Hospice Care for Pets - Overview - Part 2

By Courtney Barnes, BSc, DVM; Tammy Hunter, DVM; Robin Downing, DVM, CVPP, CCRP, DAAPM

Hospice care for pets is an emerging niche of veterinary medicine that creates a unique, caring collaboration between the pet owner and the veterinary healthcare team. Pet hospice is patterned after human end-of-life care, with the additional provision for humane euthanasia when the pet's day-to-day quality of life becomes unacceptable.

How will I know if my pet needs to enter hospice care?

Open, honest, and direct communication with your pet's veterinarian and the veterinary healthcare team, throughout the pet's life, lays the foundation for effective communication as the end of life approaches. As soon as a life-limiting disease is diagnosed, it is time to begin a dialogue about treatment options and how the approaching end of life will be handled.

Many life-limiting diseases or incurable illnesses can be treated aggressively and managed well, sometimes for many years. Examples of these diseases include diabetes mellitus (also called sugar diabetes), kidney disease, heart disease, degenerative joint disease associated with osteoarthritis, and various cancers. Treatment strategies are as varied as the diseases themselves. Your veterinarian can clarify appropriate treatments, the medication schedule, a recommended schedule for reassessment at the veterinary practice, and the costs associated with all aspects of the recommended therapies and re-checks.

As veterinary medicine has advanced, treatment options for chronic incurable diseases have advanced as well. It is now common for pets to successfully live with chronic diseases that, until recently, would have required euthanasia soon after diagnosis. Although this has been a boon for older pets, it complicates our decisions as our pets age. Communicating with your veterinarian is the key to transitioning from chronic disease management to hospice.

How can I provide what my pet needs in a hospice setting?

Hospice care is as individual as the pet and the family. There is no right way to provide pet hospice. Instead, there are many different aspects of care that may be appropriate for your pet in a hospice setting. Ask your veterinarian and veterinary healthcare team to be as specific and detailed as possible in creating a hospice care plan. That way, you can ask all the necessary questions to feel confident in the care you will provide. This plan may include medication, mobility support, fluid and nutritional support, hygiene, and anything else your pet needs to stay comfortable.

If a procedure or treatment is uncomfortable to perform, seems to make the pet uncomfortable, or is simply impossible to perform, communicate openly so that an alternative can be explored. A particular pet's hospice care plan A may need to evolve into a plan B or plan C, depending on the pet's response to the treatments/procedures, as well as the progression of the life-limiting condition.

It is important not to be intimidated by the idea of providing hospice care in your home for your pet. Your veterinarian and veterinary healthcare team will help in any way they can. Remember, euthanasia remains the final compassionate gift we can provide our dying pets when that time comes.

How will I know when hospice care for my pet should end?

When a pet enters hospice care, your veterinary healthcare team needs to identify the benchmarks by which they will measure the quality of day-to-day life of that animal. Dr. Alice Villalobos' quality-of-life scale is an easy-to-use document that helps your veterinary healthcare team make a more objective measurement of a very subjective experience (see handouts "Quality of Life at the End of Life for Your Cat" and "Quality of Life at the End of Life for Your Dog").

As your pet’s death approaches, you may struggle with the timing and details that surround euthanasia. It is often easier to begin with the end in mind. At the beginning of hospice care, have a detailed discussion with your veterinary health team and create a plan around euthanasia; specifically, when, during the course of the disease, euthanasia would be considered most appropriate, how and where euthanasia will be performed, and your desires for taking care of your pet's body.

As difficult as these discussions are, it is easier when the important decisions are made before the crisis is before us. We don’t want our pet’s last day to be their worst day. Establishing a plan for the very end of a pet's life merely creates guidelines. The final details of such a plan will be determined by the pet as his or her life comes to a close, so it is important to maintain some flexibility.

"Living and caring in the day-to-day way that is associated with hospice care supports a unique emotional connection and intimacy with the pet."

Applying hospice and palliative care principles to our pets as they approach the end of their lives can be an emotionally rich and satisfying experience. Caring through the end of life honors the precious, loving relationship we have with our pets, and it honors the pet's own life force and desire to live.

It may be frightening to think about the death that is inevitable and coming soon. We also must acknowledge the emotional and physical toll that goes along with caring for a dying pet. That said, living and caring in the day-to-day way that is associated with hospice care supports a unique emotional connection and intimacy with the pet. With a bit of help and guidance, we can help our pets live until they die.

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