‘They've probably had those animals for years – they are like family’: accommodating pets in care homes and their contribution to creating a sense of ‘home’

Abstract

Companion animals, or ‘pets’, are integral to many people's lives and to their sense of home. However, older people living with companion animals are vulnerable to separation from their animals when moving to a care home. Such separation is often a highly significant loss which, combined with other losses, may reinforce experiences of dislocation. Existing research draws attention to the importance of developing a sense of ‘home’ in a care home through reinforcing and preserving personal connections. However, there is a paucity of research examining the preservation of connections between older people resident in care homes and their animal/s. This study draws on thematic analysis of 29 qualitative interviews with older people living in care homes, relatives, care home staff and other relevant stakeholders. It highlights that retaining existing, often long-term, bonds with companion animals represent important continuities and connections which may contribute to positive adjustment to life in a care home and creating a sense of home. However, participants highlighted that supporting an older person to move into a care home with their companion animal may be challenged by real or perceived constraints such as use of shared space, concerns about the risks posed by animals and staff implications. While our study found examples of good practice of how shared residence between an older person and companion animal can be achieved in a care home, other examples highlighted that the time, complexity of planning and structures required to accommodate animals were prohibitive to merit a change of policy and practice. Our research concludes that more attention should be given to the older person–animal bond as an important source of continuity and connection.

Background

The concept of ‘home’ is complex and multi-layered. Attempts to define home and its significance in later life typically juxtapose a range of factors, including the immediate physical dwelling environment, layout and suitability for need; the wider local neighbourhood or region, including the availability and accessibility of key resources; and also the social and emotional dimensions of security, identity, privacy and control, as well as the maintenance of biographical continuity and identity (Rowles and Chaudhury, 2005; Cristoforetti et al., 2011; Peace, 2015). Peace et al. (2005) define home as providing a secure base, from which older people can undertake their daily activities, and create and maintain social relationships. As such, a sense of home is a core basis of security and identity.

Companion animals, also called ‘pets’, are integral to many people's sense of home, realised through factors such as their continuous and shared occupation of the domestic living space including shared occupation of private spaces such as beds and furniture (Beck and Katcher, 1996; Charles, 2016). Moreover, animal care and human–animal interaction are identified as an essential part of daily routine, accompanied by valued social and emotional connections between human and animals (Power, 2008; Fox and Walsh, 2011; Fossey and Lawrence, 2013). These elements of shared space, regular routine and emotional connection may be closely linked to ideas of home.

Care homes and home

Moving into a care home in later life is often a significant disruption to the experiences and meanings that an older person may ascribe to their sense of home and connection with home. Fundamentally, moving into a care home re-locates (or dislocates) the individual physically, psychologically and biographically from their previous home, necessitating the need to create/recreate a new sense of home somewhere else (Rowles and Bernard, 2013). Given the extent to which a sense of home is linked to place and social connections, recreating home can be hard to do, especially where the move was at short notice or unwanted. Moving to a care home often occurs following either a crisis event such as a hospital admission, or gradual deterioration in physical or cognitive health (Cole et al., 2018), meaning older individuals may be facing multiple concurrent sources of disruption, loss, uncertainty and adjustment. This may reduce a person's capacity to invest the physical and emotional energy and effort that may be needed to make a new home in a care setting (Peace, 2015).

Features of the care home environment may tend to inhibit home-making activities. For example, domestic tasks such as laundry are likely to be managed on an institutional level (Buse et al., 2018), and activities such as taking a walk in the garden or even opening a window may be subject to staff approval or availability (Evans et al., 2018; Lovatt, 2018). Bedrooms – typically perceived as the space which most clearly represents the person's ‘own’ space – may be primarily designed to meet the economic requirements of the care home operator as a business, e.g. in providing the most economically profitable mixture of standard-sized and larger ‘premium’ rooms, or in laying out rooms for efficiency of staff access (Nettleton et al., 2018). Horton (2021) notes that investors in the care home market may equate care homes to hotels from an economic modelling perspective. This suggests that they may fail to respond to the significance of care homes as residents' homes, despite rhetoric that encourages the older person to consider the care home as home.

