Unleashing insights from Toronto Humane Society’s urgent care fostering program: a community case report

The Urgent Care (UC) fostering program at the Toronto Humane Society (THS) supports individuals experiencing crisis situations (housing instability, fleeing interpersonal violence, or undergoing healthcare treatments), by providing a no-cost fostering service for their animal(s). All applications to THS’s UC program between January 1, 2020 and October 1, 2022 and all successful admissions to the program during this period were included in this study. There were 358 admissions of 328 unique animals, from 244 families. Seventy-four percent ( n = 265) of admitted animals were reunited with their owner. The highest rates of reunion at the end of the program were linked to dogs, requests in support of people fleeing interpersonal violence, consistent or frequent communication with the client, and not requiring veterinary or behavioral care/training beyond standard levels. THS’s UC program presents an inexpensive and effective way to help support people undergoing temporary crises, preserving the human–animal bond, which may help them heal in the aftermath of these crises, and prevent the needless relinquishment of animals to shelters. Through writing this report, opportunities have been identified for improving the program to better serve our community, and details have been provided that might help other organizations operating or planning to launch a similar program.

T he importance of the human-animal bond for mutual well-being is being increasingly recognized across both human and animal health and welfare organizations worldwide. 1A biopsychosocial framework underpins the many interacting factors that make up this beneficial relationship. 2Pet ownership has been shown to improve mental and physical health, as well as provide social support and companionship broadly 3 and in supporting resilience in the face of adversity specifically. 4ixty percent of Canadian households include a cat and/or dog. 5 When families experience unanticipated hardship such as housing instability, fleeing interpersonal violence, or undergoing treatments for mental or physical health, families may be forced to surrender their animals effectively severing these bonds.Families who are unable to afford boarding and have limited support networks may be especially at risk.
The exact numbers of Canadians experiencing housing instability, interpersonal violence, and healthcare treatment are difficult to capture.Approximately 95/100,000 people in Canada experience homelessness on any given night. 6,7Up to 20% of these individuals are pet owners. 6 2021, Canada reported 336/100,000 people experienced interpersonal violence. 8One study found that almost 90% of abusive relationships that had pets reported at least one instance of animal maltreatment by the abusive partner. 9People who leave abusive homes may have no other options than to reside in a shelter, many of which do not accept pets.Without pet-friendly options, survivors often delay leaving or return to their abuser. 9The number of Canadians undergoing healthcare crises that may necessitate temporary care for their pets is more difficult to identify, but anecdotally it is not uncommon for people to refuse or delay procedures if they do not have people in their lives who can care for their pets during these periods.Refusal or delay of treatment can have long-term health consequences for the individual, but this can be deemed preferable to severing the human-animal bond.
The Urgent Care (UC) fostering program at the Toronto Humane Society (THS) supports individuals experiencing these crisis situations by providing a no-cost fostering service for their animal(s).It is a response-based and preventative program that aids individuals experiencing crisis while simultaneously decreasing avoidable surrenders and mitigating animal abandonment.Individual owners or community caseworkers could apply for up to 1 year of care.Occasionally, cases are identified through information disclosed during surrender appointments, and animals are diverted to the UC program.Applications are considered based on current resources to support the medical and behavioral needs of the animal(s), as well as the availability of foster homes and the exploration of alternative options.Upon admission, animals receive a veterinary exam, wellness services, and treatment for any immediate needs before being placed in a suitable foster home.Foster homes are secured before admission whenever possible to reduce the animal's length of stay (LOS) in a shelter.Throughout their tenure in the program, UC animals are provided medical and behavioral support from THS, but applicants retain legal ownership and are consulted on major decisions (such as spay/neuter).Confidentiality is maintained at a high standard with clear expectations of all staff, volunteers, and foster families to protect privileged owner information.If an owner cannot be reunited with their pet, adoption is facilitated.

Background
This report summarizes the data associated with applications and admissions to THS's UC program, from January 1, 2020 to October 1, 2022.The goal of this manuscript is to report the data guiding changes made to the program internally in hopes that they could help other organizations operating or planning to launch similar programs.Accordingly, this report will focus on variables impacting operations.

