For most of us, companion animals are family. In fact, 97% of U.S. companion animal guardians say they consider their animals part of the family, and over half say they’re just as important as human members. Yet, despite this strong emotional bond, a staggering number of companion animals are going without the veterinary care they need. According to PetSmart Charities, an estimated 50 million companion animals in the U.S. currently lack access to adequate veterinary services.

To understand why this is happening and what might help, PetSmart Charities partnered with Gallup to conduct a nationally representative survey of nearly 2,500 dog and cat guardians across the country. Their study explores how often people seek veterinary care, the challenges they face, and the kinds of support or alternatives they wish they had.

The survey, conducted between November 2024 and January 2025, gathered responses from a diverse sample of companion animal guardians. To ensure that people without internet access were included, Gallup used both web and mail-based questionnaires. The aim was to better understand not only whether companion animal guardians access veterinary care, but also what influences their decisions, and what would make it easier to say yes to care when their companion animals need it most.

Not Just About Cost For Guardians

One of the most concerning takeaways is that more than half of companion animal guardians — 52% — have either skipped a veterinary visit when they believed their animal needed care, or declined care recommended by a veterinarian. This figure was even higher among younger adults, Black and Hispanic guardians, and people living in households earning less than $60,000 annually.

Financial barriers were the most commonly reported challenge. Among those who had skipped or declined care, about 71% said it was because they couldn’t afford the services or didn’t believe they were worth the cost. Notably, affordability was a concern even among higher-income guardians: one-third of those earning over $90,000 said they had foregone care for financial reasons.

The consequences of delaying or declining care can be severe. Only a third of those who skipped care said their animal’s condition improved. Around 4% said their companion’s condition worsened, and 10% reported that the animal passed away. Nearly one in three respondents also said they knew someone whose companion animal had died because the guardian couldn’t afford treatment.

Importantly, the issue isn’t just about cost. About 29% of those who declined care said it wasn’t practical for them or their companion animal — for instance, the treatment might have caused the animal stress, or the guardian may have felt uncomfortable administering it. Yet, the majority of these individuals said they weren’t offered any alternatives. In fact, 73% of those who declined care for financial reasons said they weren’t given a more affordable option, and 46% of those who declined care for practical reasons said they weren’t offered an alternative that worked better for their needs.

Despite these challenges, trust in veterinarians remains high. Only 7% of those who declined care said it was due to mistrust, while 83% of those who have ever visited a veterinarian say they believe the services their companion animal receives are worth the cost.

Where Guardians Turn And What They Want

While most guardians continue to consult veterinarians when their companion animals are sick or injured, nearly one in five rely exclusively on non-veterinary sources like online forums, friends, or other animal care professionals. This trend is especially common among those facing the greatest access barriers — younger adults, low-income households, and Black guardians.

What could help? Two things stood out: payment flexibility and alternative care models. About 65% of respondents said they could only afford up to $1,000 for a life-saving treatment. However, 64% said they could at least double that amount if they were offered an interest-free payment plan over a year, yet, fewer than one in four had ever been offered that option.

Respondents also expressed strong interest in community clinics, in-home veterinary visits, and telemedicine — all of which could help reduce financial and logistical barriers. These options were especially popular among the groups who currently struggle most to access care.

What This Means For Advocates

These findings reveal a widespread, preventable form of suffering — and an area of opportunity for advocates and funders seeking scalable, cost-effective impact in companion animal welfare.

What’s needed now is support for implementing and evaluating these alternative care models at scale. Flexible, lower-cost care models — like payment plans or simplified treatment options, where applicable — can reduce avoidable suffering by making care accessible, while also helping veterinary teams avoid moral distress by offering realistic alternatives when clients can’t afford gold-standard care. Clinics that adopt these approaches may not only reach more animals, but also foster stronger relationships with clients and improve long-term outcomes.

What this research shows is that many guardians are doing their best in a system that often makes care difficult to access. Expanding flexible, lower-cost care options won’t solve every challenge, but it can make a meaningful difference — especially for those most at risk of going without. For advocates, it’s a reminder that small, practical changes in how care is delivered can have a real impact on the lives of companion animals and the people who care for them.