Your loved one has made real progress. The doctors say they’re ready to leave the hospital. But when you start looking for the right next step, nothing seems to fit.
Standard adult family homes don’t have the staff or specialized training. Assisted living wasn’t designed for someone with complex behavioral health needs. And staying in a state psychiatric hospital longer than necessary isn’t good for anyone.
If this sounds familiar, enhanced services facilities may be exactly what you’ve been searching for. Washington State created this category of care specifically to fill this gap; a real community-based home for adults who need more support than standard settings can offer.
The Gap Enhanced Services Facilities Were Designed to Fill
For years, Washington State faced a specific problem. Some adults were medically ready to leave an Eastern or Western State Psychiatric Hospital, but no community placement existed for their level of complexity.
Standard residential settings weren’t equipped for people with intensive behavioral health and personal care needs. As a result, people were staying in state hospitals far longer than necessary; at significant cost to the state and, more importantly, at cost to the person’s quality of life.
To close this gap, Washington State established funding in the 2013–2015 state operating budget to create a new category of licensed residential facility. Enhanced Services Facilities, authorized under RCW 70.97, were built specifically so that people who no longer needed inpatient treatment could have a real place to call home.
Who Lives in an Enhanced Services Facility?
ESFs serve a specific population. According to the Washington State Department of Social and Health Services (DSHS), residents are adults who:
- Are transitioning from Eastern or Western State Psychiatric Hospital, or are on the state hospital waiting list
- Are no longer in need of active inpatient psychiatric treatment
- Are functionally and financially eligible for home and community-based services
- Have more complex personal care and behavioral needs than standard community settings can manage
It’s worth knowing that ESF residents aren’t defined by their limitations. Many have jobs, volunteer in their communities, and lead active lives. An ESF provides the support structure that makes that possible; not a locked door.
Referrals are managed exclusively through DSHS’s Behavioral Support Unit (BSU). Families cannot contact an ESF directly to request placement. Working with a DSHS case manager is the required first step.
What Services Do Enhanced Services Facilities Provide?
ESFs offer a combination most Washington State residential settings don’t: behavioral health services, personal care, and nursing under one roof.
Per DSHS documentation, ESFs are required to provide:
- On-site nursing staff
- Mental health professionals and behavioral health support
- A minimum staff-to-resident ratio of 1:4 at all times
- Daily living support: medication management, meal preparation, housekeeping, and transportation
Each facility serves a maximum of 16 residents. That smaller scale means more individualized attention, and a more genuinely home-like environment.
How ESFs Compare to Other Care Options in Washington State
Understanding how ESFs differ from other options helps clarify whether it’s the right fit:
Adult Family Homes (AFHs): AFHs serve a general population and provide excellent residential care. However, they typically don’t have the specialized behavioral health staffing ESF residents require.
Assisted Living Facilities: These focus on daily living support and general wellness for a broad population. They are not designed to manage the level of behavioral complexity ESF residents often present.
State Psychiatric Hospitals: Hospitals provide active inpatient psychiatric treatment. ESFs serve people who no longer need that level of care but need more support than standard community options offer.
It’s also worth knowing that the U.S. Supreme Court’s 1999 Olmstead ruling established that people with disabilities have a legal right to services in the most integrated setting appropriate to their needs. ESFs help make that right real for people who would otherwise have no appropriate community placement.
How to Access ESF Care and How Sunrise Can Help
ESF placements in Washington State are managed through DSHS. Here is what the process typically looks like:
- The person must be discharging from, or on the waiting list for an Eastern or Western State Hospital.
- DSHS’s Behavioral Support Unit (BSU) manages referrals and matches individuals with appropriate facilities.
- Families work with their DSHS case manager to understand eligibility and next steps.
Sunrise Services operates an Enhanced Services Facility and has more than 45 years of experience supporting people with complex needs throughout the Puget Sound region. Our staff includes nurses, caregivers, mental health professionals, and an on-site administrator; all focused on helping residents stabilize, connect with their community, and thrive.
If you’re exploring options for a loved one, our team can help you understand what’s available and what might be the right fit.
Frequently Asked Questions About Enhanced Services Facilities
What is an enhanced services facility in Washington State?
An enhanced services facility (ESF) is a licensed residential care setting for adults with complex personal care and behavioral health needs who no longer require institutional psychiatric care. ESFs combine behavioral health services, personal care, and nursing in a community-based home with a maximum of 16 residents and a minimum staff ratio of 1:4.
Who qualifies to live in an enhanced services facility?
Adults transitioning from Eastern or Western State Psychiatric Hospital who no longer need inpatient psychiatric treatment may qualify. Residents must be functionally and financially eligible for home and community-based services and have needs that exceed what standard community settings can provide. Referrals are managed by DSHS’s Behavioral Support Unit.
How do enhanced services facilities differ from assisted living?
Assisted living facilities focus on general daily living support for a broad population. ESFs are specifically designed for adults with complex behavioral health needs and require on-site nursing and mental health professionals. ESF staffing ratios are higher, and placement is exclusively through DSHS referral.
How do I get my loved one placed in an enhanced services facility?
Placement is arranged through DSHS. Your loved one must be discharging from or on the waiting list for a Washington State psychiatric hospital. Work with a DSHS case manager to understand eligibility. Organizations like Sunrise Services can also help you navigate available options.
Does Sunrise Services operate an enhanced services facility?
Yes. Sunrise Services operates an Enhanced Services Facility serving adults with complex behavioral and personal care needs in the Puget Sound region. Our ESF brings together nurses, caregivers, mental health professionals, and an on-site administrator to help residents stabilize and participate fully in their community. Visit our Enhanced Services Facility page to learn more about how we can help.
Ready to Learn More?
Finding the right care for someone with complex behavioral health needs is one of the hardest things a family can do and you don’t have to figure it out alone.
Click here to learn about Sunrise’s Enhanced Services Facility and explore how we can help you find the right path forward.
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