Washington State

Office of the Attorney General

Attorney General

Bob Ferguson

AGO 1953 No. 126 -
Attorney General Don Eastvold


Where a hospital operates a nursing home separately and independently from its operation of a hospital, the facilities so operated may be licensed by the Department of Health as a nursing home.

                                                              - - - - - - - - - - - - -

                                                               September 1, 1953

John A. Kahl, M.D.
Acting Director
Department of Health
Smith Tower
Seattle, Washington                                                                                                              Cite as:  AGO 53-55 No. 126

Dear Dr. Kahl:

            You have requested our opinion upon the following question:

            "May the Department of Health, under Chapter 117, Session Laws of 1953 as amended by Chapter 160, Laws of 1953, and Chapter V, Section 6, Extraordinary Session 1953, license a portion of a hospital as a nursing home."

            Our answer to the above question might be summarized as follows:

            The Department of Health may license that portion of a hospital that is operating as a nursing home, provided that portion that is operating as a nursing home is separate and apart from the other functions of the hospital.


            Section 1, (1) of chapter 160, Laws of 1953, amending section 2, chapter 117, Laws of 1951, provides in part as follows:

             [[Orig. Op. Page 2]]

            "'Nursing Home' means any home, place or institution which operates or maintains facilities providing convalescent or chronic care, or both for a period in excess of twenty-four consecutive hours for three or more patients not related by blood or marriage to the operator, who by reason of illness or infirmity, are unable to properly care for themselves.  * * *  Nothing in this definition shall be construed to include general hospitals or other places which provide care and treatment for the acutely ill and maintain and operate facilities for major surgery or obstetrics, or both.  * * *"  (Emphasis supplied)

            It is our opinion that the underscored portion of the above statute was intended by the legislature to include only those areas of hospitals which perform normal hospital functions.  Under this statute, hospital areas which render ordinary hospital services are not required to be licensed as nursing homes.

            It is clear that the legislature did not intend to waive the requirements of the nursing home statute in instances where a hospital is performing nursing home services in addition to its normal hospital functions.  When a hospital maintains a nursing home separate and apart from its ordinary hospital operation it, like any other individual or group of individuals or corporation, must conform to the statutory requirements in regard to nursing home licenses.

            In order to determine that a nursing home operated by a hospital is separate and apart from the usual hospital functions, the following facts are to be taken into consideration:

            1.         Is the area dedicated to nursing home services physically separated from the general hospital area?

            2.         Is the immediate supervision of the nursing home independent of the general hospital administration?

            3.         Are the nurses permanently assigned to nursing home care restricted to those duties?

            4.         Is the standard of care and treatment confined to that which is limited by the nursing home statute?

             [[Orig. Op. Page 3]]

            5.         Is a separate accounting system utilized?

            6.         Are the rates charged considered nursing home rates as opposed to general hospital rates?

            These forgoing qualifications are all necessary in order to indicate that the nursing home is clearly segregated from the rest of the hospital operation.  If these requirements are met, it follows that a hospital in maintaining such a service is operating a nursing home, for which a license is required.

            Any prior opinions inconsistent herewith, are hereby overruled.

Very truly yours,

Attorney General

Assistant Attorney General