Attempts to support older people in recreating a sense of home within a care home often emphasise the importance of a sense of ‘connectedness’ (Bradshaw et al., 2012; Cooney et al., 2014). However, there are varying accounts of what connectedness means. Typically, there is a strong emphasis on social dimensions of connectedness, such as meaningful interactions with family, friends and wider society, and engaging in activity which is purposeful and meaningful (Murphy et al., 2007; Cooney, 2012). Knight and Mellor (2007) similarly emphasise social connection and suggest that there is sometimes a tendency to over-focus on providing activities in care homes rather than supporting people to develop new social connections and maintain long-standing social connections. Other research has highlighted that connection is more complex than a focus on social connection and includes domains such as spiritual, biological, connection to others, environmental, metaphysical and connection to society (Register and Herman, 2010).

Another line of scholarship has looked at material practices of home-making within care homes. Lovatt (2018) highlights how care home residents engage in home-making through activities such as cleaning their bedroom or offering hospitality to guests. Being able to arrange and organise personal possessions within the care home and having a sense of privacy (e.g. through staff knocking before entering a bedroom) facilitate a sense of home through the demonstration of personal agency, whereas decisions which emphasise a lack or loss of agency (lack of privacy, the absence of defensible space; decisions made for the person about retaining person possessions) inhibit opportunity and motivation to try to find or establish a sense of home (Fitzpatrick and Tzouvara, 2019). As well as these more day-to-day practices of exercising control over one's own home space, Sury et al. (2013) additionally indicate that involvement in the initial decision-making about entering a care home also appears to facilitate adjustment to a move into a care home and motivation to feel or be at home.

There are, however, significant constraints associated with facilitating or achieving a sense of home within a care home. The combination of demands on staff time, the numbers of older people under a single roof who may need support to engage in activities safely, achieving the care and support needs of a population with complex and changing needs, as well as concerns about risk may result in individual preferences being overlooked or perceived as too difficult or time-consuming to meet (Evans et al., 2018; Paddock et al., 2019). In the economic context of care homes frequently being modelled as ‘hotel-like’, or as bedrooms for staff to service as quickly as possible (Nettleton et al., 2018; Horton, 2021), homeliness may be judged implicitly inefficient.

Animals in the care home

Scholarship on pet ownership in later life tends to focus on community-dwelling older adults (see e.g. the majority of pet ownership studies described in Gee and Mueller, 2019). Conversely, much of the scholarship on animals within care homes focuses on animals as a visiting presence within the care home. Often this is with an expressly therapeutic purpose, such as dog-assisted therapy for people living with dementia (Jain et al., 2020). Reviews of both areas of research report some evidence of potential benefits, e.g. increased levels of physical activity and improved mood, although they also note that studies are often small, low-quality and heterogeneous in method and focus (Barker and Wolen, 2008; Perkins et al., 2008; Cherniack and Cherniack, 2014; Gee and Mueller, 2019; Jain et al., 2020). Arguably, however, operationalising the animal–human bond in terms of seeking to prove therapeutic benefit to older people rather detracts from the moral case of the importance of promoting personal connections, choices and sense of home in later life. If, for example, an older person wants to live with her dog in somewhere she is told she should consider to be her home, it is reasonable to ask why that should be contingent upon a demonstrable health benefit. An alternative perspective is that the companionship relationship between a vulnerable adult and their companion animal should be given ethical and legal weight, recognising the substantial elements of loss that older people often undergo as they move into care (Fox and Ray, 2019).

McNicholas (2008) looked specifically at the question of older people living with their own animals within either care homes or sheltered housing, and reported that such settings typically did not have clear policies on permitting companion animals. Managers and staff were generally conscious of the possibility that separation from a pet could be distressing to an older resident, but in some cases inappropriately minimised potential distress for certain groups of residents (e.g. people living with dementia). Managers tended to highlight the perceived challenges of managing animals in a communal setting and often presented the logic of the care home market as a solution: that ideally there should be a mix of care homes that did and did not permit animals, allowing individuals a choice. Visiting animal schemes, however, were regarded by residents primarily as entertainment rather than creating any real sense of affection, connection or relationship with the animal. This may in part be because arranged animal visits are often classed as part of an ‘activities’ schedule, organised by staff who decide upon matters such as frequency and timing of visits. This can perhaps be related back to the earlier-discussed observation of Knight and Mellor (2007) that there is sometimes a tendency to conflate activity with connection within care homes. An enjoyable visit from an animal, arranged by someone else for a set timespan, is unlikely to create a satisfactory alternative connection for those people who have been separated from their own companion animal. Indeed, it could exacerbate feelings of loss and grief associated with the separation.

