cats and capacity for care

Cats, care, and capacity: how much is

enough?

Kate F. Hurley, DVM, MPVM Koret Shelter Medicine Program Director

Center for Companion Animal Health University of California, Davis

www.sheltermedicine.com www.facebook.com/sheltermedicine

My local, open-intake public

shelter, 2014

Maybe it’s not as hard as I thought Scheduled intake

and/or alternatives to intake for cats that exceed capacity for

care and live release

Remove barriers to adoption and

sterilize/return healthy free-roaming

cats that exceed adoption capacity

Just maybe not all at

once…

Reality check

What can our superpowers control?

• Whether there are free roaming cats in the world?

– On any given day?

– In general?

• Whether people are allowed to have or care for cats?

– From a shelter?

– In general?

The limits of our superpowers

• 11 by 7 miles; 2500-3000 cats

• 96 cats trapped, infected with panleukopenia, released by helicopter

• 8 full time teams of 2 hunters hunting day and night

• 5 full time teams of 2 trappers running 500 lethal traps

• Poison injected into 30,000 day-old chicks

• Cats eliminated after 14 years

Climate is not a constraining factor

“there is no apparent relationship between estimates of feral cats and latitude or January temperature in southern Canada (Table 2), and feral cat numbers may be significant in parts of Alaska”

Blancher, P. (2013). "Estimated Number of Birds Killed by House Cats (Felis catus) in Canada." Avian Conservation and Ecology 8(2).

Cats!!!

15 HSUS Pets for Life Report 2014

What can we control?

• Which cats come through our doors, and the outcomes for these cats

• The conditions in our shelters

• The messages that we share with the public

• Where we focus our limited resources

Easier said than done

In all seriousness

• Take time to acknowledge and mourn the ways in which things aren’t the way we wish they were

• Energize yourself with the knowledge that working within our limits maximizes our effectiveness

• Start by setting the bar for capacity for care within the shelter

Where will you set your bar?

The Five Freedoms

How are you doing?

Freedom from hunger and thirst

• Consistent, high quality food – Adequate variety – Properly stored

• Cage setup that prevents spilling or contamination – At least 3 feet (90 cm) of

separation between food and litter

• Calm, quiet feeding time • Adequate monitoring daily and

long term • Freedom from chronic stress

or illness

37/58 cats lost average 6% body weight in first 7 days

Problem?

Solutions… TLC takes a little time

Problems

Partial fixes

Real solution

Freedom from discomfort

• 3 inch (8 cm) soft surface

• Cool hard surface • Sufficient room to

stretch out – 15” by 36” clear space

• Comfortable ambient temperature (60-80 F)

• Dry, clean cage most of the time

Problem

Solution

Freedom from fear and distress

• No dog sight or sound for confined cats

• Hiding place/visual protection

• Limited noise in general

• Protection from hostile interactions

• Limited environmental change

• Stable caretakers

Problem

Solution

Portals: not just for cats any more

Much better

Problem

Next 26 hours

Solution

Quick partial fixes for small cages

http://www.sheltermedicine.com/cage_covers

http://www.sheltermedicine.com/shelter-health-portal/information-sheets/building-an-elevated-bed-for-use-in-shelter-cat-housing

Another solution?

Sufficient space in group housing

• At least 18.3 square feet (1.7 square meters) floor space for group housed – Vertical space doesn’t

count • But it’s good!

– Outdoor space can count in clement weather

• Small enough groups for some stability/ complete turnover

• Single housing option for non-cat-social cats

How many cats?

http://www.sheltermedicine.com/documents/handy-dandy-group-housing-calculator-for-cats

Hmm, this looks to be about 8’ by

9.5’

Freedom from pain, injury and

disease

• Vaccination on intake starting at 4-6 weeks, and every 2 weeks to 20 weeks

• Treatment for external and internal parasites

• Intake screening and daily health monitoring

• Effective, safe cleaning and disinfection

• Reasonable protection from disease exposure

• Isolation and effective treatment for sick animals

• Freedom from stress sufficient to maintain health

Problem?

