This toolkit is written for hospital discharge planners and social workers who face the hardest part of the job: placing high-acuity patients into long-term care. Ventilator patients. Trach patients. Bariatric patients. Dialysis patients. The cases where every general referral comes back empty. Use this as a working reference — the questions to ask, the paperwork to gather, and the partner who can actually place these patients.

1. What Makes a Patient "High-Acuity" for Placement Purposes

In adult family home placement, high-acuity generally means the patient needs one or more of:

  • Skilled nursing hours beyond what standard AFH staff can provide (covered by private duty nursing / PDN contracts)
  • Specialized equipment — a ventilator, suction, feeding pumps, bariatric beds
  • Frequent clinical interventions — suctioning, medication titration, monitoring
  • Specialized training on staff — trach, vent, or dialysis competence

If any of these apply, the standard placement playbook won't work. The home you need is the exception, not the rule — which is why hard-to-place patients accumulate in hospitals.

2. The Referral Package That Gets a "Yes"

Homes that accept high-acuity patients make decisions on clinical facts, not phone calls. Bring a complete package:

  • Current orders: medications, treatments, and any equipment settings (vent settings, trach size, feeding rates)
  • Diagnoses and prognosis: what's expected in the next 30–90 days
  • Level of care documentation: DSHS assessment, current functional status, cognitive status
  • Funding confirmation: Medicaid/COPES eligibility, PDN authorization, or private-pay capability

This is the difference between a home saying "maybe" and saying "yes" in one review.

3. Washington Adult Family Homes: What They Can and Can't Do

Adult family homes in Washington are licensed for up to six residents. Within that license, homes vary widely:

  • Standard AFH: activities of daily living, medication assistance, some skilled care via visiting nurses
  • RN-operated AFH: a registered nurse owns or operates the home — higher clinical capability by design. See why nursing-led care matters.
  • PDN-contracted AFH: skilled nursing hours delivered under a private duty nursing contract, enabling vent/trach care at home-scale

Most high-acuity placements land in the latter two categories. A placement partner who maintains relationships with these homes is the key to speed.

4. The 48–72 Hour Placement Process

  1. Intake (Day 1, morning): referral, clinical review, funding verification
  2. Matching (Day 1, afternoon): shortlist of 3–5 homes that have accepted similar patients
  3. Family + planner coordination (Day 2): tours, questions, decision
  4. Confirmation (Day 2–3): bed secured, contract signed, discharge date held

This is what specialized placement looks like in practice — the case study of a vent patient placed in 48 hours walks through it step by step.

5. When to Call Us

  • Your patient's needs fall into the high-acuity categories above
  • Three or more referrals have come back empty
  • Your discharge date is fixed and can't extend

Discharge planner? Call our direct line — 24/7 for placement teams. We place the cases others can't.

Call (425) 400-3202 — Direct Line for Placement Teams

Related Resources