*Editors’ note: During the 2026 EFA Conference + Expo, March 16-18 in Phoenix, the session “E24 – The Codes, They Are A-Changin’: A Sneak Peek at the 2026 FGI Guidelines,” will be presented by speakers Addie Abushousheh, Gaius Nelson, and John Shoesmith. For more information on the conference schedule and to register, visit environmentsforagingmagazine.com.
When the Residential Document Group (RDG) of the Health Guidelines Revision Committee (HGRC) began work on the 2026 FGI Code for Planning and Design of Residential Care and Support Settings (2026 FGI Codes), the goal for the new edition was practical rather than aspirational: improve clarity, adoptability, and enforceability.
Barbara Stretchberry. Courtesy of FGI
Those objectives shaped decisions, large and small, and influenced how requirements were organized, which requirements were made prescriptive instead of performative, and how the document’s structure was improved for easier use by designers, owners, and authorities having jurisdiction (AHJs).
Over four years of committee deliberation, public comment, and technical review, the emphasis remained consistent, focusing on selective additions alongside a sustained effort to clarify and strengthen how minimum standards are defined and applied across residential care and support settings.
That intent is most visible in a handful of targeted revisions—most notably the move toward predominantly single-occupancy resident rooms—and it is reinforced throughout the document in more incremental ways.
Requirements that once were buried in appendices have been pulled into alignment. Ambiguous language has been tightened, and overlapping provisions consolidated.
Taken together, these changes signal that the 2026 FGI Code is designed to function first as a regulatory instrument, setting the stage for one of the most significant structural shifts in the document’s history: the formal separation of enforceable code from advisory guidance.
Setting enforceable minimum standards in 2026 FGI Codes
Before a single technical requirement is encountered, the 2026 FGI Code establishes a clear boundary between regulation and guidance.
For the first time, the FGI Codes are presented strictly as a set of enforceable minimum standards—requirements intended for adoption and enforcement, such as resident room dimensions, clearance and circulation criteria, and occupation limits.
By contrast, all nonmandatory guidance, such as explanatory commentary, research background, and design strategies guidance, has been removed and relocated to the companion FGI Handbooks for Planning and Design, where it can inform decision-making without carrying regulatory weight.
This shift is in response to enforcement challenges, inconsistent interpretation, and increasing unauthorized reproduction and distribution of the FGI Codes. By clearly separating enforceable requirements from explanatory guidance, FGI reinforces the integrity of the code as a regulatory instrument while reducing the risk that owners and designers access incomplete, outdated, or inaccurate information.
The FGI Handbooks preserve and expand the explanatory material that people who use the Guidelines have long depended on, while allowing the FGI Code itself to function as a concise, authoritative standard intended for formal adoption and enforcement.
For experienced designers and AHJs, the benefit is immediate, and the distinction between requirements and recommendations is no longer ambiguous.
Designing for adoption of FGI Codes
Although more than 40 states have adopted some version of the FGI Codes/Guidelines, the Residential FGI Codes/Guidelines generally lag behind the acceptance of hospital and outpatient documents due to the wide variation in residential care models and state oversight structures that have not always kept pace with the increasing clinical complexity of residential care and support settings.
In response to FGI and HGRC leadership identifying adoptability and enforceability as key considerations for the 2026 edition, the RDG broadened its membership to include a wider range of owners, clinicians, engineers, and AHJs, ensuring the language reflects not only design intent but also the practical realities of both regulation and owner operations.
That shift proved to be tremendously impactful on the shape and structure of the FGI Code. It drove a full terminology audit, tightened scope language, and eliminated ambiguities that routinely surface during plan review, addressing long-standing questions about accessibility definitions, renovation triggers, and which requirements apply across different residential settings. The goal was not to dilute design intent, but to reduce interpretive friction, especially for states considering first-time adoption.
Rebalancing the FGI Code structure
The familiar framework of the FGI Code remains, but its internal logic has been tightened. Part 1 (General Project Requirements) has been reorganized into five sequential chapters to follow a project’s timeline: Introduction, Planning, Design, Construction, and Commissioning.
Part 2 (Common Elements for Residential Settings) continues to consolidate requirements that apply across multiple facility types,such as room clearance requirements in nursing homes, hospice settings, and assisted living settings. This set-up reduces the circular cross-referencing that made earlier editions confusing. Facility-specific provisions then live where users expect them in parts 3-5, which provide requirements for individual setting types.
One notable deletion signals a broader philosophical shift: The chapter for independent living settings has been removed. While its inclusion in earlier editions acknowledged continuing care retirement communities, it offered few standalone requirements. After public comment and internal review, the RDG concluded that it added complexity without regulatory value.
Filling that space is a new chapter with far greater impact: Residential Behavioral and Mental Health Facilities. Its addition formally recognizes a care sector that has expanded rapidly, often without tailored minimum design requirements.
Clarifying FGI renovation guidelines
Renovation scope has long been one of the most inconsistently interpreted aspects of previous editions of the Guidelines. The 2026 FGI Code addresses this head-on.
Revised language in Part 1 clarifies when renovation work must comply with new construction requirements, aligning more closely with other building codes. For example, changes in use or resident room capacity can trigger compliance, while limited-scope renovations may be confined to the affected work area and its supporting systems.
