Washington’s rules define who can qualify to perform the assessment.
A qualified assessor may include someone who meets specified education and experience requirements in social services, human services, behavioral sciences, or an allied field; a Washington-licensed nurse with the required clinical experience; or a Washington-licensed physician.
You can see the state’s qualifications directly in Washington WAC 388-76-10150: Qualifications — Assessor.
So if you’re a private-pay family and an adult family home tells you:
“We need an assessment before your parent can move in,”
that may be completely normal.
But it is more accurate to call it a required resident or pre-admission assessment rather than automatically calling it a nursing assessment.
Who Pays for a Private-Pay Assessment in Washington?
This is something families should ask before scheduling an assessment.
If your loved one is paying privately, ask the prospective provider:
“Who arranges the required assessment?”
“Who is qualified to perform it?”
“Is there a fee?”
“Who is responsible for paying that fee?”
“Is the assessment included in any admission or move-in costs?”
“If we decide not to move into this home, can the assessment be used for another provider?”
Do not assume the answer will be identical for every provider.
The state establishes assessment requirements, but the logistics and private-pay arrangements surrounding an assessment can vary.
Ask before agreeing to pay for anything.
Washington Assisted Living Also Requires a Preadmission Assessment
Washington’s assessment requirements aren’t limited to adult family homes.
If you’re considering a Washington assisted living facility, the facility must also conduct a preadmission assessment for each prospective resident.
The assessment includes information such as medical history, medications, diagnoses, behaviors or symptoms requiring special care, personal-care needs, activities, and preferences.
You can read the official requirement at Washington WAC 388-78A-2060: Preadmission Assessment.
Except in an emergency, the assisted living facility generally must complete the preadmission assessment before the resident moves in.
See Washington WAC 388-78A-2070: Timing of Preadmission Assessment.
Who Can Perform an Assisted Living Assessment in Washington?
Again, it does not automatically have to be a nurse.
Washington’s assisted living rules allow the assessment to be completed by people meeting specified professional qualifications.
Those can include qualified professionals in social services, human services, behavioral sciences, or allied fields; a Washington-licensed nurse; a physician; or certain experienced assessors who meet the state’s requirements.
Families can review the complete qualifications in Washington WAC 388-78A-2080: Qualified Assessor.
After admission, Washington assisted living facilities must also complete a more comprehensive full assessment within the timeframe established by state rules.
Oregon Adult Foster Homes Use a Different Process
If you’re searching across the Columbia River or comparing care in Washington and Oregon, don’t assume Washington’s process follows you into Oregon.
Oregon adult foster homes also have pre-admission requirements, but the process is different.
Under Oregon’s current rules for adult foster homes serving older adults and adults with physical disabilities, the licensee or administrator conducts and documents a pre-admission screening and assessment using the state’s current Adult Foster Home Screening and Assessment and General Information form.
The screening evaluates whether the prospective resident’s care needs are appropriate for the home’s license classification and whether the provider and caregivers can safely meet those needs.
It includes areas such as:
• Medical diagnoses
• Medications
• Personal-care needs
• Nursing-care needs
• Cognitive needs
• Communication needs
• Nighttime care
• Nutrition
• Activities and lifestyle preferences
You can review Oregon’s official Adult Foster Home Rules — OAR 411-051.
This means an Oregon adult foster home admission assessment is not automatically the same outside independent qualified-assessor process used for a private-pay Washington adult family home.
What About Oregon Assisted Living and Residential Care Facilities?
Oregon assisted living and residential care facilities also evaluate prospective residents before move-in.
Oregon requires these facilities to conduct an initial screening before the resident moves in to determine the person’s service needs and preferences and whether the facility can meet them.
The facility then has resident-evaluation and service-planning requirements designed to identify the person’s care needs.
Families can review the state’s requirements in Oregon’s Residential Care and Assisted Living Facility Rules — OAR 411-054.
