The nursing home sector in 2026 will be defined by rapid change, leaders said, as payment constraints, workforce shortages and rising expectations from the public and government entities converge.
All the while, operators brace for Medicaid uncertainty and Medicare Advantage growth. Shortened retroactive eligibility periods and potential state-level cuts to Medicaid programs may further contribute to coverage gaps and financial strain, leaders said. Moreover, MA brings lower reimbursement, shorter stays and higher administrative burdens into the new year.
Data-driven decision making and collaboration within communities are emerging as essential strategies to sustain care delivery and quality. Heavy investments in AI will be a critical lever in 2026, helping with lengthy admissions summaries and virtual nursing support in rural settings.
“One truth defines this moment in long-term care: no provider can succeed alone. Financial, regulatory, clinical, workforce and social challenges require integrated solutions,” Deke Cateau, CEO of nonprofit A.G. Rhodes, told Skilled Nursing News. “This is our village approach – a recognition that as a nonprofit, our responsibility extends beyond our walls.”
Overall, collaboration and perception popped up as central themes for 2026. Nursing home operators increasingly view success as dependent on partnerships with universities, hospitals, payers and community organizations; the ability to shift public understanding of long-term care’s complexity and value will be another hurdle with huge rewards if successful.
Skilled Nursing News connected with various sector leaders, from association heads to C-suite executives, to get insights into what’s in store for the nursing home industry in 2026. This article is the first installment in a two-part series, highlighting their thoughts in their own words.
Deke Cateau, CEO, A.G. Rhodes:
Caring for older adults is never static. It is ever changing and always evolving with policy shifts, payment structures, demographic changes and emerging community needs. For A.G. Rhodes, one of Georgia’s oldest nonprofit organizations and a stalwart in the community since 1904, this evolution requires vigilance, adaptability and strong partnerships. This year presents uncertainties, but it also presents tremendous opportunities to strengthen our services to the millions of seniors who call Georgia home.
One of the largest unknowns is the impact of recent Medicaid changes, especially the shortened retroactive approval period. This creates significant pressure on state agencies to process eligibility quickly, so residents do not face gaps in care or coverage. We are preparing for these operational and financial implications while continuing to work closely with state partners to reduce disruption. Georgia’s legislature has increasingly recognized the needs of older adults, and we will continue advocating to ensure seniors remain a clear policy priority.
Payment systems present parallel challenges. Medicare Advantage (MA) growth continues, bringing lower reimbursement, shorter stays and rising administrative demands. Providers are expected to do more with less and produce stronger outcomes with fewer resources and more documentation. In response, A.G. Rhodes is conducting a thorough review of all MA contracts and expanding our internal expertise to negotiate future agreements. Sustainable partnerships demand precision and careful analysis to ensure they support, not compromise, our mission of delivering high-quality care.
The shift to value-based care is accelerating across the sector. In 2026, our focus will not just be on delivering outstanding care, but on proving it through measurable, reliable data. Our longstanding partnerships with Georgia State University and Georgia Tech will be essential as we strengthen analytics, validate outcomes and build evidence around programs such as music therapy and horticultural therapy. These initiatives have demonstrated clear qualitative benefits, particularly for individuals living with dementia. Quantifying those results will allow us to better align with Medicare Advantage plans and other payers seeking proven, data-supported outcomes.
Georgia’s recent adoption of the Program of All-Inclusive Care for the Elderly (PACE) adds another important element to the state’s aging-services continuum. PACE helps nursing home eligible individuals remain at home and in their communities. We view PACE not as competition but as a partner. Our goal is to demonstrate quality in ways that position A.G. Rhodes as a trusted referral for short-term stays and rehabilitation. Strengthened partnerships and mission-aligned rate negotiations will be a priority in 2026.
We launched our in-house dialysis programs with DaVita Dialysis two years ago and serve communities with the highest density of end-stage renal disease in the state. The partnership has been incredibly successful, and in 2026 we see opportunities for further expansion to support residents with complex renal needs.
Meanwhile, our Cobb Memory Care Village, which opened in 2024, has now reached stabilized occupancy. The year ahead will focus on evaluating the model’s effectiveness and assessing its replicability across our other A.G. Rhodes homes and beyond. This reflects our commitment to advancing innovative, evidence-informed dementia care across the state and nation.
