Residency numbers for the skilled nursing field continue to trend downward and may have reached a new low, according to data released Wednesday.

Occupancy at SNFs dipped to 81.7% during the second quarter of 2018, the National Investment Center for Seniors Housing & Care said. Experts at NIC attribute policy and payment changes — including bundled payment and accountable care initiatives, designed to steer patients away from nursing homes — partially for the dip. Competition from assisted living has been fierce too.

“There is not just one culprit,” Liz Liberman, a healthcare analyst for NIC, told McKnight’s. “It’s death by a thousand paper cuts.”

“Until we see supply and demand come back into balance, we’re going to continue to see pressure on occupancy,” added Bill Kauffman, senior principal at NIC. “When will that happen? It’s hard to tell.”

Typically, occupancy has spiked during the winter months tied to a strong flu season, but that was not the case. While there has been a growth in the number of seniors enrolled in Medicare Advantage, that mix has stayed flat for skilled nursing over the past year. NIC found a significant gap, in particular, between urban SNF’s MA mix (7.7%) and their rural counterparts (3%). NIC noted that the occupancy dip was particularly pronounced in those rural markets, which dropped 89 basis points quarter-over-quarter.

Kauffman said occupancy trends could eventually turn, as more beds come off line, and the population continues to grey. He thinks the smart operators will find a way to survive and thrive through working closely with hospitals and Medicare Advantage plans in their markets.

“Industries in general go through cycles. They go through challenges, but I think the question is: How can operators turn those challenges into opportunities for the future?” he said. “There are potential opportunities out there, and I think operators just have to make sure they’re willing to innovate and think differently going forward to be able to capture market share.”

The latest quarterly data from the NIC is available on its website here.