For owner-operators navigating phased renovations or campus expansions, this clarification eliminates long-standing gray areas and gives AHJs a clearer footing during enforcement.
Modernizing Common Elements chapter
Part 2 strengthens the existing Common Elements chapter by relocating, consolidating, and, where appropriate, expanding requirements shared across multiple residential settings, including resident room sizes, dining space minimums, laundry workflows, and accommodations for individuals of size.
The 2026 FGI edition builds on the established Common Elements approach to reduce cross-referencing, improve usability, and make shared requirements easier to locate, interpret, and enforce.
Design criteria are now explicitly differentiated for neurocognitive and neurodiverse populations, where sensory modulation is a primary concern, and residents at risk of harm, where safety-driven environmental strategies apply. This distinction clarifies intent and avoids conflating fundamentally different design responses within a single set of requirements.
Clearance requirements, previously scattered and frequently overlooked, are centralized, including the 36-inch clear path from door to bed, window, and bathroom. Additionally, requirements for individuals of size have been substantially expanded, addressing room dimensions, fixtures, and structural considerations that support dignity and safety.
Dialysis accommodations now reflect the reality that many residents self-perform peritoneal dialysis, which can be performed in their bedroom and requires electrical capacity, handwashing access, and significant on-site storage. Where skilled nursing communities provide hemodialysis treatment for residents, design requirements were added for a dedicated hemodialysis treatment room and facilities.
Furthermore, dining standards, long treated as guidance, are now codified as well. Minimum dining space requirements range from 28 square feet per occupant in skilled nursing, hospice, and long-term substance use treatment facilities to 20 square feet in behavioral and mental health settings.
These changes are designed to support mobility, household models, and operational flexibility without relying on advisory language.
Operational considerations meet code
Several updates quietly reflect how operational considerations have driven change to design requirements over the past decade.
Here are a few:
• A clinical service sink/hopper, once a fixture in nearly every soiled workroom, is no longer required outside commercial laundry areas, acknowledging widespread use of disposables and revised infection control practices.
• Laundry chutes, on-site processing, and off-site exchange areas are now clearly defined, with explicit drainage and clean-to-dirty workflow requirements.
• Ventilation requirements that have long varied by setting type are now consolidated in the Common Elements chapter, making the two-tier approach to ventilation standards more visible and easier to apply. Higher-acuity residential settings, such as nursing homes and hospice facilities, continue to follow ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities, while other residential settings align with ANSI/ASHRAE 62.1: Ventilation and Acceptable Indoor Air Quality or ANSI/ASHRAE 62.2: Ventilation and Acceptable Indoor Air Quality in Residential Buildings, paired with minimum MERV 8 filtration.
• Nurse call system requirements have been similarly centralized, clarifying the appropriate use of newer wireless technologies while maintaining established standards where higher-acuity populations require them.
How did private room minimums for senior living communities change in 2026 FGI Code?
No provision received more sustained scrutiny during the public comment process than resident room capacity.
The 2026 FGI Code establishes a minimum of 90 percent single-occupancy resident rooms across skilled nursing, assisted living, residential behavioral and mental health treatment, and long-term substance use disorder treatment facilities as well as settings for individuals with intellectual and/or developmental disabilities.
This requirement reflects years of evidence-based research, sharpened by the pandemic’s lessons on infection control, privacy, and dignity. Recognizing financial and regulatory constraints, the 2026 FGI Code allows exceptions—subject to AHJ approval—when the requirement would impose undue hardship, one of the few explicit exceptions in the document.
The downstream effects are significant. With private rooms as the baseline, requirements for separate exam or treatment rooms may be reduced when privacy can be achieved in-room.
FGI Code refines assisted living guidelines
With resident room occupancy now addressed consistently across multiple residential settings, Part 4 (Residential Care and Support Settings) focuses on resolving several long-standing gaps specific to assisted living and similar environments.
Minimum resident room sizes, which were previously unaddressed, are now defined, establishing baseline square footage and clear dimensions for single- and double-occupancy rooms and providing more consistent criteria for plan review.
Bathroom and toilet room ratios are also clarified through defined distinctions between “directly accessible” fixtures located within resident rooms and “readily accessible” shared fixtures located on the same floor, balancing flexibility with clearer minimum access standards.
Part 4 also formalizes requirements for central bathing in assisted living, ensuring that residents without in-room bathing fixtures have access to appropriately designed assisted bathing spaces on each floor or within each unit.
Together, these revisions bring assisted living requirements into closer alignment with contemporary expectations for safety, dignity, and regulatory consistency, without overextending prescriptive requirements into areas better addressed through operations.
FGI Code is an evolving framework for design
Taken together, the 2026 FGI Code for Planning and Design of Residential Care and Support Settings prioritizes precision over expansion. The new edition acknowledges that residential care is no longer peripheral to health care design; it is a complex, regulated environment with its own operational, clinical, and social demands.
As FGI looks ahead to the 2030 revision cycle, one thing remains constant: the FGI Codes are living frameworks, shaped by the professionals willing to engage, question, and contribute. In that sense, the 2026 Residential Code is not just a new edition—it’s a commitment to continue shaping the future of person-centered residential care and support settings.
Based in Middleton, Wis., Barbara Stretchberry is managing editor at FGI and can be reached at [email protected].
