Compliant Flooring Is Only Half the Job: What Occupied Healthcare Renovations Actually Require

For decades, healthcare facility design in the United States has run on a single set of documents most people just called “the Guidelines.” Architects referenced them. State health departments adopted them. The Joint Commission pointed to them when reviewing renovated spaces.

For 2026, that is changing in a meaningful way. The Facility Guidelines Institute is renaming its core publication from the Guidelines for Design and Construction to the FGI Facility Code, and the change is not just cosmetic. According to FGI itself, the 2026 documents will, for the first time, fully separate mandatory code requirements from advisory guidance, which were previously blended together in ways that often created confusion for design teams and reviewers trying to determine what was actually required versus recommended.

This matters for anyone responsible for healthcare facility renovations, including flooring. Most states adopt the FGI standards by reference, and accrediting organizations including The Joint Commission require facilities to use current editions when planning new, altered, or renovated spaces. As the 2026 Facility Code rolls out, it is worth confirming with your state health department or accrediting body exactly which edition applies to your facility and your project, since adoption timelines and requirements vary by state.

But knowing the code is only the first part of the job. The harder part is what happens when the work actually starts.

The Part the Code Doesn’t Solve

A hospital, outpatient clinic, or skilled nursing facility cannot close its doors to renovate. Unlike a school over summer break or an apartment unit between tenants, healthcare facilities operate continuously. Patients are present. Staff are working. Equipment is moving through corridors at all hours. A flooring project in this environment is not just a compliance exercise. It is a live operational challenge that has to be solved alongside the compliance one.

Specifying the right material is necessary but not sufficient. Seamless, monolithic flooring with proper wall base integration supports infection control, but installing it requires containment, scheduling discipline, and constant coordination with people who are not going anywhere during the work. Getting the material right and getting the installation right are two different problems, and most flooring conversations only address the first one.

What Occupied Renovation Actually Requires

The facilities teams who navigate this well share a few things in common:

• Phased scheduling built around the building’s actual rhythm, not a contractor’s convenience. That often means night and weekend work, broken into incremental sections so that no area is fully disrupted at once.

• Clear containment and zoning. Areas under active work need to be physically and visibly separated from areas in use, with a plan for how patients, staff, and equipment move around the work zone safely.

• Constant communication, not a one-time handoff. Daily coordination between the flooring crew, facility staff, and any general contractor involved in the broader renovation keeps a phased project on schedule and prevents the kind of confusion that turns a planned disruption into an unplanned one.

• A provider who has actually done this before. Healthcare-specific experience matters, but so does experience in any environment where the building never closes and the people inside it cannot simply be relocated for a few weeks.

A Parallel Worth Mentioning

ACS has executed exactly this kind of occupied, phased renovation in a senior living community with the same operational demands. At Holiday at Atria, a senior independent living community in Glenville, NY, ACS installed over 40,000 square feet of ceramic, carpet, and luxury vinyl plank flooring across common areas as part of a million-dollar capital renovation, working alongside general contractor ReFab.

The project ran over five weeks, much of it during nights and weekends to minimize disruption to residents. Work zones were strategically blocked off to protect resident safety, with clear communication in place to help residents navigate around active construction. Weekly coordination calls between ACS and the general contractor kept the phased schedule on track, and the project was completed on time.

The setting was senior living, not acute care, and the compliance frameworks are not identical. But the operational discipline, phased scheduling, zoning, communication, and coordination across multiple stakeholders in a building that never stopped operating, is the same discipline a healthcare renovation demands.

Working Through It Is What We Do

ACS has spent more than 30 years working in occupied, high-stakes commercial environments across the East Coast. We understand that a flooring renovation in a healthcare or senior care setting is never just about the material. It is about doing the work without disrupting the people the building exists to serve.

If your facility has a renovation on the horizon and you are thinking through both the compliance requirements and the operational reality of getting it done, that is a conversation worth having early. Contact our team today to talk through your project.

SOURCES

Facility Guidelines Institute. “Public Comment Period Opens for Draft 2026 FGI Facility Code.” fgiguidelines.org.

Facility Guidelines Institute. “Adoption Map.” fgiguidelines.org/codes/adoption-map.

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