This study revealed that, according to caregiving triad representatives, the roles played by pets for clients in long-term care at home (LTCH) were similar to the roles played by pets for older adults in the general population. Moreover, five clusters of potential problems were reported for pet ownership in the LTCH-setting. The potential influence of pets on caregiving relationships within the caregiving triad could be experienced either positively or negatively.
Overall, participants indicated that their pets were important to them and contributed to their wellbeing. However, (quantitative) scientific research investigating the relationship between pet ownership and wellbeing is incongruent (e.g., 24, 25, 26). Nonetheless, some evidence suggests a positive relationship between a higher quality of attachment to a pet and its owner’s wellbeing (24). People who have an insecure attachment to their pet are more likely to experience psychological distress and lower wellbeing (24). This suggests that supporting the attachment between an LTCH-client and a pet is important, which could possibly be achieved by making plans concerning sustainable pet care with LTCH-clients.
There were some inconsistencies between the outcomes of the interviews and the LimeSurvey questionnaire. Participants did not rate the role of pet-related grief under emotional aspects as relevant for LTCH-clients. However, pet bereavement was mentioned as a potential problem. Research indicates that pet bereavement can lead to high levels of grief for long periods (weeks to months), loss of social contacts (e.g., while walking the dog), and loss of relationship and support experienced from the pet (27). Thus, pet bereavement can negatively impact several domains in clients’ lives, and, therefore, requires the attention of healthcare services to improve wellbeing for LTCH-clients—for instance, through supportive counselling.
Pet relinquishment may also lead to grief. A study that looked into the reasons why pet owners relinquished their pets (dogs and cats) to a Danish animal shelter over the course of 20 years found that the most common reasons for pet relinquishment were an owner’s health (31% overall) and issues with housing such as regulations about pets in residential care (23% overall) (28). Anticipating pet relinquishment and its accompanying grief may lead some LTCH-clients to delay seeking health care (e.g., admission to a nursing home) (15). This delay can have a negative impact on the LTCH-client’s health and subsequently increase the risk of further health deterioration and healthcare costs.
When LTCH-clients experience deteriorating health, they may come to rely more on family caregivers to provide care for their pets. Despite the potential benefits (e.g., emotional support) of a pet’s presence, family caregivers may not have sufficient time to help care for the pet. They may experience caring for a pet as a burden (29). Sometimes pet care becomes the exclusive responsibility of the family caregiver. According to participants in our study this can become problematic—for instance, if the family caregiver becomes unavailable to care for the pet (e.g., due to their own hospitalisation). Therefore, it may be useful for pet owners receiving LTCH to make arrangements with others beforehand to support in pet caregiving.
The pet’s role Mirroring found in the previous review was not recognised by the participants in this study. Mirroring, however, is an important aspect of some animal-assisted therapies (30). In equine-assisted therapy, for example, therapists use the horse’s ability to respond to, or mirror, the inner emotions and intentions of people. When a client is worried and experiences anxiety, this can be observed in the worried and anxious behaviour of the horse (30). Mirroring can be a useful way to help clients explore and regulate their emotions (31). Some evidence shows that dogs also mirror their owners’ stress levels (32). A possible explanation for the finding in our study is that mirroring is easier to detect in therapeutic and research settings than in daily interactions between pet owners and their pets.
The content of the role Pet-Related Expenses on pet caregiving was not recognised in our study and pet costs were not reported as a potential problem. The participants in this study may have had sufficient funds to care for their pet. However, participants did find pet-related expenses worth considering. Expenses related to pet ownership can be problematic for people on limited budgets and for those with physical limitations (33). Therefore, it may be useful for professional caregivers to make their LTCH-clients on a limited budget aware of pet-related resources such as local pet food banks.
Overall, several of the potential problems participants reported can be anticipated and solutions found prior to their becoming actual problems. Hence, increasing awareness of and information exchange about potential pet-related problems and solutions within the caregiving triad may be particularly useful. This could take place, for instance, during care planning talks.
Remarkably, participants did not mention an increased risk of falls as a potential problem of pet-ownership, despite research indicating that pets are a major fall risk to older adults which can cause serious injuries (34, 35). For instance, people can fall over their pet’s toys or the pet itself, or they can trip, slip, or stumble while walking a dog. These types of accidents can substantially impact an owner’s health (34, 35, 36). The study participants may not have reported falls as a potential problem because they may never have witnessed or experienced pet-related falls themselves. Healthcare organisations can play a role in preventing falls by creating awareness about a safe home environment—for instance, pet items should not be placed in walkways and it is important that rooms be well-lit when walking around (37).
In addition to the positive influences of pets on caregiving relationships, such as pets being a pleasant topic of conversation, participants also reported two potential negative influences of pets. Problems can arise when pets are in the vicinity while LTCH-clients are receiving care. For example, a dog might try to intervene to protect its owner. In such a situation, the pet may need to be put in another room during caregiving (7), which may negatively impact the caregiving relationship between the LTCH-client and the professional caregiver. Differences in opinion related to pet care may also cause friction within the care relationship. The potential for these sorts of problems and the impact they can have on caregiving relationships suggest that pets need to be accounted for in the LTCH-setting.
Strengths, Limitations And Future Research
Strengths of this study include its use of several rigorous methods, multiple analysts and auditors, and several rounds of working group discussions. A limitation is that most of the people we interviewed were dog owners who were overall very positive about owning a pet. Future research should look further into the potential problems and influences of pet ownership on caregiving relationships, preferably using longitudinal and mixed methods designs. Determining which pet-related problems most urgently need to be solved should also be a priority. As in our research, it is important to involve stakeholders of the caregiving triad (pet-owning LTCH-clients, family caregivers, and professional caregivers).
Practical Implications
Conversations about pets between LTCH-clients, family caregivers, and professional caregivers may help each stakeholder anticipate potential problems and lead to satisfactory arrangements for pets. Preventing and solving pet-related problems is important for each stakeholder within the caregiving triad. Arrangements and relevant information concerning potential difficulties could be registered in a care plan. For example, this might include recording an address for (permanent or temporary) pet care in case the owner is hospitalised, or requesting additional support from an LTCH-client’s family members, neighbours, or volunteers in caring for a pet. Furthermore, professional caregivers may be able to improve the caregiving relationship with LTCH-clients and family caregivers through the attention they pay to their clients’ pets. Insight into the positive and negative influences pets have on caregiving relationships can be used to further improve relationships between pet-owning LTCH-clients, family caregivers, and professional caregivers. Attention and support from healthcare organisations with the use of tools and guidelines that account for the different roles of pets may improve the wellbeing of all those involved.