Gjergj, a patient at Silver Lake Specialized Care Center on Staten Island, arrived at the facility a year ago requiring a breathing tube, a feeding tube, and a catheter. Thanks to the care provided by the staff, he has since made a significant recovery and is expected to return home soon.
Despite these clinical successes, the facility is currently locked in a legal battle with the state over the financial viability of providing such care. Michael Kraus, the administrator at Silver Lake, is suing the New York state Department of Health, the agency responsible for setting Medicaid reimbursement rates.
The Cost of Care Crisis
The lawsuit centers on the fact that Medicaid reimbursements for nursing home patients in New York are based on costs from 2007. Kraus asserts that this income is inadequate to provide proper care for any patient.
According to a recent audit, the facility loses approximately $300 a day on patients requiring a ventilator. Kraus stated that while the facility provides the necessary care, the current system makes it feel as though the state does not care about the patients.
A Statewide Financial Struggle
The challenges facing Silver Lake are reflective of a broader crisis across the state. Stephen Hanse, president and CEO of the New York State Health Facilities Association (NYSHFA), notes that about three-quarters of New York’s 611 nursing homes are operating at a loss.
Approximately 75% of nursing home residents are Medicaid residents. Hanse reports that the state underfunds their care by $100 to over $200 per resident per day, while ventilator patients may be underfunded by $300 to $400 or more daily.
Impact on Staffing and Quality
The funding gap is also contributing to a critical labor shortage. Hanse explains that nursing homes are the only healthcare providers that have yet to reach pre-pandemic staffing levels because underfunding prevents them from competing in the labor market.
Advocates emphasize that adequate staffing is integral to patient care, a reality highlighted by the recovery of patients like Gjergj. Klementina Ndoci, Gjergj’s daughter, credited the staff for her father’s progress, stating she felt “home” from the day she arrived.
Legislative and Legal Outlook
As the governor and state legislature finalize the state budget, advocates are pushing for an investment of at least $750 million for nursing homes. Hanse suggests that while this would not fully resolve the Medicaid underfunding, it would be a necessary start.
In a statement, Nicolette Simmonds, a spokesperson for the governor, said Governor Hochul is committed to strengthening New York’s healthcare industry, citing a track record of support for hospitals and nursing homes.
Regarding the legal action, Kraus had an order to show cause in early April. The case may move forward once a judge determines which court will oversee the matter.
Frequently Asked Questions
Why is Silver Lake Specialized Care Center suing the Department of Health?
The facility is suing because Medicaid reimbursement rates are based on 2007 costs, which the administrator says is inadequate to provide proper patient care and results in financial losses.
How widespread is the financial instability in New York nursing homes?
According to the NYSHFA, about 75% of the approximately 611 nursing homes in New York are operating in the red.
What is the requested funding from advocates?
Advocates are pushing for at least $750 million to be allocated for nursing homes in the state budget.
