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A recent nationwide study found almost 28 percent of households with pets experienced barriers to veterinary care, with finances being the most common reason. In low-income households, the researchers found, financial and housing insecurity can increase the risks that animals will not receive the care they need. Sociologist Arnold Arluke, author of Underdogs: Pets, People and Poverty estimates that 66 percent of pets in poverty have never seen a vet at all.

The “why” behind those numbers is complex. Of course, money is the primary problem. Veterinary care is expensive. A majority of practitioners work in for-profit clinics, consolidation in the industry has increased emphasis on profit margins, and vet prices have risen faster than the overall rate of inflation. That has checkups starting at $50, dental cleaning going for $70-$400, and blood work and x-rays at $80-$250. If a dog breaks a leg or eats a sock, surgery costs begin at four figures.

High prices aren’t necessarily about greed. Michael Blackwell, a former Deputy Director of the Center for Veterinary Medicine at the FDA, is the chair of the Access to Veterinary Care Coalition (AVCC) that was formed in 2016 to study this very problem. Veterinary training, he said, teaches vets to practice a “gold standard” of care, which means running every possible diagnostic test and pursuing every treatment option, even when a client’s budget is limited. (Many pet owners don’t know they can decline a recommended procedure, such as blood work, and even fewer are willing to decline care for fear of looking heartless.)

Some private vets offer struggling clients discounts, added Jeremy Prupas, DVM, Chief Veterinarian for the City of Los Angeles, but they themselves carry an average of $150,000 in student loan debt, so they simply “can’t carry the immense existing need on their own.” Telling clients you can’t help them because they have no money is one of the leading causes of burnout in the veterinary profession, according to Prupas. Pet insurance might help defray costs but requires monthly premiums and comes with such a complicated array of deductibles, co-pays, caps, and exclusions that one how-to guide recommends hiring an attorney to review the policy. Credit cards designed for medical care financing, if one can qualify, can carry punishing interest rates as high as 26.99 percent.

Equally critical is a long-term failure on the part of the animal welfare movement to consider, much less prioritize, the needs of low-income pet owners. Since the 1990s, the rescue/humane world has poured vast amounts of funding and energy into cutting shelter euthanasia through adoption, but far less into helping those without money take care of the pets they have. “If you can’t afford an animal,” the thinking went, “then you shouldn’t have one.”

“Until recently, we focused on shelter-centric challenges,” acknowledged Amanda Arrington, senior director of the Humane Society of the United States’s Pets for Life Program, which assists low-income pet owners. “There was a lot of judgment and making determinations on who was or wasn’t deserving of support and resources that was influenced by what I think a lot of society is influenced by, which is classism and racism. We conflated a lack of financial means and access with how much someone loves their pet or desires to care for it.”

In fact, owners can be punished because they can’t afford veterinary care — “most humane neglect cases stem from an inability to get care for a pet,” said Prupas. In Michigan, for example, failing to provide an animal with adequate care, including medical attention, is a misdemeanor that can carry 93 days in jail and/or a fine of up to $1,000. With a second violation, it becomes a felony.

What exists for pet owners in poverty is a patchwork of low-cost care options, ranging from local efforts — such as Emancipet in Texas and the Philadelphia Animal Welfare Society — to well-funded national enterprises such as Pets for Life, which operates in several dozen cities. The great majority, however, offer only basic services like sterilization, vaccination, and flea treatments. “We are not a full-service veterinary clinic and do not treat sick or injured pets,” warns one low-cost option on its website. Another suggests that needy people travel, since “vets in smaller towns may charge lower fees,” or start a GoFundMe. As a result, many types of care are largely unavailable: emergency care (by some estimates one in three pets will have an emergency need each year), management of chronic conditions such as diabetes or kidney disease, medication, dental care (dental disease affects perhaps 80 percent of older dogs), and the mercy of humane euthanasia (which can run $50-$300).