Methods
This study reports on all applications initiated between January 1, 2020 and October 1, 2022, and all animals successfully enrolled in the program during this period.Information regarding applications was retrieved from a Microsoft Excel (Microsoft 365) spreadsheet drawing data entered by the applicant in Microsoft Forms (Microsoft 365).Final status of the application was entered manually by staff upon review and consideration.
For all animals successfully enrolled, information on admission, species, age, LOS, health concerns, behavior concerns, and outcome was retrieved from THS's data management software (PetPoint Data Management System, Version 5, Pethealth Software Solutions Inc., Oakville, ON, Canada).Information on the reason for support and frequency of client contact was retrieved from records kept by the program coordinator.Frequency of client communication was categorized (consistent, frequent, infrequent, non-existent) subjectively based on the coordinator's experience attempting to engage and/ or maintain regular communication throughout the foster period.Health concerns were refined to eliminate any conditions that were deemed by a veterinarian to not truly constitute a health condition (e.g."kinked tail" or "worn teeth, no dental required") or to combine conditions that communicated similar concepts (e.g."anorexia" and "hyporexia").Cost of care was retrieved through a review of departmental financial reports.All data were entered by our administrative, veterinary, or behavioral teams and as such is limited by any potential clerical errors, human interpretation, and protocol adherence.
Data aggregation and analyses were performed in Microsoft Excel (Microsoft 365).

Applications
During the study period, there were 713 applications for 926 animals (not necessarily unique animals, some had multiple applications).There was a mean of 1.3 animals in each application (max = 6).Details on application outcome can be found in Table 1.Rejections due to scope were largely pet owners who had to travel due to a family emergency.For animals declined because THS did not have the resources to manage the case, 19 (43.2%) were because there was no willing foster parent, 11 (25.0%) were due to medical concerns, and 14 (31.8%) were due to behavior concerns.Of the animals declined for "other" reasons, 33 were repeat applications submitted within a week, six resulted from barriers to accessing the program experienced by applicants (a lack of transport or issues with the wording of the contract, particularly a clause stating that while in the care of the UC program THS had the authority to make decisions that are in the best interest of the animal, up to and including euthanasia), five cases were more appropriate for a municipal program better suited to their situation, and one was a mistaken surrender.Of all applications that had the potential to be accepted (i.e.excluding applications declined for being out of scope, those that no longer needed support, and those categorized as "unknown" or "other"), the acceptance rate was 88% (325/369; Table 1).

Admissions
There were 358 admissions of 328 unique animals, from 244 families during the study period.Forty-five animals were admitted without the owners filling out an application.These were identified by staff during surrender intake appointments or when owners were unable to complete the application due to technology/access issues.A detailed breakdown of animal admissions by year and species can be found in Table 1."Other" species admitted to the program were three budgies, three rabbits, two sugar gliders, two parrotlets, one snake, one hedgehog, and one conure.At intake, 51 animals were juveniles (<1 year old), 204 were adults (1 to <7 years old), and 103 were seniors (≥7 years old).Most animals (n = 303) entered the program only once, while others entered the program 2 (n = 20) or 3 (n = 5) times during the study period.Most admissions were single-pet entries (n = 206), but multi-pet admissions ranged from 2 to 7 animals (47 groups of 2, 9 groups of 3, 2 groups of 4, 2 groups of 5, 1 group of 6, and 1 group of 7).The total number of animals admitted per month increased each year, with 5.9 animals per month in 2020 (71 animals/12 months), 13.4 animals per month in 2021 (161 animals/12 months), and 14.0 animals per month in 2022 (126 animals/9 months).Mean admissions peaked in the summer months, particularly in July (Fig. 1).The steep drop-off in admissions observed in September of 2022 was largely owing to reduced staffing in the program at that time and a planned cessation of program admission for the remainder of 2022, with regular activity resuming in 2023.

Reasons for needing support
A detailed breakdown of reasons for needing support by year and species can be found in Table 1.The number of Of the 25 animals who came into the program more than once, 19 entered the program under the same category of support (housing instability = 5, fleeing interpersonal violence = 3, and undergoing healthcare treatments = 11) while six had a different category of support for their second admission (from housing instability to fleeing interpersonal violence = 2, from fleeing interpersonal violence to undergoing healthcare treatments = 2, from undergoing healthcare treatments to housing instability = 2).

Client care
Communication was mostly with the primary owner (72.9%, n = 261), followed by a caseworker (22.1%, n = 79), and finally a family member (5.0%, n = 18).A detailed breakdown of client communication reliability by year and species can be found in Table 1.Client communication reliability was similar between primary owners and caseworkers.Of the families who were unable to maintain contact, many initially presented in person to the shelter requesting same-day surrenders.In an interest to be proactive, those families were offered admission for their pets to the UC program by the staff present at the time (as opposed to the UC program staff).

Length of stay
A detailed breakdown of LOS by year and species can be found in Table 1 The program began asking applicants to state what LOS they anticipated needing in March of 2020.When a range of time was stated, the maximum amount of time was used for these analyses (e.g. 2 weeks to 1 month was treated as 30 days).Of the 307 admissions that stated their requested LOS, the mean request was for 208 days, while their actual LOS was 177 (31 days shorter than requested).

