Skilled nursing operators continue to face strains on their business model and that’s translating to higher fees to consumers, according to a nationwide survey released Tuesday.

The median annual charge for a semi-private nursing home room ticked up 4.1%, to about $89,000 this year. And private nursing homes meanwhile, inched up 3%, to about $100,000, Genworth Financial found in its survey of more than 49,000 providers.

The insurance firm noted that several key factors are forcing operators to raise prices. They include a shortage of skilled workers, higher minimum wages, difficulties attracting and retaining employees, increasing incidences of Alzheimer’s and dementia, and aging Americans needing increasing amounts of specialized services.

This is the 15th year of Genworth’s annual long-term care survey and it notes what operators charge for a private nursing home room has increased about 54% since the survey’s inception. That cost is about 1.6 times the national median household income, which was about $63,000 as of August.

Increases in what long-term care operators charge for services has outpaced the 2.1% U.S. inflation rate, report authors noted. All care settings have increases charges over the past 15 years, ranging from 19% to 67% higher.

“The year-over-year cost of any kind of long-term care is rising quickly, with no sign of slowing down,” Gordon Saunders, senior brand marketing manager at Genworth, who manages the Cost of Care Survey, said in a press release. “Increasingly, people and their loved ones are finding that the cost of long term care services is staggering and often they are unaware of it in advance.”