Elder Care Interprofessional Provider Sheets

Animal-Assisted Interventions for Older Adults - Part 2

Teri Kennedy, PhD, MSW, LCSW, ACSW, FNAP, School of Social Work, Arizona State University
Melody Jordahl-Iafrato, MD, FAAFP, University of Arizona College of Medicine

December 2017

TIPS TO SUPPORT THE BENEFITS OF THE ANIMAL-HUMAN CONNECTION FOR OLDER ADULTS

  • Learn about resources in your community that support the ability of older adults to provide appropriate care for their animals. See Table 1.
  • Consider the use of assistance/service, therapeutic, facility, and emotional support animals to improve health, behavioral health, and social supports for older adults. 
  • Service animals are strictly defined by Title II and Title III of the Americans with Disabilities Act (ADA), and differ from emotional support, comfort, and therapy animals. "A doctor's letter does not turn an animal into a service animal." (Brennan et al, 2014)
  • Advance care planning with older adults should include planning for the care of a pet in the event of the individual's death or loss of cognitive function that results in placement in a facility that does not allow pets.

Older adults live longer, healthier, and happier lives when they regularly interact with cats, dogs, birds, horses, reptiles, fish, and other animals. Pet ownership has been positively associated with higher survival rates following heart attack; reduced levels of cholesterol, triglyceride, and cortisol; lower systolic blood pressure; as well as reduced and faster recovery from stress. 

Animals yield social and emotional benefits by providing companionship, reducing loneliness, and helping people remain integrated in their communities. These benefits, however, are not universal. In some cultures, animals may represent utilitarian or negative, symbolic or health associations. A culturally grounded approach and knowledge of an individual's past experiences with animals is important when considering animal-assisted interventions.

Challenges for Older Adults and Their Animals

Basic care for animals requires the physical and cognitive ability to provide care and the financial resources to purchase pet food and supplies. Assuring that animals receive appropriate care also requires an older adult to have transportation to veterinary services and financial resources to pay for spaying and neutering, vaccinations, routine examinations, follow-up, and emergency care. Older adults with limited financial resources and access to pet food may choose to feed their pet before themselves, putting themselves at risk for nutritional deficiencies. Table 1 lists organizations that can assist with these and other issues. Providing care for a pet can be physically challenging for some older adults; walking a pet can be particularly difficult in inclement weather. 

The Role of Healthcare Professionals

Healthcare professionals should note pets and companion animals in their assessment and care planning. The presence of an animal at home can necessitate care arrangements to reduce barriers to seeking treatment for older adults who may require a temporary stay in a hospital, rehabilitation or skilled nursing facility, or other out-of-home care setting.

Clinicians can reduce barriers to care by using local resources to provide temporary care for pets.

Older adults fleeing late life domestic violence also require temporary shelter for their pets, as pets are often threatened and abused by the perpetrator in an effort to control the victim of abuse. Some domestic violence shelters offer a safe haven to pets, or can assist by identifying temporary care for an older adult's pet. 

Older adults who hoard should be evaluated for possible animal hoarding, as up to 40 percent of object hoarders also hoard animals. Animal hoarding presents a risk to involved animals and public health, and such incidents should prompt a 911 call to enlist involvement of local Humane Society or law enforcement agencies.

When an older adult moves into a retirement, assisted living, or other residential facility either by choice or because they can no longer remain safely in their own home, it is important for healthcare professionals to anticipate and discuss the older adult's wishes and abilities regarding care of their pet animals. Health professionals can assist by conducting an interprofessional assessment of an individual's physical and cognitive ability to provide care for their animal, exploring resources that support the care of animals, and identifying facilities whose policies permit older adults to move in with their pets or support animal-assisted activity and therapy programs. 

Federal Laws Supporting Animal-Assisted Interventions

Service animals support the ability of older adults living with a range of physical and psychiatric disabilities to participate in everyday activities. Older adults living with disabilities have a right to the use of service animals in a variety of public buildings and accommodations such as housing, stores, medical and benefits offices, and airports through protections afforded by the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Fair Housing Act, and the Air Carrier Access Act.    

The Fair Housing Act supports the right to reasonable accommodations that are necessary to afford an individual living with a disability an equal opportunity to use and enjoy a dwelling. This includes the right to an emotional support animal in "no pet" housing.  Emotional support animals are those that a health professional has determined provide emotional benefit to an individual with a disability. A letter from a health professional (physician, psychiatrist, therapist, or rehabilitation counselor) is often needed to support an older adult's request for an exception to a landlord's no pet rule. 

