Des Moines, Iowa — For rural nursing homes, telehealth has stopped being a luxury. It’s a lifeline — and one that could disappear at any moment.
That’s the message nursing home operators and long-term care advocates are sending to lawmakers in 2026, as they push for permanent telehealth authority that doesn’t depend on temporary government waivers. The stakes couldn’t be clearer: when those waivers lapsed during last fall’s 43-day government shutdown, providers across the country had to choose between delivering care they weren’t sure they’d get paid for, or pulling back on services residents couldn’t afford to lose.
Most chose the residents.
The Waiver Problem
Facilities have relied on temporary waivers to keep telehealth services running for years. But the shutdown last November made the fragility of that arrangement impossible to ignore.
“The government shutdown for 43 days put a big spotlight on what happens to patient access to services without the telehealth authority,” said Cynthia Morton, CEO of ADVION, a national advocacy group for therapy and ancillary service providers in the long-term, post-acute care sector. “Providers had to make tough decisions whether they would continue providing services and risk not being paid retroactively.”
Care Initiatives, an Iowa-based operator with 43 facilities — most in rural communities — chose to keep going. Staff worked with clinicians to limit telehealth use where they could, but where residents needed services, they didn’t stop.
“At the end of the day, we all agreed we will do what’s best for our residents,” said Jessica McDyer, SVP and COO of Care Initiatives. “Our residents should not have seen a change in support during the shutdown.”
Where Telehealth Is Actually Doing the Work
In rural Iowa, telehealth isn’t a tech upgrade — it’s often the only option. Psychiatric care, behavioral health, speech therapy, physical therapy, occupational therapy: these are all specialties facing severe national shortages, and in rural settings, waiting for a provider to drive out isn’t always realistic.
“There’s not enough of those providers to go around, so our residents do rely on telehealth to have those sessions at times, in those moments of need,” McDyer said.
Care Initiatives serves a significant number of PASRR Level II residents — those with confirmed serious mental illness, intellectual disabilities, or related conditions — who have specific regulatory requirements around their care plans. Without telehealth, meeting those requirements in a rural setting becomes nearly impossible.
The workforce shortfall driving this demand isn’t going away. As industry reports have noted, the staffing pressures hitting long-term care facilities continue to intensify, particularly in areas far from major metro centers.
Care Initiatives is now planning to pilot an after-hours and weekend telehealth program designed to reduce unnecessary hospitalizations. The concept: when nurses have concerns in the evenings or on weekends, a virtual face-to-face with a nurse practitioner can often resolve issues that would otherwise result in a hospital transfer.
“Not every after-hours call is going to require a video visit,” McDyer said. “But our goal is to assess whether we can reduce rehospitalizations by having virtual face-to-face, versus the nurse just describing the concern on the phone.”
What Operators Want From Congress
ADVION is backing the Expanded Telehealth Access Act, which would add rehabilitation therapists to the permanent statutory list of telehealth providers. Right now, even therapy services that are clearly effective — and clearly needed — can only be delivered virtually under waiver authority that has to be renewed.
“There simply are not enough therapists,” Morton said. “So telehealth is utilized so that the therapist can at least evaluate the patient using telehealth technology, and often therapy assistants can then perform in-person treatment.”
The ask is straightforward: make it permanent. Not another extension. Not another waiver. A stable regulatory foundation that rural nursing homes can actually plan around.
“We shouldn’t have to worry about a waiver being approved or not,” McDyer said. “We’re in rural Iowa, and it’s hard. There’s not enough providers that can go around to be there in person, or it might be a couple-hour trip for a resident to get to a provider that can see them in person. It’s important to us that the government will consider a permanent solution.”
The industry’s argument is simple: telehealth has already proven itself. The question now isn’t whether it works — it’s whether Congress will let facilities depend on it.
