Nursing home occupancy had its first year-over-year increase since January 2015, hitting 83.7% in the first quarter of 2019, the National Investment Center for Seniors Housing & Care announced Wednesday.

The continuing upward trend likely relates to more than flu cases and other seasonal factors, said Bill Kauffman, senior principal at NIC.

“Occupancy was also up between March 2018 and 2019, suggesting supply and demand are becoming more closely aligned,” he said in a statemet. “NIC will continue to monitor reimbursement, labor costs and other data to see if any of these factors might be contributing to facility closures, especially in some rural areas.”

However, facilities continue to struggle with case mix, specifically since Medicaid patients account for most of the patient population in skilled nursing facilities, NIC experts said.

“Skilled nursing is increasingly reliant on Medicare Advantage and Medicaid for revenue, which is challenging many facilities’ financial wellbeing,” Beth Mace, NIC’s chief economist, said in a statement. “Reimbursement rate pressures, competition from other care settings, and high personnel costs are also impacting the sector.”