Critical care by certified canines

They bring sunshine when they walk into a room for a visit with a hospice patient. For a little while the patient forgets his or her aches and pains as they gaze at their visitors, smiles wreathing their faces, their arms stretching forward wanting to touch those special visitors who are identified as hospice workers by their vests and name tags. Their four legged furry visitors are happy to be there. And all they ask for in return for being there is a few hugs and kisses. At least that’s what their vests say. The dogs and their handlers are part of the Rice Hospice team and they visit hospice patients in an effort to enhance their lives and touch their hearts in a way no one else can. The four dogs and their two handlers are regular visitors to the Granite Falls hospital and manor and the day of the interview, Triva and Birdi, nine year old litter mates that belong to Kathy Hawk of Granite Falls, quietly watched the birds in the menagerie and took little dog naps as they waited for their handler to be finished with the interview. The other two hospice dogs, Brandi and Ivy, sat quietly at the feet of their handler, Cheryl Christensen of Granite Falls. Triva and Birdi are golden retrievers who have always been very people oriented and good listeners according to Hawk.         “They’re very therapeutic for anyone who has ever known them. They’re attentive, they stay right at your feet.” Hawk said she signed Triva and Birdi up for the therapy program with Rice Hospice after hearing they were expanding their therapy dog program and looking for people who had dogs they felt would be excellent for visits with their patients. They began with temperament training this past April, where they were run through a variation of wheelchairs and oxygen, rolling carts and noise with different people approaching them to see how they would react through all these different scenarios. “Once the dog made it through that, it was a couple days of training for the dog handler.” In June they went through three days of training with the handler and dogs. The training is done through Rice Hospice who has a consultant from Wisconsin that comes in and does all the training with them. They had to pass the AKC Canine Good Citizenship Therapy called the Good Citizen Award. They had to pass that through the American Kennel Club and the other one was through Therapy Dogs Incorporated, which Rice uses with all of their dogs. Temperament was the big test, she said, followed by basic obedience. Christensen said the other training part of being able to have them go through a nursing home or in another area that they weren’t used to, one of the commands was ‘leave it’ meaning if there was something on the floor they would be commanded to actually leave it so if there’s medication or something like that, a pill laying on the floor, they would leave it.” Both Hawk and Christensen work at the manor so they have backgrounds within the health care system. Hawk is a registered nurse who works in the home care department and Christensen is the dietary manager. Hawk said she enjoys working with the elderly and she likes giving of her time. “We used to come up here with the dogs even before they were therapy dogs…on different holidays we’ve been up here dressed in costume, the dogs too.” So it was just a natural fit to take it a step further and take the training for therapy dogs. Christensen said the training was basic, and the dogs just have to be themselves. She said she’s had her dogs her entire life. “I’ve had shelties for many years. Shelties are such a home companion, they just lay there.” They also adopted a Schnauzer and she’s very much a people dog as well and loves attention. “Working here at the nursing home and hospital I also interact with the hospice team we have here. They knew that I had dogs and they had asked if I would be interested in bringing my dogs to testing. That’s where that came about.” Brandi is the Schnauzer and Ivy, who is 10 years old, is the sheltie. They’ve had her since she was nine weeks old. “I often thought she would be such an ideal therapy dog but not knowing how you would ever get into that – that’s a pretty in-depth thing to get into.” They’ve had Brandi about a year. “She was kind of a stray in town. We contacted the people that owned her and they had decided they really didn’t have time for her. My son and her fell in love so that’s how we ended up with her.” They were told Brandi is 12-13 years old. “She doesn’t act like she’s that old but she loves to go and visit. She gets so excited.” The dogs have to wear their vests when they go to work, go do their therapeutic visits. The vests are provided through the hospice program as well. They also have their own personal name tags with a photo ID. “They’re basically volunteer employees with the hospice team. They’re all listed with the hospice program. That’s their primary area.” When they go in and do hospice therapy, they’re assigned a client. Hawk said they pretty much stick with that client. They do end up doing other visiting as well, she said. “When we come in you can’t hardly escape, you come in and