Special Considerations for Special Patients: Service Dogs
Beckie Mossor, RVT, 3K9 Working Dogs, Inc.
The term working dogs covers several different categories (ie, service dogs, therapy dogs, emotional support animals, psychiatric assistance dogs) and understanding the differences of each type can help veterinary practice teams provide better patient care and increased client satisfaction and compliance.
While supporting the health and wellness of all patients is a priority for every veterinary team member on every visit, the care and treatment provided for a working dog can be a matter of safety, and even life or death, for the handler. Working dogs have special needs depending on the tasks they provide (eg, acute olfactory, visual, or hearing ability; strong musculoskeletal systems) to ensure they can properly do their jobs, and their relationship and bond with their owner differs from most animals seen in practice.
This article focuses on service dogs and best practices in providing care that supports their work and in turn enhances their handlers’ quality of life. Because there is no regulated service dog registration, knowing exactly how many dogs are currently working is impossible, but as many as 20 000 dogs were at work in the U.S. in 2012, according to the American Humane Association.1
Types of Dogs at Work
Service dogs have been specifically trained to perform tasks (eg, alerting blood sugar changes, responding to seizures, retrieving objects, providing physical stability for movement, vision and hearing assistance) that mitigate the handler’s diagnosed disability.2 Although there are no specific regulations or requirements regarding how or by whom the dog is trained, the dog does need training to provide the specific tasks the handler needs.
Therapy dogs volunteer with their owners in public service areas (eg, hospitals, schools, nursing homes, funeral homes, courthouses, airports).3 These dogs provide positive enrichment and are meant to be petted and to interact with the people they visit. Therapy dogs are welcome in approved settings but are not afforded public access under any of the protection acts.
Emotional support animals, which are not restricted to any one species, are not classified as service animals. Their sole function is “to provide comfort or emotional support.”2 Formalized training is not required, but many emotional support animals will respond physically to the handler’s emotional energy and provide them comfort. These dogs are not afforded public access under the ADA but are included in the Fair Housing and Air Carrier acts. (See Protection Acts.)
Psychiatric assistance dogs are a category of service dogs that provide tasks related to psychiatric diagnoses (eg, pressure therapy, self-harming interruption, attention diversion) as opposed to physical disabilities.
Working dogs include dogs performing a broad range of tasks (eg, sports, competition [eg, agility, hunting]; assistance [eg, search and rescue, detection], conservation [eg, detecting and tracking endangered species, smuggled produce and animals, poachers]) that may assist the dog’s handler or be recreational.3 Working dogs have extensive training and are generally well-behaved in public, but they are not afforded public access under any of the protection acts.
Protection Acts4-6
Air Carrier Access Act prohibits discrimination on the basis of a disability in air travel. Airlines may not refuse transportation on the basis of a disability and are required to assist with boarding, deplaning, and making connections.
Americans with Disabilities Act prohibits discrimination against people with disabilities in several areas, including employment, transportation, public accommodations, communications, and access to state and local government programs and services.
Fair Housing Act protects against discrimination based on race, national origin, disability, color, religion, sex, or familial status when buying or renting a home, applying for a mortgage, applying for housing assistance, or any other housing-related activities.
Practice Concerns & Awareness
The Dog’s Tasks
When a service dog is brought to the practice, the team needs to be aware of the nature of the work the dog performs, because that is essential in choosing the best treatment or health maintenance plan. (See Health Considerations for Working Dogs of All Types.)
Also, team members must be familiar with and abide by all laws that protect the privacy and rights of disabled clients, who are protected under the Americans with Disabilities Act (ADA).2 With regard to service dogs and their handlers, the ADA allows 2 questions in public places: Is this service dog required because of a disability? and What task does the dog perform?2 The client decides how much information he or she wishes to provide.2
Health Considerations for All Working Dogs
The veterinary team must always be aware of the special considerations working dogs require.
The human–animal bond. The bond between household pets and their owners differs from working dogs and their handlers. Service dogs are with their handlers most of the time and are believed to have a sense of their responsibility to their handlers, who are dependent on the tasks their dog performs.
