Ballooning interest in managed care, along with the repurposing of SNFs, will be two major things providers must contend with next year, a long-term care consulting firm cautioned Thursday.

Health Dimensions Group issued its “Top Trends in Aging Services 2019” report on Nov. 29, detailing 11 developments that will shape the long-term care field’s future.

An increased appetite for managed care models will lead the way, the Minnesota-based consultancy noted. Participation in Medicare Advantage — which has lower skilled nursing utilization and lengths of stay than traditional fee for service — has swelled to 33.9% of the Medicare-eligible population. That’s up from 28.2% five years ago. The Program of All-Inclusive Care for the Elderly (PACE) has also increased penetration, with one association pushing to boost participation from 50,000 this year up to 200,000 by 2028.

HDG also predicts more repurposing of SNFs in 2019 as a response to dipping occupancy numbers. The firm noted that, while the over 65 population increased 26% since 2010, average daily census at SNFs headed in the opposite direction. Total licensed beds dipped 1% and occupancy fell from 82% to 79% last year.

“To adapt to the changing landscape,” report authors said, more SNF operators will convert to alternatives such as low-income apartments, memory care units or assisted living, “all of which have experienced increasing consumer demand.”

Occupancy and census challenges will continuing tugging down net operating income in 2019, HDG said.

Other trends highlighted in the report include continued significant workforce challenges, investors taking action on troubled assets, operators developing more complex networks of care, and the need to more aggressively manage cash. You can read the whole list here.