The final piece of the care gap is a practical and cultural disconnect. Because many economically challenged neighborhoods are “vet deserts,” with few if any practitioners, it’s not easy to find care, and reaching it can require wrangling an unhappy animal over distance and/or arranging private transportation. Keeping an appointment at an office with weekday-only business hours or a once a month clinic can mean losing a day’s pay. Paperwork raises the fear of immigration status inquiries. The veterinary profession also remains one of the country’s whitest: Just as people who feel alienated or unwelcome don’t utilize human health care options, pointed out Arluke, they don’t utilize care for their pets.

The result has been suffering: most directly for animals that remain untreated, die from what vets call “economic euthanasia” (putting an animal down because treatment costs too much), or end up in shelters. Fear of a looming vet bill, and the mistaken belief that all shelter animals receive medical care, is a prime cause of owner surrender.

But people pay, too.

Some sick animals can infect their humans. Roundworms, for example, can pass through contact with pet feces and cause lung, heart, and eye problems. Blackwell reports meeting an optometrist who practices in a low-income Florida community who has seen increasing numbers of children with roundworm larvae in their eyes.

The psychic toll is just as real. Families in poverty who love their pets and for whom “they offer an emotional core and possibly one of the only sources of joy” face “mental and emotional” devastation from the unimaginable choice of weighing that love against potential financial ruin, said Blackwell. Professor Katja M. Guenther, author of The Lives and Deaths of Shelter Animals, called the rupture of an animal-human bond “a kind of community violence” in a 2021 webinar.

Change seems increasingly possible. Covid-19 and the country’s recent racial and economic reckoning has prompted humane organizations to examine their assumptions and biases about who has the “right” to a pet’s love, and, said Arrington, there’s increasing recognition that “racial and economic injustice really impacts animal welfare.” Meanwhile, AlignCare, a new program out of Michael Blackwell’s Program for Pet Health Equity, is trying to create a national model of something like Medicaid for domestic animals. Under the program, families already found to be struggling (because they participate in SNAP or a similar program) and who ask for help at a shelter or veterinary clinic will be signed up and paired with a veterinary social worker or support coordinator. They’ll then be directed to a veterinarian who has agreed to offer preventative, dental, and even critical care, for a reduced fee; AlignCare will pay 80 percent of the cost. After three years of pilot programs in 10 disparate communities, it’s taking on its biggest challenge yet, Los Angeles, where one in five people live in poverty.

AlignCare won’t offer “gold standard” care, instead emphasizing preventative, incremental, and cost-saving measures (such as offering telehealth appointments and limiting diagnostics that won’t change treatment options) when possible. But it will expand the human safety net to include the animals most of us now consider part of our families. And while the effort is currently funded by grants from Maddie’s Fund, the Duffield Foundation, and Petsmart Charities, Blackwell’s goal is “community ownership:” The combined involvement of local vets, city animal services departments, social service agencies, rescue and community organizations, pet food and product manufacturers, and affluent pet owner-donors can make the model self-sustaining.

There is no perfect solution for low-income pet owners who need help accessing veterinary care. But growing awareness of the problem is a big step forward. “What we call ‘animal welfare’ is changing,” said Lori Weise, whose nonprofit, Downtown Dog Rescue, runs the Pet Support Space. “The distorted belief that ‘those people’ don’t care about their pets has never been true. People can’t afford care. Sometimes they don’t even know what’s out there; they themselves have never been in a hospital. As more people are brought into the system, we’ll see the first generation to get proper veterinary care.”

“Forty-plus million Americans live in poverty. They have pets and they love their pets,” said Matthew Bershadker, president and CEO of the ASPCA. Given the American average of 1.8 animals per household, Bershadker estimated that over 25 million cats and dogs are living in poverty, and he noted that 52 percent of the clients of the ASPCA Animal Hospital in NYC are living on less than $15,000 per year.

“We see people often who are in their darkest day,” said Lori Weise of Downtown Dog Rescue in Los Angeles, which is dedicated to helping people keep their pets. “They’re facing some other crisis, and they happen to own a dog.”

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Weise’s organization finds many people are at the shelter because they’ve run out of options — often because they’ve run out of money — and they aren’t aware of resources to help. In one ASPCA study, 40 percent of low-income pet owners surrendering an animal to a shelter said they would have kept their pet if they’d had access to affordable vet care, and 30 percent said the same if they could have gotten free or low-cost pet food.