A small number of other studies with care home staff and managers have similarly highlighted that they often have ambivalent views on pets permanently residing within care homes, and perhaps as a consequence, policies are often also unclear or absent (Smith et al., 2011; Fossey and Lawrence, 2013). The broader wellbeing considerations for residents were borne out by a recent small phenomenological study of residents living with animals in care homes (Freedman et al., 2021). However, research with staff and managers suggests that they perceive a need to strike a balance between the recognised benefits of maintaining a connection with animals, and concerns about animals as posing a risk or causing inconvenience to the care home's operation (Fossey and Lawrence, 2013).

The question of companion animals in care homes, therefore, sits at the centre of a wider debate about the extent to which care homes are or can be judged to have the same quality and meaning as a domestic home. This debate includes factors such as connectedness, the extent to which individual biographical continuities can truly be honoured, motivation to live in a care home, experiences associated with a domestic home and the practices of home-making within the care home. This paper explores participant perceptions of older people living with companion animals in care homes, and the implications for connectedness and a sense of home.

The research questions for the project were:

1. (1) What proportion of care homes in the United Kingdom (UK) currently allow/exclude animals?

2. (2) What, in practice, does advertising a care home as ‘animal-friendly’ mean?

3. (3) What are the perceived benefits and challenges (including costs) associated with permitting companion animals to accompany older people into care homes?

4. (4) What are the implications when older people are not allowed to take their companion animals with them when they move to care homes, (a) for the older person and (b) for the animal(s)?

5. (5) To what extent are policies which exclude pets in conflict with the principles of person-centred care and human rights?

6. (6) What role can law play in promoting improved care home policies, and what form should such legal interventions take?

7. (7) paper focuses on the second and third research questions, addressing them through the lens of ‘home’.

Methodology

Original ethical approval for this study was given by the University of Liverpool Central Research Ethics Committee on 5 July 2019. Recruitment of additional participants due to the impact of COVID-19 upon care home recruitment was approved by the University of Lincoln Human Ethics Committee on 20 November 2020.

The original research plan was for 36 interviews with residents, relatives, staff and managers of care homes to take place, along with a separate workstream of interviews with national charities. At the time of the COVID-19 lockdown in March 2020, 22 interviews within six care homes across three ‘groups’ had been completed. Given the extreme difficulties experienced by people living and working in care homes in the context of the pandemic, the research team concluded it was not appropriate to seek to conduct further research interviews in care homes nor ask staff to attempt to set up remote interviews. The research protocol was, therefore, amended and additional ethical approval sought, to undertake interviews with other people and organisations who might have experience and perceptions regarding older people, their pets and decisions on going into care homes. This paper reports on 29 interviews in total: 22 care home interviews plus seven additional interviews that included discussion of personal experiences of supporting older people with pets in finding care (Table 1). It does not include those interviews within the charity workstream that solely focused upon high-level policy and legislative considerations rather than lived experiences within care homes.

Table 1. Care home interviewees and community respondents

Semi-structured interviews took place either face to face within care homes or via video-conferencing software. Questions explored participants' experiences of living or working with companion animals within care homes, their perspectives of the advantages and disadvantages of older people living with their animals in care homes, and their views on how practical issues could or should be addressed. One joint interview was undertaken with the daughter and son-in-law of a care home resident who wished to be interviewed together. Interviews were transcribed and inductively thematically coded using the approach described by Braun and Clarke (2006). Thematic analysis was chosen as a flexible methodology that allowed for the inductive identification of patterns and themes in participants' discussion of companion animals within care homes. In two instances within the sample of seven additional community-based participants, respondents were unable to commit the time to an interview but provided written responses. These were substantially less detailed than interviews but have been included in thematic coding and analysis.

Findings

The initial analysis identified six key themes: (a) emotions and wellbeing; (b) use of space; (c) risk and harm; (d) about the animal; (e) processes for deciding what happens to a pet; and (f) encouraging animals in care homes.

For the purposes of this paper's focus on home, three sub-themes within these overall themes have been included: (a) connectedness and a sense of home (representing sub-themes within the ‘emotions and wellbeing’ theme); (b) shared domestic space (representing a sub-theme within ‘use of space’); and (c) care home culture and decision-making (representing sub-themes within ‘processes for deciding what happens to a pet’).

