Introduction
Pets can provide companionship, stability, and a sense of purpose for their owners or caretakers.1–3 Between 5% and 25% of people experiencing homelessness (PEH) own pets.4,5 While PEH who own pets might experience benefits, pet ownership among PEH also introduces additional challenges. Pets can be a barrier to finding permanent housing or homeless shelter admission.1,3 Previous research5 suggests that only 6% of homeless shelters allow pets, although allowances for service animals might be more common. Additionally, many public transportation services are not pet friendly, which potentially prevents pet owners from accessing other services.
People experiencing homelessness as pet owners are more likely than housed pet owners to find fleas on their pets given increased time spent outdoors as well as challenges with obtaining and consistently using flea preventatives.3,6 Furthermore, PEH might be at an increased risk of acquiring zoonotic and vector-borne diseases because of increased time spent outdoors; increased contact with animal hosts; increased contact with disease vectors, such as fleas, mosquitos, and ticks; and limited access to waste removal and pest control services.7–10 Fleas can transmit numerous zoonotic pathogens to humans, including Bartonella henselae (the causative agent of cat scratch disease), Rickettsia typhi (murine typhus), and Yersinia pestis (plague).11 In addition, fleas can transmit Dipylidium caninum (tapeworms) to dogs and cats.
Homeless shelter and outreach organizations provide health and hygiene services to PEH and are therefore an essential component of risk identification and mitigation for flea infestations among companion and service animals of PEH. Homeless shelters may provide shelter, food, laundry, or hygienic services to PEH, while outreach organizations bring services and care directly to PEH and connect them with housing and other health and social services. Limited data are available to describe standard practices regarding pets in homeless shelters and outreach settings, including admission procedures, screening and prevention of flea infestations, and availability of veterinary care.
We administered a survey to staff working in homeless shelters and outreach settings to evaluate their knowledge of fleas and flea-borne diseases, their practices regarding screening and management of flea infestations among pets of PEH, and provision of veterinary care.
Methods
Ethics statement
This study was reviewed by the CDC and the Colorado Multiple Institutional Review Board and was determined not to be human subjects research. The study was conducted consistent with applicable federal law and CDC policy.
Data collection
We analyzed a subset of questions asked during a broader survey of knowledge, attitudes, and practices related to vectors and vector-borne diseases among staff providing services to PEH (Supplementary Material S1). The full survey design and study methodology are described elsewhere.12 Briefly, between August 2022 and April 2023, surveys were administered in person to staff and volunteers working in homeless shelters or homeless outreach organizations in 7 states (California, Colorado, Minnesota, Georgia, Maryland, New York, and Washington). Between 10 and 15 sites in each state were invited to participate. Field teams visited each participating site, conducted 1 standardized site assessment per location or outreach team, and administered surveys of knowledge, attitudes, and practices to 2 to 5 staff members at each site. Each survey was anonymous and voluntary. Survey response options included multiple-choice and free-text responses. Data were recorded on paper forms and managed with a secure, web-based software platform (Research Electronic Data Capture [REDCap]; Vanderbilt University).13
Statistical analysis
We conducted descriptive statistics with Excel, version 2402 (Microsoft Corp), to summarize and compare practices involving pet and service animal admission into homeless shelters, flea preventative and screening practices, and availability of veterinary care overall and by state and setting (homeless shelter vs outreach; Table 1). Respondent age, gender, and time spent working in homeless shelters and with PEH were evaluated.
Characteristics of pet/animal services and flea control at homeless shelter and outreach sites in 7 US states, 2022 to 2023.
