Skilled nursing facility occupancy dropped to 81.7% — its lowest point in five years — in the second quarter of 2017, according to a report released Thursday by the National Investment Center for Seniors Housing & Care.

The group’s first quarter 2017 skilled nursing report showed SNF occupancy rates at 82.6%. While seasonal factors often play into low occupancy in the second quarter, occupancy drops in the third and fourth quarters of recent years may be indicators that the rate will fall further later this year, NIC said.

“Many factors, such as the growing role of managed care, sending patients directly home from the hospital, and more complex surgeries performed in an outpatient setting, are contributing to occupancy challenges for skilled nursing operators, specifically in regards to Medicare patient days,” NIC Senior Principal Bill Kauffman said in a statement. “However, recent news from the Centers for Medicare & Medicaid Services of the proposal to delay some mandatory bundled payment initiatives could be welcomed news at a time of continued pressure on patient days.”

The second quarter report also showed the more lucrative Medicare patient-day mix reached its lowest level in five years, dropping from 13.9% in March to 12.7% in June. Managed Medicare mix also fell in the second quarter.

Medicaid mix, on the other hand, increased to nearly peak levels, at 65.9%, the report found.