Pet hospice is a relatively new and evolving field for which no universally accepted definition or standards exist. For the purpose of this blog, pet hospice is a philosophy of care that can guide your pet’s end-of-life care rather than a specific modality with strict criteria. Hospice care differs from other end-of-life approaches, which typically foresee euthanasia. Hospice care foresees a pet’s peaceful, pain-free passing in its own time in its own home. In situations in which your pet’s comfort cannot be maintained despite best-care practices, euthanasia remains an option.
“You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die.” –Dame Cicely Saunders, founder of the first modern hospice
Zuzu unmistakably showed me his will to live, apparent even in the presence of discomfort. Kathy, who was owned by Zuzu
When your preferences run counter to what your veterinarian believes are the best interests of the pet patient, the needs of the pet patient are of prime importance. While the “complete” patient includes both the pet and caregiver, the veterinarian’s role as a pet patient advocate is vital.
“I was going on an unavoidable trip just when Big Orange would have cancer surgery and start chemo. In anticipation of surgery revealing broader cancer involvement than anticipated, I gave my vet permission to euthanize Orange but said, ‘Please, do whatever you can to keep him alive until I get back.’ He said, ‘I can’t promise you that. Big Orange is my patient. I have to do what’s right for him.’ As much as I hated to hear that because I might not be with Orange when he needed me most, I knew he would receive the care that was best for him.” Kathy, who was owned by Big Orange
PET HOSPICE CARE
For many pet owners, the manner in which their pet’s life ends is as meaningful as everything that has gone before.
Like the human hospice movement, the pet hospice movement aims to create conditions under which your pet can die peacefully, without pain, in its own time, of its own accord, in its own home. Those conditions include but are not limited to pain management, nutritional and mobility support, and hygiene options until natural death occurs. They include care for you and your family as you undertake this rewarding and challenging endeavor.
Pet hospice is a philosophy of care
Pet hospice is more a philosophy of care than a place. You provide care in your home, with varying levels of outside assistance. It may not be available in your locale, but the philosophy remains applicable and can be implemented under a wide range of situations.
The American Veterinary Medical Association (AVMA) describes pet hospice 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….”
The International Association for Animal Hospice and Palliative Care writes 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.”
Supporting your companion as it transitions from physical life can be the ultimate gift to a pet that has spent its life devoted to you. Further, hospice may give you peace of mind, knowing you’ve helped your pet enjoy a life that was as long and happy as possible. Nonetheless, the movement recognizes that hospice care may be insufficient to maintain your pet’s comfort, and euthanasia may end up being appropriate.
What services do pet hospices provide?
The Animal Hospice Care pyramid identifies three areas to be addressed, each of which builds on the other – physical (the animal’s physical well-being that represents the traditional clinical care services that veterinarians provide), social (engagement with the family and other pets, mental stimulation), and emotional (dignity, the will to live, and stress reduction).1
Animal care services with hospice in the name may offer the services listed below. Which services would you want or need?
- 24/7 availability of phone advice or therapeutic support.
- Veterinary care by on-site or cooperating off-site or referral veterinarians, with medical care continuing at the pet’s home until its passing.
- In-home care by a licensed veterinarian or veterinary technician.
- Written comprehensive care plan that attends to your pet’s needs and is respectful of you and your family’s culture, values, and spiritual beliefs.
- Education on the physiological and behavioral changes that take place as your pet’s life concludes.
- Quality of Life assessment.
- Nutritional counseling based on understanding the changing needs in dying patients.
- Mobility options and household modifications (temporary ramps and carpet runners, placement of food/water bowls and litter boxes, etc.).
- Acupuncture.
- Homeopathic, integrative, and/or conventional medical treatment for pain, nausea, anxiety and breathing difficulty.
- Nursing support and/or education on necessary nursing care (i.e.: medication or fluid administration, wound care, etc.).
- A comfort kit that includes a pain medication and sedative to be administered by the family in the event of sudden, acute pain.
- Caregiver support.
- Telehealth services.
- In-home euthanasia.
- Private cremation and after-care.
- Bereavement support.
For more on the philosophy behind pet hospice care and the range of services offered:
The BrightHaven Center for Animal Rescue, Hospice and Holistic Education https://www.brighthaven.org/
Palliative Care and Hospice for Pets: Overview | VCA Animal Hospital (vcahospitals.com)
What is Hospice Care for Pets? | The Grey Muzzle Organization
Pet Health: When is it time for hospice care? (colostate.edu)
Is hospice care right for you and your pet?
The benefit of hospice care is clear: you and your pet will share your loving bond until its peaceful, pain-free passing. In reaching the decision to follow the pet hospice model, understand its limits and obligations as well as its benefits. You and the other members of the care team are assuming responsibility to provide superior – not just adequate – care.
As part of determining whether care in your home until your pet dies in its own time is the best thing for your pet, consider whether the following are present:
- You have 24/7 veterinary support.
