JOHN YANG: Throughout the pandemic, millions of Americans have become pet owners.

Today, about 70% of U.S. households have pets.

Many owners struggle to cover the costs of veterinary care.

Special Correspondent Cat Wise traveled to Tennessee to find out more.

CAT WISE: It's breakfast time in Charlotte Austrew's kitchen and Bubba, Tiny, Tina, King, and Buttercup are hungry.

CHARLOTTE AUSTREW: Come on, Buttercup.

CAT WISE: Austrew, who is 68, lives alone on the outskirts of Knoxville, where she takes care of her great granddaughter and cleans homes on occasion.

Her pets are a huge source of comfort.

CHARLOTTE AUSTREW: They sleep with me, King's usually on my lap 24/7.

They're just such company.

CAT WISE: Austrew says many of her cats and dogs over the years arrived at her door as strays.

Others she's taken in from family members, including Dixie, who passed away several years ago.

CHARLOTTE AUSTREW: This is my poor Dixie girl.

This is the last night before we had her put to sleep, she couldn't walk no more.

Come here.

CAT WISE: Dixie's death was especially tough because Austrew couldn't afford some of the veterinary care Dixie needed toward the end of her life.

CHARLOTTE AUSTREW: I just loved her so much.

Makes me cry right now just to think about it.

I just didn't have the money to take her when she needed to go.

CAT WISE: She says, it's been difficult to cover medications and vaccinations for her other pets, too.

Austrew is far from alone.

According to a 2018 study from the University of Tennessee, nearly 30% of pet owners experienced barriers to veterinary care.

The main one, cost.

DR. MICHAEL BLACKWELL, Program for Pet Health Equity, University of Tennessee: The cost of care continue to rise, while household income is not.

That's the national crisis that's at work.

CAT WISE: Dr. Michael Blackwell, who led the study, is a veterinarian and director of the university's program for pet health equity.

DR. MICHAEL BLACKWELL: Over time, what we have seen happen is certain animals like dogs and cats have become members of the family, and I mean quite literally, members of the family.

We coined the term bonded family, getting at the human animal bond, at that social unit, and that's the kind of society we are.

CAT WISE: But Blackwell says many of America's bonded families are not getting the care they need.

DR. MICHAEL BLACKWELL: Unlike human health care, veterinary medicine still operates on a cash basis, 3% of the transactions involve pet health insurance, and therefore, when the public goes in for veterinary care, they are paying cash.

It may be on a credit card using debt, but not third-party support.

One can be middle class and still be challenged to pay, especially an unforeseen veterinary bill.

CAT WISE: Blackwell says everyone should be able to enjoy the benefits of owning pets regardless of income.

And he says the lack of access to veterinary care can impact owners mental health and the overall public health of communities.

Another significant issue for owners a shortage of veterinarians.

According to the American Veterinary Medical Association, there are roughly 150 million dogs and cats in the U.S. and just under 60,000 veterinarians who care for them.

Those shortages exacerbated during the pandemic have led to longer appointment wait times.

When pet owners are struggling, they often turn to animal shelters for help.

AMANDA HILTON, Young-Williams Animal Center: For families, their pet can be the reason they keep going, the reason they get up in the morning.

CAT WISE: Amanda Hilton is the Pet Resource Center and Intake Manager at the Young-Williams Animal Center in Knoxville, which takes in about 1000 animals a month.

Hilton says roughly 20% are owner surrenders, often because of housing policies that prohibit pets medical care owners can't afford.

AMANDA HILTON: So this is Dobby, Dobby came injured.

She's had to have her hips replaced.

CAT WISE: Hi, Dobby.

AMANDA HILTON: Hi, Seago.

CAT WISE: An injured dog arrived in animal control truck.

The owners suspected it was hit by a car when they were out of town.

NO NAME GIVEN: Apparently, he, like, broke the chain and was wandering around.

NO NAME GIVEN: The owner surrendered because he couldn't afford vet care.

AMANDA HILTON: It does happen often that seems like the only option.

I know I don't have the money to go take my pet to the vet.

There's one option left, and that's the local shelter.

CAT WISE: Nationally, there are organizations trying to address the problem, like the Humane Society of the United States.

Their pets for life program offers free or heavily subsidized pet care services, including transportation to appointments.

In Portland, Oregon, a new community veterinary hospital provides services on a sliding scale to under resourced clients and their pets.

And in 2020, Dr. Blackwell and his University of Tennessee colleagues launched a research project called AlignCare in Knoxville, Asheville, and eventually eight other communities around the country.

DR. MICHAEL BLACKWELL: AlignCare is designed to spread the cost and to control the cost.

If we get more parties involved with trying to support the care, then we have a better chance of success.

CAT WISE: Here's how it works.

Participating veterinary clinics reduce their fees by 20%.

Eligible pet owners are responsible for a 20% copay per visit and must be enrolled in a government assistance program like food stamps in order to qualify.

AlignCare, which is supported by grants, pays the remaining amount.

The program, which also offers support services through veterinary social workers, currently serves about 1400 pet owners, including Charlotte Austrew, who enrolled earlier this year.

DR. EMMIE TRUETT, Central Veterinary Hospital: Hi, Charlotte.

CHARLOTTE AUSTREW: How are you?

CAT WISE: She brought in one of her cats recently to Knoxville's central veterinary hospital to see if he needed oral surgery, a procedure Austrew says she probably couldn't afford on her own.

DR. EMMIE TRUETT: These resorptive lesions that pop up in the mouth, they can happen at a young age.

CAT WISE: Veterinarian Dr. Emmy Truitt says it's not just about treating ailments or injuries.

DR. EMMIE TRUETT: We actually get a lot of dogs and cats that come in with infectious diseases that could have been prevented with vaccines.

Parvovirus is a virus that we do vaccinate dogs for.

A lot of them that didn't have any vaccines beforehand are really, really sick.

CAT WISE: AlignCare's initial research grant funding will be ending by June 2024.

Dr. Blackwell and his team are now in the process of turning it into an independent nonprofit.

In the meantime, partner communities are being asked to raise their own funds, and some enrollees, including Austrew are losing benefits for now.

That worries her, but she remains hopeful.

CHARLOTTE AUSTREW: I think it would be nice if people that love animals would step up and everybody pitch in and try to help.

CAT WISE: For "PBS News Weekend," I'm Cat Wise in Knoxville, Tennessee.