The Department of Social and Health Services (DSHS) recently issued guidance clarifying the use of medical devices in Adult Family Homes (AFHs). DSHS has provided additional clarification regarding bed rails and positioning devices.  

For all residents, AFHs must: 

1. Ensure a qualified assessment has been completed to identify the resident’s need for the medical device and their ability to use it safely; 

1. Provide the resident and their family or legal representative with information about the device’s benefits and potential safety risks so they can make an informed decision regarding its use; 

1. Ensure the resident’s Negotiated Care Plan (NCP) documents how the medical device will be used; and 

1. Ensure the device is properly installed and used according to the assessment and manufacturer’s instructions. 

The Dear Provider Letter (AFH # 2026-027) further clarifies that this assessment must be completed by a qualified assessor, as defined in WAC 388-76-10150. 

What does this mean for AFH Providers? 

Medicaid residents 

The Department Case Manager serves as the qualified assessor and is responsible for coordinating the assessment. 

• If a therapy assessment is needed, the Case Manager will complete the required referral and request the assessment.  

• Once completed, the Case Manager will update the CARE assessment to reflect the findings.  

• The AFH provider should then update the resident’s Negotiated Care Plan to incorporate the assessment recommendations.  

• Whether a Significant Change Assessment is also required depends on the reason the medical device is being requested – for example, whether it is based on the resident’s preference or reflects a change in the resident’s assessed care needs. 

Private Pay residents 

The assessment must be completed by an individual who meets one of the following qualifications: 

• A master’s degree in social services, human services, behavioral sciences, or a related field, plus two years of social service experience working with adults who have functional or cognitive disabilities;  

• A bachelor’s degree in social services, human services, behavioral sciences, or a related field, plus three years of social service experience working with adults who have functional or cognitive disabilities;  

• A valid Washington State nursing license under chapter 18.79 RCW and three years of clinical nursing experience; or  

• A currently licensed physician or osteopathic physician in Washington State. 

Provider responsibilities 

AFH providers remain responsible for ensuring that medical devices: 

• Are used only to address an assessed resident need;  

• Are never used for staff convenience or as restraints;  

• Are properly documented in the resident’s Negotiated Care Plan; and  

• Are installed and used safely.  

Providers should review their medical device policies and procedures to ensure staff understand the safe use of medical devices and the distinction between medical devices and restraints. 

For additional information regarding assessment requirements, bed rail guidance, and provider responsibilities, review Dear Provider Letter AFH # 2026-027 or contact your DSHS Field Manager for guidance on resident-specific situations.