Connectedness and a sense of home

Participants, when reflecting on the emotional benefits of companion animals in care homes, made frequent references to them creating a sense of home, comfort, and continued connection and purpose for the older person living with their animal:

…while the dog was living with her, she had something to focus on and at night-time she wasn't alone, because some people feel really lonely. And that little dog slept beside her on the floor in a little bed, like it did at home. (Liz, care home manager, describing a former resident and her dog)

I think it's nice having pets in the care home because it's just like seeing something move about and a little pet and they comfort you, don't they, you know? You know, yeah, very comforting pets are dogs and cats. (Helen, care home resident)

In discussing the importance of residents' personal connections with animals, care home workers and managers sometimes specifically referenced how this might affect the process of ‘settling in’ to the care home as their new home. They emphasised the close relationship an individual might have with their companion animal. In addition, providing care to an animal might be helpful in settling into a new environment and create opportunities, or the necessity, for interaction with care home staff and other residents (whereas, conversely, worrying about an absent animal might be unsettling):

This morning I took an enquiry from a social worker who is looking for a respite bed under the conditions that the prospective resident doesn't want to leave her cat behind. So, they would need to bring the cat in. I don't have an issue with that. I think it's extremely positive that, you know, they've built up a relationship. That is no different to me as having children, you know, you build up your relationships with your children, don't you, and you nurture them, and you care for them. That's no different to having a pet, so if that would enhance their settling in process in the home then absolutely. (Tara, care home manager)

Another care home manager described a situation where a resident's family had decided (in the manager's opinion, incorrectly) that total separation from the resident's dogs would minimise disruption:

…when the resident did come in the home it was a big shock and she kept asking for her dogs and wanting to walk her dogs and it made her anxious because they'd [her relatives] not discussed it with her and they'd not told her where the dogs were. And then when we suggested that they bring the dogs in daily, because they came in to visit anyway, they didn't want to do that. They were worried it was going to – in her words – ‘set her off again’ about the dogs. But she was concerned about the dogs anyway. (Sarah, care home manager)

The manager's narrative suggests that the family may have believed that it was better for an older person to have a ‘clean break’ from pre-existing sources of connection, such as dogs. It appeared that the older person's views had not been considered in decision-making, and that the family tended to dismiss her questions and her distress about the dogs. In contrast, the manager considered that while it would not have been practical for that particular resident to keep her dogs within the care home, attempting to maintain the relationship via daily visits would have eased the process of moving into the home.

Other relatives recognised how significant separation from companion animals might be. One participant explained in written comments how distressing it had been for her great-grandmother to experience cumulative losses of connection to vitally important relationships, including her cats being rehomed, during the combination of a move to a care home and the COVID-19 lockdown:

My great grandma had two cats that had been with her for almost 13 years! She had to have them rehomed because the care home would not even consider taking them – well we (her family) had to rehome them as the social worker didn't really seem interested. Honestly it was absolutely heart breaking. I think we all cried including my poor Grandma we told her one of us would go see her every day and she agreed in the end stating that as long as she had visitors from her family she could keep going. We lost her by the end of April 2020 as I believe she had just given up. she had lost everything her husband (who she had been with for 73 years) home (been there for 45 years) and then her cats and just to top it off she couldn't see her family. I still feel cross about it if I'm honest – maybe – just maybe if she had her cats, it would have been something to keep her going. (Jade, written comment, original spelling and punctuation)

This account highlights the profound dislocation and loss of connection older people may experience when moving into care, especially in combination with factors such as bereavement or being unable to see family.

Shared domestic space

Despite the widespread acceptance that animals could contribute to helping older people to feel at home in a care home, there was substantial variations in views as to how animals could be practically accommodated in a care home setting. This often related to the constraints around shared space within care homes, with bedrooms being understood to be an individual's personal area, while other space was shared. As such, accommodating animals such as cats and dogs required consideration as to how they could occupy shared space.

Within the care homes that did accept cats and dogs, the material practices of animal care that were described often sounded relatively domestic in scale and structure. Animals were described as moving flexibly between personal and shared space:

Interviewer: Did [dog's name] enjoy being here?

Angie: He did, yes, he did like it.

