FGI Draft 2026 Codes Foreshadow Big Changes to Come

The Facility Guidelines Institute has released for public review and comment the drafts of its 2026 codes for health and residential care facilities. Known as “the Guidelines” for many years, the draft 2026 edition features some noteworthy changes.

Changes in delivery
Previous editions of the Guidelines contained a mix of requirements, guidance and best practices, and the intermingling of code with guidance sometimes caused confusion as to the true minimum requirement. The draft 2026 edition eliminates such opportunities for confusion because all appendix text has been removed from the code documents.

When the 2026 edition is released, information previously found in the appendices will be available in a new set of handbooks being developed as companions to the codes. These handbooks will expand on existing content to provide examples, checklists and drawings, with more in-depth guidance and detail than included previously.

To reinforce that FGI’s publications are codes rather than guidance documents, Guidelines are now being called the FGI Facility Code. These changes make it abundantly clear that the FGI Facility Code documents contain only minimum requirements intended to be adopted by governments and quality assurance entities.

The 2026 FGI Facility Code documents will be available with no limitations on access. There still will be a fee for paperbacks, licenses with enhanced usability and handbooks, but for those who only need basic digital access to the code, the 2026 edition will be free.

FGI is a small nonprofit organization that relies on sales of its documents to fund future revision cycles, but there are two primary reasons FGI will be offering the 2026 code for free. First, FGI is making changes in the hope that Congress will pass the Pro Codes Act that was introduced as a bill last year. The main objectives of the Pro Codes Act are to support copyright protections of standards that have been incorporated by reference into law or regulation and to ensure the public has free access to such information.

Standards development is an expensive and lengthy process that’s heavily reliant on subject matter experts. Most states would not be able to afford to comprehensively update their health and residential care codes every four years, as FGI does. The Pro Codes Act attempts to minimize interference with private standard development organizations’ ability to sell their publications, while also requiring read-only access to the portions of the codes that have been incorporated by reference. By making access to the 2026 edition free, FGI shows its support for both objectives: protection of intellectual property and the citizens’ right to unfettered access to the law. Separating the code from the guidance democratizes access to the FGI codes and supports innovation and improvement in the healthcare built environment.

Second, the institute is concerned about the possibility that FGI’s users are accessing incorrect or incomplete information. Machine learning and artificial intelligence technologies have created exciting possibilities, but also encourage misappropriation of intellectual property. Accuracy cannot be guaranteed for FGI codes or tools accessed from outside FGI. As such, errors in the content of the codes could lead to costly or dangerous mistakes. By making the 2026 edition freely accessible, users of the FGI codes will be able to base designs on a solid foundation of understanding and trust that the information is accurate and complete.

Changes to content
During this revision cycle, the Health Guidelines Revision Committee has focused its efforts on improving clarity and enforceability, eliminating redundancy and conflict with other codes and updating requirements to assure they remain current with clinical practice and support quality facility design.

Significant changes in the hospital facility code:
The draft 2026 hospital document is now called the FGI Facility Code for Hospitals. Part 1 of the draft contains changes to the functional program that attempt to clarify the types and numbers of clinical rooms (e.g., procedure rooms, imaging rooms) must be included in the narrative and are the responsibility of the owner and clinical team. The section on project phasing has been broadened to include requirements that all interim phases meet requirements of applicable codes, unless approved by the governing body and authority having jurisdiction. In addition, phased projects must provide identification of spaces that will remain operational during the project and planned disruption of essential services.

Revisions in part 2 include:

• A fixed-lift system is now required for patient rooms designated for care of individuals weighing 600 pounds or more.
• The section on telemedicine has been proposed for removal, except for a requirement to assure audio and visual privacy for patients receiving telemedicine services.
• Sections on electrical and plumbing systems have been streamlined and, where appropriate, correlated across the outpatient and residential codes.
• The top surface of fixed cabinetry located more than 68 inches above the floor is required to be enclosed by a soffit or bulkhead, extend to the ceiling with a blank panel or have a sloped top with a 1:3 vertical to horizontal ratio in rooms or areas where direct hands-on care will be provided.
• In the general hospital chapter, two post-acute care areas have been added: a discharge lounge and discharge unit. The inclusion of these spaces supports the need for hospitals to turn over patient rooms earlier in the day, while also providing a safe space for patients awaiting pickup or transfer to a post-acute facility.
• A new behavioral and mental health medical complexity unit provides a safe and clinically appropriate environment for patients with medical and BMH comorbidities.
• In the rehab hospital chapter, space and clearance requirements for patient rooms and patient toilet rooms have been updated.

Significant changes in the outpatient facility code:
In the draft 2026 FGI Facility Code for Outpatient Settings, many revisions made to the hospital code also apply to the outpatient code, though they may be scaled differently to support the unique requirements of outpatient facilities.

Revisions in part 2 of the outpatient code include:

• Imaging room requirements have been relocated from the common elements chapter to the imaging facilities chapter to improve usability.
• Behavioral health crisis units have been moved out of the freestanding ED chapter and now appear in a new behavioral health crisis centers chapter. These crisis units are permitted to be located in a freestanding ED or, for patients medically cleared, in a community-based crisis center.
• A new chapter for short stay centers provides support services to patients of ambulatory surgery centers who cannot make it home the same day. Requirements include all single-patient rooms and visual observation of the patient at the nurse station.
• A new chapter for sleep disorder clinics requires single-patient sleep testing rooms and a control room to allow observation of patients. Due to the low acuity of these patients, a high degree of user control for temperature, lighting, sound and privacy is required in the sleep testing room to facilitate patient comfort.

Significant changes in the residential facility code:
The most significant change in the draft 2026 FGI Facility Code for Residential Care and Support Settings is that a minimum of 80% of resident rooms are now required to be designed as single-resident rooms in newly constructed nursing homes, assisted living facilities, long-term residential substance abuse treatment facilities and settings for individuals with intellectual and/or developmental disabilities. Twenty percent of resident rooms may house two residents to support individuals who would prefer to room with a friend or family member.

Other changes in residential settings chapters:

• The independent living chapter has been removed in its entirety.
• A chapter for BMH residential treatment facilities has been added to support ongoing care and treatment of residents with dementia or neurodiverse or diverse neurocognitive conditions, but who don’t require acute BMH services.
• The space required for dining rooms is now 28 square feet per person, with a minimum dimension of 14 feet.
• Seating in dining rooms must now accommodate 100% of the resident population. Reduction in that percentage may allowed for considerations such as extended mealtimes, partial attendance and multiple seatings, if captured in the functional program and approved by the AHJ.

The comment period for the 2026 FGI Facility Codes is open through Sept. 30. Download the drafts and submit comments for change at https://fgiguidelines.net.

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