| No. (%) of responses | |
|---|---|
| Homeless shelter site assessment (N = 60 shelters) | |
| Are pets or service/companion animals allowed? | |
| Yes | 46 (76.7) |
| No | 13 (21.7) |
| No response | 1 (1.6) |
| Are veterinary services available on site? | |
| Yes | 1 (1.7) |
| No | 59 (98.3) |
| No response | 0 |
| Are flea control services/medications provided? | |
| Yes | 7 (11.7) |
| No | 39 (65.0) |
| No response | 14 (23.3) |
| Outreach setting site assessment (N = 29 outreach sites) | |
| Are veterinary services available during outreach visits? | |
| Yes | 2 (6.9) |
| No | 27 (93.1) |
| No response | 0 |
| Are flea control services/medications provided? | |
| Yes | 2 (6.9) |
| No | 27 (93.1) |
| No response | 0 |
| Shelter KAP survey (N = 227 shelter staff) | |
| If animals such as pets, companion animals, or service animals are allowed, are these animals screened for fleas and flea bites? | |
| Yes, at admission | 32 (18.5) |
| Yes, at regular intervals | 6 (2.2) |
| Other/unknown | 17 (9.8) |
| No | 115 (66.5) |
| No response | 3 (1.7) |
| Are steps taken to treat fleas at this shelter? | |
| Yes, at admission for all people and animals | 15 (6.6) |
| Yes, at admission for any person or animal found to have fleas | 19 (8.4) |
| Yes, at regular intervals for all people or animals | 15 (6.6) |
| Yes, at regular intervals for any person or animal found to have fleas | 17 (7.5) |
| No | 114 (50.2) |
| Other/unknown | 44 (19.4) |
| No response | 3 (1.3) |
| If an animal is found to have fleas or flea bites, are they kept away from other people and animals? | |
| Yes, individually | 97 (42.7) |
| Yes, kept separate with other animals with flea infestation | 4 (1.8) |
| No | 37 (16.3) |
| Other/unknown | 68 (30.0) |
| No response | 21 (9.3) |
KAP = Knowledge, attitudes, and practices.
Results
We administered 333 surveys at 60 homeless shelters and with 29 outreach teams in 7 states. In total, 227 (68%) surveys were completed at homeless shelters, and 106 (32%) were completed at outreach sites.
Among the 60 site assessments administered at homeless shelters, 59 (98%) responded to questions about pets/service animals; 1 staff member declined to respond. All 29 outreach site assessments included responses to questions about pets/service animals. Full details about site characteristics are presented in Rich et al.12
Homeless shelter site assessment
Most homeless shelters (46 of 59 [78%]) reported that pets or service animals were allowed (Table 1). A single homeless shelter (1 of 60 [2%]) in California reported that veterinary care was provided. Few homeless shelters of those that allowed pets or service animals (7 of 46 [15%]) reported providing flea and tick preventatives; these were located in New York (n = 4), California (2), and Maryland (1).
Outreach setting site assessment
Only 2 outreach teams (2 of 29 [7%]; 1 in California and 1 in Minnesota) reported that veterinary care was provided during outreach visits; these same outreach teams also reported providing flea control medications or services during outreach visits.
Homeless shelter survey
At homeless shelters where animals were allowed, less than a quarter of shelter workers (38 of 170 [22%]) reported that animals were screened for fleas or flea bites. At some sites, when asked, “If an animal is found to have fleas or flea bites, are they kept away from other people and animals?” staff noted that animals would not be admitted into the homeless shelter if they had evidence of flea infestation. Nearly three-quarters of participants (158 of 224 [71%]) responded either that no steps were taken to treat fleas at the homeless shelter or that they did not know if steps were taken to treat fleas at the shelter; 3 responses were not recorded. Approximately half of homeless shelter workers (105 of 206 [51%]) reported that animals with fleas or flea bites were not kept away from other people or other animals or they did not know.
Outreach survey
Most respondents (69 of 106 [65%]) reported that less than a quarter of PEH in the outreach setting had pets or service animals. When asked, “What do you do if an animal has fleas?” approximately one-third (34 of 106 [32%]) responded that they would refer the client to a veterinarian, humane society, or low-cost clinic; 25% (26 of 106) of staff replied that they did not know. Other responses included recommending products or treatment, purchasing products or treatment, keeping a safe distance or wearing personal protective equipment, and adopting out the pet.
Discussion
Knowledge of appropriate screening, prevention, and treatment of flea infestations in pets and service animals of PEH was low among homeless shelter and outreach staff that were surveyed in this study. Notably, some staff reported that they would deny shelter admission to pets or service animals or their owners if a flea infestation was identified. Flea infestation of animals is treatable and should not automatically result in separating a pet or service animal from its owner or denying homeless shelter admission or outreach service provision when many highly effective flea treatments are readily available without a prescription.14–16 When flea infestation is identified in a companion animal, homeless shelter staff should attempt to provide appropriate flea treatment and prevention and carefully balance the potential harms of someone remaining unsheltered against the potential risk of flea transmission within a facility. Staff working in homeless shelter and outreach settings might benefit from tailored education and recommendations that could lead to improved animal care and potentially allow PEH to maintain their relationship with their pets while seeking shelter or services. Public health departments may consider adapting or developing tailored training and materials on the prevention and treatment of fleas on companion animals to provide to homeless shelter and outreach staff in their community.
