Research Abstracts on the Human-Animal Bond and Long Term Care

Analysis of Laws and Regulations Restricting Companion Animals in Nursing Homes

RK Anderson, DVM., MPH and JS Quigley, DVM 1983, pgs 372-380
Information regarding laws and regulations for pets in health care facilities has been
collected to establish a reference library at the University of Minnesota – Center to
Study Human-Animal Relationships and Environments. The Center will serve as a
reference resource in sharing this information throughout the U.S. As part of this
process, the authors have analyzed the data in several categories based on laws,
regulations, or written guidelines as reported by officials in each state. Eight states
prohibit all animals in nursing homes; six states require health certificates prior to
entry; nine states prohibit specific animals such as birds, turtles, wild animals; and
eleven states prohibit pets especially in medication and treatment areas. Laws and
regulations in 24 states either do not prohibit pets, or do not address the issue except
through (1) food establishment regulations or (2) general health and safety
regulations. It is interesting and provocative to note that there appear to be no
significant differences in illness or injury problems among (1) the 24 states that
allowed pets with few restrictions, (2) the 18 states that have specific restrictions, and
(3) the eight states that prohibit all pets in nursing homes. These data clearly reveal a
wide range of differences among the states. Results of this study challenge the need
for prohibition of animals in nursing homes and emphasize the need for rational
guidelines based on sound epidemiological studies.

Summary and Recommendations:

  1. This study challenges the value and need for many of the present regulations specifying apparently ineffective and burdensome requirements and restrictions for animals as applied to all nursing homes in a given state.
  2. It emphasizes that no one state-wide method, procedure or regulation is appropriate or of value in all nursing homes.
  3. It emphasizes the need for each nursing home to develop an individual plan with defined purposes/objectives:
    a.  To permit animals based on sound epidemiological data and outcome criteria; and
    b. To provide rational precautions for health and safety of people without unduly limiting the benefit of animals (as judged by the responsible administrator with consultation from a veterinarian, a physician and others).
  4. It is recommended that:
    a. Residents, staff, and appropriate consultants be involved in developing any plan for animals in a facility as in implementation and evaluation of such plan;
    b. Such plan consider the desires of residents and staff who wish to be away from animals as well as those who wish to have the companionship of visiting or resident animals; and
    c. Such plan consider the choice of animals based on normal species/breed behavior, health needs of the animals, and the purposes/objectives for the presence of animals.
  5. Evaluation should involve outcomes and accountability–not “how to” regulations–encourage more flexible, innovative methods that most effectively achieve objectives of the facility.
  6. Veterinarians should provide leadership in developing a plan for admitting and monitoring health and behavior of visiting animals.
  7. Veterinarians should be advisors in selecting appropriate animals and provide leadership in developing a plan for promoting and monitoring the health and behavior of resident animals as a continuing health maintenance program.

Pet Ownership by the Elderly: Organizing for Legislative and Community Action

Juana P. Lyon, BA
Arizona Department of Economic Security Phoenix, AZ 85007, 1983, pgs 381-386

This paper describes a legislative effort to correct the prohibition of pet ownership in the majority of Arizona housing projects for the elderly. There is no method that always brings about the desired results. However, there are a few key elements which have worked for me in two efforts to bring about legislative change: one at the national level and not involving companion animals, and one at the state level focused on companion animals. WHAT? WHY? WHO? HOW? and WHEN?

WHAT? – What is the problem or issue? What is the desired resolution?
WHY? – Why is it a problem or issue, and to whom?
WHO? – Who is affected by it? Who has an interest in it? Who is likely to care enough to become involved? Who can take action that will result in the desired outcome?
HOW? – How should the issue be approached in order to accomplish the desired resolution?
WHEN? – When must individual action steps take place to culminate at the proper moment in a concentrated, all-out effort?

Fitting our particular issue–companion animals for the elderly–into this sequence of questions, the strategy developed as follows: The problem or issue was the denial of companion animals to older persons living in multi-unit housing. The desired resolution was legislative action establishing their right to pet ownership. Why was it a problem? Because the large majority of such housing units have a “no pets” policy, consequently, older persons were arbitrarily deprived of animal companionship without any consideration of the individual circumstances.

The question, WHO?, leads to a multitude of replies, all adding up to the total universe of individuals and groups who are affected by and interested in the issue, and who can assist in bringing about the desired outcome. In Arizona, in addition to elderly pet lovers, those with interest in the subject were service providers, educators, and advocates in the fields of aging, social work, and behavioral health, as well as the humane interests, the veterinary organizations, and many interested individuals of all ages. These categories exist in all areas of our country. What is crucial is to bring them all together, and that brings us to HOW? How do you bring representatives of such diverse disciplines together? At a conference! That is the first step in the whole range of responses to our original HOW? question.

