More and more dogs are becoming therapy dogs, bringing their good cheer and fluffy coats into nursing homes, hospitals, and other facilities not only to make people feel good but also to assist them in very targeted, therapeutic ways. For instance, energetic therapy dogs who enjoy being around young people sometimes work on college campuses during finals week in order to relieve stress for students cramming for tests and writing term papers. In settings for young children, therapy dogs have been known to increase confidence and motivation in grade schoolers improving their reading skills in after-class, afternoon programs. They have also helped bring people out of their shell in inpatient psychiatric units. Of course, being a therapy dog is also great for a pet who would benefit from environmental enrichment in the form of going out and meeting new people and making them (and themselves) feel good in the process.
But a new Tufts study led by veterinary nutritionist Deborah Linder, DVM, MS, DACVN, and colleagues just published in the American Journal of Infection Control provides evidence that those visited by therapy dogs — especially the elderly and those with compromised immune systems — are put at risk by a lack of rules about a therapy dog’s vaccination status and other health parameters. Likewise, lax rules potentially compromise dogs’ safety.
The Tufts researchers surveyed 45 elder care facilities, 45 hospitals, and 27 therapy animal organizations. These entities were located across the United States. What they found was that 100 percent of the hospitals and elder care residences that allowed therapy animals (which included the vast majority) fell short of at least one aspect of the guidelines for animals in health care facilities issued by the Society for Healthcare Epidemiology of America. These guidelines include the establishment of written policies and rules of behavior for both animals and their handlers (who are usually their owners). Elder care establishments had fewer animal health and behavior requirements than hospitals. For example, more than 40 percent of elder care facilities allowing therapy animals required only a minimal written health report for the animals rather than, say, proof that the animal had received various vaccinations.
When it came to the therapy animal organizations, results were equally concerning, if not more so. For instance, between 5 and 10 percent of the organizations did not even have a rabies vaccination requirement. And more than one in four did not explicitly require a fecal test from participating animals, which meant that dogs could be harboring pathogens dangerous to people. To make matters more troubling still, seven in 10 animal therapy organizations did not have a policy against feeding raw meat diets to therapy dogs; raw meat is a known source of those pathogens.
When you consider the patient population at issue, the lack of rules about raw-meat diets presents particularly serious risks. Immuno-compromised patients, such as those found in hospitals and elder care facilities, are more apt to become ill from pathogens found in commercial raw-meat diets, including Campylobacter and Salmonella bacteria. And those pathogens are found in raw-meat diets at high rates. Studies have shown prevalence rates for contamination with Salmonella in raw-meat diets as high as 48 percent — almost half the samples tested. At the same time, studies of therapy dogs — not just any dogs but therapy dogs — found four out of five of them harboring Salmonella and other dangerous pathogens. In other words, a therapy dog fed a raw-meat diet truly has the chance to contaminate someone whose immune system isn’t strong enough to fight off illness effectively and could become very, very sick — or worse.
There were other issues, too. About half of the therapy dog organizations did not require regular re-testing of therapy dogs and their handlers to make sure they remained appropriate for visitation as a team and that the animals were not unduly stressed from visiting various facilities. This is a common concern as dogs get older. They may have different needs and abilities, which could affect the well being of both patients and the dogs themselves.
Even rules about liability insurance are lacking, putting both the therapy organizations and the health care facilities at risk of complicated legal consequences in the event of a dog-related injury or illness. Seven in 10 organizations did say that liability insurance was provided for handlers. But the actual percentage is likely to be less because at least a couple of the organizations, when elaborating, reported that the insurance had to be provided by the handlers themselves. (Insurance can vary in its coverage, so careful consideration of the full policy is needed to insure safety for everyone.)
Why the lax rules?
A large part of the problem when it comes to keeping therapy dogs and the people they serve safe is that there isn’t a single organization either for people or for animals that is responsible for monitoring or regulating programs for therapy animals, formally known as animal-assisted interventions. The Society for Healthcare Epidemiology of America offers guidelines, as does the American Veterinary Medical Association, or AVMA. The AVMA, which came out with guidelines in 1999 and has updated them several times since, says that a veterinarian should examine any potential therapy dog, screen for parasites, assess the dog’s behavior, and consider whether exposure to people in various facilities could be harmful to the pet in any way. That is, a veterinarian is supposed to assess whether there is potential for zoonotic diseases (diseases that can be passed from animals to humans), or diseases that could be passed from humans to the dog. But there is no legal incentive to follow these guidelines for human and animal safety.
Two Types of Animal-Assisted Interventions
Animal-assisted interventions, known more colloquially as pet therapy, come under one of two headings: animal-assisted activities or animal-assisted therapy.
Animal-assisted activities are what most people think of when they think of dogs visiting nursing homes and the like. They tend to consist of plain old lovey dovey visits by dogs without any official plan for an outcome or anything in particular that’s supposed to be accomplished other than good feelings. Patients, or residents, coo over and pet the dog, and the dog provides warm, loving comfort.
Animal-assisted therapy, by contrast, has specific strategies and goals and may require a dog with specialized training. It takes place with a health service provider who’s trying to help an individual arrive at a specific outcome. For instance, a dog engaged in animal-assisted therapy might work with a physical therapist to help someone with mobility challenges, say, after a stroke or because the patient was born with a disability. If the patient is encouraged to walk with a leash attached to a walker that has a happy dog on the other end, that might prove more motivating than just trying to walk without the company of an animal. The physical therapist will then document the results, looking for clear gains in the process.
What to do if you want your dog to be a therapy animal
Make no mistake. Tufts supports dogs becoming therapy animals if they have the temperament for it and if their welfare is always considered, in addition to the welfare of those whose spirits the dogs are supposed to lift. In other words, visitation to hospitals, elder care facilities, and other places can be tiring and stressful for some dogs, so their aptitude should be tested — and re-tested at regular intervals — to make sure they’re up to the task. In addition, their handlers should be trained to monitor for and minimize stress, fatigue, fear, and, of course, aggression (usually born of fear).
At the same time, to protect the people visited, therapy dogs should not be fed raw-meat diets, and they should be examined by a veterinarian before making the rounds in order to make sure they are generally healthy enough and have had the proper vaccinations to keep themselves and those they visit safe.
The largest organization that registers therapy animals (more than 15,000) is Pet Partners (which used to be known as the Delta Society). It also has the most rigorous and stringent requirements to insure safety for “both sides of the leash.” Tufts, through its Paws for People program, is a community partner of this larger organization, which also registers dogs in Canada, Australia, and a number of European countries. The program requires training for handlers (an 8-hour course followed by a formal evaluation that about a third of the dogs don’t pass the first time around), recurring evaluations of dog/handler teams that must occur every two years, and the prohibition of raw-meat diets. For more information, go to vet.tufts.edu/paws.