"Just a little more time "

When we noticed more and more of our clients were asking about home hospice care and euthanasia, we decided to implement a quality-of-life program centered around the medical needs of the patient and the emotional needs of the families involved.

We created two types of consultations: a hospice consultation and a quality-of-life consultation. Here are some of the critical components of each.

The hospice consultation 

The quality-of-life consultation 

This consultation is for pet owners who aren't ready to say goodbye to their pet and are seeking medical management and comfort. Here's what we typically discuss:

> The pet's disease and various disease processes affecting the pet, including end-stage clinical signs

> The importance of keeping daily records of the pet's activities

> Options for additional support, such as home grooming, laser therapy, acupuncture and other services

> A list of overnight emergency facilities for after-hours care if needed

> The process of natural death and general information on euthanasia. 

This is the more common discussion we have with clients, and it includes:

> What to expect and how the process of euthanasia will take place, whether it's at the clinic or in their home

> Aftercare options, including cremation options, witnessed cremations and so on. 

After this consultation, we create a hospice care plan based on the pet's medical needs. Prices vary, based on the levels of veterinary care needed. We offer three inclusive packages-from basic to advanced-that include nutritional and pain support.

We assign a technician to each hospice case as a case manager to assist in the care and act as a liaison between the veterinarian and the families. We create prescheduled morning slots for home visits. The frequency depends on the veterinarian's recommendations, and they range from 30 minutes to an hour, depending on the amount of medical care required. And we schedule our staff accordingly, so we don't disrupt the hospital flow. 

We sedate the patient with a combination of drugs either subcutaneously or intramuscularly to minimize anxiety. We place catheters and we give an anesthetic intravenously before administering the euthanasia solution. This allows families one last moment to say goodbye until they are ready for the veterinarian to administer the euthanasia. I recommend nice bedding and blankets, so it's easy to cover the patient when it's over. Instead of hand-carrying the pet, we use a stretcher.

We schedule home euthanasia in 60-minute time slots, and try to keep them in the early morning or late evening, unless urgent, and only mornings on Saturday and Sunday. 

Payment

We allow an easy pay option through QuickBooks that allows owners to pay online for hospice care plans and euthanasia services. We generally send the invoices and receive payment before we offer the services. We also charge a mileage fee if the staff must travel outside a 5-mile radius. And we provide insurance coverage, including liability and travel coverage, for our team members who travel for home visits.

Communication tips

Create a brochure tailored to your hospital that highlights the hospice and euthanasia services you offer. This gives you a nonthreatening way to pass on information to clients with elderly pets. In our experience, having these discussions early on during senior wellness visits helps clients start thinking about the future of their pets. These materials allow pet owners to come to terms on their own and stimulates questions, so we're less likely to stumble into conversations with pet owners who aren't mentally ready for quality-of-life conversations.

Teaching the team

Cultivating the right culture with our team was one of biggest challenges. We had to explain the idea of hospice and the fact that we were not just prolonging the inevitable or causing the animal to suffer. We teach that this is a medically supervised service that allows us to offer animals superior care and comfort in their greatest time of need so pet owners have more time to say goodbye.

It took several team meetings to get the team on board, and it took our first case for team members to see the benefits of the program.

My final piece of advice: Use staff development opportunities to develop patient care and deal with grieving clients. It's important for all members of your team to be involved and on board with the care you provide.

Roger Zinn, CVPM, is the Hospital Administrator of Animal Medical Center of the Village in Houston, Texas.