Klementina Ndoci’s father, Gjergj, moved into Silver Lake Specialized Care Center on Staten Island about a year ago.

She visits her dad almost every single day, telling NY1 her dad is her “everything.” When Gjergj got to Silver Lake, he was on a breathing tube. 

“He was also on a feeding tube, also has a catheter, and not in such a great shape at all,” Ndoci said.

A year later, he’s doing much better and will be going home soon. Ndoci credited the staff for her father’s recovery, who she said has become like family.

“Since the day when I stepped here, I felt home,” she said.

Michael Kraus, the administrator at Silver Lake, said the restorative care it provides is expensive and for years now, it has done so without full reimbursement from Medicaid.

“The Medicaid income is not adequate to provide proper care to any patient,” Kraus told NY1.

That’s because Medicaid reimburses nursing homes in New York state based on costs from 2007.

“Every year as time goes on, the facility is forced to lose more money. So, for example, right now, based on our most recent audit, on a ventilator patient, we lose about $300 a day,” he said.

Kraus is suing New York state’s Department of Health, which sets the reimbursement rate for Medicaid.

“We provide the care, but it almost feels like they don’t care about the patients. That’s why we’re suing,” he said.

Stephen Hanse is the president and CEO of the New York State Health Facilities Association, NYSHFA, a nonprofit representing and advocating for over 450 skilled nursing and assisted living facilities throughout the state, including Silver Lake.

According to NYSHFA, this problem is not unique to Silver Lake. There are about 611 nursing homes in New York, and three quarters of them are operating at a loss.

“Approximately 75% of nursing home residents are Medicaid residents, and New York, right now, underfunds their care per resident per day from $100 to upwards of $200 or more per resident per day. So, really, it’s a struggle to just keep the lights on,” Hanse told NY1. “If you have a ventilator patient, the state in many instances underfunds them by $300 or $400 or more per resident per day.”

NY1 reached out to the state’s Department of Health but has not heard back.

Nicolette Simmonds, a spokesperson for the governor, wrote in a statement, “Governor Hochul is committed to investing in and strengthening New York’s healthcare industry, as evidenced by her long track record of support for nursing homes and hospitals.”

NYSHFA has been advocating to ensure there is at least $750 million in the state budget that goes toward nursing homes.

“This won’t turn the tide on the states underfunding Medicaid,” he said, “but it’s a start and New York needs to take ownership and invest in nursing homes.”

Hanse said the state also needs to focus on updating the reimbursement levels for Medicaid.

“You can’t reimburse healthcare providers on costs that are from 2007 and 2026. That’s a recipe for failure,” he said.

Hanse said doing so will also help with another problem at nursing homes: a staffing shortage.

“Nursing homes are the only healthcare provider on the healthcare continuum that has yet to achieve pre-pandemic staffing levels,” he said. “We struggle to recruit and retain workers, and really that gets down to the underfunding of Medicaid. We can’t compete in the labor market, and that is critical.”

Advocates said that staffing is integral to the care that is being provided, something the Ndoci family knows firsthand.

“I love this place so much because they were so good to my dad,” she said.

As for the status of Silver Lake’s lawsuit, Kraus had his order to show cause in early April, and now he is awaiting the judge to determine which court will take on the case.