One truth defines this moment in long-term care: no provider can succeed alone. Financial, regulatory, clinical, workforce and social challenges require integrated solutions. In 2026, A.G. Rhodes will deepen partnerships with universities, hospitals, dialysis providers, PACE programs and other nonprofits. We will formalize collaborations and continue serving as a community resource, accountable to the broader ecosystem of aging services in Georgia.
This is our village approach – a recognition that as a nonprofit, our responsibility extends beyond our walls. We depend on the community, and the community depends on us. Working together is how we ensure equitable, high-quality access to post-acute care for all who need it. I am optimistic about the future we are building together.
Neil Pruitt, CEO, PruittHealth:
It’s our goal to continue our targeted growth strategy, which includes skilled nursing and increasingly assisted living in the markets we serve. Population health management is a key focus for us, and we’ll continue our institutional special needs plan (I-SNP) expansion as well as our dual eligible special needs plan (D-SNP) expansion in the communities we serve.
We’ll also continue our efforts to leverage technology, specifically AI, to make our partners more productive and improve clinical outcomes while expanding private rooms throughout our portfolio.
We will hopefully start construction of two new facilities that will be all private rooms; a facility in Myrtle Beach, South Carolina, and one near Jacksonville, Florida. We are currently in our second phase of our continuing care retirement community (CCRC) in Raleigh, North Carolina.
That’s a huge focus for us, starting this new CCRC center. We have really focused on our culinary efforts not only at this location but with our assisted living units, all under the guise of our corporate chef who oversees those efforts. We’re trying to up our food and beverage game across the enterprise, while expanding new facilities.
As for PruittHealth’s Medicare Advantage plan, we’ve had record growth in 2025. Our customers see that as a real value add for them to be able to have nurse practitioners and physicians in the facility, enhancing care.
The other item that we’re really excited about is leveraging AI throughout our enterprise to better identify the needs of our better patients, and get a better look at the quality and efficiency of our operations. Like many other industries, we’re seeing a great increase in efficiency and productivity with the use of AI. So that’s really a big initiative that we’re rolling out this year.
For PruittHealth, we’ve seen a big dislocation in the assisted living market. A lot of developers built assisted living but then the pandemic hit and occupancy suffered. Developers deferred capital expenditures, interest rates went up; it’s not a financial model that is working for them.
So we’ve more than doubled our footprint of assisted living and kept our model simple. We go in, we renovate them to be fresh and appealing to our customers, we increase the culinary experience and customer satisfaction experience. We’re seeing great success with that. A lot of our patients are discharged from our skilled nursing facilities and sometimes they don’t want to return home. We’re pleased to be able to offer them an alternative that is best in class.
Some of the Medicaid cuts that are part of the One Big Beautiful Bill Act (OBBBA), we’re trying to see how those play out at the state level. There’s pressure on rural hospitals, there’s pressure on skilled nursing facilities, there’s pressure on the Medicaid program. There’s always pressure on the Medicaid program, so I’m not sure that’s something new, but it’s definitely a top focus for us this year.
Tim Fields, CEO and Co-Founder, Ignite Medical Resorts:
Last year was a milestone year for Ignite Medical Resorts. We continued our strategy of smart, disciplined growth with acquisitions in Oklahoma and Texas and opened two brand-new, state- of-the-art facilities in greater St. Louis and greater Chicago. We are proud to bring our LuxeRehab model into new markets and to partner with exceptional new team members committed to elevating care for their communities.
This year, Ignite was honored with numerous recognitions that reflect the strength of our culture and the dedication of our teams, including but not limited to the U.S. News & World Report’s Best in Short-Term Rehabilitation and Newsweek’s Best Nursing Homes.
This year marked a turning point in how we leverage technology to support clinical excellence, operational efficiency, and long-term sustainability. We launched an internal Technology Steering Committee to evaluate, pilot and deploy emerging tools, and we began building an in- house AI department to develop proprietary applications not yet available in the marketplace. I was grateful for the opportunity to speak about innovation at LTC100 and to serve on eCAP’s Catalyst Council, helping assess technology poised to transform our sector.
