Pet hospice: Bridging the last stages of terminal illness and euthanasia

Pet hospice is an emerging concept in veterinary medicine. It is being adapted for pets by pioneering veterinarians who are called to fill the void between an animal's terminal illness and eventual euthanasia.

On the human side, hospice took root in the 1980s when hospitals, like The Cleveland Clinic, began offering palliative care programs for terminal patients.

A gift to end suffering: "It was hard to see pets in pain," says Dr. Dani McVety (right), who created a Florida service to offer at-home euthanasia and hospice care for veterinary patients without treatment options. (PHOTO BY ALEX MCKNIGHT PHOTOGRAPHY, AMCKNIGHT.COM)

By 2009, fueled by Medicare-funding, there were approximately 5,000 hospice programs in the United States and an estimated one-third of dying people were enrolled in hospice care.

Pet hospice, on the other hand, is currently a little known and little understood option, even within the veterinary profession. This month, four veterinarians tell their stories. All are determined to find ways to deliver this last option to pet owners who are looking for ways to extend the quality and length of their pets' lives before the final good-bye.

Cody, a yellow Labrador Retriever treated by Dr. Alice Villalobos, offers a good example of when and how a pet can benefit from hospice. Cody's crippling arthritis had finally progressed to the point that there was little more that could be done. Too often in situations like Cody's, pet owners are urged to consider euthanasia to spare their pets pain and suffering. Villalobos' oncology training and cancer-care background helped her see another option. Instead of euthanasia, she felt confident offering Cody's owners "pawspice care" (a name she uses to describe hospice care for pets).

"Cody had this wonderful spirit," she explains. "He loved his walks and the red wagon. Excellent pain management provided a way for him to enjoy them with his family, despite his crippled condition. He was a perfect candidate for pawspice."

In addition to working closely with Cody's family to adjust his medications as his condition changed, Villalobos asked them to assess Cody's quality of life through a scale she developed for the Veterinary Clinics of North America (Table 10.1 in the chapter titled "Palliative Care: End of Life 'Pawspice' Care"). The scale, she says, was created to help a pet owner monitor his or her pet and decide the right time to make the difficult decision of euthanasia. She hopes it will give veterinarians a tool to talk about end-of-life options with their clients.

Villalobos, a 1972 DVM graduate of the University of California-Davis, is considered a pioneer in the field of animal oncology and hospice care for pets. She currently conducts two-day clinics, one in Hermosa Beach and one in Woodland Hills for pets in Southern California. She also provides consultations out of her home office to offer cancer and hospice services to veterinarians and clients around the United States. Caring for her pet cancer patients through their last days helped her see the need for end-of-life care, especially when all medical options were exhausted. From her perspective, the issue is very simple: Veterinarians have an ethical obligation to communicate honestly with clients who have pets with terminal illnesses, and they should offer palliative, hospice care when they run out of other treatment options.

Veterinarians can do this work themselves, or they can refer cases, like Cody, if they cannot make the time commitment that pawspice requires. Keep in mind that pet owners and their pets require time and attention to help make the necessary psychological and physical accommodations necessary. This can require a lot of hand holding and medical adjustments as a pet's condition changes, she says.

However, Villalobos is one of a growing number of veterinarians across the country who offer pawspice as a referral service to veterinary practices and directly to clients who want pet hospice care. Villalobos says she was blessed early on to find a highly trained, registered veterinary technician (RVT), Carreen Lynch to work with in her practice. Lynch was just as passionate as she was about wanting to help patients and clients battle pet cancer. And she wanted to find ways to help clients during the highly emotional journey that follows the end of life. Together Villalobos, Lynch and veterinary team members built and refined the pawspice service she offers today. The members of her pawspice staff are compassionate with the patients and family members, and they provide home-care visits as needed and they honor the human-animal bond at the end of life.

Compassionate Veterinary Care, Chicago

Other veterinarians, like Dr. Amir Shanan, are at different places on the pet hospice path. Shanan and his wife, Liat, share a common vision that spans from combining pet hospice, pet home euthanasia, pet memorials, burial and cremation, bereavement counseling and more for pet owners who face end-of-life decisions. Amir says this is a very emotional time for pet owners, who often find him when their veterinarians tell them there are no treatment options left for their pets. His greatest frustration is that he could do so much more to help make the last stage of a pet's life easier for owners if given the opportunity to see the patients sooner.

Shanan has a conventional companion-animal practice on the near north side of Chicago. He believes so much in the need for this type of service, he hired an associate to see patients at the hospital so that he could devote time to developing pet hospice into a referral service for northern Illinois. Sometimes, he says, when he goes out on calls, he discovers that euthanasia can be delayed. He offers those clients the option of pet hospice care. Other times, euthanasia is the only option, and he performs this service for them.

Pet hospice requires training in end-of-life communication and grief support as well as creative treatment modalities to keep pets comfortable within the realm of what their owners can manage. Shanan spends a lot of time educating clients about the progression of their pets' diseases, what to expect and what they can do to help their pets. Shanan says he is always touched by the gratitude pet owner's express when he can give them ways to extend their pets' lives. A few more weeks, days, and, sometimes, hours can make a very meaningful difference. In the hope of encouraging hospice referrals from local practices, Shanan started visiting nearby emergency practices to explain pet hospice to veterinarians and hospital teams. He encourages doctors to refer patients to him while there is still time to help them and their owners in a pet-hospice program.

