Handle with care

The year 2030 will mark an important demographic turning point in U.S. history, according to the U.S. Census Bureau's 2017 National Population Projections. In 12 years, all baby boomers will be older than age 65, expanding the size of the older population so that 1 in every 5 people will be retirement age, according to a March press release from the bureau. By 2035, there will be 78 million people 65 years and older.

Similarly, the need for care for pets belonging to older populations is only going to climb, said Dr. Kimberly Pope-Robinson, a board member of the Human Animal Bond Association. She gave a talk July 16 at AVMA Convention 2018 in Denver about the special needs of elderly animal owners.

"There is a growing trend of people wanting pets in their lives more," she said. "What this means for veterinarians is, while they are primarily concerned with the health of the pet, the owner's health, too, may also need to be taken into consideration. This is particularly true for aging owners, along with those with disabilities."

Indeed, 40.7 million Americans qualify as having a disability in 2016, representing 12.9 percent of the population, according to the U.S. Census Bureau. And increasingly that population owns pets or working or assistance animals

Client accommodations

Emma K. Grigg, PhD, is a certified applied animal behaviorist and a research associate at the University of California-Davis School of Veterinary Medicine. She said some of the challenges those with disabilities face are a difficulty in accessing services and a lack of training to make sure their needs are met by service providers.

Veterinarians can ensure the best possible care for patients by helping animal owners access and navigate the physical space of the clinic safely and comfortably, allowing some extra time for the visit, and finding ways to communicate that work for the client, Dr. Grigg said during a presentation at the 2018 Student AVMA Symposium in March in Philadelphia.

Approaches could include finding another suitable location if the examination room is not big enough to hold a client's wheelchair or other items, scheduling appointments at slower times of day to allow enough time, and simply asking what the client needs during the visit.

"Client needs vary by disability. So when in doubt, ask the client," Dr. Grigg said. "This may require altering ways of the practice to meet a client's needs."

Clients who are blind, for example, shouldn't be called from across the room. Instead, staff members should approach the person and offer to guide him or her. During the examination, Dr. Grigg said, "It's helpful to introduce yourself and others in the room by name and title. Indicate if anyone leaves the room and any possible hazards, like the edge of an exam table."

Alternatively, written instructions are important for clients with dementia, Dr. Grigg said. Instructions should be put on brightly colored paper. Staff could also make a calendar for follow-up appointments or when medications need to be given. And identifying a friend or relative to help the client follow through on directions also proves helpful.

Clients with a working or assistance animal should be asked for permission before staff begin interacting with the patient, particularly if the animal is actively working.

"Maintaining the trust of the owner in the dog's working ability is important. That's why low-stress handling is essential here," Dr. Grigg said.

Above all, staff training in advance is an essential component for a successful visit for an elderly client or one with disabilities. Dr. Grigg recommends emphasizing the following:

• Disabled clients are people first. They are not their disabilities.
• Recognize that every client may have special needs from time to time, and not all disabilities are visible.
• Ask yourself and your staff: How far would you be willing to go for this client if he or she were family or a friend?
• Confront prejudices or incorrect assumptions about people with disabilities.
• Always address the client directly, not the helper, translator, or companion.
• Do not assume clients have understood or that they will speak up if they have not understood.

Further considerations for elderly or disabled clients include finances and transportation.

Sixty-two percent of all baby boomers have less than $200,000 saved for retirement, and only 17 percent have $500,000 or more, according to the 2017 Employee Financial Wellness Survey by PricewaterhouseCoopers. The reality for many is they are still working or relying on family, Dr. Pope-Robinson said. Those on a fixed income don't have money for unexpected expenses.

Further, transportation can also be limiting, as some are unable to drive or don't have reliable access to public or private transportation.

"For them, it's a whole-day experience. They might have to wait a while for the bus to get to or from your clinic," she said.

Dr. Pope-Robinson encouraged clinics to develop protocols for providing house calls or working with organizations that do so.