In 2025, we advanced technology and AI applications across key areas, including:
• Admissions and referral management
• Managed care authorization workflows
• Reimbursement capture
• Clinical change-of-condition detection and predictive analytics
• Remote patient monitoring
• Enterprise-wide business intelligence and data visualization
• Quality measure improvement
• Month-end close, cash forecasting
• Robotic floor cleaning technology
We are fully leaning into the role of technology as a force multiplier for our teams and an essential component of the future skilled nursing model. We enter 2026 with strong momentum and an active pipeline of acquisitions—including opportunities in new states—that align with our model and mission. However, our industry still faces three systemic challenges: regulation, reimbursement and staffing.
The current regulatory environment, what many providers experience as “the stick and the stick,” has created unnecessary burden without improving quality outcomes. Skilled nursing remains more heavily regulated than nuclear power, yet the system is not delivering better care or protecting seniors more effectively. During the federal government shutdown, when survey activity paused, operations continued uninterrupted, and many would argue care improved because teams were able to focus fully on residents rather than compliance theatrics. We need sweeping reform that differentiates between bad actors and the majority of providers delivering strong care.
Managed care, meanwhile, continues to expect more while paying less. Federal alignment between Medicare Advantage and Medicare fee-for-service reimbursement is long overdue. Without structural correction, we risk perpetuating a system of “Medicare disadvantage.”
Additionally, the lack of a national pay-for-performance model remains a glaring gap. Today, two operators with dramatically different quality outcomes can be reimbursed identically. A rational incentive structure would elevate quality across the board—because even poor performers will chase better results if reimbursement is tied to them. On Medicare, CMS gave our industry a rate increase but re-aligned wage indexes and value-based purchasing (VBP) to wipe them out.
Reimbursement isn’t keeping up with rising inflation and case mix index (CMI) – it needs to be addressed. State Medicaid disparities also remain indefensible. The fact that reimbursement for the same resident’s care in Kansas is double that of Texas, for example, is alarming.
The next five years present an urgent workforce challenge as the “silver tsunami” accelerates. We will not meet rising demand without a national strategy that includes:
• Expanded federal pathways for foreign-born health care workers
• State and community-based pipelines to grow certified nursing assistants (CNAs), nurses and therapists
• Investment in upskilling the existing workforce
Ignite will continue to lead by example with Ignite University, our growing internal training and leadership development ecosystem. In 2026, we will train dozens of emerging leaders through our Leadership Lion program to become administrators, directors of nursing and directors of rehabilitation. Our new partnership with Clasp is designed to create clear advancement pathways: from CNA to licensed practical nurse (LPN) or licensed vocational nurse (LVN); from LPN/LVN to registered nurse (RN); and from physical therapist assistant (PTA) to physical therapist (PT). These initiatives will be essential in shaping the workforce of tomorrow.
We work in an extraordinarily challenging business, and the model Ignite operates is even more complex. But our commitment to technology, standards, culture and most importantly our frontline caregivers remains unwavering. Without our hardworking superheroes, our model simply does not work.
There is tremendous optimism heading into 2026, and I look forward to a year of continued growth, meaningful impact and shared success.
Nate Schema, CEO, The Evangelical Lutheran Good Samaritan Society
I’m energized by the opportunities in front of us. This will be a year of building on what’s working; bringing new technology to our teams, strengthening access to care in rural communities and continuing to elevate the experience for both residents and caregivers. With two-thirds of our residents living in rural areas, we have a special responsibility to lead with solutions that are scalable and grounded in the needs of our communities.
One of the most exciting areas of momentum is virtual care. My Care Line has already shown just how powerful timely clinical support can be for teams in remote locations. Today, the service connects 27 Good Samaritan skilled nursing and assisted living locations across 14 South Dakota communities with registered nurses and advanced practice providers after hours – including 24-hour coverage on weekends and overnight support during the week.
This ensures caregivers can quickly address changes in condition, medication questions or resident assessments. We’ve already seen more than 500 calls, and early indicators point to greater stability and fewer hospital transfers. In 2026, we will expand My Care Line, starting with rural communities where around-the-clock support will have the greatest impact.
We’re also investing in technology that meaningfully lightens the load for our caregivers. One example is a new AI-enabled admissions tool our clinical leaders developed with our enterprise data analytics team. Instead of reviewing hospital packets that can be 150 pages, our local care teams will soon receive a clear, four-page summary that highlights the most essential clinical information. While it won’t replace clinical judgment, it will offer a faster, more focused starting point – helping nurses prioritize the information that matters most.
