The practice of veterinary medicine in animal shelters (Proceedings)

The American Society for the Prevention of Cruelty to Animals (ASPCA) estimates that there may be anywhere between 4-6,000 animal shelters in the United States. There is no federal oversight of these shelters. While some states do have regulations and guidelines governing the operation of municipal shelters, many are privately funded and operated with no oversight. Animal control programs were originally designed in the 1900s to handle the growing concerns about public health and safety issues posed by stray dogs, including increasing numbers of dog bites, automobile accidents, rabies concerns etc. Local ordinances governing licensing, vaccinations, leashing dogs in public, noise and nuisance issues were enacted to make owners more responsible. When those laws are broken, animal control steps in to enforce them. But animal sheltering today entails much more than enforcing the animal control laws. Animals are housed in shelters for a variety of reasons, but regardless of the reason, in order to implement appropriate and humane standards of care and provide for quality of life, the input of the veterinary community is increasingly being sought. In addition to providing necessary shelter, food, water and basic veterinary care, shelters are expected to implement programs that enhance wellness, alleviate suffering and promote the health and well-being of the individual animal as well as the population as a whole. While shelters in the past often utilized euthanasia to manage disease and population numbers, this method is increasingly being rejected as a primary means of animal control in many communities, resulting in an increased demand for veterinary services.

Shelters may be generally categorized as municipal or private. Knowledge of their governance, mission and funding is essential for design of effective health care programs. Municipal animal shelters are often primarily concerned with animal control. They do not turn animals away and are thus often referred to as "open admission". Animal intake can occur for a variety of reasons. The National Council on Pet Population Study and Policy (NCPPSP) conducted studies to determine owner reasons for relinquishment, but animals are held in shelters that were not voluntarily relinquished. In addition to stray and abandoned animals, some animals may be housed because their owners are temporarily homeless due to eviction or fires, the owner may be deceased or in the hospital and there is no one else to care for the animal, or they may have been seized because of cruelty complaints against their owners. Shelter stays may be long or short term, requiring different housing arrangements, enrichment procedures and medical protocols. Municipal shelters can range from being marginally funded by the city and managed by the police department with minimal standards of care, to a few being well funded with the highest standards of care developed by animal care professionals. In some cases, a privately operated Society for the Prevention of Cruelty to Animals (SPCA) or humane society may accept the contract for animal control and receive private as well as municipal funding. Animal shelter funding is often limited regardless of whether it is private or municipal, resulting in limited options for the implementation of optimal health care protocols and operational guidelines. Internal policies, resource limitations and local statutes have a tremendous impact on veterinary decisions and policies aimed toward the provision of care.

Some private shelters are run by the local society for the prevention of cruelty to animals (SPCA), or the local humane society with no municipal funding. They are usually limited admission although some may accept all animals. While they are also bound by some legal restrictions imposed by local and state government, their internal policies will affect many of the decisions the veterinarian must make, especially in the face of disease outbreaks and overcrowding. Some private shelters are also known as "no-kill" shelters, which represent a growing trend in animal sheltering. Many of these shelters are operated by not- for -profit organizations. Their internal policies generally state that they will not euthanize "adoptable" animals, thus eliminating the use of euthanasia to control overcrowding or manage disease outbreaks. They maintain the right to refuse to admit animals when they run out of space, thus effectively eliminating them from performing many municipal animal control functions. Adoptability is defined by each agency and may be affected by many factors, including their financial ability to isolate sick animals and treat disease, the expertise of the staff in performing behavior evaluations and treatments, population numbers, etc.

"No kill" shelters may keep animals for several months to years before they are placed. They may have been partly responsible for the increased demand for on- site rather than on –call veterinary services. Edinboro (1999) showed that the longer cats stay in shelters, the more likely they are to contract disease. Puppies that contracted parvovirus in a study on pediatric neutering (Howe et al 2001) were housed in a long- term facility, whereas the puppies from the short-term facility did not develop illness. While the "no kill" movement has received enormous attention from the media as communities strive to reduce the number of animals they euthanize, many other shelters still euthanize to manage crowding and disease outbreaks. Few, if any, "no kill" shelters never euthanize animals, but decisions are made based only on health and behavior issues, not space. Because the term " no kill" can be inflammatory and misleading and many of these shelters are able to reduce their euthanasia numbers by limiting their admissions, many animal care agencies refer to "No Kills" as "limited admission" shelters.

