Hidden-camera footage reveals overstretched nursing home staff struggling to care for residents

CBC's Marketplace went undercover to find out what life was like for staff and residents at a busy long-term care residence north of Toronto and found an overstretched staff struggling to provide patients the care they need.

Journalist went undercover at long-term care facility and found staff struggling to keep up with care needs

Ontario currently has no legislated minimum staff-to-resident ratio requirement for long-term care facilities. (CBC)

Marie Harris's mother died alone, after calling out for help from her bed in a long-term care home in Markham, Ont. She was found the next morning, her body slumped half off her bed, pointed toward the chair where her call bell — a button used to signal the nurses when a patient is in distress — sat out of her reach.

Harris, 59, who had just retired from her job at a bank, was living a five-minute drive from Markhaven Home for Seniors. When her 84-year-old mother, Giovanna Conforti, died there in May 2017, Harris says the home's initial assessment was that it happened overnight, likely as a result of congestive heart failure.

She wouldn't find out that her mother died suffering until two months later, when she watched the footage recorded by a small camera she'd placed in the room.

Harris had installed the camera because she wanted to be able to monitor her mother's breathing after her complaints to the home and to the Ontario Ministry of Health and Long-Term Care about her mother's tracheostomy care went unaddressed.

When she watched the footage, what she saw only amplified her grief.

"She died alone, struggling, which is the hardest part," Harris said. "I wasn't there to help her — nobody was there to help her."

Marie Harris put a hidden camera in her mother's room at Markhaven Home for Seniors north of Toronto. The footage it recorded added to her grief after her mother died. (Dave MacIntosh/CBC)

In the video, Conforti starts calling out in the darkness around 3:30 a.m. Her cries taper off after about 20 minutes.

Conforti had used a wheelchair, but it was her habit to spend the day sitting in the recliner in the corner of her room. Her care plan said her call bell was supposed to be placed on that chair when she was awake and on the bed while she was sleeping. Staff were supposed to check on her oxygen levels every four hours throughout the night.

The hidden camera footage shows she was put to bed around midnight, but the call bell was not transferred from the recliner to the bed. And no one entered the room again until after 7 a.m.

WATCH | Video footage captures Giovanna Conforti's final hours:

Marketplace | Grandmother struggles to breathe, her call bell too far to reach

4 years ago
Duration 1:00
Marie Harris is calling for more staffing regulations for Ontario nursing homes after she captured her mother’s death on a camera she’d installed in her room.

Harris believes her mother's death was premature, and that understaffing is to blame.

"There should be legislation that has to have more people to take care of our loved ones," Harris said. "More nursing staff, more [personal support workers, or PSWs] on the floor."

It's a sentiment shared by many experts, staff, and families with loved ones living in Canadian nursing homes.

As part of its ongoing investigation of this nationwide problem, CBC's Marketplace sent a journalist undercover to volunteer at the facility north of Toronto where Harris's mother died. The goal was to see firsthand what conditions are like for staff and the elderly residents in their care.

Marketplace gets hired

The journalist, equipped with hidden cameras, spent a month working as a volunteer at Markhaven twice a week. The facility has around 96 residents and ranks in the middle of the pack when it comes to the number of critical incident reports it generates for issues such as abuse, medication errors and disease outbreaks — all of which are tracked by the ministry.

It was immediately clear the home relied heavily on volunteers. Many of them were high school students looking to fulfil their required 40 hours of volunteer work.

On one occasion, a student volunteer tried to lift a resident out of her wheelchair and into her bed.

"That's a dangerous situation," said Miranda Ferrier, president of the Ontario Personal Support Workers Association, who viewed some of the hidden camera footage.

"The resident could fall and break something."

The undercover journalist intervened in this situation, telling the student to wait while she flagged down a nurse for help. The nurse informed the student that residents should be left at the nursing station where they can be watched at all times.

The nursing station was where many residents spent most of their time, waiting for lunch, for the next activity or to have the briefs or pads they wear to deal with incontinence changed.

Long waits for the washroom

The journalist observed one resident in a wheelchair waiting an hour to use the washroom despite her cries for help.

The journalist asked several care workers to help the woman. Two workers said they'd come back but never did. Another care worker said the resident couldn't go out of turn.

"There is a schedule for washroom," the staffer said. "The PSWs know their schedule."

WATCH | A wheelchair-bound resident forced to wait an hour to use the bathroom:

Marketplace | Elderly woman waits an hour to use the washroom

4 years ago
Duration 0:51
An undercover volunteer wearing a hidden camera is told that staff have a schedule for taking long-term care residents to the washroom, and they can’t go outside that schedule.

Ferrier said it is common for residents at long-term care facilities to have to wait to have soiled incontinence products changed.

