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July 01, 2020

COVID-19 highlights access-to-care challenges

Unemployment rises, increasing need for low-cost care
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Dr. Jeff Rosenthal, chief executive officer at the Idaho Humane Society, has noticed an increase in the number of clients coming into the hospital who can’t afford veterinary care. The increase is likely tied to the rise in unemployment caused by the COVID-19 pandemic.

“We have the impression that the people coming in are situationally under duress—the hopefully temporarily poor,” Dr. Rosenthal said. “Qualitatively, our impression is we have a whole lot more people in our communities who can’t afford care.”

He sees similarities between what is happening now, as people continue to lose their jobs or are unable to find work, and what happened during the Great Recession.

“It is a general sense that people don’t look low income on paper but have no money. Folks are coming to us for urgent care, and they’re asking for reduced costs.”

Veterinary services during COVID-19 pandemic
(Top left) A veterinarian with Banfield Pet Hospital delivers care to a patient. (Courtesy of Mars Veterinary Health)

(Bottom left) A VCA Animal Hospitals veterinary team member conducts a telehealth appointment. (Courtesy of Mars Veterinary Health)

(Top and bottom right) Veterinary professionals meet with patients in May at a pop-up clinic at the San Diego Convention Center, which was acting as a temporary shelter for over 1,000 homeless people and their pets. (Photos courtesy of Dr. Jon Geller)

How to provide access to affordable veterinary care for pet owners with financial needs or limitations has always been a dilemma for veterinarians, but the issue has only become more acute.

Nearly 40% of people who were working in February and had an annual household income below $40,000 reported a job loss in March, according to a Federal Reserve report released in May. The report is typically released yearly to summarize the financial standing of U.S. households, but the Federal Reserve released an addendum surveying people in April related to the impact of COVID-19.

The overall unemployment rate in the U.S. was just above 14% in April, according to the U.S. Bureau of Labor Statistics. By comparison, during the Great Recession in 2008, the annual mean U.S. jobless rate was 5.8%.

Dr. Kendall Houlihan, an assistant director in the AVMA Animal Welfare Division, said the AVMA is dedicated to supporting the veterinary profession by identifying novel ways to increase access to care.

“As COVID-19 continues, its health impacts as well as its financial impacts continue to be felt by veterinarians and by their clients,” she said. “That is why it is important for veterinarians to engage in creative strategies when working with clients to provide veterinary care for our patients, including offering various approaches to care as well as discussing options to pay for veterinary services that are provided.”

The American Veterinary Medical Foundation, the charitable arm of the AVMA, has seen a moderate increase in grant requests through its Veterinary Care Charitable Fund, a program that helps veterinarians offer services to clients facing hardships. The AVMF processed 90 grants in April.

Matthew Salois, PhD, chief economist in the AVMA Veterinary Economics Division, said tools for affordable veterinary care should be communicated before a pet is in the examination room.

“Discounting is an option, but is not ideal,” Dr. Salois said. “Instead, work with clients to inform them and help them understand other options including deferred payment, extended payment plans, and finance options like credit with possible preferred interest rates, and of course there is pet insurance.”

Stepping up

Other organizations have also noticed an increased need for financial assistance.

Nicole Forsyth, president and CEO of RedRover, an animal welfare organization, said the nonprofit is designed to help people and animals in crisis.

RedRover has seen a sizeable increase in the number of applicants for its RedRover Relief Urgent Care program, a $200 emergency grant. The organization received 76 applications for the first quarter. Currently, RedRover is receiving over 100 applications per week.

Forsyth said it is clear that the increase is related to the pandemic. “Most people mention COVID-19 in the application,” she said.

AlignCare, a subsidized veterinary care program out of the Program for Pet Health Equity at the University of Tennessee, rolled out in three cities before the pandemic, but the need for more low-cost care is causing the program to accelerate its operations.

Dr. Michael Blackwell, director of the PPHE, told JAVMA News in May that AlignCare is working to expand into Long Island, New York; Las Vegas; Reno, Nevada; and certain areas of California.

“Once we saw the growing impact of COVID-19, we decided to scale up,” he said.

AlignCare is accepting inquiries from interested practices in the locations mentioned. The program requires an affiliate veterinary practice to be willing to provide incremental levels of care, accept a discounted fee, work with a veterinary social worker, and use relevant technology when applicable.

Other organizations such as the American Society for the Prevention of Cruelty to Animals are working to keep pets and families together.

Matt Bershadker, ASPCA president and CEO, said, “Even before the COVID-19 crisis, many low-income pet owners faced challenges accessing veterinary care for their pets, and the pandemic will only deepen that gap as more families struggle financially.”

To combat potential access-to-care issues during the pandemic, the ASPCA has deployed mobile clinics in New York City, Miami, Los Angeles, and Asheville, North Carolina, to provide urgent care to pets. The ASPCA had treated more than 2,000 animals through these services from March 17 through press time in mid-May.