Animal ID Age Intake date

Date of:

FVRCP #1

Clinical

Signs (Y/N)

Parvo test

Parvo test +

A030632 1 yr 9/2/2010 9/10/2010 Yes N/A

A030633 4 wks 9/2/2010 9/9/2010 Yes N/A

A030728 2 yrs 9/16/2010 9/19/2010 Yes 9/24/2010 Pos

A030377 4 wks 07/22/10 08/01/10 Yes N/A

A030375 4 wks 07/22/10 08/01/10 Yes N/A

A030681 3 mo 09/11/10 09/12/10 Yes N/A

A030682 3 mo 09/11/10 09/12/10 Yes N/A

A030772 8 wks 09/21/10 09/22/10 No N/A

A030774 8 wks 09/21/10 09/22/10 No N/A

A030730 4 mo 09/16/10 09/19/10 Yes 9/24/2010 Pos

A030731 4 mo 09/16/10 09/19/10 Yes 9/24/2010 Pos

A030587 4 wks 08/26/10 09/10/10 Yes N/A

A030588 4 wks 08/26/10 09/10/10 Yes N/A

A030589 4 wks 08/26/10 09/10/10 Yes N/A

Problem

Animal ID Age Intake date

Date of:

FVRCP #1

Clinical

Signs (Y/N)

Parvo test

Parvo test +

A030632 1 yr 9/2/2010 9/10/2010 Yes N/A

A030633 4 wks 9/2/2010 9/9/2010 Yes N/A

A030728 2 yrs 9/16/2010 9/19/2010 Yes 9/24/2010 Pos

A030377 4 wks 07/22/10 08/01/10 Yes N/A

A030375 4 wks 07/22/10 08/01/10 Yes N/A

A030681 3 mo 09/11/10 09/12/10 Yes N/A

A030682 3 mo 09/11/10 09/12/10 Yes N/A

A030772 8 wks 09/21/10 09/22/10 No N/A

A030774 8 wks 09/21/10 09/22/10 No N/A

A030730 4 mo 09/16/10 09/19/10 Yes 9/24/2010 Pos

A030731 4 mo 09/16/10 09/19/10 Yes 9/24/2010 Pos

A030587 4 wks 08/26/10 09/10/10 Yes N/A

A030588 4 wks 08/26/10 09/10/10 Yes N/A

A030589 4 wks 08/26/10 09/10/10 Yes N/A

Solutions?

The real problem

Solution

Problem

Dinnage, J. D., J. M. Scarlett, et al. (2009). "Descriptive epidemiology of feline

upper respiratory tract disease in an animal shelter." J Feline Med Surg.

661/2203 (30%)

Solution?

9 shelters, one year, 49 factors,

25,000 cases of URI…

9 shelters, one year, 49 factors,

25,000 cases of URI…

Drum roll please…

Cage size > 9 square feet Limited movement in first week of care

Solution I am starting to sense a theme…

Full body rub

Relax in a cool spot

Snooze in a warm spot

Get up high

Get down low

Stand tall

Chin rub

Get real long

Look out the window

Snuggle with people

Pounce

Hang out with other cats Drink fresh water

Hang out with dogs Scratch

Spend time outside

Spend time alone

Get real small

Plot world domination

Freedom to express normal behavior

How are you doing?

Partial solutions

At lease 5’ from cage fronts Assigned carriers or beds

Best solution of all

Keep cats in shelter confinement only for necessary time to

rehome: < 2 weeks on average for healthy, weaned cats

Neuter and return or provide alternatives to intake for healthy

cats that can’t be rehomed

One more freedom?

How much is enough?

What kind of capacity do you

Holding capacity: how many animals you can care for at once

Flow capacity: how many animals you can care for over time

Algebra :-0!

• Capacity = Intake x LOS

1. Increase physical and/or staff capacity

2. Decrease intake

3. Decrease LOS

LOS effect on LOS

• LOS is single greatest risk factor for disease

• LOS increases risk for chronic stress

• Every day of LOS takes times and costs at least a little

• Decreasing LOS reduces disease risk, lowers stress for animals and staff and reduces cost

• Less disease, less stress and more money can be used to further decrease LOS

Housing, health and LOS

• Adequately sized, double compartment housing for newly admitted cats reduces risk of URI

• Reducing URI reduces LOS

Housing, stress and LOS

• Adequately sized, double compartment housing reduces stress and encourages friendly, active behavior

• Adopters respond to friendly, active behavior

• Reduced stress and friendly, active behavior reduces LOS

Housing, staff time and LOS

• Adequately sized, double compartment housing takes less time to clean and helps reduce disease spread