Nearly 80% of workers reported that their homeless shelter allowed pets or service animals; this proportion is much higher than in previous reports.5 The survey distributed as part of this project did not distinguish between pets and service animals when asking whether animals were allowed in shelters. In accordance with the Americans with Disabilities Act, service animals must be allowed to accompany the handler to any place in the building or facility where members of the public, program participants, customers, or clients are allowed; the service animal must, however, remain under control of its handler.17 Pet owners experiencing homelessness might have a particularly difficult time finding adequate housing; a previous study18 found that approximately 95% of surveyed pet owners experiencing homelessness reported that they did not consider housing to be acceptable unless pets were allowed.
In the current study, few respondents in both homeless shelter and outreach settings reported providing veterinary care or flea preventatives as part of their work. While PEH might be able to seek veterinary care through outreach teams or low-cost clinics, these services might be unaffordable or inaccessible. Homeless shelter and outreach teams could consider connecting more PEH to free or low-cost veterinary resources, including those specifically providing services for PEH.19,20 The health of their companion animals is a priority for many PEH pet owners, and improving access to veterinary care could improve the health of both animals and their owners.21–23 While most respondents noted that they did not know what to do if an animal had fleas, or that they would refer the animal for treatment, flea treatment does not require a veterinary appointment, and effective over-the-counter treatment products are widely available, though maybe cost prohibitive.
Our findings are subject to several limitations. First, participants were recruited via convenience sampling, and results might not be generalizable to all staff, outreach workers, or organizations that work with PEH in the US. Second, surveys and self-reported behaviors are subject to information biases, including social desirability and recall bias, and therefore might not represent the practices that occur. Third, given small frequencies when stratifying data by state and survey setting, we were unable to perform meaningful statistical comparisons between groups. Additionally, we were unable to assess the burden/frequency of fleas as a problem among companion and service animals of PEH, as no data were collected on the number of animals with flea infestation. Lastly, asking the survey questions directly to PEH might provide additional context and perspective and should be considered for future surveys.
Improved knowledge related to flea prevention, screening, and treatment might help ensure PEH and their pets can consistently access homeless shelters or outreach services and might help prevent flea-borne disease transmission among PEH and staff in homeless shelters and outreach settings. Increasing access to veterinary care and preventative medications might not only reduce the risk of vector-borne diseases in people and animals, but also reduce the risk of other zoonotic diseases that companion animals can potentially transmit. Training staff that serve PEH in homeless shelters and outreach settings might mitigate these knowledge gaps. Homeless shelters and outreach organizations serve as important source of information and resources and provide a potential opportunity to connect PEH with education about the risks and prevention of flea-borne diseases, affordable veterinary resources, and flea-preventative products. Addressing the health needs of pets and service animals in homeless shelter and outreach settings might also improve access to care and services for PEH, a population at higher risk of vector-borne diseases.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org.
Acknowledgments
The authors thank the staff and administrators at each participating homeless service organization for their contributions to this study. Additionally, they thank Brian Herrin, Taylor Bostic, Heather Barr, Miguel Chevere-Rodriguez, Caroline Waddell, Marissa Taylor, Julie Thompson, Alicia Fry, Uk Chi-Ukpai, Devon Mendez, Alejandro Ramirez, Renee King, Christina Ng, Alyssa Bouscaren, Patrick DiBari, Kinsey Dinan, Nang Thu Thu Kyaw, Jeannie Asbury, David Washington, Danielle Stahl, Diana Gaviria, Miguel Franco, Emily Matthews, Angela McCauley, Paniagu Kostak, Liana Kostak, Carolyn Sledzik, Julie Bowlby, Mary Grace White, Neil Patel, Andrea Natal, Megan Groves, Megan Goffney, Angela Moore, Anna Katz, Joseph Eldred, Dillion McManus, and Melinda Becker for assistance with creation of survey materials, participant recruitment, survey administration, and/or data entry. The authors thank Ed Cotton and Rebecca Klenda for assistance with gift card acquisition and Ashley Meehan for her thoughtful review and input.
Disclosures
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or other agencies with which the authors are affiliated.
No AI-assisted technologies were used in the generation of this manuscript.
Funding
This study was funded by the CDC.
ORCID
A. Carpenter https://orcid.org/0000-0003-0118-2726
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