May 2014
Developmental Disabilities Administration
Fact Sheet: RESIDENTIAL HABILITATION CENTERS
Overview
The Developmental Disabilities Administration (DDA) operates four
Residential Habilitation Centers (RHCs). The RHCs currently serve around
850 people, down from a census of more than 4,000 people in the early
1960s. The census varies as all facilities will admit some individuals for
short-term care, treatment, or assessment.
The RHCs are federally certified as Intermediate Care Facilities for
Individuals with Intellectual Disabilities (ICF/ID) or Nursing Facilities (NF)
or are a combination of both. Federal certification means that each facility
must provide a range of services that meet specific standards set by the
Centers for Medicare and Medicaid Services (CMS) under the authority of
the Social Security Act.
All services and supports are intended to make a difference in the lives of
the people living at the facilities. Services, while taking family wishes and
desires into consideration, are developed through extensive annual
interdisciplinary assessment and planning processes and written into yearly
plans for Individual Habilitation (ICF/ID) or Personal Care (NF) plans.
SERVICES
The RHCs provide 24-hour supervision, habilitation training, health
services, skill development training, therapies and other professional
supports. All of the RHCs provide the service of short-term admissions for
planned respite, evaluations and/or emergency interventions. Admissions
are arranged through DDA case resource managers.
The RHCs have some individual characteristics:

Fircrest, located in Shoreline, is the Western Washington facility in the
Puget Sound urban corridor. Fircrest supports about 215 people ranging
in age from 12 to 85 years. Fircrest residents may receive their services
from the ICF or NF programs. Residents benefit from 24-hour nursing,
an in-house medical-nursing-allied health professional team, as well as
regularly scheduled on-site clinics from community specialists in
neurology, podiatry, ophthalmology, and gastroenterology. Dental
services are provided by practitioners trained in caring for persons who
have significant physical disabilities and challenging behaviors.
Fircrest has dedicated expertise in child development supports as about
30 student-aged residents receive services there. Fircrest has affiliations
with the University of Washington, Harborview Medical Center, and
Children’s Hospital for medical resources.
WASHINGTON STATE DEPARTMENT OF SOCIAL & HEALTH SERVICES
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An Assistive Technology and Treatment Center (ATTC) located at
Fircrest offers interdisciplinary specialization in the use of technology
to enhance resident skills. The team finds solutions for individuals
experiencing difficulties with communication, wheelchair positioning
and seating, mobility and other environmental controls. The ATTC
Personal Empowerment Program collaborates with researchers at the
University of Kansas and University of Washington and is focused on
finding ways for people with serious and severe disabilities to have
independent control over some part of their lives.

Rainier, located in Buckley, is the largest RHC and has an ICF
certification. Rainier supports about 350 residents. For many years,
Rainier has collaborated with Western State Hospital and has developed
expertise in services and supports for people with co-occurring mental
health conditions. Rainier is able to provide short-term respites for
families, emergency intervention or crisis response as the facility
capacity and budget allows.
Rainier operates dynamic and extensive resident employment services –
a store, work crews for community jobs and crews who produce goods
for sale (e.g., Adirondack furniture, planters, garden stones, and other
products). The Rainier employment program collaborates with Green
River Community College and other local employers for resident work.

Lakeland Village, located in Medical Lake, is the Eastern Washington
facility. People who receive services from Lakeland have a wide range
of needs, from profound physical, intellectual, health and social
development challenges, to co-occurring mental health conditions.
Lakeland maintains both NF and ICF certifications in order to support
this wide range of disabling conditions. Around 215 people receive
services from Lakeland.
Lakeland Village residents have extensive daytime employment and
activity programs, which involve treatment and teaching programs
designed to maintain or improve health and wellness, social
development along with sensory-motor activities to improve residents’
interaction with the environment around them. Similar to Fircrest, some
approaches incorporate activation of assistive devices for cause and
effect and controlling part of the resident’s the environment. Using
assistive technology has assisted residents to achieve measured success
and reduce interfering behaviors along with improving their well-being.
Residents work in a campus store, participate in work crews, provide
print shop services, work in the greenhouse, or produce ceramics as well
as perform contracted work for community businesses.
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The Lakeland Village College in Residence Volunteer (CIRV) program
is noteworthy. CIRV provides college students campus housing for a
small fee and in exchange for 15 hours of volunteer work weekly. The
students focus on quality of life social interactions with residents along
with being part of educating other students about people with
disabilities.