"You just let them sit in it until it's full, because you don't have the time," she said. "It's been accepted as the norm. Should it be? Absolutely not."

But staff didn't just cut back on residents' care; they also cut out their own breaks in some cases. One employee said on hidden camera during a lunch hour that many staffers wouldn't be able to take a lunch break that day.

"Sometimes, they will have a big breakfast," she said. "It's not good."

The home told Marketplace that staff have staggered lunch breaks and are encouraged to take them. But care workers were seen skipping lunch or eating dinner in the nursing station area, where they could watch residents who needed close supervision.

Staffing levels at Markhaven are in line with ministry requirements, but staff-to-patient ratios vary according to time of day and the specific wings of the home. At night, on some wings, there is one personal support worker for around 25 residents, Marketplace found during the time it was at the home.

Violence in the home

Personal support workers at Markhaven are assigned a specific wing of the home for their shift. The wing with the fewest staff was the locked wing, where residents are "exit-seeking" and often confused about where they are. Some of them can be violent.

In December, the home received a written notification of non-compliance from the ministry for failing to comply with the Long-Term Care Homes Act, which requires every licensee to "protect residents from abuse by anyone."

The report says a resident assaulted three other residents on different occasions, two of whom ended up in the hospital because of their injuries.

A nurse who works on the locked wing told the undercover journalist that since there are only two PSWs and one nurse on the wing with the most aggressive residents, they don't always know what happened when they find a resident on the floor.

Hidden-camera footage recorded by a Marketplace journalist posing as a volunteer at long-term care residence north of Toronto shows a resident kicking a staffer. (CBC)

The nurse said she is frustrated that when she is on her lunch break, there are even fewer staff to protect the residents.

"People can fight, [and do] what they like," she said.

Marketplace's hidden cameras caught two acts of violence during the course of the investigation — both were against care workers. In the first case, a resident grabbed a care worker from behind.

"He grabbed me!" she said, after jerking away from the male resident. "This is the stuff I have to deal with."

In the second case, a female resident kicked a care worker in the leg as he tried to lead her down the hall.

Little time for emotional care

The stress caused by the hectic nature of the job was a problem some workers in the home discussed with Marketplace's undercover journalist.

"I go home most days with a headache and confused because you're thinking, 'Did I do that? Did I do that?'" a personal support worker said of the rush to get everything done.

"That's why I'm retiring early. I don't want to die on the job."

With so little time and so many basic physical care needs to tend to, staff struggled to help residents who had more complex emotional needs.

I don't have five minutes. I don't have two minutes, or one.-Markhaven staffer to an undercover

One resident was found alone and crying twice. Another resident was often confused because she didn't recognize her surroundings.

"She says she wants me to stay with her," a staffer told the undercover journalist about the confused resident.

"I don't have five minutes. I don't have two minutes, or one."

Another resident had not been eating because she was depressed and wouldn't leave her bed. Two PSWs tried to coax her to get up and have something to eat.

"Let's try some, please. We love you," said one of the workers, stroking the resident's arm. "Come on, mama."

They tried various tactics to convince her to get up, but soon, a call bell was ringing from another room, and they had to move on.

'More staff are needed'

In some provinces, there is a guideline for "hours of direct care," which is the average number of hours that each resident should receive one-on-one care from PSWs, nurses or other care workers in a given day.

The guidelines for hours of direct care range from 1.9 hours in Alberta to 3.6 hours in Manitoba. Provinces use this number to determine how much funding a home needs for staffing.

Ontario once had a standard for hours of direct care, but it was scrapped in 1996 and has not been replaced.

Currently, the only legislated staffing requirement in Ontario is that each home have at least one registered nurse (RN) on staff at all hours.

Markhaven Home for Seniors says it provides a safe and comfortable working environment for its staff, and that 'anyone in the LTC sector would agree that more staff are needed.' (Katie Pedersen/CBC)

Markhaven told CBC in a statement that it provides a safe and comfortable working environment for its staff and that "anyone in the LTC sector would agree that more staff are needed." Markhaven said it provides "the best possible care for residents with the funding received from the Ministry of Health."

The home also told CBC that "independent medical professionals" had determined that appropriate care was provided to Conforti on the night of her death. After Markhaven learned of Harris's video, it referred the matter back to the ministry for review.

The ministry said it could not comment on the specifics of Conforti's death. But Minister Christine Elliott told Marketplace that the ministry is currently doing a human resource review of "what health-care professionals need in various health-care settings."

She also said she's committed to listening to front-line workers.

"We want to hear from front-line workers because we want to make sure that they feel safe in the work that they're doing, that they're able to do it in the best way, the way that they were trained to do it, and to make sure all patients receive high quality care."