5 Pillars of veterinary hospice care

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Veterinary hospice care is often misunderstood, according to Mary Gardner, DVM, cofounder and chief information officer of Lap of Love, a nationwide network of doctors dedicated exclusively to veterinary hospice and in-home euthanasia. At the recent Atlantic Coast Veterinary Conference®, Gardner explained that veterinary hospice care is the medically supervised service committed to offering comfort and quality of life to both the pet and the owner until euthanasia is requested or natural death occurs.

Gardner works as an at-home veterinary hospice practitioner and noted that the key aspects of a successful hospice case are communication, preparation, and more communication. She emphasized providing details to the pet parent about the progression of their pet’s disease so they can make the most informed decisions.

What follows are the 5 pillars of hospice care that Gardner outlined to ensure the most comfortable, safe transition for the pet and the most considerate process for the pet owner.

No. 1: Medicine

Gardner noted that when she was in general practice and caring for advanced-aged pets or those with terminal illness, she never actually viewed the condition as “hospice,” but rather as palliative care and ensuring comfort. Most patients in hospice are experiencing pain, usually arthritis, so managing this pain is critical to keeping them comfortable.

The next important step is to monitor any mental changes, mostly in cognitive dysfunction, although anxiety, aggression, and other changes can also take place as a pet ages (such as nausea during organ failure or in pets with cancer). Additionally, inappetence is associated with certain diseases; fortunately, there is a selection of appetite stimulants on the market to choose from. Inappetence is a major factor to pet owners in determining quality of life, Gardner said.

No. 2: Environmental management

Because Gardner cares for pets in their home, she can access their surroundings and suggest small changes to their environment to make life a little easier for these pets. For example, she said to put bathmats or yoga mats over tile or hardwood floors in the home to comfort weak, wobbly patients.

She also recommended educating pet parents about keeping their companion animals safe by blocking off areas of concern (eg, steps, dark areas, pools, etc). In addition, products such as harnesses, toe grips, halos (for vision), night lights, and more are available to help pets with certain ailments.

No. 3: Caregiver burdens

Caring for a geriatric pet is both a physical and emotional burden, and Gardner admitted she didn’t fully grasp this until she experienced it herself. In addition, having to determine when euthanasia is appropriate can be a tough decision. Quality of life is subjective, and pet parents aren’t always sure when it’s the right time and often need guidance. Gardner noted the conversation that hospice practitioners have most often with families is about end-of-life services.

A study that Gardner cited analyzed the toll of caregiving on pet owners and measured owners’ mental health by monitoring depression, stress, anxiety levels, quality of life, and enjoyment. The findings revealed that caregivers of terminally or chronically ill pets experienced the following¹:

• greater levels of caregiver burden and stress;
• greater perceived stress;
• greater symptoms of depression and anxiety; and
• lower indicators of quality of life and enjoyment.

No. 4: Quality-of-life conversations

If only the answer to, “When is it time?” was straightforward, Gardner remarked.

It is the responsibility of the hospice care professional to assist owners with end-of-life decisions to help prevent an animal from suffering. Gardner explained that there are various methods for answering families’ questions around end-of-life decisions and emphasized that it’s an injustice to the profession to simply inform pet parents to “call you when it’s time.” She suggested guiding pet parents to Lap of Love’s website, which features a detailed resource² on this topic to help them with this decision.

No. 5: Euthanasia conversation

Gardner said she always engages in a brief discussion with the pet’s family to understand their wishes for the details of their pet’s passing, including whom they want to be there, what the pet may eat before/during, what memorial items they may want to keep, etc, to help them plan for the best possible experience. Additionally, a conversation allows the clients to establish the expectations they have for the services she offers (eg, how far in advance she should let them know an estimate of how long their pet has left, does the hospice care professional go to the home, etc).

Hospice: Caring not curing

Gardner noted that using the word “hospice” with clients emphasizes that she isn’t there to cure the pet; she’s there to care for the pet in the last stage of their life and to prepare the family for death and grieving. She can then adjust her medical management to ensure that the pet remains comfortable and safe and that the family is content with how the end-of-life process goes.

References

1. Spitznagel MB, Jacobson DM, Cox MD, Carlson MD. Caregiver burden in owners of a sick companion animal: A cross-sectional observational study. Vet Rec. 2017;181(12):321. doi:10.1136/vr.104295
2. How will I know when it’s time to say goodbye? Lap of Love. Accessed October 6, 2021. https://www.lapoflove.com/how-will-i-know-it-is-time