According to the Americans with Disabilities Act (ADA), individuals with disabilities must be allowed to be accompanied by their service animals in all areas of a place of public accommodation. ADA requires healthcare facilities, as places of public accommodation, to modify policies, practices, or procedures to permit the use of a service animal by an individual with a disability unless the presence of the animal would compromise health or safety standards, such as in the operating room.

A facility may ask an individual with a disability to remove a service animal from the premises only if any of the following conditions apply:

• The animal is out of control and the animal's handler does not take effective action to control it.
• The animal is not housebroken.
• The animal is properly excluded.

If a patient cannot care for their service animal, then the patient should make arrangements for a friend or family member to care for the animal. If that is not possible, the hospital may make other appropriate boarding arrangements.

Only dogs and miniature horses may be considered service animals. While service animals must be accommodated under the ADA, emotional support animals (or "comfort animals") that do not perform a specific task for the person with a disability are not covered under ADA. Trained tasks may include:

• Retrieving objects for a person who uses a wheelchair.
• Guiding people who are blind.
• Calming people who have post-traumatic stress disorder during an anxiety/panic attack.  
• Performing a behavior that reminds a person with a mental illness to take medication.
• Detecting seizures for a person with epilepsy and assist with keeping them safe during the seizure. malfunctions.

• Is this service animal required because of a disability?
• What task or work has the animal been trained to perform?

If the answer to the first question is yes and the patient can explain what work or task the animal is trained to assist with, most law experts agree that the organization must accommodate the animal. If not, the patient can be invited to return later without the animal.

Staff may not do any of the following:

• Ask for documentation, such as proof that the animal has been certified, trained, or licensed as a service animal.
• Request that the animal wear a special harness or vest.
• Request a demonstration of the animal's training.
• Ask about the person's disability.
• Isolate individuals with service animals or treat them differently from other patients.

General Guidance

ECRI recommends consulting legal counsel regarding the organization's policy on animals; for example, a policy might indicate, in part, that pet dogs are not allowed, while stating that a service animal or an assistance animal allowed as a reasonable accommodation for an individual with a disability is considered a working animal, not a pet, and is allowed. State law should also be considered, as laws may vary regarding the presence of pets and nonservice animals in public places.

If the organization opts to allow comfort animals and nonservice animals, policy should dictate what the animal is allowed to do and what behaviors will result in the animal's not being permitted to remain on-site.

The Society for Healthcare Epidemiology of America offers extensive guidelines for policy consideration for animals in healthcare environments, categorized into four buckets: animal-assisted activities (e.g., animal therapy programs), service animals, research animals, and personal pet visitation. Animal-assisted activity guidelines, for example, describe policy considerations for handler certification and infection prevention recommendations (such as response to urination or defecation). Other guidelines address patient allergies, arrangements for feeding and care of the animal, and others.

Considerations Specific to Housing

In the long-term care, assisted living, and other group home living environments, the federal Fair Housing Act (FHA), Section 504 of the Rehabilitation Act, and guidance from the US Department of Housing and Urban Development (HUD) should all be considered. FHA and Section 504 require reasonable accommodations for "assistance animals," which includes “support animals," for people with disabilities. For purposes of reasonable accommodation, neither FHA nor Section 504 requires an assistance animal to be trained or certified. Housing providers cannot limit breed, size, or weight for assistance animals, and they cannot require residents to pay a pet deposit or fee for an assistance animal. However, under FHA and Section 504, housing providers do not need to provide a reasonable accommodation if allowing the animal would pose an undue financial or administrative burden or would fundamentally alter the nature of the housing provider's services; if the specific assistance animal in question poses a direct threat to the health or safety of others that cannot be reduced or eliminated by another reasonable accommodation; or if the specific assistance animal in question would cause substantial physical damage to the property of others that cannot be reduced or eliminated by another reasonable accommodation. The latter two criteria must be based on individualized assessment and not on speculation or general fears.

Additional resources that may be helpful include the following:

• Legal information/guidance:
  • Table of State Service Animal Laws (Michigan State University College of Law, Animal Legal and Historical Center)
  • Understanding How to Accommodate Service Animals in Healthcare Facilities (US Department of Health and Human Services' Administration for Strategic Preparedness and Response)
  • Service and Emotional Support Animals in Housing (Minnesota Department of Human Rights)
• Sample policies:
  • Ambulatory Clinic Policy and Procedure: Guidelines for Service Animals and Pets (Texas Tech University Health Sciences Center El Paso)
  • Service Animals (University of North Carolina Medical Center)
  • Service Animals (Stanford Health Care)
  • Management Policy and Procedure: Service Animals (University of Illinois Hospital and Clinics)
  • Service Animal Policy for Hospitals and Facilities (Michigan Department of Health and Human Services)
  • Service Animal Handler Responsibilities (Johns Hopkins Medicine)
  • Animals in the Long-Term Care Facility (Mt. Carmel Rehabilitation and Nursing Center/Catholic Charities New Hampshire)
• Infection control:
  • Environmental Infection Control Guidelines: Animals in Health Care Facilities (Centers for Disease Control and Prevention)

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