Interviewer: OK, so did he have his bowl in your room and so on as well?

Angie: He did, yes. But sometimes he used to get fed on the unit. You know when we're having our dinner. Sometimes he'd have a plate of meat or whatever. (Angie, care home resident who had formerly owned a dog)

I think it was a Shih Tzu, and that was deaf and blind, and again it knew – its food bowl used to be in the kitchen, and it used to automatically go to its food bowl and then go to the door. And then whatever staff was in the kitchen at that time, let it out. (John, senior carer, discussing a former resident's dog)

In contrast, participants who had little or no experience of animals living in care homes often had difficulty envisaging how arrangements might work. Some simply assumed animals were never permitted in care homes:

Interviewer: I was mentioning earlier that there are some care homes that allow animals to live on the premises. Is that something you've ever come across?

Jo: No, I haven't, I didn't even know they did anything like that to be honest. (Jo, head housekeeper)

Other participants were aware of the concept of a care home permitting dogs but assumed that the dog would need to be living separately rather than occupying domestic space within the care home:

Tony: What they would have to do, they would have to have some sort of kennels nearby or on-site.

Carol: They'd have to have somebody…

Tony: And they would have to look after the dogs and then they could go and see the dog.

Carol: Yeah, they'd have to have somebody specially looking after them, walking them and everything.

Tony: But the cost would be quite a lot, wouldn't it? (Tony and Carol, son-in-law and daughter of a care home resident)

Some residents similarly highlighted that while they enjoyed having animals visiting, they would have concerns about the possibility of resident animals entering private bedroom space overnight:

Interviewer: So, you're positive about having animals in care homes?

Evelyn: Well, I don't know about them sleeping. But probably have a kennel outside.

Interviewer: OK. So, you think they couldn't probably sleep inside?

Evelyn: No. It all depends how they feel. I mean you wouldn't want a dog wandering in your bedroom at night. (Evelyn, care home resident)

Some care homes were sub-divided into units, and this arrangement was sometimes seen as a useful arrangement to resolve issues over shared space. Both care homes that currently had cats living in the care home had initially put arrangements in place where the cat was only permitted in one unit. In one case this had persisted. The cat lived in the downstairs section of the home, and residents and staff based upstairs stated that they had little contact with her. In the other, the arrangement had been relaxed over time:

We had some people who had been scared of cats when they were younger, so they were a bit concerned about a cat moving in. So, when [cat's name] first came in she was confined to the unit, the part of the building just where [cat owner's] bedroom was, I'm pointing over there because it was that side of the building. So, she stayed there but then she got a little bit cheeky, and she was jumping out the windows and kind of accessing other areas and people just got used to seeing her around. (Maggie, care home manager)

Overall, therefore, decisions about keeping animals within care homes were frequently influenced by the fact that care homes are not straightforwardly a private domestic home. For animals such as cats and dogs, which could not be confined to a private bedroom, there was a need to consider how they could occupy shared space.

Care home culture and decision-making

Linked closely to issues of how animals might use space in the care home was a tension between, on the one hand, recognising the potential benefit for an older adult to live in the care home with their animal, and on the other, managing other aspects of care home operation, such as risk management, demands on staff and financial arrangements. As a result, decision-making was often perceived as the need to balance the perspectives of the individual resident and their family/friends with those of other residents who used shared space, and care home staff.

In care homes that accepted companion animals, the ultimate decision to accept an animal resided with the registered manager. However, all the homes in this study were part of a group, and hence also subject to corporate policy. For care homes 1–4, the group policy encouraged accepting animals where possible. Care home 6 accepted animals but this had been heavily championed by the home's current manager rather than reflecting the policy of the care home group. The manager of a care home that did not accept animals would have referred any inquiries on the subject to a more senior level:

…that's something I would speak to Head Office about, and go along those routes, a bit of guidance as to what we do in that situation, because at the moment I haven't experienced that … touch wood we haven't at the moment. (Louise, care home manager)

Risk was a key consideration in such assessments and was often explicitly balanced against the emotional and other benefits of having animals present:

Because we have got quite advanced dementia here, which yes, I do believe they love it when they [animals] come in. But I think to be here constantly, I think they would – could be quite a risk if they get in the way, or anything like that to the residents, and trip hazards, sort of like that. (Louise, care home manager)