The effects of separation during examinations, procedures, or treatments. Handlers may be vulnerable to their disability while separated from their dogs and may need alternate means of support. Dogs may feel increased stress when separated from handlers and may attempt to alert to their tasks (eg, a dog trained to alert the handler to a change in surface texture or table height may stop and refuse to move).
Mental and physical health and wellbeing must always be considered based on the dog’s work demands.
The nature of the dog’s tasks and the sensory requirements (eg, olfactory system of detection dogs; oral cavity for dogs with retrieval or bite tasks; musculoskeletal system for mobility assistance, sporting, and protection dogs) are important considerations when planning treatment.
Nutrition requirements may vary during times of work and times of rest.
Parasite and disease protection is necessary for dogs traveling nationally or internationally, and for dogs exposed to humans who are elderly, very young, or sick.
Transition assistance. As the working timeframe decreases for patients and handlers, the veterinary team must be prepared to help by ensuring the emotional and behavioral needs of the dog are met. Retiring dogs may need behavioral medications that will help them relax as they transition from working dog to stay-at-home pet and experience more separation from their handler.
End-of-life needs may differ for service dogs and their handlers because of their dependence on each other and their strong bond. As the dog ages and quality-of-life concerns arise, the handler may experience a deep emotional toll.
The Client’s Abilities
Considering the handler’s abilities is important when his or her service dog requires treatment, medications, and procedures. Team members must respect the handler’s rights while also considering his or her ability to comply with recommendations. For example, handlers with short-term memory conditions may have difficulty remembering when to give medications, and the veterinarian should offer alternative suggestions (eg, long-term injectable options, follow-up visits, in-home care as needed) in these cases.
Separation Concerns
Separating the service dog from the handler for long periods can be medically dangerous for the handler, so always ensure the separation is necessary, discuss the separation with the handler ahead of time, keep separation periods to a minimum, and ensure the handler is comfortable. Alternative therapies, procedures, or accommodations may be required.
Practice accommodations can include:
Performing tasks in the examination room if the handler is comfortable and the environment is safe
Scheduling services early in the day to allow service dogs to go home the same day, if safe and appropriate
Allowing the handler to wait with his or her dog somewhere more private than the reception area
Handlers can prepare ahead of time in order to accommodate separations.
They can ask a family member to stay with them while they are separated from the dog.
They can use medical devices or medications provided by their physician during separations.
Most handlers will follow a set procedure when his or her dog is unable to accompany him or her (eg, events on private property that do not allow dogs [eg, religious facilities, sterile hospital environments]). When veterinary professionals show understanding and empathy for the stress the handler and dog suffer during separation, handlers are more likely to be patient and understanding when separation is unavoidable.
Confusion & Abuse
Unfortunately, there is abuse of the system, confusion regarding public access, and lack of regulations regarding training standards for service dogs. Under current ADA guidelines, service dogs must be trained to perform a task that mitigates a disability,4,5 so the handler must have a disability that requires assistance.
The mere presence of the dog to comfort the handler does not qualify as a task and therefore does not afford the dog general public access. Dogs are sometimes seen in public that observers believe to be fake service dogs, but it is impossible to identify the authenticity of a service dog not currently performing its task. The ADA states a dog must be under the handler’s control, house broken, not posing any public danger, and not disrupting the normal flow of work.4,5
Veterinary Professionals at the Forefront
The veterinary community has the opportunity to be at the forefront of client education and communication regarding types of work and activities for dogs. Regular clients can be educated on opportunities to provide enrichment for their pets through sport or work. Clients can be educated on opportunities for themselves or their dogs to give back to the community through many popular activities (eg, therapy dog volunteer work, search and rescue, fighting obesity and behavior-related issues through regular activity and training).
Conclusion
Working dogs and their handlers offer special opportunities for the veterinary team, who must understand clearly the differences in the types of tasks the dogs perform, as well as the abilities of both the dogs and their handlers. Understanding can improve efficiency when providing services, prolong the dog’s working life, help ensure the handler’s safety, and increase client trust and compliance.
Also, veterinary teams have the opportunity to advocate for service dogs through their knowledge, including correct terminology, and understanding of the laws, and to educate their clients on the different roles of working dogs in the community.