Oregon facilities also have nursing requirements. For example, facilities must have an Oregon-licensed nurse regularly scheduled onsite and available for consultation, and RN assessment is required according to facility policy and resident condition, including at minimum when a resident experiences a significant change of condition.
But that is different from saying that every private-pay Oregon resident must hire an outside nurse to conduct a pre-admission assessment before moving in.
Why Do States Require Assessments Before Someone Moves In?
Imagine a family tours a beautiful home and loves it.
The room is perfect.
The location is close to family.
Everyone gets along with the provider.
But the prospective resident requires a two-person transfer, frequent nighttime assistance, complex medication management, dementia support, or nursing care the provider cannot safely deliver.
Finding that out after move-in could create a dangerous situation — and another stressful move for the resident.
The assessment helps answer the question before admission:
Can this provider actually care for this person?
That protects the resident, the family, the caregivers, and the provider.
An Assessment Can Help You Compare Providers
Families often think of the assessment as something they simply have to “get through” before admission.
Try looking at it differently.
The assessment gives you better information for choosing a provider.
Once you understand your loved one’s needs, ask each provider:
“Can you meet all of these needs today?”
Then ask:
“What happens if these needs increase?”
For example:
• What if Mom eventually needs help transferring?
• What if Dad begins needing nighttime assistance?
• What if dementia progresses?
• What if medication needs become more complicated?
• What if nursing care becomes necessary?
• What if they become incontinent?
• What if they need hospice later?
A provider that works today may or may not be equipped for tomorrow.
Understanding that before move-in can help families make a more informed decision.
What Should Private-Pay Families Ask Before Paying for an Assessment?
Before paying anyone to assess your loved one, ask the prospective provider these questions:
1. Is a pre-admission assessment required for this type of care in our state?
2. Who is qualified to perform it?
3. Does your facility or home perform the assessment, or do we need to arrange one independently?
4. Is there a fee?
5. Who pays the fee?
6. What information or medical records should we provide?
7. How recent does the assessment need to be?
8. If we choose another provider, can the same assessment be used?
9. Will another assessment be required after move-in?
10. If my loved one’s condition changes, when will they be reassessed?
Those questions can save families from unexpected costs, duplicated work, and confusion.
What Should You Bring to a Care Assessment?
Ask the assessor or provider exactly what they need, but it can be helpful to gather:
• Current medication list
• Medical diagnoses
• Recent hospital or rehabilitation records
• Physician information
• Current care plan, if one exists
• Mobility information
• Information about falls
• Dietary restrictions
• Allergies
• Dementia or cognitive diagnoses
• Behavioral-health information relevant to care
• Current nursing needs
• Information about nighttime assistance
• Medical equipment used
• Emergency contacts
• Power of attorney or guardianship information, if applicable
The more accurate the information, the better the provider can determine whether it is equipped to care for your loved one.
Don’t Hide Care Needs Because You’re Afraid a Provider Will Say No
Families can feel tremendous pressure when they desperately need placement.
It can be tempting to minimize a parent’s needs because you’ve finally found a home you like.
Don’t.
If your loved one falls frequently, say so.
If they wander at night, say so.
If transferring requires two people, say so.
If there are significant dementia behaviors, explain them.
If medications or nursing needs are complicated, provide accurate information.
A provider saying “We aren’t equipped to safely meet that need” before admission may be disappointing.
Discovering it after your loved one has moved in can be much harder.
The goal isn’t simply to get accepted.
The goal is to find a provider capable of safely caring for your loved one.
Assessment Requirements Vary by State
Washington and Oregon alone show why families should not assume there is one national rule.
Washington adult family homes require a written pre-admission resident assessment performed by a qualified assessor or, for certain state-funded residents, an authorized department case manager.
Washington assisted living facilities also have preadmission-assessment requirements and qualified-assessor rules.
Oregon adult foster homes require a pre-admission screening and assessment, but the licensee or administrator conducts that process under Oregon’s rules.
