A touch of magic: using a service dog for dementia care.

Adapting the demonstrated positive experience of using service dogs to aid the blind, deaf and physically disabled, an 816-bed academic nursing home introduced a trained service dog to work with elderly nursing home residents on its 63-bed Alzheimer's Special Care Unit.

In the only known program of its kind, the dog is trained to use distraction and diversion techniques to minimize dangerous wandering and reduce confrontation involving Alzheimer's patients. In addition, the dog promotes safety awareness, provides social support and adds to the unit's homelike environment. Residents' wandering has been greatly reduced, and response to the service dog from staff, residents and family is extremely positive.

The dog is also trained to provide support and social stimulation through brief, repetitive contacts. The practice of using animals as friendly visitors is well known, as are "pet-assisted therapy" programs. This innovation advances the practice by training the dog to perform specific, vital tasks and assist in the care of residents. This supports staff and families as well as residents, and greatly enhances the facility's milieu.

The following describes how this program was created and developed.

The Problem

Our 63-bed Alzheimer's Special Care Unit was designed to provide a warm, social and homelike environment for residents with midstage Alzheimer's disease and related dementias. To maintain this environment, the Home sought a way to keep residents away from the exits without disturbing the unit's ambiance. Local fire laws prohibit the use of magnetic locks on fire exits; therefore, residents of the care unit wear sensors that trigger a soft-sounding alarm if they approach a fire exit. Nevertheless, a great deal of staff time was needed to persuade residents to avoid the exit areas. Thus, not only did we want to move residents away from exits without confrontation, we were attempting to reserve staff time for important clinical tasks rather than guiding patients away from fire doors.

As a solution, we considered the positive results service dogs had achieved assisting the blind, the deaf and the physically challenged with their tasks of daily living. We decided to implement the use of a well-trained service dog to help shepherd residents away from exits. We sought, as well, to enhance social contacts and communication among the residents through the use of the service dog.

For further information, the Home consulted Canine Companions for Independence, The Seeing Eye, and a nationally known dog trainer and animal behavior specialist. Despite our numerous inquiries, there was no known use of service dogs assisting Alzheimer's patients. Our goal was to find an appropriate service dog that had a low-key nature, was pleasant and nonaggressive. We hired a nationally known animal behavior specialist/dog trainer to help us conduct a nationwide search.

The Plan and Implementation

Our major objectives included:

* Reducing/eliminating dangerous wandering

* Minimizing confrontation through distraction and diversion techniques

* Enhancing our homelike environment

* Increasing social interaction among residents

* Increasing family communication

* Increasing staff time for important clinical tasks

* Promoting staff satisfaction and appreciation.

The major challenges were:

* To identify a dog with a temperament complementary with the frail elderly.

* It was essential that the dog be tolerant of wheelchairs, walkers, visitors, staff, confused residents, etc.

* The dog had to be able to focus on a specific task/job and be capable of integrating into the community of the unit.

* There were no common training, certification and uniform standards among trainers.

* We had to find a professional who could conduct the search and the demanding process of animal screening.

* We had to find a professional who could conduct the training.

* We had to train staff to deal with some residents who might respond inappropriately to the dog.

* We had to create schedules for feeding, walking the dog, use on weekends, etc.

The most challenging aspect of this project was finding an appropriate service dog. Supported in this effort by a dog trainer and animal behavior specialist, we conducted a national search, including contacting breeders, private dog owners and shelters. After screening many animals, a golden retriever (now five-and-a-half years old) was acquired from a well-known breeder. We called him Magic.

Magic began training at the CNG Canine Patrol School. His training centered around "socializing" him with wheelchairs, crutches and walkers; taking him out for long walks in town; and visiting stores and shops to observe his reaction to different people. Following CNG training, Magic attended the Center for Applied Animal Behavior. At the Center, he continued the basic exercise of gently pushing and nudging people away from doors. He also learned to respond to the door alarm system and made frequent visits with the trainer to the unit to acclimate to a new environment.

In the unit itself he continued to respond to the alarm and to distract residents, nudging them away from exits and redirecting them to other locations. Residents perceive this behavior as a form of social contact and an expression of affection, and they have responded favorably.