In addition to private and municipal shelters, some shelters are rescue groups, sanctuaries and foster care homes. These facilities may operate out of private homes and be staffed by volunteers. There is usually minimal to no oversight of these facilities and programs. They may hold animals indefinitely.

As stated previously, most shelters have functions that extend beyond just housing animals. Shelters must address a number of issues in order to meet the mandate imposed upon them by the community to provide humane and appropriate care. In addition to providing housing, sustenance and medical and preventative care to animals, some other shelter programs include physical and chemical capture of stray and free roaming animals, lost and found, enforcement of cruelty and nuisance animal laws, cruelty investigations, animal placement, euthanasia, disaster relief, humane education, wildlife rehabilitation, low cost spay neuter services of both shelter and publicly owned animals, behavior counseling and foster care and volunteer programs.

Shelters try to reduce the euthanasia of adoptable animals by providing information on responsible pet ownership and offering programs to increase animal retention in the home, increase adoptions and reduce shelter intake through aggressive, affordable spay neuter services. Veterinarians can help communities reduce the euthanasia rate by working responsibly with reputable shelters. The ASPCA benchmarks of a good shelter include 1) reasoned placement of animals into responsible homes 2) convenient hours 3) well maintained, cheerful and bright appearance 4) a polite, well informed and helpful staff 5) a policy of mandatory neutering of adoption animals 6) offering information about proper pet care and responsible ownership, animal behavior, etc.7) maintaining stress reduction and behavioral enrichment programs 8) providing a clean, dry and safe environment for the animals 9) providing community outreach and 10)a comprehensive health care program that both treats animals and provides preventative health care. (ASPCA Keys)

Shelter medicine is a very complex field. Traditional veterinary education and care is generally divided into two categories; individual care for companion animals and herd health management of animals for food production, breeding or research. Shelter medicine is herd health medicine for small or companion animals. Unlike private practice, the focus of shelter medicine is on disease prevention, not treatment. Most small animal practitioners are unaccustomed to this approach to small animal medicine. Shelters are not hospitals and their stressful environments often are not appropriate for providing medical treatment. Furthermore, treatment of a few animals with highly infectious diseases may jeopardize the lives of all the shelter animals. The protocols that are successful in small animal practice are often not practical for use in the shelter. There is ongoing and growing support and interest at the university level for developing special training programs in shelter medicine for both students and practicing veterinarians. The first course in shelter medicine was offered at Cornell University in 1999. Since then, there are classes and programs offered at UC Davis, U Penn, Colorado, Ohio, Illinois, Iowa, Florida, Purdue, Wisconsin and so on. Continuing education courses are being offered by the North American, Western and Midwest veterinary conferences, on the Internet through VIN and at various other venues. The Association of Shelter Veterinarians or ASV (www.sheltervet.org) was formed in 2001 and has over 600 members. It is in the early stages of seeking specialty board status from the American Veterinary Medical Association. (AVMA). The practice of veterinary medicine in shelters is definitely a challenge for the average practitioner.

As alluded to previously, shelters operate a variety of programs both in-house and for the community that require veterinary input. In addition to being knowledgeable about disease transmission, the characteristics of the various disease agents affecting shelter animals and other traditional areas of veterinary expertise (vaccinations, deworming, nutrition, treatment etc), shelter veterinarians must be well-informed about sanitation procedures, bite quarantines, zoonosis and public health issues, stress reduction and behavior enrichment, temperament testing and behavior evaluations and modification techniques, shelter design, data collection, veterinary forensics, high-volume and pediatric spay neuter techniques, etc. They may be asked to design a program for euthanasia of multiple animals, set up trap neuter return (TNR) programs for management of free roaming and feral cats, operate vaccination and microchipping clinics, manage an animal transport program etc. They may be consulted on the creation of a health care program for staff because veterinarians tend to be more knowledgeable about zoonosis than physicians are. Although it may not be apparent on casual observation, shelters require veterinary expertise in designing virtually every aspect of the shelter program as there are few areas that do not directly affect animal health.

