Ottawa Citizen


Susan Hagar’s company, Nurse On Board, is a private business that allows patients such as Janet Lee to have nurses bridge the gaps in the complex health-care system for them. Some love the service, but others fear it will create two classes of patients.


In 2013, Susan Hagar’s mother spent six days in intensive care and four more in hospital. Hagar, a registered nurse, was there to support her and to navigate the often complex health system. She remembers wondering what people who don’t have a nurse in the family did in similar circumstan­ces.

“Everyone needs a nurse on board,” she thought.

That was the genesis of Hagar’s business, Nurse on Board, which provides registered nurses to work as private patient navigators, or care managers, as they prefer to call it.

The service provides a bridge over gaps in the health system and between patients and health-care providers, said Hagar.

The nurses attend appointmen­ts with patients, keep an eye on their clients’ medication and make sure tests and appointmen­ts are followed up, among other things.

They will also sit in an emergency department with a patient when needed.

The Ottawa-based company, now expanding across Ontario, is part of a burgeoning patient-navigator industry across North America. The industry meets the demand created by an aging population, among other things. It also directly confronts the fact that the health-care system is complex and patients who advocate for themselves, or have someone to do it for them, often get better care.

“As Canadians, we all benefit from a publicly funded healthcare system,” says the company’s website.

“But when you’re ill or looking at options, you suddenly realize just how little time the system has for your specific case and your individual needs. We thought, why can’t patients and their families have someone there, just for them?”

The service costs $250 for an initial assessment then generally $100 or $125 an hour. Nurse on Board differs from many similar businesses in that it employs only nurses, who can provide health care as well as problem-solving and management services.

The growing trend toward patients hiring their own navigators worries some who fear it will create two classes of patients — those who can afford a private advocate and those who cannot.

Monika Dutt, chair of Canadian Doctors for Medicare, has noted in the past that those who would benefit most from patient advocacy services can’t afford them.

Dr. Danyaal Raza, a family physician in Toronto and a board member of Canadian Doctors for Medicare, said the emergence of patient navigator businesses is a symptom of “very real problems in our health-care system ... that it is too fragmented.”

He said this trend is an argument to address the root of the problem. “We need to do a better job of how we organize our services. These are solutions to this problem, but only for people who can afford it.”

Hagar acknowledg­es there are people who cannot afford such a service, but adds that for clients and their families — adult children often retain the service for their elderly parents — it can be a gamechange­r.

“This is a fragmented, complex system that is difficult to navigate,” said Hagar.

“With a navigator, I do think (patients) get better health care.”

Kevin Lee says he was skeptical when his mother Janet, 86, first talked about hiring the company to help her a few years ago.

Cost was part of his concern, but he also wondered whether it was necessary,

“What could they give to my mom that I couldn’t?” he asked.

After relying on the service at a time when his mother’s health is declining, Lee said he has completely changed his mind.

“I don’t know how I could manage without it.”

Nurse on Board has coordinate­d Janet Lee’s medical appointmen­ts, gone with her to the hospital at times and “calms her down,” according to her son. “They know the answers to a lot of the questions, they calm her down and they have become friends.”

Hagar said their clients range in age from 20 to 96. The company works with some younger clients with acute health-care needs. Twothirds of the company’s clients are seniors, she said, and, in almost half of those cases, the adult children have retained the company to help with the care of their parents.

Among clients the company says it has worked with is an elderly man who turned out to be the victim of elder abuse.

He now lives on his own, is off anti-psychotic and other medication and is back in control of his life.

Another client is a woman in her 50s with chronic complex medication conditions. She felt she was not getting an appropriat­e diagnosis and wanted to hire a nurse to help better navigate the system.

Another client hired a nurse to give her mother extra care in a long-term care home to make sure she got to the bathroom regularly, could have her teeth brushed after meals, “and a lot of things the system couldn’t offer.”

A second Nurse on Board has opened in Oakville, and others are due to open this summer in Kingston and Cornwall, Hagar said.

 ?? TONY CALDWELL ?? Susan Hagar listens to Janet Lee’s heart in Ottawa on Friday. Hagar operates a company that offers nurses for hire.
TONY CALDWELL Susan Hagar listens to Janet Lee’s heart in Ottawa on Friday. Hagar operates a company that offers nurses for hire.

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