I can see why homes would be scared of doing that [having animals] because it is, it does involve a lot of forward planning and thinking about it and when our Infection Control Nurse visits on an annual basis, she always kind of pulls a face, oh you've still got the bloody cat, you've still got the chickens, you've still got the birds. (Maggie, care home manager)

As Maggie acknowledged, the decision to accept pets involved substantial planning, that went beyond domestic-scale decision-making. Managers who had housed animals described drawing up detailed plans for animal care, considering issues of where the animal would be permitted to go, mitigation of identified risks and the extent of staff involvement. Even for care homes within the same group, there seemed to be different perspectives on how far it would be reasonable to expect care home staff to contribute to animal care, for example whether a carer could be expected to walk a dog:

…we do have a pet's policy obviously, we draw a care plan up to make sure that the cat or the dog or the budgies, or whatever it is, is being well looked after. And families know what their part of responsibility is, especially somebody who lacks capacity, because obviously we don't mind taking the dog for a walk, we find that being a companion, that's their role, as long as it's the right companion who likes the dog, so we have to think about our carer who likes dogs and can take it for a walk, doesn't mind picking up after it. (Liz, care home manager)

I think the actual walking of a dog, we would have to look at that, because obviously the carers, they can't do that. Occasionally they probably could but their focus is resident care. You know you can't go off the floor for an hour and take the dog out … it's a big consideration really. It's not just as simple as saying ‘Yeah, bring your dog in’ because there's a lot more involved than a dog just being in the home. It needs exercise you know. We need someone to take it to the toilet, to clear that up as well. (Claire, care home manager)

Claire's concerns focus on staff capacity. Managers often highlighted an expectation that family would be heavily involved in most aspects of supporting their relative to keep their animal, for example through arranging veterinary care, regular flea and worming treatments, vaccinations and insurance. Care home 6 was an exception to this, possibly due to apparent differences in the demographic profile of residents. Many of their residents did not have families who could or would support them with companion animals:

We've not really had an awful lot of impact from families. But obviously that would be fabulous if they wanted to be involved … People have always said that they would pay for food when the animals came in but that ended up going by the wayside within a few days. So, we pay for that, we fundraise and add that to our activities budget and then we buy the pet food out of that budget. (Maggie, care home manager)

In contrast, the relatives we spoke to generally highlighted the overall difficulty of finding a suitable care home. Such decisions were often already heavily constrained by factors such as geography, costs and care needs. In this context, relatives were doubtful about whether it would have been feasible to find a care home that would also accept a companion animal:

I think certainly if they had a dog, I would have kept going until I found somewhere that would let them have a dog. And I guess if there was nowhere in the area, I would have had to have the dog and then taken it in to see them. But I mean that would have been horrible actually, trying to find them somewhere, knowing they would be separated from … Awful. My main issue, when I was looking for mum and dad was that mum didn't need nursing care but dad did, and there's only two places in [my area] that do that – one of them was horrendous so it left me very few options really. (Sara, owner of an organisation that took animals to visit care homes, and also the daughter of a care home resident)

Interviewer: Was it something you considered when you were looking for care home options? Animal contact?

Sue: No – unfortunately with dementia, not all homes will cater for their needs. Also with Mum's mobility issues, a lot of the older converted old houses, although they might have very high ratings, they weren't suitable for Mum's needs. Similarly, there's some again, highly rated care homes, they only have a commode in the room. Mum is a bowel cancer survivor, so there are quite a few basic needs that are needed, i.e. her own bathroom was paramount. (Sue, daughter of care home resident)

Grace, an older person living in the community, had attempted to ring round care homes for a friend who wished to keep his cat with him, but after several calls had been unable to find any homes that would consider it. Care home managers also acknowledged the challenge for families:

…it's normally a stressful situation before – or a difficult decision to make when somebody comes into a care home – so I think the pet is probably the last on the list. (Sarah, care home manager)

Overall, it appeared that circumstances in which an older person could remain living with a companion animal were often dependent on an alignment of factors, including a care home in the area that was willing to consider animals; a favourable assessment of the older person and the companion animal by the care home manager; and family who were able to advocate for the older person and the animal, as well as provide practical and financial support.

Discussion

This paper has presented findings from interviews with participants who were asked to consider the opportunities and challenges of companion animals living with older people residing in care homes, focusing on the extent to which such discussions addressed matters of ‘home’, connection and space.

