Skilled nursing operators felt the financial vise tightening late this spring, as concerns about the sustainability amid a rate cut and more regulation collided with broader economic worries.

An American Health Care Association report created with CliftonAllenLarson in late April predicted 400 nursing homes could go out of business this year. It found a 5% reduction in Medicare rates ­— just over the 4.6% proposed — could put 38% of U.S. nursing homes at risk.

Federal regulators’ consideration of a direct care spending minimum and a new database tracking nursing home sales added to the pressures. Meanwhile, interest rates were increasing and inflation remained above 8%, according to data released in May.

“We could go through a list of five or six things that are very, very scary,” AHCA President and CEO Mark Parkinson said recently on a McKnight’s podcast. “This is a super hard time.”