The ASPCA has also launched the $5 million COVID-19 Relief & Recovery Initiative, which provides grants to animal welfare organizations in need of funds and provides pet food to those in need.

“While some of our own services have shifted or are temporarily closed to the public as a result of COVID-19, we have also expanded our work to meet the current needs of pet owners and the animal welfare community,” Bershadker said.

Weathering the storm

Dr. Rosenthal said nonprofits are used to ramping up their efforts when things get difficult in the greater society. That part isn’t new.

However, while organizations are committed to assisting pet owners facing financial hardships, there is growing anxiety around whether the outpouring of support, including grants and financial assistance, can last forever.

Curbside emergency veterinary service
A BluePearl Specialty and Emergency Pet Hospital veterinary team delivers curbside service during the COVID-19 pandemic. Mars, which owns BluePearl, donated $1 million in April to Humane Society International to fund programs in the countries most impacted by COVID-19. (Courtesy of Mars Veterinary Health)

Dr. Rosenthal said he has seen a lot of changes in his 20 years with the Idaho Humane Society, but the COVID-19 pandemic has created many unknowns and new developments.

“Long term, if the workload keeps being the same or more, at some point, you run out of resources,” he said. “It has never happened like this. This is new. This is unknown.”

Other relief efforts from organizations include the following:

  • Stella & Chewy’s donated nearly $530,000 worth of dog and cat food to the ASPCA for pet owners affected by the COVID-19 pandemic.
  • VCA Animal Hospitals is investing nearly $500,000 to support access to care for pet owners in financial distress, including offering free boarding to pets of essential human health care workers.
  • The Banfield Foundation, the charitable arm of Banfield Pet Hospital, launched a COVID-19 Respond and Rebuild Grant to provide support for organizations helping pets receive care. Since April 1, the foundation has awarded more than $225,000 to organizations across the U.S., including a $10,000 grant to the Pima Animal Care Center in Arizona to help cover veterinary care for vulnerable pets. The foundation also is footing the bill for 3,000 to 5,000 telehealth calls for pet owners in need of assistance, working in partnership with shelter partners across the country.
  • Mars donated $1 million in April to Humane Society International to fund programs in the countries most impacted by COVID-19.
  • The Petco Foundation distributed $13 million to animal welfare organizations, including a donation to regional food banks operated by the ASPCA.
  • The NYC COVID-19 Pet Hotline started operating in April to provide New York City pet owners with information and support for their pets during the pandemic.

Homeless access, looking ahead

Many pet owners may be facing new financial hardships, but homeless pet owners have always faced challenges related to access to care.

Curbside veterinary service
BluePearl Specialty and Emergency Pet Hospital veterinary staff members transport a patient to the hospital during the COVID-19 pandemic. (Courtesy of Mars Veterinary Health)

Thanks to veterinarians such as Dr. Jon Geller, there is some help available.

He is founder of the Street Dog Coalition, a nonprofit organization that provides free care to the pets of the homeless in more than 40 cities across the U.S. He and other volunteers met with patients in May at a pop-up veterinary clinic at the San Diego Convention Center, which was acting as a temporary shelter for over 1,000 homeless people and their pets.

“It (the clinic) highlighted the need for more-extensive care,” Dr. Geller said. “We’re scrambling to find funding.”

He said that there are emergency-related funding and grants available, but he’s still looking for more veterinary clinics to partner with him and other street veterinarians.

Because of the COVID-19 pandemic, the nonprofit has had to substantially scale back and adapt its street clinic services.

In Fort Collins, Colorado, volunteers had been working out of a truck bed in the parking lot of a local homeless shelter. That was until a cluster of clients tested positive for SARS-CoV-2 and even more for norovirus. Instead, the volunteers moved to using telemedicine to triage urgent cases.

“Unfortunately, these distancing protocols go against our values of direct human interaction, but they are obviously necessary for pets that need care,” according to the Street Dog Coalition website. “We are working with our Team Leads in other cities to develop safe protocols while prioritizing their safety, and that of their colleagues and families.”

While all communities continue to struggle with health and safety concerns because of COVID-19, Dr. Rosenthal said he is optimistic about how the veterinary community will come out of the pandemic.

“In these times, people prioritize their pets,” Dr. Rosenthal said. “That is always gratifying, and I know veterinarians are always hit by economic downturns, but the profession is resilient.”


Veterinarians interested in providing more access-to-care options during the COVID-19 pandemic could consider the following:

  • Consider less-costly alternatives that are medically appropriate for patients.
  • Offer a variety of payment plan options, and inform clients of options such as CareCredit.
  • Participate in the American Veterinary Medical Foundation’s Veterinary Charitable Care Fund to help cover pro bono cases.
  • Refer owners who are struggling to afford care to local low-cost clinics.
  • Research nonprofits and animal welfare organizations that may offer grants and funding options.
  • Expand telemedicine services and use when medically appropriate.