Research supports the assumption that animals have a positive effect on people including hospitalized patients. But not all people are animal friendly and not all animals are people friendly. Risk managers can assist their organizations by knowing the legal definitions and rights of service and other such animal classifications.
Service animals are specially trained and certified animals that work with or perform specific tasks for people with disabilities to support physical and behavioral health needs. These animals are covered under the Americans with Disabilities Act (ADA) and therefore can accompany their owners anywhere open to the public. The ADA definition of a service animal is limited to dogs. However, regulations make one exception and that is a certified miniature horse.
A behavioral health service dog is trained for functions to remind their owner to take medications, stop them from self-harm or enable them to leave the house.
Although you may not demand proof that it is a service animal, you can ask two questions:
- Is the service animal required because of a disability?
- What work or task has the service animal been trained to perform?
Health care facilities cannot ask for documentation but can outline expectations including that the hospital staff can’t supervise or care for the animal. If patients cannot care for the animal, they must make other arrangements, which could include bringing in an animal caretaker. Any aggressive behavior by the service animal can be cause for barring it from the health care facility.
Emotional support animals (ESAs) may have no specific training for providing their services. The Air Carrier Access Act and The Fair Housing Act legally allow these animals to accompany their owners in airplanes for free and in no-pet housing situations.
A letter from a licensed behavioral health professional is required for ESAs with specific information outlining the following:
- The individual is currently a patient under the provider’s care.
- The individual has a disability as defined under the ADA (a physical or mental impairment that substantially limits one or more major life activities).
- An explanation is provided of how the emotional support animal helps alleviate the condition and a recommendation that the individual needs the ESA to assist with their disability and to ease the symptoms of the disorder.
Such letters do not guarantee allowing ESAs where animals are routinely prohibited except in the two circumstances — airlines and housing. As these letters must state that the individual has a disability, an unintended consequence could be the labeling of the individual. Writing such a letter is up to the discretion of the provider. There is some controversy over whether a provider writing such a letter for an active client is a conflict of interest. However, an uninvolved provider would need to spend time with the individual to make the determination to support the request with a letter. This could damage the therapeutic patient-provider relationship.
Therapy animals are also used in many health care facilities. They provide joy, comfort and support to those with illnesses and limited mobility. Such animals are trained to be docile and gentle with people. They must be certified and current on their vaccinations. They are always accompanied by handlers.
Many pet owners would prefer to have their animals accompany them. However, this may be denied based on potential negative effects on others. Some people have allergies to dander and fur. Others are simply fearful of animals. Some landlords state they receive complaints from other tenants and risk property damage.
Be aware that while most people follow the rules, some attempt to circumvent them with service animal attire for their pets. There are companies that sell jackets or vests identifying the animal as an emotional support animal when, in fact, it does not meet ESA criteria that grants the special privileges.
In conclusion, service animals are the only classification of animals that have special privileges that impact health care providers. Most facilities have policies regarding service and pet therapy animals that should be referenced for information and associated rules. Risk managers need to be familiar with an individual’s legal rights under these various classifications of animals to set appropriate parameters, protect individual rights and prevent discrimination claims. If your city, county or other local regulations differ from ADA and federal regulations and definitions, consult your legal counsel.
For more than two decades, Heidi Harrison, BS, RN, CPHRM, has been a risk manager at Inova Health System, which serves more than two million people each year from throughout the Washington, DC metro area and beyond. She is also the former chair of the ASHRM Forum Task Force and has led the team that writes, acquires and edits the submissions to share in the Forum.