there’s residents out here and they call that public relations, but anything else we do is usually assigned with a patient.” Hawk said when they enter a room with the dogs, what goes on depends on what kind of a patient you’ve got. “Most of what I’ve been assigned to so far is three, one is communicative and two are not. You get the reach of the hand, you get a smile, the eyes follow the dog all the time. If the dog walks across the room, they’re watching.” They may not be able to say anything, she said, and for others its a conversation starter. “Even when you make your way to the patient’s room everyone stops and the residents that are sitting in their chairs start talking about dogs that they’ve had or different experiences they had through their life. They always tell you a story and even if it’s a story you’ve heard many times before, you listen.” She said she had one patient whose daughter was in the room and she was able to then draw on times out on the farm, all the different dogs they had. “She told the story about how one dog was always running away and then the dog would get in the way when he was trying to do this. One dog’s name was Tippy. She just went through this whole scenario, and even if he didn’t participate much, he was listening. He would smile and she’d say ‘you remember that don’t you dad’ and he’d squeeze her hand.” The dogs have such a calming effect, she said. Christensen has a couple of clients that are in bed and if the dog weighs 50 pounds or less they can put the dog on the bed on a towel. “Usually its Ivy and she gets all cozened in right next to them. We were with a client Monday night and we just sat and visited and the dog just laid next to her, Ivy did and she just sat and scratched her.” Just the sight of the resident’s face was something to see, she said, explaining how calming it was for the resident. “It was just neat. We just kept talking and you could almost see the calm they were feeling, the comfort.” Ivy fell asleep, she said, and they just kept talking. “She was reminiscing, talking about the past and how they had had a Sheltie when they were first married.” She added, “it’s them reaching back into their memories and taking the time where maybe they’re focusing on the dogs and they’re not focusing on their pain and discomfort, having that on their mind all the time too, or their loneliness.” Hawk said when someone asks what a therapy dog can do, its hard to measure . . . “unless you’re able to put yourself in the position of the patient.” You think of those endless hours and minutes ticking away when they’re in their room, she said, and the fact they don’t get endless amounts of visits. When you come in with the dog they see that animal and that’s what they focus on. “My unresponsive ones are more reactive to it then my one that can speak and converse. That has been very interesting.” Hawk said she thinks the biggest thing is the train of thought changes. “It is calming, comforting and it’s just something different than the norm of the day.” She continued, saying, “I think they’re comforting because of their unconditional love. They meet you at the door every day, the wag of the tail. It doesn’t matter how their day’s been, they’re always accepting and it doesn’t matter who it is, they’re just happy every time.” They also get to identify with the vest, she said. “I take those out and they just know they’re going for a car ride.” The visits with the clients varies. Christensen said she may spend half an hour with one and 15 minutes with the next, and sometimes they just don’t want you to leave. “It depends on the dogs as well. If the dog is anxious and not wanting to stay there then you shouldn’t make them. Then it’s time to go.” Hawk said the timeframe for her has been anywhere from 15 minutes, to about 40 minutes. The time varies with what the resident is doing. Sometimes they’re getting them ready for bed, sometimes they’re getting them ready for supper. “You learn to choose times that are adaptable to the patient. They’re awake because they are getting them ready for supper, a perfect time. If they can’t be left alone in their room unless they’re with their protective rails and guards and alarms on the beds, then its nice when they’re getting them up, then the staff that works here can leave because we’re in there.” When they come and get them for supper that’s your cue to leave, she said. One of the residents is sleeping or appears to be sometimes when they come. But, she said, you talk to him, hold his hand and put his hand on the dog and if there’s no response then he’s truly sleeping so you don’t stay. Its good for the staff to have a little bit of a connection too, Christensen said. It brings them pleasure as well to see the dogs. “That’s what we’re all about, bringing pleasure and joy.” Hawk said these visits are not only for the patient, but also the family. “That daughter that was here when I was here that day had just as much fun reminiscing and talking to her father and petting the dogs. They were thrilled the service was available through volunteers.” Hawk said it was a good move by Rice Hospice to expand their program. Hawk