DDA CARE Assessment Washington — How to Prepare and What to Expect

What the CARE Assessment Decides

The Comprehensive Assessment Reporting Evaluation determines how much support a DDA client needs — and by extension, which services they can access and how many personal care hours they're authorized. It's the single most consequential meeting in the DDA system, because the number that comes out of it directly controls funding.

For clients age 16 and older, the CARE assessment incorporates the Supports Intensity Scale for Adults (SIS-A), a standardized instrument that measures the frequency, duration, and type of support needed across multiple life domains. The SIS-A generates a composite score that DDA uses to calculate the Individual and Family Services (IFS) allocation level and to evaluate whether the client meets the functional threshold for Community First Choice or a waiver upgrade.

How the Assessment Works

A DDA Case Resource Manager conducts the CARE assessment, typically in the family's home. The assessment covers:

• Medical and behavioral needs — medications, seizure management, behavioral episodes, overnight supervision
• Daily living activities — bathing, dressing, toileting, meal preparation, money management
• Community participation — transportation, shopping, social interactions, accessing services
• Employment and learning — job-related skills, following instructions, maintaining pace
• Health and safety awareness — understanding danger, self-administering medication, emergency response

For each activity, the assessor asks three questions: how often does the person need support (frequency), how long does each support episode last (duration), and what type of support is needed (monitoring, verbal prompting, partial physical assistance, or full physical assistance).

The "Unaided Performance" Trap

The SIS-A measures what the individual can do without help — not what they can do with the support system currently in place. This is where families routinely undermine their own assessment.

Parents naturally want to highlight their child's growth. When the assessor asks "Can your child prepare a meal?" the instinct is to say "Yes, they make sandwiches" — when the accurate answer is "They can make a sandwich if I set out the ingredients, remind them of the steps, and supervise the knife." The first answer scores as independent. The second scores as requiring verbal and physical prompting.

Rules for accurate reporting:

• Describe what happens when you're not there — not what happens with your constant supervision
• Include every prompt — verbal reminders, visual schedules, hand-over-hand guidance, and safety monitoring all count as support
• Don't minimize behavioral episodes — if your child has meltdowns, aggression, elopement, or self-injury, describe the frequency and intensity honestly
• Include overnight needs — bed checks, seizure monitoring, bathroom assistance, and medication schedules that interrupt sleep

Bringing documentation helps: a behavior log covering the previous 30 days, a list of all medications with administration times, school IEP data on prompting levels, and any incident reports from school or community settings.

What the Results Mean

The CARE assessment produces a support level that maps to service authorizations:

• IFS waiver allocation levels: Level 1 ($1,560/year) through Level 4 ($4,680/year) — based on assessed need
• Community First Choice eligibility: requires meeting the functional criteria for an institutional level of care (nursing facility or ICF/IID equivalent)
• Basic Plus or Core waiver consideration: higher support needs may qualify for these more comprehensive waivers

If the assessment results seem too low — fewer hours than the family expected, or a support level that doesn't match daily reality — you have the right to request a reassessment or file an administrative hearing request under WAC 388-825.

When to Request a New Assessment

Reassessments happen when circumstances change: a new medical diagnosis, increased behavioral episodes, loss of a caregiver, or transition out of school-based services. Families can also request a reassessment if they believe the original assessment didn't accurately capture their child's needs.

Contact the assigned Case Resource Manager to initiate a reassessment request. Submitting updated medical documentation and a written statement explaining what has changed strengthens the request.

Our Washington SSI at 18 & Adult Disability Benefits Guide includes a CARE assessment preparation worksheet — structured around the SIS-A domains — so families can organize their documentation and talking points before the assessor arrives.

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