In-Shelter Support Care Program

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What is In-Shelter Care?

In-Shelter Care is a shelter-based medical program to prevent relinquishment due to urgent medical needs when the shelter can legally provide medical care to owned animals and the owner/caretaker is unable to access that care. The shelter can intervene by providing cost-effective, resource-efficient interventional medical care directly to the pet therefore, removing the need to surrender the animal for services. In-Shelter Care is meant to be for “one and done” scenarios, not chronic management.

The Hypothesis

In-Shelter Care serves as a safety net within the community to save lives, reduce animal relinquishment, keep overall shelter care costs down, and support the human-animal bond in communities.

What are the defining elements and assumptions of the In-Shelter Care Model?

  • There is a veterinarian & support staff working in the shelter to provide veterinary care. 
  • Animals served in this program are at immediate risk of euthanasia or relinquishment due to a medical concern. 
  • Ideally, the shelter is legally able to provide care to owned animals so that the human-animal bond is maintained.  However, when that is not reasonable or legal, organizations may resort to having the animal surrendered to the shelter for care, and then return animals to the client.
  • The scope of medical care is interventional or urgent rather than comprehensive and recurring.
  • There are adequate supplies and facilities to provide humane and legal medical care. Funding for the program is not separate from the shelter’s medical budget (if the animal was surrendered this care would need to occur in-house anyway).  The benefits of the program come from reallocation of existing medical care dollars. 
  • At least initially, the program is not advertised widely. A recommended approach is to start by recruiting clients and patients through referring agencies such as veterinarians,  human social service organizations, community triage hotlines, humane officers in the field, or other partners engaged in family-centered services. In addition, clients may present with animals requiring programmatic support at admission. 
  • The program provides family-centered care, focusing on maintaining the human-animal bond, reducing barriers to care and providing collaborative care as opposed to paternalistic care. 
  • The shelter in this model functions more as a community resource center rather than a destination for relinquishing animals.

What problem does the In-Shelter Care program solve?

  • Increased access to care in underserved communities
  • Improved quality of life for animals whose owners cannot access affordable veterinary care
  • Unnecessary intake of animals to shelter for medical care and rehoming, which can result in a prolonged stay in the shelter system and compromised welfare
  • Unnecessary separation of pets from families due to a medical need they cannot afford
    • 85% of dog owners and 75% of cat owners consider their pets “family members

How is this accomplished?

  • Providing interventional care to animals and returning them to environments where they are already supported  
  • Enabling shelters to not exceed their capacity for care by providing an alternative to intake and holding 
    • keeps daily inventory in shelters lower
    • reduces resources used in other parts of the shelter system by reducing intake
    • shortens length of stay for these animals in the shelter by providing them with a humane outcome already identified at entry
    • provides better post-treatment care in an in-home scenario
  • Transforming the shelter into a resource center rather than a rehoming center

How Organizations Can Begin

Phase One: Planning

Identify a point person in your organization to lead this effort.

Ideally this person will also act as the medical to provide triage and liaise between the medical team and the client.

Allocate a start-up budget.

Although the goal is that programs be budget neutral by shifting costs from standard shelter care to shorter term interventional care. It is likely that for the first 12-18 months, this program will need added funds for staff support and additional materials, but these may be offset by client contributions, payment plans, reallocation of staff, and efficient use of specialized volunteers.

 

Create a staffing plan for the program and delegate responsibilities for start-up and long-term activities.

 

Consider developing an appointment-based structure for the program.

For example, allow for management/intake of these cases on specific days of the week when supporting staff has been delegated to work on this program.

 

Create a decision-making flow chart for cases.

Example: Flow Chart for Case Management

 

Decide on financing plan for client contributions: at point of service only, in-house financing or third party billing system. Create necessary payment agreement documents and a system.
Review the document library provided with this document for sample SOPs and forms related to operating such a program. Find Incremental Care SOPs here.

 

Create some starter incremental care protocols for common conditions you expect to qualify for this program.

Don’t reinvent the wheel – adapt others’ protocols for your operations. These are most likely to be useful and relevant to you if developed by similar organizations in your area or a comparable location.

  • Keep them simple. They are a how-to list, not a literature review.
  • Use direct speech.
  • Use a consistent, accessible format
  • Ensure that staff are educated on key protocols and know how to find others.
Create standard forms for medical services intake, in-shelter care, and discharge so that these processes are stream-lined as much as possible.
Define and document the scope of medical and surgical cases the program can offer. This may change over time.
Create a system for post-clinic emergency care access in the event that it is needed.

Ideally, scope of care cases should not require this level of care, but there must be at least a process by which cases can be triaged and access emergency care in the event it is needed.