said a lot of the facilities talk about having resident dogs or cats. “I think the therapy dog idea has been around for a while. We covered it through our training but its with all the other therapies they’re trying to introduce. The music therapy gave us a taste of that through our training. That was phenomenal and gives a measure of comfort and relieving the thought process of the doom and gloom they may be facing or the long days they may be facing, or the pain they may be in. There’s also massage therapy on the hands, another you can be trained in called healing touch over the body. “It’s very forward thinking for the hospice team, for Rice to incorporate as many different types of therapies to treat the body, the mind, not just the medical but the other facets of what goes on with the total person, to add that to the whole program they’ve got.” Christensen said there are policies and procedures in place at the Granite Falls facility, including a pet policy so if pets come into the facility they’re required to be up-to-date with their immunization shots, rabies shots, that type of thing. Hawk said with their training they had to make sure the dogs were AKC, and had all of the vaccinations. “They had an extensive list, that was part of the training requirements, and if we were missing something we got a little check mark and had a time frame to get those things done.” She said they’re pretty particular about making sure everything is done from worm vaccination, to rabies distemper, and some things they had never heard of. “Our local vet didn’t even carry the vaccination, they had to get it.” Hawk said they’re covered under Therapy Dogs Incorporated when they’re on the job. “If we’re not working for hospice we simply take off the vest. If the school would ask us to come and meet with the children or the library for reading hour, we can go as therapy dogs under Therapy Dogs Incorporated, we would not go under the vest and name tags of Rice.” Both Hawk and Christensen are volunteers as well. Christensen said with working in the nursing home she usually brings her dogs in when she’s done with work once or twice a week either before or after supper. “I’ll come up for about an hour and do my little routine. I also have another client outside the facility who lives in their own home, I usually do that about once a week, maybe every two weeks or week and a half.” Christensen said she tries to work within their time frame because they’re still active, they’re not totally homebound. The visits vary depending on their level of need, what stages they are in health wise. “Right now this person is in stable condition, I go over every week and a half. But if the condition would change I’d probably go a little more often.” She said this particular client loves when we come. “They look forward to that time. It’s Brandi who goes and visits outside the facility. And this client had a schnauzer and we reminisce a lot. This particular person talks a lot about the schnauzer they had so it can be emotional for them as well to think back.” Both the clients and the dogs enjoy it so much, she said. The hospice nurse and hospice social worker tell the residents about the services offered through the hospice program so if there are some that aren’t into animals or pets they don’t bring the pets to them. “Since we’ve started we’ve heard many requests from them so I think we’re looking at getting a little busier now. Our social worker has said they’re having more admissions now so we will be busy because there are more requests.” Hawk said they haven’t had requests from individuals in private homes yet so that will be interesting.” Hawk said she has two residents that don’t respond and one that does. “The one that is able to converse, every time I come, its like a new visitor so we start all over again. She’s just delighted and wants us to come again.” Hawk continued, saying, “the simple pleasure just to watch what it can mean, the visit for number one, to be addressed by name and to watch the interaction with a pet. That’s the neatest thing I’ve seen. They’re as accepting as the animal is, they’re welcoming.” On one of their first visits to a patient, they leave a bookmarker that has the dog’s photo on it and a little bit of information about the dog and the dog handler. “That way, here in the nursing home, if there isn’t family that’s there they’ll come in and see this and its conversation for them as well.” She said the residents she’s brought the dogs to visit have this bookmarker taped right where everybody can see them. “Its more conversation for them. Its taking their minds off themselves – they leave more of an impression.” Hawk also explained that their dogs are therapy dogs, not service dogs or guide dogs for the blind. “They don’t answer telephones, they don’t bark when someone’s at the door. They’re strictly a companion dog meant to go in for comfort with the handler.” They never leave the dog with the patient and walk away, Christensen said.     “We go with the dog, the dog doesn’t get to go by itself so it’s a dual volunteer program…but the dog is the focus, they wait for the dog, not the person.”