Patients sometimes request that health professionals write such letters simply for purposes of being able to keep a pet with them in no-pet housing. Such requests can trigger difficult conversations with patients. Health professionals should be prepared to explain what an emotional support animal is and recognize that they can tell patients they will not write the letter when the animal is simply a pet and does not meet the definition of an emotional support animal.

Bereavement, Death, and Relinquishment

Older adults often view their animals as family members. The loss of an animal through death, as a result of a facility policy, or the inability to continue to provide appropriate care represents a major loss. Removing an animal during times of transition can be particularly stressful for people who have grown up with animals, as they have a greater emotional need for a companion animal. Pet bereavement support is offered by local humane societies, grief support groups, and hospice programs. Local animal welfare organizations, animal sanctuaries, and no-kill shelters can assist in finding a new home for animals if the older adult can no longer provide appropriate care. 

Policy Advocacy

An older adult who finds it necessary to move into a long-term residential care facility grieves the loss of their home and independence. Pet-friendly policies can prevent the additional loss of a pet, and provide emotional support to residents by increasing social interaction and reducing isolation. Federal regulations do not address the use of pets or therapy animals in nursing homes, therefore states set their own policies. Residents and health professionals can partner with attorneys to advocate for expanded policies that support the rights of residents to keep their pets, service, or companion animals, and to have access to animal-assisted activities and therapy. 

Table 1: Resources Supporting Animal-Assisted Interventions with Older Adults 
  • Pets for the Elderly Foundation Helps pay fees to participating animal shelters throughout the United States for older adults who adopt a companion dog or cat; may include pre-adoption veterinary exams and spay/neuter fees.  
  • Pet Partners Registers and provides continuing education for handlers of multiple species and volunteer teams providing animal-assisted interventions.  
  • Meals on Wheels Loves Pets Provides grants and pet food donations through Meals on Wheels America to keep pets and their homebound older adults together. 
  • Pet Food Pantries Look for a pantry in your area that is free-standing or associated with a food bank or animal welfare organization.
  • Animal Licenses, Training Classes, Vaccinations, Spay and Neuter Check with your local animal welfare organization for senior, disabled, and low income discounts. Review state or local laws, which may reduce or waive license fees for service and/or companion animals.
  • Temporary Care for Pets Check with local veterinarians, boarding kennels, and animal shelters. 
  • Late Life Domestic Violence & Temporary Shelter for Pets The Humane Society of the United States offers a Directory of Safe Havens for Animals™ Programs for older adults fleeing domestic violence. If a program is not listed in your area, contact your local domestic violence shelter, animal shelter, veterinarian, or boarding kennel to see if they have a Safe Haven for Animals program or can provide temporary pet care. 
  • Pet Bereavement Support Groups & Pet Cremation/Burial The Association for Pet Loss and Bereavement provides a roster of support groups across the United States. You can also check with local humane societies, grief support groups, and hospice programs for pet support group and pet cremation/burial options in your community. 
  • Animal Relinquishment Check with your local animal welfare organizations, animal sanctuaries, and no-kill shelters.

References and Resources

Interprofessional care improves the outcomes of older adults with complex health problems

Elder Care Editors: Editor-in-Chief: Barry D Weiss, MD;  Deputy Editor: Mindy Fain, MD
 
 National Editorial Board:  Theodore M Johnson II, MD, MPH, Emory University; Jenny Jordan, PT, DPT, Sacred Heart Hospital, Spokane, WA;  Jane Marks, RN, MS, FNGNA, Johns Hopkins University; Josette Rivera, MD, University of California San Francisco; Jean Yudin, CRNP, University of Pennsylvania
 
 Interprofessional Associate Editors: Carleigh High, PT; David Coon, PhD; Marilyn Gilbert, MS, CHES; Jeannie Lee, PharmD, BCPS; Marisa Menchola, PhD;  Francisco Moreno, MD; Linnea Nagel, PA-C, MPAS; Lisa O'Neill, DBH, MPH; Floribella Redondo; Laura Vitkus, MPH, CHES

Published by: The University of Arizona, PO Box 245027, Tucson, AZ 85724-5027  |  (520) 626-5800  | https://uofazcenteronaging.com

 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1QHP28721, Arizona Geriatrics Workforce Enhancement Program.   This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.