Yakima Valley Nursing Facility, located in Selah, is the central
Washington facility. Yakima Valley is a certified NF and has no ICF
capacity. The facility provides supports to 88 to 96 residents.
A number of years ago, Yakima Valley received dedicated funding to
expand the short-term admission program, up to a capacity of 16 spaces.
The short-term program admits individuals from across the state. The
capacity is frequently scheduled months in advance, especially during
the summer and holiday periods. Of the 16 beds, eight are designated as
crisis beds for individuals in need of emergent care. The
interdisciplinary team provides treatment and support to these
individuals as well as transition planning for placement to return home
or to other community residential living.
Yakima Valley has a relationship with the local school district to
provide student supported employment training at the central laundry.
For Yakima residents, specialized services and therapies are provided
according to annually developed individual plans.
Individuals who:
Eligibility
Requirements  Are enrolled and eligible clients of DDA;
 Are 18 years of age or older;
 Meet Medicaid eligibility and need active treatment as defined in the
Code of Federal Regulations;
 Who have a functional or intellectual disability that requires ICF/ID
level of support and supervision; or
 Need 24 hour per day nursing level of care provided by NFs.
Chapter 71A RCW, Developmental Disabilities
Authority
Chapter 388-837 WAC, Residential Habilitation Center ICF/ID Program
As a state plan service, service from an ICF program is an entitlement,
provided the person meets the eligibility criteria, needs the level of care
provided, wants to participate in the service, and does not create a danger to
other residents. Since three of the state’s RHCs have ICF levels of care,
many think that admission to an RHC is an entitlement. It is not. A
statewide Admissions Review Team assesses all requests for admission and
makes recommendations to the DDA Deputy Assistant Secretary, who is
the final decision-making authority for long term admissions to all RHCs.
Approval of admission does not guarantee a particular facility.
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Budget
Rates
Partners
Oversight
Information
Contact
FY 2013 Expenditures:
GF-State: $81,313,379
Federal: $78,529,880
Local: $11,498,269
FY 2014 Budget:
GF-State: $ 85,261,000
Federal: $ 80,708,000
Local: $ 11,522,000
FY 2014 Daily Rates:
Fircrest:
ICF/ID - $682.11
Nursing Facility - $509.71
Rainier:
ICF/ID - $578.33
Lakeland Village:
ICF/ID - $657.26
Nursing Facility - $568.39
Yakima Valley:
Nursing Facility - $570.92
These rates are based on the respective RHC’s FY 2014 allotment /
estimated expenditures, estimated RHC department indirect, depreciation,
bond interest, vacation liability, and unallowable costs and estimated FY
2014 resident days.
 Aging and Long Term Support Administration (ALTSA), Residential
Care Services Division
External – The Centers for Medicare and Medicaid Services (CMS)
delegate oversight to the Aging and Long Term Support Administration
(ALTSA) Residential Care Services (RCS) Division, which conducts
periodic review of the ICF/ID certification and licensing standards.
Internal – DDA Case Resource Managers make on-site visits.
 The Department conducts complaint investigation activities.
 The facilities themselves have regular monitoring of each person’s
program and services by qualified developmental disabilities
professionals.
Developmental Disabilities Administration
Don Clintsman, Deputy Assistant Secretary
360/725-3421
Email: Donald.Clintsman@dshs.wa.gov
Website: http://www.dshs.wa.gov/ddd/index.shtml
WASHINGTON STATE DEPARTMENT OF SOCIAL & HEALTH SERVICES
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