By Jennifer Coates, DVM
Pet parents are often faced with a dilemma when a beloved animal companion is nearing the end of his or her life. Pursuing aggressive treatment in the face of a poor prognosis and/or advanced age may not seem reasonable. On the other hand, most owners want to maximize the amount of time they have with their pets and make sure that time is enjoyable for everyone involved. That’s where hospice care comes in.
The concept of hospice has been around for a while in human medical circles, but veterinary hospice is a relatively new concept. The American Veterinary Medical Association describes it this way:
“[H]ospice care focuses on providing the best quality of life possible for a pet with a terminal disease or condition until the pet dies or is euthanized. Hospice care also helps you by providing you with time to adjust to the coming loss of your companion. The care is tailored to the needs of both you and your pet.
“A pet hospice service typically includes on-call availability of the veterinarian to provide urgent care as needed; extended appointments including counseling and support for decision-making; in-home care; medications and other therapies administered to relieve discomfort, stress and pain; euthanasia options tailored to your and your pet's needs (which may include in-home euthanasia); and pet loss support/grief counseling.”
Or, as the International Association for Animal Hospice and Palliative Care puts it, hospice care for pets is “an alternative to premature euthanasia and… an alternative to prolonged suffering which can result either from isolating an animal in intensive care or from inadequately treating the animal at home.”
When Is Pet Hospice Care Appropriate?
The biggest difference between “regular” veterinary care and hospice is that, with hospice, the goal shifts from directly treating the patient’s underlying disease to keeping him or her comfortable and content. Hospice does not mean that you can no longer treat the pet’s primary problem, but you avoid any forms of treatment that could reasonably be expected to have a significant, adverse effect on quality of life. In general, hospice care is appropriate when a pet has been diagnosed with a terminal disease, has a life-expectancy in the range of a few days to months, and the pet’s guardian does not want to euthanize at this time.
Treatment options in hospice care depend on the patient’s individual situation but often involve some combination of the following:
- Nutritional support
- Ensuring adequate hydration
- Assistance with urination and defecation
- Keeping pets clean and well groomed
- Helping pets safely move around their environment
- Symptom management (e.g., medications or procedures that ease pain, nausea, difficulty breathing, etc.)
- Providing mental stimulation and loving contact with family members
Goals of Hospice Care for Pets
The goal of hospice care is to maintain a good quality of life for as long as possible, but it’s important to understand that quality of life is a roller coaster. A diary is one of the best ways to keep track of all the relevant information. Regularly monitor five things: eating, drinking, urinating, defecating, and joy in life. Without adequate nutrition, hydration, and elimination, suffering inevitably follows. Evaluating “joy in life” is more difficult but no less important. Write down a few concrete milestones or “red flags” related to behaviors that are an important part of your pet’s personality. As health declines, we get used to a new normal, and it can be hard to remember what a pet’s life used to be like. Has your cat always greeted you when you arrive home but doesn’t have the energy to do so anymore? Has your dog always wanted to snuggle on your lap but is now seeking solitude behind the couch? When you observe a “red flag,” you must reassess your pet’s situation. Dr. Alice Villalobos has developed an excellent, in depth quality of life scale that is also very useful.
Veterinary hospice does not focus solely on pets, it also addresses the needs of human family members. Preserving the bond between people and their pets is essential during this difficult time. When decisions are being made, the well-being of the entire family must be taken into consideration. Friends, family members, spiritual or religious leaders, and people trained in pet-loss support can help those bearing primary responsibility for a pet’s care. Veterinarians also play an important role by making sure that owners understand how their pet’s condition will change over time and pointing out signs that can indicate the treatment plan needs to be modified or that the end is near. Communication between veterinarians, owners, and everyone else involved in a pet’s care is never more important than it is during hospice.
Some pet parents choose hospice because they are spiritually, ethically, or otherwise opposed to animal euthanasia. In these situations, pets typically receive an increasing level care until natural death occurs. However, the majority of owners eventually elect euthanasia when their animal companion’s quality of life declines past a certain point. Your hospice veterinarian can help you identify when euthanasia might be in your pet’s best interests and provide you with details about the procedure itself and options for body care after death.
Hospice certainly doesn’t eliminate the grief associated with the death of a beloved pet, but it does give you the peace of mind that comes from knowing you’ve helped them enjoy a life that was as long and happy as possible.