Outcome
At the end of their time in the program, 74.0% (n = 265) of animals were reunited with their owner, 15.4% (n = 55) were surrendered to the shelter because their owner was unable to resume care, 7.5% (n = 27) were surrendered to the shelter due to a lack of contact with their owner, and 3.1% (n = 11) died (8 were euthanized in a shelter for medical  reasons: three cats, three dogs, and two sugar gliders; three died in foster homes: one cat died in foster with no obvious cause found during post mortem exam, one rabbit died in foster with no obvious cause and no post mortem exam, one dog died in foster from being hit by a car; Table 1).
The LOS varied by outcome type (reunited with owner = 144.8days, surrendered because owner could not resume care = 248.1 days, surrendered due to lack of contact with their owner = 354.1 days, died = 64.6 days).The mean LOS of animals reunited with their owner was 137.9 days (n = 230) for clients identified as communicating consistently, 117.8 days (n = 9) for clients identified as having communicated frequently, 196.5 days (n = 23) for clients identified as communicating infrequently, and 353.0 days (n = 3) for clients identified as having nonexistent communication.
The breakdown of outcome type by species, the reason for support, frequency of client communication, and the presence of medical and behavioral concerns can be found in Table 3.A greater proportion of cats with identified behavior concerns were surrendered because their owner could not resume care than cats without behavior concerns or dogs with or without behavior concerns (Fig. 2).Animals without identified behavior concerns were reunited with their owner more frequently (78.8%, n = 197) than animals with identified behavior concerns (63.0%, n = 68).

Cost of care
The mean cost of care was $19.20/day, which is notably less than the mean cost of care for pets housed in the shelter ($115.23/day;Table 4).The difference in cost was almost entirely due to staffing costs.

Discussion
Most animals in THS's UC program were reunited with their owner at the end of their term, helping preserve the human-animal bond 265 times.This may be particularly meaningful for people healing from crises such as housing instability, fleeing interpersonal violence, or undergoing healthcare treatments.The factors associated with the highest rates of reunion upon program completion were species (specifically dogs), requests in support of people fleeing interpersonal violence, consistent or frequent communication with the client, and not requiring veterinary or behavioral care/training beyond standard levels.
This builds on a comparable study 11 reviewing a similar program, by including data on applications, reviewing a larger sample size, including data on client communication, and including information on behavioral concerns.Notable differences in findings are that the current study presents a greater number of animals per year, a greater number of cats than dogs, a longer LOS, a lower percentage of animals reunited with their owner, and variation in disease prevalence.THS's program also supports a wider range of reasons clients' needed support, allowing  12 .THS is currently considering offering low-cost foster-based support for people citing "personal emergency travel" as the reason for applying for the UC program, to help applicants rejected due to scope and reduce surrender in these cases.Finding placements for large dogs was particularly challenging, a problem common across the industry. 13Creating targeted marketing campaigns for large dog foster parents may be helpful in the future.Declines due to behavioral or medical concerns may have been because the concerns expressed on the application were beyond the capabilities of THS, but frequently were because THS was at or above its capacity for animals with those types of concerns and require a high degree of support from our veterinary and/or training departments (whether in a shelter or in foster).It is crucial that all shelters operate within their capacity for care in order to provide appropriate care to the animals in their custody. 14dmissions per month to THS's UC program increased each year during the study period.This could be reflective of increased need or due to increasing awareness of the program within the community.Creating targeted marketing campaigns for foster parents in the late spring could help meet the need during the months where demand has historically been highest.This study took place during the COVID-19 pandemic, and the timeline of events such as restrictions lifting in the summer months, the ending of eviction moratoriums, resumption of elective medical procedures, reopening of community health and social services, as well as legislative changes regarding shelter capacity could easily have impacted peaks in admissions.
Continued monitoring of program admissions will reveal if summer months continue to have the highest number of admissions.The number of animals admitted per month has increased each year in support of people experiencing housing instability.While there may be many factors contributing to this trend, the rising cost of living (and housing in particular), seemingly an indirect impact of the pandemic, is almost certainly a factor -especially considering inflation impacts low-income households relatively more than high. 15Caretaker hardship is among the most commonly reported reasons for surrender, often felt most acutely by structurally marginalized populations (e.g.health, housing, low socioeconomic status). 16,17There is a relative lack of research on interventions to prevent surrender. 16,18It has been suggested that animal surrender may be best prevented by programs utilizing a One Health framework, 13,17 such as the UC program at THS.This may help to curb the inequitable flow of animals from more vulnerable communities into more privileged communities, 19 ensuring that all populations are able to enjoy pet ownership and its resulting benefits on mental and physical health.
LOS declined each year of the study -possibly due to increasing efficiency as THS's experience with the program matured.Accordingly, the decision was made to reduce the maximum LOS for the program to 6 months (with the possibility for extensions in unique circumstances) to be more in line with the reported data and to make placements more appealing to foster parents.
Based on our results regarding the ultimate surrender of UC foster animals, organizations that launch similar programs should be aware that a large proportion of cats presenting with behavior concerns may end up in their adoption streams.However, a large proportion of the behavior concerns observed were associated with fear in a new environment, rarely accompanied by aggression.Once settled in a foster environment very little intervention or support was required.Also, at least at THS, this type of behavior concern is not known to be a barrier to adoption.
It was notable to find that pets from people fleeing interpersonal violence had the highest rates of being reunited with their owners, had the lowest rate of medical conditions, and had the lowest rates of behavior concerns identified.Organizations that choose to launch similar programs may consider starting with this particular reason for support in order to gain experience and streamline systems before adding the other support streams.
The data support making additional changes to THS's UC program.While no changes have been made to the requirement of the program in response to concerns about the wording of the application, an effort is being made to make the language more clear and less distressing.THS is also considering offering transport to UC program applicants who are unable to participate in the program because they lack this resource.Finally, deviation from standard protocol to facilitate same-day requests may have contributed to miscommunications, leading to animals being enrolled into the program in cases where families had no intention of reuniting with the animal.Accordingly, the process has been adjusted to ensure that UC program staff conduct the suitability assessment and provide alternatives (where appropriate) to families presenting with immediate needs.
There are a few other aspects of THS's UC program that may answer questions that could be posed by other organizations operating or considering launching similar programs.Ontario currently has Breed Specific Legislation that imposes significant restrictions on ownership of some dog breeds.THS's UC program accepts banned breeds but requires strict adherence to the associated bylaws.When requests are received for brachycephalic breeds or animals with non-Canadian origin, extra caution is exercised due to concerns of morphological medical conditions or disease transmission.Often families requesting care for multiple pets request the animals remain together in foster homes.This is typically manageable for cats but not always feasible for dogs, especially larger breeds.While domestic pets other than cats and dogs are welcome in the program, it is up to each organization to determine if they have the ability to meet the needs of these animals in similar programs, taking into account factors such as the life span, medical, husbandry, and enrichment needs.