• Staff that spend less time cleaning and more time interacting with adopters can help reduce LOS

Number of animals housed and

• For a given rate of outcomes, length of time awaiting outcome is determined by the number of individuals awaiting that outcome

• Self sustaining at any level • Fewer, better quality housing units means fewer individuals in line

Decreasing the # in line at any one time is the most

powerful way to decrease the length of time in the line

Whoaaa…

Start here

And here

C4C at the BC SPCA

• Calculated C4C target (“Adoption Driven Capacity”)

• Put healthy strays straight into adoption

• Eased response to sneezing cats – No more “one sneeze” rule

• Waiting list for owner surrenders and strays – Not without exception

• Portalized or opened portals, dropped group room population to recommended levels

http://cfhs.ca/athome/cat_overpopulation_crisis/ page 47

Before

Taking the plunge

http://www.spca.bc.ca/branches/vancouver/news/news-cat-portals.html#.UyeAZ8tOXIU

Capacity for care is now in implementation

across the province, with strong results

already from most shelters across the

province

• “I know our shelters and most of the staff well. Within seconds of walking in and without asking questions or looking at animals I can tell if they’re practicing C4C simply by reading the staff and reflecting back to what they were like prior to C4C. I can actually feel the reduction in their stress. It’s due to them having the time to properly provide for the animals. “

“Very rare for us now to have URI” “Cats are more

relaxed and healthy…staff is less stressed”

“An overwhelming

success: adoption rate is way

up…cats are happier and more

adoptable”

“The best thing I have seen happen

for cats in the shelter…adoptions up 22%...less stress

for animals and staff”

“Almost doubled our adoption

rate…much larger number are finding

homes faster”

“I love this program…adoptions up 13%...the cats are so happy they don’t say long…length of

stay is down by over 50%”

“Euthanasia down by 15%...length of stay decreased by an amazing 63%”

“Adoptions are up, sickness is down, staff have more

time.”

“Everyone is less stressed…euthanasia is down 40%...we can

now take in more surrenders and strays”

Wow!!!

The math behind the magic

Can you do it?

• Without fooling around with numbers at all:

• If current length of stay in the shelter from intake to adoption is ~15-20 days or more, you can almost certainly double space per cat and drop population – Decreased LOS will be self

sustaining

• If current LOS < 15 days, then let’s get out the calculators

Calculating your overall C4C

• How many cats will come in each day?

• How long will each cat stay?

• Intake x LOS = recommended capacity

Overall recommended daily capacity for non-project cats is:

Daily average intake x 14 or less

Counting cats

• Intake, outcomes and adoptions by month

• Last year and 2 years ago to get average

• By cat versus kitten if you have it

– Err on the side of categorizing cats as adults if you’re not sure

• Think about trends

Intake Adults Kittens

2 years ago 40 25

Last year 31 18

Average 36 22

Expected 35 20

Daily average by month

• Monthly daily average (MDA)

• Intake or adoptions per month, divided by days in the month

• Dividing every month by 30.5 is close enough

• Just look at average, peak and trough to start with

Get cats on the right path

• Start at intake

• Match with housing

• Adoption, transfer, foster, return to field, euthanasia when appropriate

• Don’t load the train with more than can get off at the next stop – Schedule intake by

pathway

– Provide alternatives in the meantime

We are horrified by Dr. Hurley’s

shameless mixing of metaphors on

this slide!

It was not our fault.

Example

Every Monday 100 cats in the shelter

Over the course of the week 75 cats are adopted

Need thoughtful process for other 25

TNR/SNR

Transfer

Admit 25 fewer this week

Euthanasia

OR…cats will continue to stack up…25+25+25…

This won’t end

well…

This won’t end

well…

Ideal LOS pre-adoption/other

outcome • Legal hold

– Short as possible to live outcome for unidentified cats

• Time for evaluation – Don’t wait for friendly and

healthy to get friendlier and healthier

• Needed services – Are you sure? – Max vaccine wait 3 days

• Time for transfer/transport

IDEAL PRE-ADOPTION LOS USUALLY < 7 days

Calculating pre-adoption LOS

Ideal LOS to adoption

• Usually < 7-10 days

• Long end if not visible during pre-adoption hold or for very small shelters

• Cats that move faster make time and space for cats that move slower

This is not a time limit!!!!

