Hospice for pets? What are you talking about?!

What Is Veterinary Hospice?

Per the IAAHPC (International Association of Animal Hospice & Palliative Care), animal hospice is a program of care designed to address all needs of animals in the advanced stages of a disease or disability, including physical, emotional, and social needs, as well as offer strong support to the human caregivers every step along the way.  This care can be provided from the time of a terminal diagnosis through death.  This differs from palliative care, at least in my concept of it, in that palliative care is treatment to maintain an aging pet's quality of life and minimize suffering caused by curable or chronic diseases, such as adding an anti-inflammatory medication into a care plan to help manage arthritic pain.  Hospice is the intensive care and support offered close to life’s end.

Unfortunately, end-of-life care is a subject that often receives little attention in veterinary schools, or at least historically that has been the case.  On graduating in 2014, I was not even aware that a special-interest focus in veterinary hospice & palliative care was even an option.  But in recent years it has become a more established area of the field, and that is amazing because it truly is so desperately needed!  Geriatric pets have their own special needs, and spending over a year in post-doctoral, elective training to receive CHPV-certification ensures certified hospice vets offer the most comprehensive, most advanced, and BEST end-of-life care available to our fragile senior dogs and cats, including euthanasia.  Not to mention that medicine is an art, and spending your every day focused on one specific area generally elevates the care you can offer in that area of expertise.  In home services like ours also eliminate some huge stressors for older pets and their family, as understandably transport itself can be painful or impossible, and clinic visits can add additional stressors on a pet that may already be in a fragile state. 

Most importantly, true veterinary hospice care means offering exceptional support.  Did your pet just receive a terminal diagnosis, and you have been given minimal guidance on what to expect, how to plan/monitor, and how best to help your pet maintain their quality of life as long as possible with their health issues?  This story is all too common.  Our hospice care program is bond-centered, meaning we are not just caring for your pet, we are supporting your needs as you navigate their end-of-life journey together, and ensuring that our care plans do not harm the loving bond you share.  We also explore your wishes and concerns for your pet’s end-of-life journey so that we can approach their care with your needs in mind. 

Does it make a difference?

Veterinary hospice care absolutely can make a difference in getting more good time with your pet.  In 2015, Western Carolina Animal Pain Clinic found that rehab and palliative care dropped musculoskeletal causes of death (such as mobility loss secondary to osteoarthritis) from the 2nd leading cause of death to the 7th!!(1)  I have experienced this with my own patients as well – with hospice care, I have had many pets live GOOD lives well past the timeframe they were expected to survive.  In some cases, the family and I have even helped a pet survive into the time expected with incredibly painful surgeries – but they didn’t have to go through weeks/months of a tough recovery, we did not risk losing them in surgery without a chance for goodbye, and their family was able to gain comfort from taking an active role in their care.  Our hospice care is offered in partnership with your pet’s primary veterinarian, to guarantee that your pet has a whole care team working together to ensure the absolute best care, which is always our foremost goal. It is important to note that while we give you the guidance, tools, and support you need to care for your pet, you will need to be committed to taking an active role in their daily care for best results.

Where to start?

Faithful Hearts’ hospice program begins with an at home assessment in order to fairly assess your pet’s comfort, understand their (and your) daily challenges, and check for potential environmental & lifestyle modifications.  Together with the family we work as a team to decide on a realistic and effective care plan (we all know not every cat is going to accept a daily oral medication!), should we decide that ongoing hospice care is a good option for them at that time.  Although, truly, it begins beforehand as I typically spend 2-3 hours ahead of time reviewing medical records, the caregiver-submitted questionnaire, designing multiple care plan options, and preparing the extensive, customized folder of resources for the family.  This extensive preparation allows us to be able to comprehensively discuss every aspect of your pet’s history, condition (including expected progression, anticipated symptoms, and what to watch for to indicate an oncoming crisis), and care within the 2-3 hours our assessments typically take in the home.  Because of the extensive time needed to do justice to you and your pet, we do require these assessments be scheduled at least 4 days in advance.  And due to the intensive nature of our support, we may need to schedule out 3-4 weeks at times so that we have the continued availability to support those already in our care. However, each pet’s medical record and caregiver-submitted questionnaire is reviewed upon receipt for suitability for the program and urgency of scheduling needs – also, as we understand home hospice care is a significant expense, we always let families know if we think we are not going to be able to help make a difference.

A typical care plan might include medications, neutraceuticals/supplements, diet, physical medicine (physical therapy exercises, acupuncture/acupressure, massage, etc), home modifications, hygiene care, and more to manage pain, organ dysfunction, cancer, and all the symptoms that can go along with decline in an older pet.  Often I use multimodal pain management, which is applying multiple treatments that can work together to target different areas in the pain pathway and therefore offer the strongest relief, hopefully at lower doses to ease stress on an aging body.  Based on your pet’s personality and needs, we work diligently to get medications promptly, in the form that will be the least stressful to administer, for them and for you.  I also provide training, education, and/or resources to give you confidence in your ability to implement my recommended care such as therapy exercises, fluid therapy, etc, and how to assess your pet’s pain, quality of life, and more.  For example, for a patient with lung cancer, we would discuss how (and when) to take resting respiratory rates, free apps you can use to track the rate, and what rates or trends might be concerning for needing to make care plan changes, consider humane euthanasia, or seek emergency care.  A crisis kit of medications for a respiratory emergency might be dispensed, with guidelines on when and how to administer.

After the assessment, you have highly responsive, ongoing support through the Faithful Hearts team with regular check-ins, but you also have the ability to reach out at any time with questions.  We do not expect you to have all the answers, and we know how scary it can be seeing a loved one struggling and not know how best to help.  Did your pup throw up 2 hours after meds, and now its 9pm and you are wondering if you should re-dose or withhold food?  That is what we are here for, and our mission is to make sure you feel comfort at a stressful time, knowing that you have a veterinary team available to help with every concern, no matter how big or small.

What about euthanasia?

Finally, the extensive training pursued and the focused experience from a certified hospice veterinarian also means we can offer the most supportive euthanasia experience as well.  The CHPV certification includes significant training in offering the most gentle euthanasia care available to pets, especially in a home setting.  Altogether, it means these special-interest veterinarians are the best trained to rapidly assess a senior pet’s condition and quality of life, using all of our knowledge and experience to help you feel more at peace with your decision.  It also means we can also offer the best guidance should we see that more good time together is a valid possibility for you and your pet. 

***Please note that other services offering hospice care may be in fact mis-labelling a shorter, less involved, standalone quality of life assessment.  Please check with providers in your area to see what their hospice program actually includes.***

1.      Musculoskeletal Conditions.  T Shearer.  Module 3 – Advanced Hospice - IAAHPC CHPV-certification program.