  • This can include in-shelter services, or referral and financial support at another facility in collaboration with the shelter.
  • It’s essential to provide access to urgent and emergency care or at the very least inform the client of the location of nearby clinics. Ideally, a pre-existing relationship between the shelter clinic and the emergency clinic will better enable communication and manage financial challenges.
  • Set up a Memorandum of Understanding (MOUs) with local veterinary care providers, particularly emergency facilities. Providers should be clear on what they will and won’t be compensated for, and what you do and don’t want them to do. Typically they will be asked to stabilize patients pending transfer to your facility or a designated clinic, and hold off on any diagnostics and treatments that can safely be delayed.
  • Always teach clients how to provide basic post-procedural care at home.
  • Sample Documents
Facilitate communication with other members of the patient’s healthcare team.
  • If the client has a primary veterinarian, ask the client to update their veterinarian to ensure that their records are complete and smooth transfer of care back and forth is achieved.
Provide staff education on the new program.
Create a template letter to distribute to local practitioners regarding the scope of the program, including both the status of cases you are taking on referral  (ie pets at risk of relinquishment to the shelter) and the scope of services you can offer.
  • Reach out to your local/state VMA to gain support for your program to hopefully decrease tension with local practitioners.
Create a system for dispensing pharmaceuticals that meets state regulations.
Create or refine your current medical records system to support the external facing program.
  • Should meet standards required of medical records for owned animals. The major elements of medical records should include:
    • primary care practitioner’s contact information
    • owner information
    • animal identification
    • chief complaint
    • physical exam
    • treatment
    • vaccination history
    • history
    • prognosis
    • diagnosis or tentative diagnosis
    • chronological order of medical and surgical events
    • various reports (laboratory, radiology, cardiology, etc.)
  • Complete records should be provided to clients and, ideally, should be sent to the client’s primary care practitioner.
  • Electronic medical records are preferred.
Evaluate your current data collection system for tracking intake, outcome and other shelter metrics.
  •  Will your current process work to track points of care and impact of this new program?
  • This system should at minimum be able to capture monthly numbers of patients treated by this program (and kept with their owners) and the monetary value of these services. Remember to account for costs and resources saved by preventing animals from entering the shelter.
Review relevant laws and regulations in your state, including the VCPR and the Veterinary Practice Act for your state.

Phase Two: Implementing and Refining the Program

Choose a start date for a stepwise implementation of the program.
Develop a more extensive library of client education resources and discharge instructions, including videos and bilingual resources when possible.
  • Veterinary Partner is a good starting point for medical discharge information. These pages have a translation feature, but these are automated translations.
Must include access to services for emergency post- surgery or treatment.
  • Utilize pro-active local collaborations and financial support for clients to access emergency care through local clinics when necessary 
  • Although not currently available, there is discussion of creating interstate or intrastate collaborations to enable this access through a telehealth triage system.
Refine your algorithm for entry of a client/patient into the program, both in terms of admission policies and your scope of care. 
  • Admission examples: open admission, at the point of shelter relinquishment, referral from practice or rescue group, referral from social service organization or animal control, or other.
Start a running SOP checklist/template for what the program needs to be successful so these can continue to be developed over time or recruited from materials available from other programs or resource libraries.

Phase Three: Tracking Success and Challenges

Create your shelter’s data/metrics template. 
  • Intake type/subtype: clinic in, service in, or surrender for care
  • Outcome type/subtype: clinic out, service out, or return to owner
    • There can be nuance in states that require pets to be relinquished for care by the shelter. Options include adopting animals back to the owner, or creating a sub-type of RTO.
    • Review whether there are legal restrictions on the shelter providing care for owned animals. Ideally, animals are not surrendered to the shelter in this type of program. 
  • Service type:
    • Medical conditions
    • Surgical conditions
    • Dentistry
  • Quantitative data:
    • Number of appointments
    • Number of new clients
    • Number of surgeries
    • Number of dentals
    • Number of lives saved from euthanasia
    • Number of animals saved from relinquishment
    • Number of euthanasias performed
    • Cost value of in services provided 
Qualitative stories of success or challenges met.

Consider developing a shared document among staff to collect and compile stories and photos that your marketing team can use for social media, reports and grant reporting.

Data on any educational component (vet students, techs, apprentices).

What does success look like?

  • When successfully implemented, the shelter will have a clear, streamlined approach to providing medical services, within a defined scope of care, to owned animals at risk of relinquishment.  
  • Staff will have consistent messaging, lines of communication, and documentation of these services. 
  • Program staff meet regularly to discuss and address successes and challenges. Program staff meet with shelter leadership, marketing, finance and development teams at least quarterly. 
  • Services will meet all legal and regulatory requirements
  • The program will fit within the daily work of the medical team and not require excessive commitments outside of standard work expectations for the organization. 
  • The program is financially sustainable over time. 
  • Owner surrender shelter intake due to medical cases will decrease over time.  
  • The shelter is able to meet the need within your community without having to turn clients who qualify away.

