DSHS Home and Community Services: Washington's Dementia Care Agencies Explained

You searched for help with your parent's dementia care and got hit with a wall of acronyms: DSHS, ALTSA, HCS, AAA, DDA, HCA. You're not sure which agency handles what, where to call first, or how they relate to each other.

Here's how Washington's aging and dementia care system is actually organized.

The Agency Map

DSHS (Department of Social and Health Services) is the parent agency overseeing most long-term care programs in Washington State.

Under DSHS, three divisions matter for dementia families:

ALTSA (Aging and Long-Term Support Administration)

ALTSA manages all aging-related services. It's the division that administers:

• The CARE assessment (the functional gateway to all state-funded long-term care)
• Community First Choice (CFC) personal care services
• COPES waiver services
• Medicaid Personal Care (MPC)
• The Specialized Dementia Care Program (SDCP)
• Adult Protective Services (APS)

Home and Community Services (HCS)

HCS is the operational arm within ALTSA that directly manages case assignments, authorizes care hours, and oversees community-based care. When you apply for services through DSHS, HCS is the division that schedules your parent's CARE assessment and assigns a case manager.

Area Agencies on Aging (AAAs)

Washington has 13 regional AAAs that serve as the local access point to ALTSA's programs. They operate under the Community Living Connections brand — the statewide information network that connects families to local resources.

AAAs handle:

• CARE assessments (on behalf of DSHS/HCS)
• Family Caregiver Support Program enrollment
• TSOA and MAC program administration
• Information and referral to local services
• The TCARE caregiver assessment protocol

The Specialized Dementia Care Program (SDCP)

SDCP is Washington's Medicaid-funded program for dementia residents in Assisted Living Facilities. It provides enhanced daily reimbursement rates for facilities that hold Expanded Adult Residential Care Specialized Dementia Care (EARC-SDC) contracts with DSHS.

To qualify for SDCP, your parent must:

• Be financially and functionally eligible for CFC services
• Score 3 or higher on the Cognitive Performance Scale (CPS) via the CARE assessment
• Have at least one active challenging behavior (wandering, exit-seeking, combativeness) or require direct assistance with eating
• Have a documented irreversible dementia diagnosis from a licensed healthcare practitioner

Because dementia is medically irreversible, if your parent transfers between SDCP-contracted facilities, the case manager doesn't need to submit a new eligibility checklist.

Other Agencies That Intersect with Dementia Care

Health Care Authority (HCA) manages Apple Health (Medicaid) eligibility determinations and the financial side of coverage. While ALTSA handles functional assessments and care authorization, HCA handles the financial application.

Department of Licensing (DOL) handles driver evaluation requests when dementia compromises driving safety.

Washington State Patrol (WSP) administers the Endangered Missing Persons Advisory system, including Silver Alerts for missing adults 60+ with cognitive impairment.

Where to Start

If your parent has dementia and you're not sure what they qualify for, your starting point is Community Living Connections — the statewide gateway to your regional AAA. They'll:

1. Screen your parent's general eligibility
2. Schedule a CARE assessment if appropriate
3. Connect you with the Family Caregiver Support Program
4. Explain TSOA options if your parent doesn't yet qualify for Medicaid
5. Provide referrals to local support groups and the Alzheimer's Association

Don't try to navigate DSHS's website on your own — the AAA system exists specifically to serve as a human guide through the bureaucracy.

The Washington Dementia & Memory Care Guide includes a complete agency directory with contact information for every regional AAA, a step-by-step walkthrough of the CARE assessment process, and detailed instructions for accessing SDCP and other specialized programs.

See more Washington guides →