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FURRY COMPANIONS

Ann Barron

CHRMS WINTER PROGRAM

January 26, 2018

SERVICE ANIMALSv.

EMOTIONAL SUPPORT ANIMALS

v.THERAPY ANIMALS

v.PETS

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SERVICE ANIMALS

COVERED BY

THE AMERICANS WITH DISABILITIES ACT

THE ADA

The American with Disabilities Act is a Federal Act which prohibits discrimination by places of public accommodation against people with disabilities. 42 U.S.C. Section 12101.

Businesses, including hospitals, must allow people with disabilities to bring their service animals onto the premises and access all areas where the public is generally allowed.

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Violation of the ADA

Monetary Damages.

Intervention by the DOJ resulting in a formal settlement agreement.

ILLINOIS STATUTES

The Service Animal Access Act (720 ILCS 5/48-8) guarantees the right of a person with a disability to be accompanied by a service animal in public.

Neither the person nor the service animal shall be denied the right of entry.

Violation is a criminal misdemeanor.

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What is a Service Animal?

Under Title II and III of the ADA a service animal is defined as:

Any DOG that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual or other mental disability.

Miniature Horses May Also Count

• Horse that ranges in height from 24 inches to 34 inches and weighs between 70 and 100 pounds.

• Entities covered by the ADA must modify their policies to allow miniature horses where reasonable.

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What is a Disability Under the ADA?

• A disability is a physical or mental impairment that substantially limits one or more major life activities of such individual.

• Major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working.

Spotting a Service Animal

• Often Easy to Spot a Service Animal.

– Highly trained– Tasks dog performs relate to the disability of the handler

• BUT, the dog is not required to wear any certain identifying markers.

• Animal is NOT considered a PET.

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Spotting a Service Animal

• The animal need not be certified by a particular entity. Home training may suffice.

• The animal must be harnessed, leashed or tethered, unless these devices interfere with the service animal’s work or the individual’s disability prevents using these devices.

– In such a case, the individual must maintain control of the animal through voice, signal or other effective controls.

EXAMPLES

• Guide Dogs a/k/a seeing eye dogs

• Hearing or Signal Dogs

• Psychiatric Dogs (often used for PTSD)

• Sensory Signal Dogs (often used by those with autism)

• Seizure Dogs (detecting the onset of a seizure)

• Dogs pulling a wheelchair

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What Accommodations Must Be Made?

• Service animal must be allowed to go into any area where members of the public are allowed.

• A public accommodation must modify its policies to permit the use of a service animal by an individual with a disability, unless doing so would result in a fundamental alteration of the business or jeopardize the safe operation of the public accommodation.

• If a direct threat to others cannot be mitigated or eliminated, then access can be prohibited.

Why Have Service Animals in Medical Facilities?

Required by ADA.

Need for holistic care for a patient with a service animal.

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What Does the DOJ Say?

DOJ guidance states:In a hospital, it would be inappropriate to exclude a service animal from areas such as patient rooms, clinics, cafeterias or examination rooms.

However, it may be appropriate to exclude a service animal from operating rooms or burn units where the animal’s presence may compromise a sterile environment.

These rules applies to all medical facilities.

What Can I Ask About the Service Animal?

Staff may ask ONLY TWO questions:

(1) Is the dog a service animal required because of a disability?

(2) What work or task has the dog been trained to perform?

Stated another way, you can ask “Are you disabled, and is this your service dog?”

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What Can I Ask About the Service Animal?

Ask, “What task does your dog perform specific to your disability?”

Facilities are advised to accept the verbal re-assurance of the person that he or she has a disability and that the animal is a service animal.

EXAMPLEThe handler says: “My dog carries insulin or candy for me because I am diabetic?”

This is not sufficient or acceptable as carrying insulin is not a major life task.

If the individual answers, “My service dog carries my insulin and candy and alerts me when my blood sugar drops too low.”

That is sufficient.

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EXAMPLE

Question: Is this animal a service animal?Answer: Yes, he is a service dog and he alerts to a medical condition.

Is this sufficient? Yes.

Asking additional questions is prohibited. Must take verbal assurance of handler. Any further inquiry will improperly inquire about a disability.

What Can I Not Ask?• Staff cannot ask about the person’s disability, require medical

documentation, require a special identification card or training documentation for the dog, or ask that the dog demonstrate its ability to perform the work. – Cannot say:

• “Show me your identification.”

• “What is your disability?”