We plan to pilot this tool in our highest-volume locations early in 2026 with plans to scale the resource across the organization by mid-year.
Supporting our workforce remains essential. The National Center for Healthcare Workforce projects a 24% RN shortage in rural areas compared to 7% in urban areas by 2027. The workforce investments we make today will ensure our parents, neighbors and loved ones can access the care they need tomorrow. One example is our redesigned licensed nurse orientation that helps new nurses build confidence from day one. Since its launch this past summer, more than 200 nurses have completed the program, and the feedback has been overwhelmingly positive. The combination of virtual learning, on-site training and one-on-one coaching creates a consistent, high-quality experience across our communities — including our most rural locations. In 2026, we will continue expanding this work, offering clear pathways for growth and reinforcing Good Samaritan as an exceptional place to build a long-term care career.
We also see an opportunity to help shape common-sense, streamlined regulations that encourage innovation and support quality care. As states set their agendas, we’ll stay focused on what we can influence: using technology to expand access, investing in our people and operating with discipline and purpose.
I’m optimistic about where we’re headed. With transformative technology, a strong and supported workforce and a deep commitment to seniors in rural America, 2026 will be a year that advances the future of long-term care.
Clif Porter II, CEO, American Health Care Association and National Center for Assisted Living (AHCA/NCAL)
In 2026, long-term care is sitting at the fulcrum of change: on one side are the pressures of the here and now. On the other, the blue-sky potential of what lies ahead. Our constant challenge is to deliver for our residents in our current environment while also shaping the future. AHCA is focused on helping providers strengthen our workforce, address concerns around Medicare Advantage and rationalize the regulatory environment. As we pursue a better way forward, long-term care will come out stronger, wiser and even more prepared to answer the nation’s call for care.
Starting out as an administrator-in-training, I know firsthand that the strongest aspect of long-term care is our workforce. And yet, as the nation ages, we still find ourselves in critical need of federal and state support to build a pipeline of qualified caregivers. In the new year, we will continue to advocate for expanded training programs, better recruitment channels and retention incentives that will make it possible for us to find, educate and develop the passionate people who make this work possible.
The vulnerable populations we serve deserve safety, accountability and transparency. But today’s regulatory environment hasn’t delivered, and no one is satisfied with the results. It is quick to penalize, slow to recognize modern care practices and inconsistent in its approach. While remaining accountable, we must continue to foster an oversight system that promotes quality, prioritizes patients over paperwork and supports innovation. To date, the profession has offered 45 proposals to federal officials on how to create a more rational regulatory environment.
We will continue to push for improvements, like the successful expansion of the Civil Monetary Penalties Reinvestment Program, allowing providers to dedicate more time and resources to enhancing care.
In 2026, we will continue to encourage policymakers to reaffirm the promise of Medicare Advantage (MA), ensuring that plans provide seniors access to care when they need it. Research shows that post-acute care is disproportionately affected by MA prior authorization practices. Denials are frequent and often reversed, indicating they should never have been issued in the first place. With more than half of eligible seniors enrolled in MA plans, we must insist that clinical decisions remain with medical professionals and patients — not AI and insurers.
We begin 2026 as a stronger profession because of our unity in 2025. I’m incredibly grateful to our members for their trust and guidance in my first year as the new president and CEO at AHCA/NCAL. Together, we overturned a staffing mandate that threatened our ability to serve our residents. We also shielded skilled nursing facilities from reductions to provider taxes. These wins bolster my outlook, my optimism and my pride, but the better way forward is not just playing defense. In 2026, we’re going to be on the offense. When we deliver solutions that matter, we make progress. When we focus on our residents and stay united, we win.
Katie Smith Sloan, CEO, LeadingAge
Workforce is the defining issue for aging services, and it remains LeadingAge’s highest priority for 2026. We are doubling down on efforts to strengthen the pipeline of professionals entering the field and to invest in those already serving older adults. This means advancing comprehensive strategies that combine training, education, and career development with advocacy on key policy issues to ensure providers can recruit and retain qualified staff. We’re committed to supporting and expanding the aging services workforce, because without staff, there is no care.
In addition to workforce, nursing homes face a complex set of challenges in 2026. Providers will contend with heightened scrutiny from the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG). Audits targeting fraud and abuse are likely to intensify; therefore, providers will be particularly meticulous in their documentation and compliance practices.