Human-animal bond

For these more vulnerable populations, the human-animal bond is that much more important.

A study published in 2009 in the journal Psychogeriatrics found that animal-assisted activity can make a difference in the depression levels of residents in long-term care facilities. A study on the impact of a therapy animal program on cognitively unimpaired, institutionalized elderly, published in 2006 in the Archives of Gerontology and Geriatrics, found those who received a pet canary reported noticeable improvements in perception of quality of life and psychological well-being.

Breaking the human-animal bond with an elderly person or an individual with disabilities provides emotional stress not only for the owner but also for the veterinary team, Dr. Pope-Robinson said.

Clients may need to re-home their pet because they are entering a facility that doesn't take animals or they can no longer care for the pet properly. Because they don't want to burden others or are worried no one would care for their pet, they may ask for the animal to be euthanized, she said.

Veterinary staff can help with the re-homing process by providing structure as to how the process would look. Another way is to encourage owners to place pets in their will via an end-of-life directive.

Debra Vey Voda-Hamilton, owner and principal at Hamilton Law and Mediation, specializes in helping people resolve conflicts involving animals. She created a blueprint for pet owners on this topic called "MAPPing the Journey Your Pet Takes When You Can't Care for Them Yourself." The basics are as follows:

• Make a plan outlining the care that you would like to have your pets receive.
• Address each of your pets and its unique needs.
• Appoint at least three caregivers; only one can be a family member.
• Publish your plans and keep them readily available.

For veterinary staff, Dr. Pope-Robinson recommends the following:

• Have open conversations about the topic of elderly clients.
• Develop discussions with the team in managing the emotions related to this topic.
• Develop a protocol for each situation that could arise, and put someone in charge of the protocols.
• Develop personal pets as therapy pets, and visit facilities.
• Work with local elderly and hospice care facilities on creating pet-friendly policies.

Leaving home

As it stands, a small percentage of nursing homes and assisted-living facilities provide animal-friendly options. Only 16 percent of senior centers allowed participants to bring their pets, according to a 2017 survey by the Human Animal Bond Research Institute and National Council on Aging.

Fifty-six percent of senior centers had no pet policies in place, while 32 percent did, and 12 percent were unsure. Forty percent said model policies from the National Institute of Senior Centers would encourage them to offer animal programs, and 28 percent said a model would probably encourage them to offer these programs. Nine percent said that a model would not help at all, and 22 percent were unsure.

From the survey, HABRI and the NCOA put together the document "Older Adults and Animal Programming: A Handbook for Senior Centers" this past May. The two organizations collaborated to explore animal programs held in senior centers and to develop guidelines to ensure that the positive benefits of the human-animal bond can be widely and safely enjoyed in senior centers across America. The document is available at jav.ma/seniorcenterhandbook.

Hospice facilities also generally don't allow pets. The limitations involve concerns about allergies, vectors for spreading disease, tripping dangers, phobias, liability, shedding, and noise and odor issues, Dr. Pope-Robinson said.

Pet Peace of Mind was founded in 2009 to fill a void in the nonprofit sector dedicated to helping hospice and palliative care patients care for their pets. The national nonprofit was started by a group of professionals working in the fields of human health care, medical research, academia, palliative care, veterinary medicine, business, and nonprofit operations.

Leaders educate local hospice and palliative care organizations about the importance of pets in the lives of their patients and help them support those pets in practical ways. The program provides a turnkey approach to help organizations establish a local program to train volunteers to help patients with their pet care needs. A list of participating hospices is at petpeaceofmind.org/participating-hospices.

Dr. Pope-Robinson said the work of these organizations is very important to these populations.

"Many people won't pass until they know a pet is taken care of," Dr. Pope-Robinson said.

Related JAVMA content:

In with the new at VMX 2018 (April 1, 2018)

Attention given to disabilities at diversity summit (Aug. 1, 2016)

Deaf veterinarians pave their own way (Nov. 15, 2009)