• Unnecessary inquiry into the nature of the disability or requiring proof of the person’s disability or the animal’s training is prohibited by the ADA.

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When Can A Medical Facility Exclude a Service Animal?Assumptions about a dog’s behavior?

A staff member’s fear of dogs?

A staff member or other patient’s allergy?

Is the Animal a Direct Threat?• The CDC recommends asking the following questions to

determine if an animal can access the area:– Does the area meet environmental criteria to minimize the risk of

disease transmission?– Is strict attention to hand hygiene required?– Are barrier protective measures (gloves, gowns, masks) indicated

for anyone in the protected space?

• Generally preclude entrance to: OR, areas treating immunocompromised, some ICUs, burn units, isolation rooms, and rooms requiring special ventilation.

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The Animal Must Be Controlled• Service animal must be under control of handler at all

times.• If a service animal behaves in an unacceptable way and

the person with the disability does not control the animal, the medical facility can ask the animal to be removed. – Uncontrolled Barking (not relating to the disability)– Jumping– Running away

• Ask: does the animal pose a direct threat to the health or safety of others?

The Animal Must Be Housebroken

If the animal is not housebroken, you can ask the person with the disability to remove the animal.

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Fear of Dogs

• If the roommate has a fear of dogs, place the roommate in another room.

• If the staff member has a fear of dogs, move the staff member.

Allergies

• Employees who have documented allergies to a service animal should not be expected to give primary care to the patient having the service animal.

• If the roommate has a fear of dogs, place the roommate in another room.

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With Horses

Can a miniature horse be accommodated?

(1) is the horse housebroken; (2) is the horse under the owner’s control; (3) can the facility accommodate the horse’s type, size

and weight; and (4) will the horse’s presence compromise legitimate safety

requirements necessary for safe operation of the facility.

Does the Staff Have to Take Care of the Service Animal?• You are NOT required to provide care, food, water or a

special location for the animal.

• What about when the Handler cannot take care of the animal?– The handler must have someone else who can assist. If not,

the dog can be placed in a boarding facility until the patient is released. Before doing so, the hospital must allow the patient to make other arrangements.

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Ambulances

Should allow the dog to ride in the ambulance unless the ambulance is too crowded or the dog’s presence would interfere with the emergency medical staff’s ability to treat the patient.

12 Things Your Hospital Policy Should Say1. Persons with disabilities accompanied by service animals will be allowed access with

their service animal into healthcare facilities. Where the general public can go, the service animal can go. This includes employees, visitors and patients.

2. Persons with disabilities are not required to provide documentation of service animal status, but may be asked to provide veterinary information and the animal’s shot record.

3. If healthcare personnel, patients, and visitors are permitted to enter an area without using personal protective equipment (e.g. gloves, gowns, masks, scrubbing), the service animal should be allowed access with the handler.

4. Service animals may be excluded from Operating Room, Recovery Room, ICU, Burn Unit, Delivery Room or other restricted areas as strict attention to the environment, hand hygiene or protective measures are required.

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Hospital Policies5. Service animals may be excluded if animal perceives danger to the

handler and the animal’s actual behavior becomes threatening.

6. Care of the service animal is the obligation of the person with the disability and not the healthcare staff. If the person cannot provide care, an alternate plan needs to be determined.

7. Persons being admitted to the hospital with a service animal may be assigned a private room at no additional charge.

8. A sign should be placed on the patient’s door that a service animal is present.

Hospital Policies9. Service animal should be precluded from coming into contact

with any patient’s non-intact skin such as a surgical site, drainage tube or wound.

10. Notify infection control if an in-patient has a service animal.

11. Healthcare providers should not interact with the service dog unless granted permission by the handler. Do not pet the dog.

12. Do not separate the handler and the animal without the handler’s consent.

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EMOTIONAL SUPPORT ANIMALS

YOUR BEST FRIEND

Emotional Support Animal

• Animals which provide comfort, support of affection and companionship to an individual suffering from mental or emotional conditions.

• Not required to perform any specific task, and thus, are not service animals under the ADA.

• Assist with conditions such as anxiety, depression, bipolar or mood disorder, panic attacks, fears/phobias, PTSD, ADD.

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• Need not be professionally trained.

• But, must have a letter from a physician or mental health professional recommending that you have an emotional support animal for your condition. Upon request, must provide this documentation.

The ADA Does Not Apply

• ESA are not routinely granted access to places of public accommodation.