There’s a growing awareness that meeting the needs of low-income pet owners is central to the mission of animal rescue. “Everywhere I go, we are either involved in or are talking to people about safety net services,” said Bershadker. “It’s almost as if a few years back a massive light bulb went off in the animal welfare community and we stopped thinking about how to get animals out of shelters and we started thinking about how to keep animals from coming into shelters.”

Some programs have, in fact, been working to keep pets together with low-income owners for a while, and the people running them have learned some important lessons about what it takes. Downtown Dog Rescue, founded in 1996, has helped keep 12,000 pets from being surrendered to shelters in south Los Angeles since 2013. They don’t have fancy facilities, just a card table and two chairs outside the shelters they partner with, where they start a conversation with people who may be in a panic.

“They’re crying, bawling, shaking, maybe they have a citation — they’re scared,” said Weise. “I say, ‘if I told you I could help you, would you want to get rid of your pet today?’ And they often say: ‘Oh no, I love him.'”

Once they’ve established that someone would rather keep their pet, the counselors start to connect people to resources: a volunteer handymen that will patch a fence for someone who’s been cited for their dog running loose, low-cost training advice, and crucially, options for lower-cost vet care. In L.A., there are free spay and neuter services for low-income pet owners, as well as vets who provide a discount on services to people working with Downtown Dog Rescue. The numbers needed to help someone keep a pet often aren’t huge — Weise said it generally costs them less than $100. One challenge is often persuading vets to volunteer time and offer discounts. “A lot of them have tremendous amounts of student loans,” said Weise. “The young ones are struggling.”

Weise has found that it’s crucial to make it easy for vets to help. They work with three main animal hospitals, so no one vet is bombarded with cases. They make sure billing is free of complications: Clients show up with written vouchers stating what Downtown Dog Rescue is paying for, and there’s one point of contact for billing the organization. For their monthly free clinics, they handle all the organizational details: tables, chairs, event permits, outreach flyers. “The vets just show up, do the work and leave,” she said. “We stay in our own lanes. We don’t give medical advice, they don’t do planning and outreach, and it’s a beautiful relationship.”

As a national complement to the kind of work Weise is doing locally, the ASPCA is researching ways to lower the cost of vet care without diminishing quality. “How do we shorten diagnostic and treatment protocols?” asked Bershadker. “If the vet can diagnose more quickly with fewer tests, it’s cheaper, and if it’s cheaper it’s more accessible.” He pointed to a previous success: a technical advance in performing spay/neuter surgeries called the pedicle tie that’s allowed vets to complete the procedure in a shorter time.

Taking a broader view, Bershadker also thinks the field needs to take a cue from the legal world, which has a discipline of community-based lawyers, and find a way to make that possible for vets. “We need to create an economy around being a community veterinarian,” he said. “There’s a desire for vets to give back to their communities — we need to make it economically viable for them.” Making basic procedures more efficient is one way of doing this. More loan repayment programs for vets practicing in underserved areas like the Veterinary Medicine Loan Repayment Program are another possibility.

It’s critical that services be geographically accessible and that people are aware of them. One way to address those issues and be more efficient in general is to make use of existing institutions that already reach low-income people. One example is the ASPCA’s partnership with Food Bank for NYC to supply pet food, which in its first year has distributed nearly 100,000 pounds of dog and cat food to 254 food pantries.

“Rather than recreate the distribution system that they have perfected over time, we simply add pet food to that,” Bershadker said. “They’re happy about it because they want to serve the entire family, and we’re happy about it because the animals are getting fed.” What’s more, ASPCA puts stickers on the bags of food that inform clients about other services, so now if they need low-cost vet care, they know where to go.

Bershadker said that the animal welfare world needs to think creatively about partnerships like this with other systems such as child protective services, domestic violence services, and law enforcement. “You don’t need to rebuild the infrastructure — it exists,” he said. “You need to attach yourself to what is there.”