The extent to which participants felt that companion animals supported older people to remake a sense of home and connectedness in an unfamiliar care home environment was also considered. Participants almost universally recognised that keeping companion animals could be extremely important for some older people, facilitating continuity, emotional connection and helping to create a sense of home. These conceptualisations can be related to the notion of Peace et al. (2005) of home as a secure base from which to undertake activities and social interactions, concepts of comfort and security, as well as Register and Herman's (2010) environmental and spiritual domains of connectedness. Comments about companion animals helping people ‘settle in’ were clearly rooted in empathy, the importance of the animal–human bond as a relationship continuity and concern for older people moving to a care home. These sentiments were underpinned by an aspiration to support older men and women new to a care home to be supported to feel and be ‘at home’. However, references to ‘settling in’ to the care home may also, to some extent, have a more pragmatic connection to the idea of a smooth and non-disruptive transfer, in which the new resident adapts to the care home routines and accepts that this is where they will be living (Leyland et al., 2016; Scheibl et al., 2019).

Alongside this, there were also some descriptions of incidents in which connections with animals were not prioritised. This may link to the findings reported by McNicholas (2008), who described some participants believing that older people, especially those with dementia or other cognitive impairment, would quickly forget connections with animals, or would have grown accustomed to separation and loss.

Facilitating older people to remain with their animals in a care home was often dependent on decisions perceived to be going ‘above and beyond’ the norm in championing a sense of home. For instance, this might include a care home group deciding to adopt a pet-friendly policy, an individual manager championing animals within her group, or openness to support and advocacy from family and friends for an older person to keep an animal. Often the role of the older person in articulating their desire to remain with their animals and taking an active role in the process was not mentioned. This may reflect a tendency to overlook the importance of ensuring older people, especially those people with cognitive impairment and complex needs, are fully included in decision-making. Foregrounding the animal–human relationship may also be difficult in the overall structural and organisational context of decision-making about care homes. Older people and their families are also likely to have to balance factors such as care home availability, proximity, suitability of care, cost and the potential need to make decisions urgently following a hospital delay or sudden health decline (Katz et al., 2013). In the context of other factors deemed imperative, factors that would support an older person to remain with their animal may end of being compromised or even substantially overlooked.

As noted in McNicholas (2008), discussions were often implicitly framed by the logic of the care home market, with the onus on older people and their representatives to ‘shop around’ to find a care home that would meet their needs, match their budget and include keeping an animal if that was important to them. However, the (dys)functionality of the UK care home market, and the ability for older people and their representatives to access sufficient information to make informed decisions about care options has been previously highlighted (Competition and Market Authority, 2017). At a strategic level, there is a fundamental mismatch between approaches that promote greater recognition of older people's diverse needs in later life (e.g. in the Care Act 2014), increasing costs of care and declining social care funding, along with widespread public lack of understanding of social care funding (Thorlby et al., 2018; Glasby et al., 2021). In this context, care homes often have difficulty recruiting and retaining staff, fees paid do not necessarily meet the costs of providing care, and at least some providers are facing significant financial challenges and considering exiting the market. Under the circumstances, it is perhaps unsurprising that many providers are reluctant to consider potential additional demands associated with companion animals, even where the benefits for an individual older person may be significant.

In this context, it seems doubtful whether individuals can truly exercise an informed choice on moving into care, which reflects important personal priorities such as finding a care home that will allow them to keep a companion animal or otherwise promote a sense of home. The relatives we interviewed highlighted that their choices were often heavily constrained, to the extent that there might only be one or, at most, two care homes that met their relative's health needs within the required geographic area. In this context it would be difficult to prioritise a home that accepted animals. The Competition and Market Authority (2017) notes that older people and their relatives are often poorly prepared for trying to make important decisions within a complex system, often at a time of personal crisis. Information provided by care homes may be unclear, terms and conditions are at times unfair, and it is difficult to correct a bad decision because of the undesirability of repeatedly moving a care home resident. Independent Age (2016) noted that while older people and their relatives often valued factors in a care home that link to concepts of ‘connectedness’, such as a friendly atmosphere, a ‘homely’ feel or continuity of staffing, in practice, they were often unable to prioritise such factors, and tended to settle for a home that met functional requirements, was within budget and seemed satisfactory. Being able to keep a pet may fall into the category of issues people would like to prioritise but feel forced to compromise.