Also on the regulatory front, infection prevention and emergency preparedness remain critical responsibilities, even as federal agencies’ capacity to guide providers through communicable disease threats and other crises is diminished.
Finally, ownership transparency continues to be a federal priority, with enhanced reporting requirements aimed at curbing misuse of funds and poor performance across entities. Combined, these pressures underscore the need for strong leadership, robust training and systemic support to ensure quality care and operational stability.
Our LeadingAge LTSS Center at UMass Boston is working with Moving Forward and 24 Geriatric Workforce Enhancement Programs (GWEPs) nationwide to establish CNA apprenticeship programs in nursing homes, creating sustainable career ladders. This collaboration leverages local partnerships to strengthen the pipeline of certified nursing assistants while ensuring training aligns with community needs. By connecting GWEPs with nursing homes, we’re building a model that can be replicated nationwide to address workforce shortages.
We’re also updating our Nurse Leadership Enrichment and Development (Nurse LEAD) program to help nurse supervisors strengthen team dynamics and reduce turnover. The revised modules will launch in early 2026 and will include new content informed by focus groups with nurse leaders to address real-world challenges. By reframing supervisory skills as an integral part of everyday nursing practice, we aim to empower nurses to lead effectively and foster a culture of support and collaboration.
Through a partnership with Rush University and the Illinois Department on Aging, we’re developing standardized training and career advancement badges for direct care professionals, focusing on dementia care, mental health and peer mentoring. These badges will provide recognition for specialized skills, open doors to expanded responsibilities and may lead to wage increases or academic credit. This initiative is designed to create clear, rewarding career ladders that help retain talent and improve care quality.
We continue to push for common-sense immigration and workforce policies to ensure providers can recruit and retain qualified staff. Our advocacy focuses on expanding visa programs and reducing barriers for foreign-born workers who play a critical role in long-term care. At the same time, we’re working to secure federal and state investments in training and education programs that support both new employees and existing staff.
Together, these efforts position providers to reduce turnover, strengthen quality care and build resilient teams prepared to meet the evolving needs of older adults. LeadingAge’s mission is clear: support our members in navigating these challenges while advancing solutions that strengthen their workforce and improve the lives of older adults.
Tracey Moorhead, CEO, American Association of Post-Acute Care Nursing (AAPACN)
This year will be pivotal and exciting for AAPACN – the association’s board of directors recently approved an ambitious new strategic plan to guide our next phase of growth and expanded services to post-acute care providers. AAPACN’s recognized strength in regulatory and compliance arenas will continue to be a core focus, but we’ve heard that our members want more assistance and support.
Specifically, members have asked for more targeted, individualized support for facilities and for additional educational products and certifications for members of the broader interdisciplinary team. These new products will enhance AAPACN’s legacy focus on the Resident Assessment Coordinator (RAC-CT) and the Director of Nursing Services (DNS-CT). The AAPACN Board believes that new services and resources can equip facilities to achieve operational efficiency and care quality.
AAPACN members continue to cite workforce and culture challenges as the most pressing challenges. We know a healthy workforce culture improves the quality of care residents receive, strengthens trust among families and residents and supports overall staff well-being and retention. Our board believes we have a unique opportunity to unite owners, administrators and clinical leaders to drive transformational culture change within facilities through AAPACN tools and resources.
More broadly, the AAPACN board recognizes a growing need to elevate the visibility, perceived value and appeal of post-acute care as both a vital health-care delivery sector and as a rewarding career path. The current regulatory climate, including a recent proposal to declassify nursing as a profession, requires a greater focus on long-term, post-acute care opportunities available to nursing students and current nurses.
AAPACN will launch initiatives in 2026 to redefine, elevate and unite long-term, post-acute care providers and to foster a robust, resilient and confident community of professionals. These initiatives will include research and data analytics to demonstrate which facilities are high performers, the factors that have contributed to their success and to highlight opportunities for further improvement. For individuals, AAPACN will launch innovative new ways to access high- quality tools and resources throughout the workday. AAPACN’s board and staff are committed to achieving and highlighting excellence in post-acute care through innovation and transformation in post-acute care, enabling providers to deliver unparalleled care. Stay tuned for big developments throughout 2026.
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