Flow and prevalence

Even if “slow track” cats are only a minority of the population moving through, they will tend to be the majority of the cats in the shelter

Adoption LOS fast

track/slow track (adults)

Fast/slow track Percent

Average

Weighted

average

Fast track 75% 3 2

Slow track 25% 20 5

Overall 7

Fast track Slow track

31% 69%

Daily population

predictor based on fast

track/slow track LOS

Let’s try it!

• E.g. 60 cats admitted on average in June

• MDA intake = ?

• MDA intake = 60/30 = 2

• Pre-adoption LOS: 7-10

• Pre-adoption C4C = ?

• Pre-adoption C4C = MDA intake * LOS

• Pre-adoption C4C = 2 * 7 = 14, 2*10 = 20

• Pre-adoption C4C = 14-20

Let’s try it!

• E.g. 45 cats adopted on average in June

• MDA = ?

• MDA = 45/30 = 1.5

• Adoption LOS: 7-10

• Adoption C4C = ?

• Adoption C4C = MDA adoptions * LOS

• Adoption C4C = 1.5 * 7 = 10.5, 1.5 * 10 = 15

Pre-adoption/hold Adults Kittens Total cats Adult housing Kitten housing Total housing

On-site adoption track holding 3 5 8 3 2 5

Other outcome holding 5 -2 3 5 -1 4

Total pre-adoption holding C4C 8 3 11 8 1 9

Actual pre-adoption inventory 10 15 25 10 5 15

Over or under? 2 12 14 2 4 6

Adoption on site C4C 5 5 10 5 2 7

Actual on site adoption inventory 20 30 50 20 15 35

Over or under? 15 25 40 15 13 28

Total moving towards outcome C4C 13 8 21 13 3 16

Total moving towards outcome inventory 30 45 75 30 20 50

Over or under? 17 37 54 17 17 34

The Capacity 4 Care Pathway

Calculator

http://www.sheltermedicine.com/documents/capacity-for-care-pathway-calculator or type “capacity” into search box

Special project cats and kittens

• Cats purposely not actively moving towards adoption

• Treatment in addition to in-house illness e.g. ringworm program

• Neonatal nursery

• Hoarding cases

• C4C makes room for these

Getting on track

• Define your goal and track progress

• Wait for slow season

• One big push – Or a few smaller pushes

• Fast track/open selection

• Schedule intake/wait list – Serve more over time!

• Reconfigure housing to support C4C as space opens up

Engage the community: explain

what and why

http://catadoptionteam.org/news-events/stories/cat-adoption-team-reduces-adoption-fees-to-empty-the-shelter-for-constructi/435/

Fast track/slow track to reduce

population

What if?

Customer # in line Average minutes to serve

Time in line 40

The UC Davis KSMP Muffin Versus Coffee Calculator

What if?

Customer # in line Average minutes to serve Customer type Minutes to serve

1 2 Muffin 1

2 2 Coffee 3

3 2 Coffee 3

4 2 Muffin 1

5 2 Muffin 1

6 2 Coffee 3

7 2 Muffin 1

8 2 Muffin 1

9 2 Muffin 1

10 2 Coffee 3

11 2 Coffee 3

12 2 Coffee 3

13 2 Coffee 3

14 2 Muffin 1

15 2 Muffin 1

16 2 Coffee 3

17 2 Coffee 3

18 2 Muffin 1

19 2 Muffin 1

20 2 Coffee 3

Time in line 40 40

What if?

2 2 Coffee 3

3 2 Coffee 3

6 2 Coffee 3

10 2 Coffee 3

11 2 Coffee 3

12 2 Coffee 3

13 2 Coffee 3

16 2 Coffee 3

17 2 Coffee 3

20 2 Coffee 3

1 2 Muffin 1

4 2 Muffin 1

5 2 Muffin 1

7 2 Muffin 1

8 2 Muffin 1

9 2 Muffin 1

14 2 Muffin 1

15 2 Muffin 1

18 2 Muffin 1

19 2 Muffin 1

Time in line 40 40

What if?

2 2 Coffee 3

3 2 Coffee 3

6 2 Coffee 3

10 2 Coffee 3

11 2 Coffee 3

12 2 Coffee 3

13 2 Coffee 3

16 2 Coffee 3

17 2 Coffee 3

20 2 Coffee 3

Time in line 40 30

What if?