Oregon assisted living and residential care facilities have their own screening, evaluation, service-planning, and nursing requirements.
Other states have their own licensing categories and admission-assessment rules.
Before paying for an assessment or assuming you need a nurse, check the requirements for both your state and the specific type of care provider you’re considering.
How Do I Check My State’s Requirements?
Start with the state agency responsible for licensing the type of residential care you’re considering.
For Washington families, the official Washington Adult Family Home Minimum Licensing Requirements contain the rules governing adult family home assessments.
For assisted living, families can review the Washington Assisted Living Facility Licensing Rules.
For Oregon adult foster homes, use the Oregon Adult Foster Home Licensing Resources.
For Oregon assisted living and residential care, use the state’s Residential Care and Assisted Living Facility Rules.
If you’re in another state, look for the state agency that licenses assisted living, residential care, adult foster care, adult family homes, or the equivalent category in your state.
Don’t rely solely on an internet article for a regulatory requirement.
Frequently Asked Questions
Do private-pay residents need an assessment before moving into an adult family home in Washington?
Generally, yes. Washington adult family homes must obtain a written assessment of a prospective resident’s current needs and preferences before admission, except in a genuine emergency. For private-pay residents, the assessment must be performed by a qualified assessor under Washington’s rules.
Does the Washington assessment have to be done by a nurse?
No. A nurse who meets Washington’s qualifications can be a qualified assessor, but the state’s rules also permit certain qualified social or human-services professionals and Washington-licensed physicians to perform assessments.
Does Washington assisted living require an assessment before move-in?
Yes. Washington assisted living facilities generally must conduct a preadmission assessment before a prospective resident moves in, with an exception for emergency admissions subject to the state’s timing rules.
Does Oregon require a nurse assessment before moving into an adult foster home?
Oregon adult foster homes require a pre-admission screening and assessment, but the state’s rules direct the adult foster home’s licensee or administrator to conduct and document that screening. That is not the same as a blanket requirement that every private-pay resident hire an outside nurse for a pre-admission assessment.
Does Oregon assisted living assess residents before move-in?
Yes. Oregon assisted living and residential care facilities must conduct an initial screening before move-in to determine the prospective resident’s service needs, preferences, and whether the facility can meet those needs. Oregon also has additional resident-evaluation, service-planning, and nursing requirements.
Who pays for a private-pay care assessment?
The answer can depend on the state, type of provider, assessor, and provider’s admission process. Before scheduling an assessment, ask who arranges it, what it costs, who is responsible for payment, and whether it can be used with another provider.
Can I use the same assessment for more than one care home?
Possibly, but don’t assume so. Ask each prospective provider whether it can accept an existing assessment, how recent it must be, and whether it meets that provider’s and state’s requirements.
The Bottom Line
Finding the right care provider involves more than touring rooms and comparing prices.
Before a resident moves in, the provider needs to understand who that person is and what care they actually require.
That’s why assessments matter.
But don’t assume that “assessment” automatically means “hire a nurse.”
Washington and Oregon have different requirements, and different types of care settings within the same state can have different assessment processes.
If you’re paying privately, ask about the assessment process early — ideally while you’re touring and comparing providers.
Ask:
Is an assessment required?
Who performs it?
Who arranges it?
What does it cost?
Can this provider actually meet the needs identified in it?
Understanding those answers before move-in can help your family avoid surprises and, more importantly, choose a care setting that’s equipped to safely care for your loved one.
Ovella Living helps families explore and compare residential care providers so they can ask better questions, understand their options, and find care that fits their loved one’s needs.
This article is for general educational purposes and is not legal, medical, regulatory, insurance, or financial advice. Admission, assessment, licensing, payment, and nursing requirements vary by state, provider type, payer, and individual circumstances and can change. Verify current requirements with the appropriate state licensing agency and prospective care provider.
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