Conclusion
THS's UC program presents a relatively inexpensive and effective way to help support people undergoing temporary crises, thereby preserving the human-animal bond that may help them heal in the aftermath of these crises and preventing the avoidable relinquishment of animals to shelters.Through analyzing program data, opportunities have been identified for improving the program to better serve our community, such as offering low-cost foster-based support for people applying to the UC program during "personal emergency travel," initiating targeted marketing campaigns for foster parents in the late spring or for large dogs, reducing the maximum LOS for the program to 6 months, clarifying language used in our contracts, offering transport where this resource is prohibiting participation, and improving our adherence to standard protocols for admission to the program.

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Consider starting with a program tailored to helping people fleeing interpersonal violence, to gain experience and streamline systems before adding the other support streams.However, it is notable that there are far fewer programs servicing the other reasons for support included in THS's UC program (housing instability and healthcare treatments), so opening your program to these causes as soon as possible could greatly help these underserved communities.• Send all program animals to foster as soon as possible -preferably arrange foster placements before intake.This will not only be best for the welfare of the pets, but the organization will also incur less cost.• Create targeted marketing campaigns for foster parents in advance of summer months in anticipation of increased program need and for large dogs in order to secure foster homes for animals that can be more challenging to place.• Data suggest that 6 months is a suitable maximum length for this service, with the potential to extend in extenuating circumstances.• Allow owners to self-refer for the program.Some similar programs require applicants to be referred by a case worker, but our data did not reveal a disadvantage with self-referral (i.e.communication reliability was similar between primary owners and caseworkers).

Fig. 1 .
Fig. 1.Number of animals admitted each month to THS's Urgent Care foster program during the study period.

Table 2 .
Number of health concerns recorded for all animals enrolled in THS's Urgent Care foster program during the study period, by species

Table 3 .
Outcome of animals admitted to THS's Urgent Care foster program during the study period, by species, reason for support, frequency of client communication, and additional care requires -n (%) Insights from THS's UC fostering program this paper to analyze differences in animal-level variables between reasons for support.The cost per animal per day was surprisingly similar, with the previous study 11 reporting a mean cost per animal per day of $16.27 USD ($22.73CAD).Admittedly, neither study took into account how the cost of care per animal can vary based on a variety of factors such as size, age, and care requirements Citation: Journal of Shelter Medicine and Community Animal Health 2024, 3: 82 -http://dx.doi.org/10.56771/jsmcah.v3.82 7

Table 4 .
Cost per animal per day for animals in THS's Urgent Care foster program (UC) and for animals in THS's shelter facility (CAD)