October 9 - 13, 2002
Lynn Chilton, DSN, GNP/FNP
American College of Nurse Practitioners National Clinical Symposium, Albuquerque, New Mexico
The therapeutic benefits of dogs have long been recognized by healthcare providers. In 1859, Florence Nightingale wrote that patients should be allowed to care for animals as it would help with their recovery. She especially recommended animals for patients with chronic, long-term disorders. Today, professionals are again recognizing the benefits of trained service animals for patients. All types of animals are being called on to help patients who are chronically and acutely ill. Primary goals of therapy are to improve the patient's physical and emotional state and to reduce stress.
Dogs are especially amenable to being trained as service animals. Dogs are known for their affection and loyalty, but for those with disabilities, a trained service dog can offer greater independence and self-confidence. Many lay persons and even healthcare providers do not understand the roles a service dog can play.
The umbrella term for dogs that are trained to help people is assistance dogs. The term "service dog" has been reserved for animals that assist those who are physically or psychologically handicapped, while the term "guide dog" is used for those that lead the blind, and "hearing dog" for those that assist individuals who are deaf.
Service animals can provide a variety of benefits and often even help humans form therapeutic relationships. Service dogs can be useful to patients with a variety of physical disabilities including spinal cord injuries, arthritis, multiple sclerosis, seizure disorders, HIV, and sickle cell anemia. Service dogs are increasingly being used to assist individuals with emotional and psychological disorders including depression, recovery from trauma, anxiety, and neuroses.
When living with a trained service dog, people with physical disabilities experience improved self-esteem and psychological well-being. When disabled people go out in public with their service dogs, individuals in the community are much friendlier toward them, which serves as an incentive for the disabled person to go out more often. Disabled individuals who own service dogs thus become more active socially, attend school, and go to work more often; they also require less assistance from caregivers, including paid healthcare workers, family, and friends.
At this year's Clinical Symposium, Dianne Canafax, a hearing-impaired speaker and President, All Things PawsAble, Kingston, Washington, who trains service dogs and uses one herself, discussed the ways that service dogs benefit individuals with disabilities. She provided personal insights into training and using these animals. She also included a demonstration by service dogs -- a 5-month-old mixed black Labrador puppy in the first phase of training, and a 2-year-old Golden Retriever that had completed the final advanced training portion of the program and is used as a facility dog at nursing homes. The dogs demonstrated to the audience a variety of skills that they performed on command.
From Deafness to Immobility: Can a Service Dog Help?
Assistance dogs are trained to help a particular individual with disabilities. These animals are categorized by the specific disability of the person who needs the assistance dog. Categories of service animals include hearing dogs, seeing-eye and guide dogs, seizure alert dogs, and those trained to assist the physically and psychologically handicapped. These dogs are selected early in training to partner with an individual.
Other dogs work better with groups of patients and are called therapy or facility dogs. Therapy dogs are brought to groups of patients in settings such as nursing homes or pediatric hospitals by volunteers. Healthcare professionals such as occupational and physical therapists use facility dogs in various settings.
Service Dog Training
The dogs are trained in 2 phases. The first part of training is done one-on-one by a skilled trainer and lasts about 1 year. For the second, more advanced phase, dogs are sent to specialized training centers for about 6 months. Certain dogs are suited to work with individuals; at the end of the second phase, these service dogs are trained to perform certain functions based on the individual needs of the matched patient. They learn a variety of skills including opening doors, pushing wheel chairs, retrieving dropped objects, and pushing elevator buttons. These dogs can also carry items, alert their owners to sounds such as alarm clocks or a doorbell, and provide emotional support.
Canafax related an anecdote about a service dog that was trained to help a young school-aged child with cerebral palsy. The child was one of several children in a family and specifically needed help to stand after sitting on the floor. When the child came home from school, he would sit on the floor to watch television for a while. The mother would be busy cooking supper and was not immediately available to help the child stand when the program was over. The service dog was taught to lie down directly behind the child. When the boy was ready to get up, he would lean back onto the dog, roll over, and then give a command for the dog to stand up, which allowed the boy to place his feet under him and stand.
Controversial Uses of Service Dogs
Some service dogs are said to be trained to warn patients of an impending seizure up to 1 hour before it occurs, allowing the patient to find a safe environment and take medication as needed. Another new specialty training claims to teach dogs to "sniff" out tumors in very early stages. Some healthcare providers are skeptical about these uses, and studies are ongoing to validate the reliability of these uses for service dogs.
Rights of Disabled Individuals With Service Dogs
Individuals with disabilities are allowed to bring their service dogs into public facilities under the Americans with Disabilities Act (ADA). Disability is defined as any physical or mental impairment that substantially limits 1 or more major life functions. The humans are afforded rights under the ADA, not the animals. Some people carry a prescription from their healthcare provider stating that it is necessary for the service dog to stay with them.
Managers of public facilities are allowed to ask whether the person needs the animal to stay with them as a trained service dog that assists with a significant activity of daily living. According to law, managers are not allowed to ask the person to identify the disability. The law applies to individuals with all types of disabilities and relates to general public access. If the dog's presence would fundamentally alter business or safety, a proprietor may deny access. Disabled individuals are permitted to bring service dogs into restaurants, stores, hospitals, movies, hotels, sports arenas, and even on airlines.
Considerations Concerning Ownership
Disabled individuals must be aware of certain general considerations before requesting a service dog. These dogs require daily care and training, and thus need an ongoing financial commitment for food and routine healthcare. The service dogs will draw attention to the person. Some people do not appreciate this attention from strangers, and may not be suited to own a service dog. However, the attention can be a good thing if the person is even a little outgoing, as it can help with socializing. But it does takes longer to get places because people will stop and talk more frequently if a dog is present.
Interacting With a Service Dog Team
A certain etiquette should be observed by people who meet individuals with service dogs. Speaking from personal experience, Canafax stated that people should always talk to the person first, not the dog. Next, do not delay the person with long stories about your own dog. Be aware that you may be distracting the dog from performing an essential service for the owner. And finally, if the owner gives permission, hold out your hand and let the dog smell it and shake hands before attempting to pet the animal.
Obtaining a Service Dog
Service dogs may be obtained from various sources. Pretrained dogs may come from organizations or private trainers. The organization Canine Companions for Independence alone has paired more than 1200 people nationwide with service dogs. In many parts of the country, however, waiting lists of people who qualify for a service dog can be long.
Some individuals have the skill and knowledge to train their own service dog. It is not recommended that a family pet be retrained to be a service dog. The initial cost varies depending on where the dog is obtained. Some organizations use a sliding fee scale that can range from no cost to up to $30,000. Agencies such as Canine Companions for Independence are nonprofit and charge a minimal fee, whereas private trainers usually charge higher fees. Medicare, Medicaid, and most private insurance companies will not pay for service dogs.
Nurse practitioners should assess patients with disabilities for possible pairing with a service dog. The patient should be given all of the pros and cons of owning such dogs. Patients should be made aware of their rights of ownership of service dogs under the American Disabilities Act and any existing state laws. Advanced practice nurses should consider the option of prescribing service dogs to meet the specialized needs of patients with disabilities of all kinds.
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