2 2 Muffin 1

3 2 Coffee 3

6 2 Coffee 3

10 2 Muffin 1

11 2 Muffin 1

12 2 Coffee 3

13 2 Coffee 3

16 2 Coffee 3

17 2 Coffee 3

20 2 Coffee 3

1 2 Coffee 3

4 2 Coffee 3

5 2 Coffee 3

7 2 Coffee 3

8 2 Coffee 3

Time in line 40 39

Fast track/slow track

• Prioritize movement of “highly adoptable” – E.g. juveniles, super

friendly, special look (or use scoring system)

– “Skip to the head of the line” to move up to adoption and/or…

– Keep fast trackers in view during stray hold

• Prioritize promotion and enrichment for slow trackers

Cat care day total in 2009: 43,004 Cat care day total in 2010: 32,459

Admitted 179 more cats, adopted 182 more

http://home.arlboston.org/

Win, win, win, win!

• It is working so well I am completely blown away. The response from the public with regard to the lack of crowding has been very positive, and our volunteer retention for cat volunteers has improved with the improved housing conditions for the cats. It is a win win win win program I wish we would have started years ago!

ASPCA PRO: Fast Tracking to Save Lives http://www.aspcapro.org/node/78849

Warning: Adoption promotion

still needed • Promote adoption early,

often and by a variety of means

– Do not wait for crowding!

• Population special efforts

– Historic patterns

– Special occasions

• Individual special efforts

– Characteristics/slow track score rather than time

Adoption Promotions A new, proactive approach to the monthly cat promotions will target cats with low FT scores needing the most promotional support. …to help get them adopted BEFORE they become long term cats.

Turning up the outflow

• Landlord checks?

• References?

• Long applications?

• Proof of vet care?

• All family members/other pets to meet?

Remember me

• Landlord checks?

• References?

• Long applications?

• Proof of vet care?

• All family members/other pets to meet?

• When we started to concentrate on the sense of urgency and how to get them into homes now -- and not hang onto them because we want, not need, but want to do just one more thing; it is amazing how many things are eliminated because they were never really necessary in the 1st place...

• Conversation with adopters to match them with the right pet – It’s ok if it doesn’t work out

– They learned something

– You learned something about the pet

– The pet got a little furlough

• It’s ok to trust your instincts but remember the risks of being too careful too

• So with our 'we can hold 200 cats mindset' -- for the last 3 months, our cat count has been in the 40s and 50s. We are not euthanizing; we are adopting.

Managed admission: controlling

the front end • Short term to get to C4C

or ongoing • Allows thoughtful

balancing act – Needs of cats in the shelter – Needs of cats outside the

shelter

• Allows opportunity for alternatives to be found – By the shelter – By the community

members

• ≠ limited intake

Scheduling just makes sense

• Implementing a managed admission process, in conjunction with calculating our capacity for care to determine the number of appointments, has been incredibly powerful and truly changed how we care for animals and serve the community. Our length of stay has dropped dramatically, the health of the animals has greatly improved and our staff/volunteers are so much happier and truly feel we are doing the best we can for every animal.

Adoption rate went from 54 to 76%!

Length of stay went from 31 to 11

days! Cats euthanized for

URI went from 1279 to 52!

WOW!!!

www.yourspca.org

Not just for owner surrenders

Fast track/slow track scheduling

• Prioritize kittens and highly adoptable young adults

• Set aside designated high quality space for at least a few slow track and super slow track cats

• If possible offer sterilization in the meantime

This is Lou, he is 12 and diabetic. Because we manage our intake he is safe at OHS waiting for a hero to walk in the door. We can only do that because we only accept animals when we have the capacity to care for them. Lou says thanks for advocating for managed intake!

Engage public and staff

118 Cats in Canada report: http://cfhs.ca/athome/cat_overpopulation_crisis/ (page 47)

Take Credit!

Communicate to staff & stakeholders

Still helping animals, just in a different way

Still using resources

Do NOT want the budget cut

Wait for the right time to make C4C

transition

• “We are always low on cats this time of year and do not have kittens on site. So, for us, we did not really have to do much to reduce population except limit intake and move cats to other locations. I only stopped intake on two days to make this happen (12 cats total).”