Pets in Therapeutic Programs for the Aged

Michael J. McCulloch, MD
Northwest Resource Group, Portland OR 1983, The Pet Connection, pg 387-398

Animals have been utilized to improve the well being of people throughout history, serving many roles, such as: protection, companionship, work, sport. In recent years there has been considerable interest in the therapeutic use of animals to improve the physical and emotional health of people. Programs are widespread and directed toward people with specific health problems requiring rehabilitation – the deaf, the blind, the physically handicapped, the emotionally ill, the medically ill, and the elderly. Some of the programs began over a century ago. Because of the success of some local programs devoted to concerns for this population, the use of pets with the elderly has gained considerable interest.

Because of the rapid growth of the geriatric population, the demand on society for health services will continue to increase in proportion to the survival rate and the decreasing birth rate. Whether the use of pet therapy can create impact on the problems of the elderly is a subject deserving intensive study.

(This paper goes on to talk about important research conducted in the 1970’s by Sam and Elizabeth Corson on a program to evaluate the feasibility of pet therapy in a psychiatric hospital setting at Ohio State University & then latter moved their research to Castle Nursing Home in Millerburg, Ohio, a facility with 800 residents. Also covered is some of the early history of Community Oriented Programs associated with animals in LTC settings, as well as some Animal-Facilitated Therapy Models at that time.)

Recommendations from this article:

The practice of placing pets with the elderly is gaining considerable momentum in therapy programs all over the world. Evolution and development of these programs will continue at least until the research necessary to document benefits and hazards is completed. However, based on what is currently known about problems and benefits, the following recommendations can be summarized for those interested in beginning a pet therapy program.

  1. Perform a thorough “system” analysis before beginning – institution, caregivers, and individual families.
    Carefully review the structure of the institution or family, capabilities, and attitudes of the caregivers, the administrative staff, and the specific problems to be addressed by an AFT program.
  2. Proper selection and timing.
    Tailor the animal(s) to the individual’s/institution’s needs and capabilities. Carefully match type, age, and temperament of the pets for the specific problem to be addressed. Assess the capabilities of the individuals who will respond to the animals. Some may be too ill or impaired for pets to have any effect. Also, there must be provisions for caring for the basic needs of the animal.
  3. Define goals and outcome criteria.
    What are the animals supposed to do – improve staff morale, patient motivation, patient physical or emotional health, or reduce violence in the treatment setting? Establish methods of evaluating these criteria.
  4. Understand the risks and benefits (do no harm).
    Carefully screen for potential problems, i.e., inappropriate animal size, untrained animals, inadequate staff for care of pets, or inappropriate handling by impaired patients. These can cause injury to the animals and/ or patients. Patients with severe cognitive impairments may not be capable of handling pets with care. For example, common sense dictates that it is unwise to place a dog unsupervised in an apartment with an elderly person who has know episodes of confusion and memory disturbance.
  5. Conduct proper orientation to all involved.
    It is essential to “sell” the staff, volunteer group, and family on AFT, and assess the degree of resistance or opposition to the program.  Negative attitudes at this level can seriously undermine any therapeutic benefit. It is essential to have the support and cooperation of the involved personnel.
  6. Coordinate “prescription pets” with other therapy modalities.
    AFT should not displace other therapies. It should be an adjunct to those already being utilized, such as physical, occupational, recreational, group, or individual therapy, as well as the necessary forms of drugs and medical treatment. AFT can be a facilitator to patient motivation for other therapies.
  7. Maintain supervision of patient, staff and animals.
    Supervision is necessary for maintenance of successful programming. Continued monitoring of all elements of the international network is necessary to assess potential problem areas and maintain the focus of the stated goals and directions. Monitoring safety issues is important, including evidence of animal and/or patient injury. Awareness of staff attitudes toward the program and avoidance of any open-ended situation with no controls, such as the failed program at San Quentin, is vital.
  8. Evaluate data – cost/benefit, modify, delete, add, and improve.
    Analyze effects of AFT and refine the program accordingly. Trial and error is a necessary part of any new therapy endeavor. Periodic evaluations are required. Pet therapy failures must be documented. These experiences form important records for those instances in which AFT may not be useful, or where there has been a system breakdown that is correctable. The strong bias that AFT works should and must be tempered with objective scientific observation.
  9. Maintain realistic expectations – animal facilitated therapy is adjunctive.
    Pets are not a panacea. They serve only as useful adjuncts to existing programs. AFT will not remedy defects in other areas that need special attention, such as relationships between staff and administration, inadequate staff-to-patient ratios, poor overall program design, and negative attitudinal sets of caregivers. Pets should not be expected to execute permanent personality changes in the patients. They can, however, help amplify capacities for warmth and empathy. Permanent character change, however desirable, is not essential for AFT programs to have value. If pet therapy can improve staff patient relationships, then a more humane treatment environment may result.