• No species or breed restrictions – need not be a DOG.

• Fair Housing Amendments Act of 1989 – allows emotional support animal to live with person, even when there is a “no pet” policy. A landlord cannot charge pet rent or pet deposits.

• Air Carrier Access Act – allows animal to fly in cabin of airplane without having to pay additional fees. 49 U.S.C. Section 41705

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Is this Dog a Service Animal or an ESA?

• May be a hard/difficult determination.• Look at the situation:

– Is it a dog (or miniature horse)?– Has the dog been specifically trained?

Example: If a dog has been specifically trained to sense an anxiety attack is about to happen and take specific action, it is likely a service animal. But if the dog’s mere presence provides comfort, it is an ESA.

Register Online

“At USA Service Dog Registration we provide full registration of your emotional support animal (ESA). The registration is completely free and we can arrange a licensed mental health counselor to provide an emotional support animal letter which is very often necessary to travel on airlines or sign a new lease.”

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Order Your Kit

• Animals may wear an emotional support dog vest or tag, although not mandatory.

• Kits easily ordered on-line for between $20 and $70. Need the vest to fly.

WHERE CAN THEY GO?

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Where Can They Go?

By law, will not be allowed into restaurants or any place where food is sold or served.

Cannot go into the Hospital cafeteria.

What about the rest of the Hospital?

Hospital Policies for ESA

• Generally do not allow pets to enter the facility.

• Consider exceptions based on recommendation of medical team – case by case basis.

• Restrict visitation to only dogs and cats.

• Animal must follow commands and be housebroken.

• Animal must be in good health, have all vaccinations and be well tempered. Consider requiring proof.

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What Proof is Required?

Citing “comfort turkeys, gliding possums known as sugar gliders, snakes, spiders and more,” Delta Airlines says consumers have been abusing the privilege and definition of a service animal on their travels.

Delta Airlines will start requiring “Proof” on March 1:– Veterinary Health Form. (For both SA and ESA.)– Confirmation of animal training. (Signed by owner. ESA only.)– Letter from physician/mental health professional. (ESA only.)

THERAPY ANIMALS

A New Kind of Staff Member

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Therapy Animal• Animal trained to provide affection and comfort to people in

hospitals, retirement homes, nursing homes, airports or other stressful areas.

• Not considered a Service Animal or Emotional Support Animal.

• No protections under the Law.

• “Works” for more than one person. Skills and training not specific to any one person.

• AAA – Animal Assisted Activities

• AAT – Animal Assisted Therapy

• Required to be free of diseases and fleas/ticks.

• CDC recommends avoiding non-human primates.

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Hospital Policies

• Designate a liaison for such activities. • Visits must be scheduled in advance. • Allow only dogs to serve in this role.• Animal and handler must be specially trained.• Animal and handler must have all required

immunizations. • Handler must have same immunizations as for

employees.

Hospital Policies

• Everyone handling animal must perform hand hygiene after contact (as recommended by the CDC).

• No animal contact with invasive devices.

• No animal contact with at risk patients – burns, infection, open wounds, etc.

• Permitted to visit patients on only a supervised basis.

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FAMILY PETS

A New Kind of Staff Member

FAMILY PET

• Generally not allowed.

• Handled on a case by case basis, with input from medical team including infection control.

• No reptiles.

• No non-human primates.

• Require vet records/clean bill of health up front.

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OVERARCHING CONSIDERATIONS

Infection Control

• Role of animals in disease transmission in hospitals is not largely unknown and has not been significantly studied.

• Believed that risk of transmission of disease from canine to human is low and can be decreased with basic hygiene.

• All research tends to preclude reptiles, insects and non-human primates as they are sources of disease.

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• CDC recommends minimal contact with saliva, dander, or waste elimination.

• Those coming into contact should wash hands with soap and water.

• Enforce exceptions for areas needing a sterile environment – burn unit, ICU, operating room.

• Require Delta Information

– Date of Rabies Vaccine and Distemper Vaccine– Name of Veterinary Practice– Address and Phone Number– Name of Veterinarian– License Number, Date of License and State of Issuance– Signature of Veterinarian and Date

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HIPAA

• Staff should not be at nurses station discussing the “cool dog.”

• Staff should not be on elevator discussing the beautiful service animal on the med/surg floor.

• But some things are obvious: – If a dog is wearing a vest that says “Diabetic Alert Dog”,

it can be assumed by other patients and staff that the handler has diabetes.

QUESTIONS