Veterinarians work with shelters in a variety of capacities as volunteers, employees or consultants. The range of authority can be very broad. They may be on the upper end of the chain of command as shelter directors or board members, or they may enter the shelter merely to provide per diem surgical or medical services whenever called. They may be full time administrators or executive directors, full or part time medical supervisors or hands on employees. Many veterinarians fall somewhere in the middle as regular or part time employees in charge of the health care program. Whatever the role, veterinarians should take care to work closely with management to establish the parameters and limitations of decision making in order to make the health care program work smoothly.

Employment and consulting opportunities for shelter veterinarians are rising, and these represent rewarding and challenging options for professional practice. However, currently only a relatively small number of veterinarians have specialized training, knowledge or expertise in this area. There is a great need to expand learning opportunities so that veterinarians may better serve shelter populations. Veterinarians who find themselves involved in difficult situations in shelters should look to universities with shelter medicine programs or infectious disease experts who have some experience working with shelters.

Why is it necessary to develop a specialty area that deals specifically with the management of the health of shelter animals? Why is disease transmission so difficult to control in animal shelters? There are some similarities to the problems that kennels, catteries, research facilities or other programs that communally house dogs and cats face, but many differences as well. Factors that may be similar to those encountered in other facilities that must be considered include the variety of ways that diseases are spread; incubation periods and carrier states that make disease difficult to detect; the ability of certain disease agents such as parvo and calici virus and ringworm spores to survive long term in the environment etc. Factors that are very different include shelter holding periods that may mandate holding stray animals with infectious disease; stress; high turnover of animals from many unknown sources; poor staff and volunteer training; high turnover of staff; aging and poorly designed facilities that do not have adequate ventilation or isolation areas for effective disease management; inadequate healthcare program; lack of data/poor data management; lack of financial and human resources; inability to use the tried and true methods of disease control that were designed for use in agricultural herd situations; open access to the public who may inadvertently help spread disease; lack of epidemiological data and so on.

Some disease is inevitable in shelter animals because of the interplay between agent, environmental and host factors. The host factors to consider include their immune status, stress levels, nutritional state, age, overall state of health, etc. All of these factors will affect the animal's ability to withstand exposure to disease. Environmental factors include overcrowding, air quality, facility design, etc. Some agent factors include the virulence, shedding pattern, carrier state, route of infection, and so on of the pathogen. Reasonable goals should be set when designing a shelter health care program. An effective disease control program must employ management techniques that manipulate modifiable environmental factors, exploit the weaknesses of the disease agent and enhance the strengths of the host. It must incorporate elements of proper shelter design, stress reduction and behavior enrichment, proper sanitation procedures and implementation of a sound veterinary medical health program in order to be successful.

Veterinarians who work for and with shelters should have an in depth understanding of the mission, policies and goals of the shelter in order to make effective recommendations about health care. Effective shelter health care advice cannot be offered in a vacuum; it is useless and frustrating to recommend all cats be tested for FeLV and FIV if the shelter has a high turnover of cats and no budget for disease testing cats that may be euthanized a day or two later. Conversely, limited admission shelters with budgets for treatment will resist (and resent) recommendations to euthanize animals unless it is clear that there are no other options. Shelter medicine is far more complex than making recommendations about vaccinations and treatments. In fact, separate vaccination guidelines have been developed for shelters by both the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP). Many relationships between shelters and community practitioners have failed in the past because of misunderstandings between both parties. Veterinarians who wish to work with shelters are encouraged to visit and spend time at the facility, talk with staff and supervisors and consult with other shelter veterinarians in order to develop effective health care protocols.