What is the downside? How do we account for it?

  • In-Shelter Care can be time consuming & labor intensive without solid communication SOPs. 
  • Anticipating staffing and facilities the program will need to be successful is important to prevent inadvertently under-serving the client and patient. 
  • The shelter will also need to be very explicit when communicating to the owner what the shelter has the resources to provide and what limitations there are with the particular case. A call system with clear talking points, algorithms, and options to manage these requests can help this challenge. 
  • Accordingly, alternative clinics or resources should be kept at-hand to share with an owner in the case of a pet emergency or if a pet needs complex or chronic care management. 
    • Sometimes the shelter will need to say no if the service can not be done humanely or within the shelter’s allocated resources.
    • Having a fund that helps to pay for services at local veterinary clinics may be a better alternative for some cases. 
      • Having an MOU with one or two local veterinary clinics that outlines agreed upon costs of care is ideal. 
  • Intimately working with the community through this program can be emotionally and physically challenging. Providing social work training and/or onboarding a social worker, particularly someone with veterinary social work  can help support the staff and the program. Another option is to have a medical staff member complete a certificate program in Veterinary Human Support

FAQs

Focus on whether the new program can be implemented with current staffing levels or if additional staffing is needed. In theory, many of the initial cases your shelter supports would be potential surrenders to the shelter (i.e. cases your shelter were already likely to have to handle), so workload or caseload should not increase and re-allocation of staffing should suffice. Initial re-allocation of staffing should include the designation of a point person (medical case manager). As the program grows and the community learns of the program, you may need additional staffing. For example, you may need to eventually designate staff to shelter pet services or public pet services. 

Use incremental care techniques when treating animals. For example, use a tiered diagnostic and treatment approach over time. Non-critical procedures are avoided and diagnostics are limited to those that could provide results that will change how the case is handled. Strong communication with clients and the ability to adjust a patient’s treatment plan are needed. 

Start small and simple with what you have, and grow the program over time. Document effective protocols and practices as you go, so they can be replicated for the next case. Develop a record keeping system for the program to track touch points and to slowly better understand what services your community is most in need of. Utilize staff where they are most essential, prioritizing veterinary staff to veterinary care and communications and management staff to client and community relations. Over time, consider additional ways to make the program financially sustainable. For instance, grow your financial model by updating sliding scales for emergency surgeries or, if legally allowed, by providing service to non-qualifying clients who are willing to pay higher fees. 

In general, this is why we recommend that in-shelter care programs start on a referral basis only; e.g. the client is referred by a veterinary practice or social service agency, or at the point of surrender to the shelter.  While the ultimate goal of the program may be to allow access for any pets and people that have need, care should be taken in the early stages to avoid exceeding the program’s capacity.  This can be achieved through limited acceptance of referrals and/or triage by the case manager based on an assessment of need and on current veterinary team bandwidth.

Although adoption fees are a source of revenue, they are rarely substantial once the cost of shelter care is factored in, especially if placement is delayed by medical care or other issues.  In-shelter medical programs can also be a source of revenue by collecting some degree of client contribution, reducing the costs of sheltering the animal to the point of rehoming. They may also serve as an attractive grant or donor program.

This depends on the ease of providing spay/neuter in your facility.  In some communities, low-cost spay neuter is available through organizations other than the shelter. Spay/neuter status should not be a barrier to accessing in-shelter interventional care; however, the shelter may want to provide these services once the condition has resolved. 

There may be initial additional costs in establishing the program. Ultimately, the intention is to be budget neutral, and in the end the program should reduce the shelter’s expenses associated with animal care by reducing treated pets’ length of stay in the shelter and daily shelter census, as those pets are cared for by their owners or members of the community. 

Regulations regarding veterinary practice differ widely from state to state, and so investigating your state requirements is essential. A guide to VCPR regulations by state is available here. It is important to be clear on who owns the animals and makes decisions regarding its care throughout all stages of the intervention. In some places, regulations determine the scope of care that can be provided by nonprofits to owned animals. In some jurisdictions, relinquishment may still be required if the shelter is not legally allowed to provide care for publicly-owned pets. In all cases,  the intended outcome for the pet will be adoption back to their owner (or a designated return-to-owner subtype outcome). 

This can be a serious rate-limiting step. In some states or jurisdictions, the only way to provide medical care to an animal is to have it surrendered to the shelter or to pay for services through a veterinary clinic. However, the HASS legal working group is a great resource for exploring how your organization might begin to make headway in providing medical services to owned animals at risk of relinquishment. Contact HASS to learn more about creating change in your state.

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