The work involved in navigating the market may also tend to produce inequities. Isolated older people with poor social support, ageing without children, and/or who have financial or health factors that limit their choice of care home may be unable to prioritise retaining a companion animal when entering a care home, as described in the Canadian context by Toohey and Krahn (2018). Older people receiving local authority assistance with care home fees have a personal expenses allowance of £24.90, intended for minor personal expenses (Age UK, 2021). This may be insufficient to meet the costs of caring for an animal. For instance, the PDSA (2022) estimates the average cost of keeping a medium-sized dog to be £61 per month, but this does not include expenses such as veterinary fees for illness or a prescription diet. Recent government social care policy emphasises ‘choice’ and ‘connection’ (Department of Health and Social Care, 2021), values which might seem consistent with permitting people to retain their pets. However, reforms to social care remain hampered by a difficult financial and political climate, resulting in a narrative which focuses on funding at the expense of opportunity to discuss the complexities of achieving good quality social care (Local Government Association, 2021; Wise, 2021; Oliver, 2022). Worsening pressures on cost of living in areas such as energy and food are likely to pose a further challenge to both social care providers and local authority budgets, potentially further reducing flexibility to try to offer meaningful, individualised choices in care that help people feel at home.

The toll of the COVID-19 pandemic on the care home sector may also have an ongoing impact, worsening pre-existing staffing and financial challenges, and introducing new barriers to supporting older people and their animals. The ‘infection control’ concerns regarding animals in care homes may have been heightened, especially given cases of cats and dogs contracting COVID-19 (Stout et al., 2020). Some arrangements for caring for pets within a care home described within this research, such as family members managing walks or vet visits, are likely to have been much more difficult at a time when visits were restricted and personal freedom to be outdoors was limited to daily exercise. On the other hand, contact with pets was also flagged as a potential simple, low-cost intervention to maintain social connection during the pandemic (Bethell et al., 2021).

Our findings are therefore located within a broader context of structural and financial factors that may make it difficult for an older person to remain with their companion animal within social care, potentially placing them at risk of grief at separation, and additional difficulties in forging a sense of connectedness and home. It remains uncertain how far proposed reforms will address these challenges, particularly given the impact of volatile global and political circumstances on the pandemic recovery, cost of living, and recruitment and retention in the care sector.

Strengths and limitations

This study captured a range of perspectives from care home residents, relatives, staff and managers on pets within several different care homes. This included practical examples of different approaches that had been adopted, as well as rich qualitative personal and emotional accounts of the impact of different policies.

The context of the COVID-19 pandemic meant that not all planned fieldwork was completed. We conducted fewer than intended interviews within care homes that did not permit resident animals. It is also likely that this type of research is subject to self-selection and possibly social desirability factors: people who are strongly passionate about the benefits of animal contact are probably more likely to volunteer to participate in interviews on the topic, compared to those who are indifferent or dislike animals. It is also possible that the institutional context of care homes may have tended to make it harder for some individuals, such as junior staff, to disagree expressly with the company or management policy. It is therefore likely that there are other views on animals within care homes that were not fully captured here. In analysis, we have tried to highlight the extent to which participants emphasised the need to balance different considerations and perspectives.

Conclusion

This study highlighted that companion animals were widely recognised as a potentially important source of connectedness for older people in later life. Most participants recognised, in principle, the benefits of supporting an older person in remaining with their companion animal and emphasised how this might build a sense of home and connection. However, participants also highlighted constraints and concerns attached to keeping an animal, related to the nature of a care home as a space that was both the individual's home and subject to other practical and economic considerations.

It is widely recognised that the social care sector in the UK needs significant reform. It is important that reforms facilitate older people who need care to be supported to maintain key sources of connectedness and a sense of home should they move to a care home – which for some people, includes keeping a companion animal. Participants described factors such as good care planning, advocacy by relatives and care home staff, and flexibility in problem-solving, as helping to overcome barriers to keeping older people with their companion animals. However, ultimately such good practice is likely to remain localised and inconsistent in the absence of structural reform that helps to facilitate meaningful choice about home in later life. The older person–companion animal bond should be recognised as an important source of continuity and connection in later life. We recommend that future research and policy development be directed towards practical routes to supporting and maintaining that bond, including within residential care settings.