Last updated on May 20th, 2026 at 06:50 pm
Medical disclaimer: The information in this article is for general informational purposes only and does not constitute medical, legal, or financial advice. Please consult a qualified healthcare provider regarding your specific situation.
If you are reading this, the situation has probably narrowed. Your loved one is ready to leave a hospital, but home is not safe and the nearest nursing home is not the right level of care. The system seems to keep saying no.
Enhanced Services Facilities, or ESFs, exist because of that exact gap. Yet most families have never heard of them, and the ones who have often pictured something very different from what an ESF actually is.
This article explains what residents actually receive in a Washington State ESF, why the benefits of enhanced services facilities are so often misunderstood, and how families can tell if it is the right fit. If you are weighing options now, you can also contact Sunrise Services to talk through your loved one’s situation directly.
What do residents do at an Enhanced Services Facility?
Residents at an ESF receive 24-hour personal care, behavioral health support, nursing oversight, and help with daily life skills in a small home-like setting of up to 16 people. The goal is to stabilize, build community connections, and move toward more independent living when the resident is ready.
A therapeutic environment that is not a hospital and not a group home
The most common misunderstanding about ESFs is that they are like psychiatric hospitals or locked facilities. They are not.
The Washington State Legislature authorized DSHS to create ESFs under Chapter 70.97 RCW specifically as a community placement option. They serve adults whose personal care and behavioral needs are too complex for a typical adult family home or assisted living facility, but who do not need an institutional psychiatric setting.
They are also not group homes. ESFs include nursing oversight, mental health professionals on staff, and an onsite administrator. The staffing ratio is intentionally high, with strong attention to behavioral support.
In practical terms, residents live in a small, home-like setting (no more than 16 people) and receive a level of support that does not exist in any other residential category in Washington State.
What residents actually receive day to day
The benefits of enhanced services facilities show up in three areas of daily life: behavioral health support, help with everyday living, and coordinated medical care.
Behavioral health support
ESFs provide behavior support services and connect residents with treatment when they need it. At Sunrise, the ESF has mental health professionals on staff who work alongside caregivers. They observe patterns, respond to challenges, and help residents develop coping strategies.
This is different from formal outpatient treatment, which Sunrise also offers separately through its behavioral health clinics in Everett, Mountlake Terrace, Mount Vernon, Bellingham, and Oak Harbor.
Help with daily life skills
Caregivers help residents with personal care like bathing, hygiene, and medication assistance. They also help with the parts of life that often get harder during a long hospitalization (cooking simple meals, doing laundry, keeping a routine).
These skills sound small. They are not. For someone re-entering community life after months in a hospital, rebuilding a daily rhythm is the foundation everything else stands on.
Coordinated medical care
Nurses and caregivers handle medication passes, monitor health changes, and coordinate with outside providers for primary care, psychiatric care, and any specialty needs. The onsite administrator keeps the whole system moving.
For families, this matters because it means no one is left to manage a complicated care plan alone.
Who qualifies for an Enhanced Services Facility
Per DSHS, an ESF “provides personal care and behavior support services to a maximum of sixteen residents who have complex personal and behavioral care needs that exceed the capacity of other residential settings.” (Source: DSHS Residential Long-Term Care Facilities Specialty Contracts.)
In plain terms, ESFs are designed for adults who have a combination of needs: physical disabilities, cognitive impairment, mental health support needs, or some mix of all three. Most residents are referred from state psychiatric hospitals or from situations where no other community placement has worked.
Referrals typically come through DSHS, hospital discharge planners, or community case managers. Families can also reach out directly to ask whether their loved one might be a fit.
What real outcomes look like for residents
It is fair for families to ask: does this actually work? The honest answer is that outcomes vary, and recovery is not a straight line. But the structure of an ESF is built around a clear progression.
A typical path looks like this. A resident arrives stabilized but fragile, often straight from a hospital. Over weeks and months, they rebuild routines, work with the behavioral health team on their specific challenges, and slowly take on more of their own life again.
For some residents, that means eventually moving to an adult family home or supported living arrangement. For others, the ESF becomes a longer-term home where they can live with dignity and the right level of support. Both outcomes are successful.
What matters is that the resident is no longer cycling between hospitals and unsafe situations. That stability is the deepest of all the benefits of enhanced services facilities.
How families can tell if an ESF is the right fit
If you are trying to decide, a few questions usually clarify things quickly:
- Has your loved one been turned away from adult family homes or assisted living because their behavioral needs are too complex?
- Are they currently in a hospital with no clear discharge destination?
- Do they need 24-hour staffing that includes both caregivers and behavioral health support?
- Have prior placements not held because the level of support was too low?
If you said yes to one or more, an ESF is worth a serious conversation. Sunrise’s ESF can serve up to 16 residents and is staffed with nurses, caregivers, mental health professionals, and an onsite administrator.
Frequently asked questions
What is the difference between an ESF and a nursing home?
A nursing home focuses on medical and skilled nursing care, often for older adults with significant medical needs. An ESF is designed for adults whose primary challenges are behavioral and personal care, not medical-skilled. ESFs include behavioral health staff, which most nursing homes do not.
Are Enhanced Services Facilities locked?
No. ESFs are state-licensed residential facilities, not psychiatric hospitals. They are designed as community placement settings, not secure ones. Specific safety features vary by facility.
How long do residents stay in an ESF?
There is no set length of stay. Some residents move on to less-intensive settings within months. Others remain longer because the ESF is the right ongoing fit. Each plan is built around the resident, not a timeline.
Who pays for an ESF?
ESFs serving DSHS clients are typically funded through state contracts. Eligibility and payment paths are determined by DSHS case managers as part of the referral process. Sunrise can help families understand what applies in a specific situation.
Talk through your situation with Sunrise
If you are weighing whether an ESF is right for someone you love, you do not have to figure it out alone. Contact Sunrise Services to discuss whether the Enhanced Services Facility is the right fit for your loved one. Our team can walk through what they need, what an ESF would look like for them, and what the next step would be.
Want to picture daily life in more detail first? Read our companion post on how Sunrise supports quality of life at our Adult Family Homes and Enhanced Services Facility.