- Your pet’s will to live is apparent to you when symptoms of discomfort are addressed.
- You are ready to engage in what may be a gratifying and emotionally and physically challenging experience. You can muster support for the physical and emotional challenges ahead.
- Your pet’s human family is in agreement for following this course, or they can be brought on board.
- Your pet’s quality of life and safety can be maintained through symptom management (e.g., medications or procedures that ease pain, nausea, difficulty breathing, etc.), assistance with urination / defecation and grooming, mobility assistance, and social interaction with loving family members.
- You can provide the needed care (administration of subcutaneous fluids if indicated, lifting a large pet, etc.) or you can marshal a support network.
- You have the time and money to provide at-home care for weeks or possibly months.
- You understand how your pet’s condition will change over time and what signs indicate the treatment plan needs to be modified or that the end is near.
- You are prepared for the possibility that your efforts may not maintain a pain-free, peaceful environment for your pet and that euthanasia may, in the end, be the most kind course.
If your veterinarian brings up euthanasia and it isn’t the course you want to follow
Your pet’s condition may be such that your veterinarian suggests euthanasia. If that isn’t the course you want to follow or if you see euthanasia as a last resort only after all comfort efforts have failed, say so. Have a straightforward discussion of your hopes and goals during this process. Have an equally frank discussion of the chance that you will be able to create conditions in which your pet actually can be kept comfortable at home.
Your current vet may be prepared to assist you in implementing the philosophy of your pet’s peaceful, pain-free passing in its own time in your home. Or your vet may be able to refer you to a hospice in your area, either relinquishing your pet’s medical care to their veterinarian or continuing to provide veterinary care in cooperation with a pet hospice or a house-call veterinarian.
Can your veterinarian provide hospice care?
If a pet hospice with the services you and your pet need is not available in your area or if you choose to continue to work with your current veterinarian, ask (at least) these questions to determine whether your vet is willing and able to assist you in providing care that will allow your pet to die at home without pain:
- Are you able and willing to support me in providing comfort care for my pet at home until it passes in its own time?
- Are you willing and able to educate me about what to expect before and during the dying process so that I can best support my pet?
- Have you done this for your own pets? For any other clients? What percent of pets in hospice were able to die peacefully in their own time?
- Can you or your veterinary technicians offer in-home visits, or can you refer me to someone who can?
- Are you available outside of business hours?
- Can you provide in-home euthanasia outside of office hours if comfort-care practices are not sufficient for my pet’s comfort?
Children and hospice care
It is natural to want to shield children from the harsh reality that a beloved pet will die. It may feel too daunting to help a child understand that death is a natural part of life. On the other hand, consider that caring for a pet dying at home is an opportunity for your children to express love through their gentle, hands-on caring and to prepare them for an eventual goodbye that can be said while your pet is alive, at home. As a parent, you know what’s best.
However your pet dies, give yourself and your children a chance to say goodbye.
Hospice care isn’t a panacea
Wouldn’t we all want our beloved pet to die peacefully and pain-free at home, surrounded by its loving family? We envision Prince putting his head on our lap and wagging his tail that one last time. It may not be that way. Have a frank talk with your vet about the likelihood of a calm, peaceful death. The veterinarian you trust to care for your pet through this last journey is the best person to tell you what to expect and the conditions under which it could be time to consider euthanasia for a pet that has been in hospice care.
There may be people in your circle who believe that hospice care is prolonging your pet’s suffering (which you may hear as an accusation that you are putting your needs before your suffering pet’s needs). Take the opportunity to educate them about hospice care. Hearing them out in an open, honest conversation and weighing their opinions can help you clarify your own beliefs. This clarification can spell the difference between you regretting your decision and you continuing to believe in it. In the end, however, every person needs to find their own way of facing the terminal illness of their pet.
Veterinarians have an ethical “duty of care” to the animal client. According to Principles of Veterinary Medical Ethics adopted by the American Veterinary Medical Association, “Veterinarians should consider first the welfare of the patient for the purpose of relieving suffering and disability while causing a minimum of pain or fright.”2 When what you feel would be best for your animal runs counter to what your veterinarian believes are the best interests of this patient, the needs of the patient — your pet — are of prime importance. While the “unit of care” in animal hospice includes both the pet and caregiver, the veterinarian’s role as a pet patient advocate is vital.
Most of us want our pet to die in its own time, free of pain, free of fear, and we would choose pet hospice in a heartbeat if we knew that is how its death would take place. Increasingly available pet hospice services may be a dream come true. But it isn’t right or even possible for every person or every pet. You are not letting yourself or your pet down if you don’t choose hospice care. And if you choose it, you are not letting yourself or your pet down if, in the end, you choose euthanization as the kindest way for its physical life to end.
All the named animals pictured in this blog were someone’s treasured pet. They may have crossed the Rainbow Bridge, but their absence makes them no less beloved.
I may not know what tomorrow will bring, but today I have you.