Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
|Courtesy of PAL, Inc., and Delta Society|| |
The prescription, "Take two pets and call me in the morning", may not be far away, since the acceptance of the human/animal bond has become an interdisciplinary fact. With the ever increasing number of successful pet-mediated medical therapies being reported, it is often difficult to remember that this alternative form of dosage is only adjunctive therapy to a skilled healthcare professional. The human/animal bond programs are not a panacea for the healthcare delivery of tomorrow, but they do hold an important role for the veterinary healthcare representatives. With the advent of the interdisciplinary healthcare professional team, alternative modalities such as pet facilitated therapy are becoming an acceptable need rather than a luxury of a few.
The Pet Therapist
Utilization of animals to reduce feelings of stress, loneliness, depression, or boredom has been used since the late 1800s in Europe and has been well documented in the literature of the Delta Society and related publications (1,2,3,4). The behavioral changes associated with the introduction of animals, whether subjectively or objectively proven, generally results in a reduced staffing requirement. The harmony and tranquility, as well as the increased communications, that accompany an animal facilitated therapy program improves the quality time ratio for each patient and staff member. This leads to the secondary subjective benefit of an improved cost-benefit ratio due to the reduced stress therapy requirements, whether chemical or personal. When comparing the role of the animal to the long accepted Kubler-Ross Loss Phenomenon seen during stress/bereavement (Denial - Anger - Guilt - Depression - Acceptance), the humanistic application of the pet therapist becomes readily apparent.
This sequence of emotions cannot be isolated to only medical conditions, as we can illustrate with the average teenager. It is final exam time and our teenager knows the teacher can't flunk him...then gets angry when the fact is put out that achieving anything less than 100% on the final will result in a failed grade. The teacher is out to get him...but then, on the way home, the realization hits that the folks have been pushing the homework in lieu of the phone every night for a full month; guilt sets in quickly. Our teenager gets home, storms through the house muttering about a miserable teacher, heads to his room and slams the door. The depression and remorse begins to set in and the teenager starts to feel sorry for himself. The noise at the door distracts him, it is the dog scratching to get in to say hello. As the dog enters, the 'brightness' of the room improves, the mood changes, and our teenager vents his feelings to the dog. The dog sits and wags the famous happy tail. Acceptance is reached after an in-depth discussion with the dog...but it doesn't help at all facing Dad. As the discussion with Dad goes from bad to worse, the dog decides he needs to go out for a walk and our teenager quickly seizes the opportunity to escape. During the walk, after another discussion with Mr. Dog, our teenager gets to the bargaining stage of resolution (and Dad's temper has cooled a little with the help of Mom back home). When the family gets back together, a compromise is struck, and the dog makes the rounds of a happier family group.
Teenagers generally don't talk to authority figures about their depression or anger. In our younger day, "they" didn't talk to us either. Throughout time, the family pet has had the waiting ear, and has provided the nonjudgmental love so critical to youth, and to adults although we are often too big to admit it. By talking the crisis through with the pet, often a perspective evolves that leads to resolution for the stress situation. In cases of stuttering children, geriatric patients, cardiac care patients, hospice situations, or just depression cases, the pet therapist stands ready to listen and love.
The Hospice Situation
Hospice is a family-oriented healthcare program that provides support to patients with terminal illnesses. The nonjudgmental love of animals can make the difference for a family working through the stress and grief associated with losing a loved one. The animal will interact with the patient as if they were a real important person, not a sickly patient. This is a critical factor in any hospice situation. The pet will also help the family by being there for warmth and companionship, and often provide a neutral topic for communication with the patient.
The scientific use of animals in hospice programs could be evaluated from the perspective of the patient's needs, or from the needs of the family. Regardless, the key factor in any animal facilitated program is the acceptance by all the participants: patient, family, therapists, and the veterinary healthcare provider. The veterinary representative and hospice team must interview all the people who will interact with the animal(s), whether it is a new companion animal or an existing family pet. If consensus cannot be reached early, the veterinary healthcare representative must educate the participants about the expected benefits and insure the hospice team and patient-family group understands the companion animal's role as an adjunctive therapy alternative.
Cost Effective Quality Care
Healthcare costs have risen 700 percent since 1965, with hospital charges now exceeding $150 billion each year. The average hospital stay soared from $670 to over $3000 between 1970 and 1980. Using animals to reduce the length of stay or the intensity of treatment allows the healthcare costs to be maintained rather than escalated in these times of spiraling prices.
The search for alternative treatment modalities to save money has lent to the acceptance of animal facilitated therapy programs, hospice programs, and an increase in outpatient procedures. Concurrent with the cost-saving considerations, there has been an awakening of a more realistic attitude toward death and quality of life factors. The companion animal improves the quality of life in virtually every household, and becomes very important to households under stress. The need for an improved quality of life rather than just longevity, as a therapeutic goal, has made the application of the human/animal bond in healthcare delivery a very desirable adjunctive therapy resource.
The proportion of elderly in this nation's population has increased faster than any other age group. The challenge of meeting the long-term healthcare needs of the elderly with cost-effective measures is enormous. Quality care is no longer equated to quantity care. The medical industry has started to embrace minimal or adequate care standards for economic and technological reasons. Animal facilitated therapy is perceived as both quality care and beneficial to the entire patient-family-provider group (the holistic approach).
Animals have been utilized at multiple levels of the stress/grief process, often without the premeditation or even realization needed to effectively facilitate the needed professional therapy. The potential roles of animals in the resolution of stress/grief include: safety, companionship, nonjudgmental love, security, neutral communication topic, stress reduction, third-party triangulation, mood distraction, stabilization of the environment, physical detractors, reality anchors, or simply an alternative demand on the mental direction. The veterinary staff can benefit from any human/animal bond program, especially if trained as pet-by-prescription agents. Utilizing staff members can lead to improved self-esteem and feelings of worth that are seldom matched in daily activities. The placing of new pets in homes does bring in new clients, and the goodwill involvement often causes increased client referrals, but the real benefit of becoming involved in any animal facilitated therapy program is the personal healthcare team changes. The caring and sensitivity that overflows into the daily client relations within any delivery program makes all the difference in client retention and harmony.
Animal facilitated therapy has been labeled many things during the eight years since it was formally introduced as a treatment modality in the United States of America. In truth, animal facilitated therapy was used by the Army in convalescent centers in the United States during World War II. Regardless of labels, animal facilitated therapy is based on providing a source of warmth, compassion, and dignity for the stressed patient. This is also the definition of the hospice program as an alternative to acute care. Palliative care is based on patient dignity, and the interdisciplinary healthcare team that utilizes the human/animal bond benefits as adjunctive therapy realizes the great benefits early.
Any human/animal bond program is really people -- the patient, the family, and the healthcare/support team. It is also the community it serves. Every program has realized the need for the support of the community and the support of volunteers. It also needs the skills of the healthcare professionals who desire quality of life over quantity of care. The human/animal bond implications are substantial, but they are still only adjunctive to the efforts of the healthcare team, family, and patient. The "caring heart" pet therapist must be utilized by "caring heart" healthcare professionals if the new horizons in therapy are to be conquered.
1. The Pet Connection, CENSHARE, Univ. of Minn., MN 55455
2. New Perspectives on Our Lives with Companion Animals, Univ. of Penn Press, Philadelphia, PA
3. B. M. Fogle, Interrelationships Between People and Pets, Charles C. Thomas, Springfield, IL
4. Delta Society, 289 Perimeter Road East, Renton, WA 98055-1329.