Matching housing with C4C

• Fine housing but too many cats: – Drop the number of cats in

each group room – Open existing portals – Repurpose extra for special

needs animals

• Plenty of too-small housing: – Portalize side-to-side in

holding areas, up-and-down ideal in adoption

– Closable doors for maximum flexibility/no risk

www.tinyurl.com/portalproject

Coming soon!!!

sheltermedicine@ucdavis.edu

• Still not enough housing?

– Condos/cages with 30” compartments with up/down, side/side portals for maximum flexibility

• Kittens per 30” compartment at peak

• Cat per double or quadruple at trough

• Not enough slow track housing?

• Break large group rooms into smaller groups – 3-5 cats ideal – Periodically adopt down to

• Create some large single units, e.g. repurposed dog runs

• Use a good disinfectant and feel free to use coated wire, wood, other cost effective, lightweight material

Remember C4C tends to increase

C4C increases C4C

“I am a dedicated advocate for C4C. I have noted a significant increase in LRR (last year 86%) and we have not seen URI at the shelter for a couple of years. With the reduced LOS, less illness and reduced euthanasia cost we are now able to help cats we previously would not of had the budget for. A couple of weeks ago we were able to have a large benign tumour removed from a 16 year old cat who is now available for adoption. “

Putting it all together

• Staying within C4C

• Less illness and more, quicker adoptions

• Shorter length of stay, reduced costs

• More resources to build community capacity

• Fewer animals needing shelter in the first place

Repeat as necessary

The 5 million lives campaign

• “Prevent incidents of harm” compared to pre-campaign baseline

• Identified 6 key initiatives and provided specific resources for implementation

• Voluntary declaration of participation by > 4,000 hospitals

"The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.“ http://www.ihi.org/Engage/Initiatives/Completed/5MillionLivesCampaign/Pages/default.aspx

The Million Cat Challenge

• UC Davis and University of Florida shelter medicine programs

• 5 initiatives to balance intake, capacity and outcomes

• Voluntary participation by North American shelters

• Baseline 2012, decrease euthanasia/increase live release 2014 – 2019

www.millioncatchallenge.org

Alternatives to intake

Managed admission

Capacity for Care

Neuter and Return for

Community Cats

Remove barriers to adoption

Coming to a world wide web near you in

November 2014!!!

Want to get on the bus?

info@millioncatchallenge.org

Return to field mini-overview

Feral cats are being captured, neutered or spayed, microchipped then released back to the streets under a new program called Feral Freedom, adopted by the City of San Jose.

Return to field aka SNR

• Un-owned feral or fearful cats presented to the shelter

• Good body condition

• Sterilize, vaccinate, ear tip

• Return near location found

• No feeder required

http://www.bestfriends.org/uploadedFiles/Content/Resources/Resources_for_Rescuers%281%29/Community_Cats/FeralFreedomGuide.pdf

Sharing the good news?

During the first several months of the program, animal control officers and intake desk staff told people dropping off nuisance cats that the cats would be sterilized and returned. This resulted in many heated discussions and complaints from citizens. So, JACPS decided to take cats in and gather the needed information without getting into the specifics about what would happen next. This policy has resulted in far fewer complaints and less stress for the staff involved.

Results

More results

DOA pickups

down 17%

Why???

Rabies risk from cats decreased by 11% Toxoplasmosis risk unchanged

What about sterilization without eradication?

Rabies and toxoplasmosis risk from cats decreased by 33%

The end?

Or just the beginning?

sheltermedicine@ucdavis.edu for questions, portals, to enroll in the million cat challenge, to tell us how it’s going, etc. etc. etc.

cats and capacity for care

Documents

mental capacity act 2005 - parliament.uk€¦mental capacity...

adult intensive care capacity planning

policy brief : capacity planning in health care · capacity...

capacity building for developing trauma care facilities...

kindergarten - default page - splash page · cats need care...

cats care by catherine parks

cats, cats and more cats!! by anna

first aid and emergency care for dogs and cats aid and...

quality in health care: building systemic capacity

first aid and emergency care for dogs and cats e-book

how to care your cats/ cat care tips

dental care for dogs c cats dental-care cats tbd—jd. 50ml...

ontario‘s critical care surge capacity management …...

building capacity in trauma-informed care

animal care & enclosure standards and related policies and...

chapter 8 small animal care. describe nutritional needs of...

audit of the bonnie l hays animal shelter · focused audit...

domiciliary care services for older people aims overview of...

capacity, care planning and advance care planning in life...

dogs of ‘rover’...