An essential part of a service dog's life is to separate the work environment from its living quarters. If the dog lives and works in the same place, he can become confused about his duties. Magic lives and works in the unit; however, when he goes off duty, he is taken off the floor and returned by elevator to his living quarters in the unit. This removal from the floor signals to him that now is the time to eat, play and rest.

The Staff

The program was initiated by the unit's Clinical Care Coordinator, Mary Shelkey, RN, with strong backing from the administrator (himself a dog trainer) and the Home's director of psychiatry. The program was made possible through a team of interdisciplinary staff volunteers. This included engineering and housekeeping staff who made moderate changes on the unit, including creating a room where Magic could sleep.

The operational team is highly unusual, spanning both clinical and nonclinical staff and involving all three shifts. Staff include personnel from nursing, medical, housekeeping, engineering, maintenance, materiel management, psychiatry, clerical and medical records. They participate in the three-times-a-day walks and twice-a-day feedings. Members of the nursing staff care for Magic in their own homes on weekends.

The Evaluation

The service dog program proved enormously effective in contributing to the safety and well-being of the residents. All the residents have responded affectionately to the dog and spend hours interacting with him. Magic, who enjoys placing his head in residents' laps, brings back memories for many. One resident, who was particularly despondent, has come out of her shell and developed a special relationship with him.

Outcomes Follow-up

We undertook a 2-week survey during which the nursing staff recorded every attempt made by residents to leave the unit during the day shift (7 a.m. to 3:30 p.m.).

Baseline: During the two-week period before the dog arrived on the unit for full-time work, there were 120 attempts to leave, exit or enter the elevators. Four weeks after the dog had been in place working daily on the unit, there had been only five exit attempts spanning two weeks. This is statistically significant, at p [less than] 0.01. At further follow-up these results were replicated.

Another opportunity to study results arose after the dog had been in place for six months. He required minor surgery and left the unit for one month. Immediately prior to his absence, there had been six occurrences over a two-week period. During the four weeks without the dog, there were 28 occurrences over a two-week period. Four weeks after the dog had returned, there were two occurrences over a two-week period. Again, this was statistically significant, at p [less than] 0.05.

There were further attempts to measure outcomes. For example, 21 unit staff members were surveyed prior to the project and again three months after the dog was in place. Results pre- and post-implementation are shown in the table.

Table. Staff Perception of the Usefulness of a Service Dog in an
Alzheimer's Unit

Survey Questions
Q1. Do you think a dog will help the unit?

Q2. Do you think a dog can help people with dementia?

Q3. Will the dog make the unit more homelike?

Staff Responses

              Before Magic               After Magic(*)

         Yes       No     Unsure      Yes     No    Unsure

Q1.      10         3        8         18      0       3
Q2.       8         6        7         20      0       1
Q3.      15         3        3         20      0       1

* After Magic = 3 months after Magic was in place on the unit.

Family Responses

Family members were asked for their subjective comments after the dog was in place. Prior to the project, all family and friends were sent a letter detailing it and asking for their comments or objections. No objections were forthcoming - indeed, all family and friends were supportive. A few relatives expressed concerns about possible allergic reactions to the dog, but generally believed this would be a minor problem.

A sampling of their comments:

"The dog helps me visit. I feel I have something to talk about with my mother. Now I bring my children to see the dog, too."

"My father loved the dog, and I have never seen him this happy."

"I love the dog, and my mother does, too. All nursing homes should do this."

"The dog makes it easier to come here. We can talk to the dog, pet the dog and we all feel better."

"My mother talks more now, and she is happier. She talks to the dog, pets the dog, and is calm. We used to have a dog like him at home."

"My father is like a new person around the dog. He talks more and looks so much happier."

Conclusion

In general, the service dog program has achieved its objectives. We have:

* reduced or eliminated wandering away from the unit;

* increased social interactions among residents;

* increased family communication;

* increased family visits;

* heard families report they are more likely to bring younger family members;

* reduced confrontational behaviors;

* increased staff satisfaction and appreciation;

* increased staff time for clinical tasks.