"Most veterinarians agree with the goals of pet hospice once they understand that hospice care allows the pet to enjoy the last days of life in familiar surroundings in the company of loved ones and that it allows the family to have more time with their pet and prepare for the loss of this beloved family member," Shanan says. Most pet hospitals and ER practices, he says, lack the time and training necessary to provide the clients effective emotional support and the ongoing medical attention that pets in hospice need.

This pet hospice program fills that gap and gives them a way to offer hospice care for pets near the end of their lives.

To help veterinarians who want to know more about pet hospice care, Shanan founded the International Association for Animal Hospice and Palliative Care (IAAHPC). The IAAHPC is planning to publish guidelines for pet hospice care for veterinarians and other pet hospice professionals later this year. Shanan feels that pet hospice care demands such specialized skills that it should become a recognized specialty in veterinary medicine.

Lap of Love Veterinary Hospice & In-Home Euthanasia, Lutz, Fla.

Dr. Dani McVety, a veterinarian in central Florida, started doing pet home euthanasia in August 2009, just a few months after graduating from the University of Florida College of Veterinary Medicine. A few months later, McVety invited Dr. Mary Gardner, whom she had met in school, to join her. She named the practice, Lap of Love Veterinary Hospice and In-Home Euthanasia, after watching a Chihuahua pass peacefully curled up in its owner's lap and thinking, "This is how euthanasias should be."

The goal from the start was to develop a pet hospice and home euthanasia model that they could take around the country so that other veterinarians wouldn't have to keep re-inventing the wheel. Lap of Love offers only pet euthanasia, pet hospice, after-care service and no other veterinary services. Currently the service covers central and southern Florida areas. And their plan is to open another service in Charlotte, N.C.

"I was a volunteer at a human hospice in undergrad and then worked in pet emergency care right after graduating," McVety explains. "It was hard to see pets in pain. Combined with my human hospice experience made me think about pet hospice and the need for comfort care at the end of a pet's life." At first, McVety thought they would offer care similar to the kind that human hospice programs provide. They soon found out that it was too much for pet owners to manage. She and Gardner went back to the drawing board and worked out more practical, client-friendly ways to provide quality of life and comfort care for terminal pets that includes home euthanasia and even pet cremation as well as resources to help with bereavement.

The work itself is rewarding, McVety says. In fact, her clients let her know how much home euthanasia and pet hospice mean to them. Client communication remains the most challenging aspect to this service, she says. In fact, they spend much of their time educating pet owners about disease progression, quality of life and pain control so they can formulate their plans based on what the pet is going through. Most clients appreciate knowing what to expect, she says, and it makes them feel better to have something they can do for their pets, even if the decision is to humanely euthanize them.

McVety says she started this service simply by visiting area veterinarians to let them know that she would make home visits for pet euthanasia and pet hospice care for them. It helped get the word out. Her practice really took off after an article appeared in the St. Petersburg Times in early 2010 on pet hospice. Between people reading the article and finding them online at their practice's website and on Facebook, they've been busy and growing. She said they just added another location in North Carolina and will be starting another in Orlando soon. She and Gardner will be talking about how to provide pet hospice care at the 2012 North American Veterinary Conference to share their experience with others.

Home to Heaven, Loveland, Colo.

Dr. Kathleen Cooney, a 2004 Colorado State University veterinary school graduate, saw a lot of pets with cancer in her first job after graduation. She realized there was no good setup to provide home care for these pets. As a CSU veterinary student she had taken advantage of the pet-hospice training at the Argus Institute. This training, in combination with her practice experience, opened her eyes to the need to offer pet hospice and home euthanasia for pets. By 2006, she moved back to Ft. Collins, Colo. and opened Home to Heaven, a mobile veterinary practice dedicated to serving pet owners with terminally ill pets by providing hospice and palliative end-of-life care. Her practice averaged about 10 calls a week in the first year, she says, but now she receives as many as 35 calls a week and services northern Colorado and southeastern Wyoming. She was not surprised at the growth. There are a lot of pets with cancer, and they would be likely candidates for her services. In addition, she called the local pet crematory to estimate the number of pet deaths in the area. When she spoke with them, she learned that they were getting four calls a day asking for references for pet euthanasia. This knowledge inspired her to go ahead with her plans.

To start, Cooney sent a letter to local veterinarians asking them to refer their terminal pets for either pet hospice and/or home euthanasia. She also took out advertisements in the local newspaper. She does a lot of pet home euthanasia right now, but her vision is broader. She sees pet hospice and euthanasia as vital resources for practitioners to turn to for end-of-life support for pets.

When a pet is euthanized, Cooney in turn contacts the pet's regular veterinarian so that clients don't have to make this call. She also provides memorial space on her website for owners of deceased pets to help them grieve about the pet's loss. She takes pride in helping pet owners understand the progression of disease and prognosis so pet owners make informed decisions about a pet's end-of-life care. Cooney says she wants to help other veterinarians find information on home pet euthanasia, and she has recently published her first e-book on this subject at www.hometoheaven.net/ebook.

Cooney also started a web-based Pet Euthanasia Directory (http://inhomepeteuthanasia.com) so that other veterinarians who are providing pet end-of-life services and home euthanasia can be listed in one place for pet owners to find.

Resources

• American Veterinary Medical Association pet hospice guidelines: http://ebusiness.avma.org/EBusiness50/ProductCatalog/product.aspx?ID=66

• Cornell University College of Veterinary Medicine Pet Loss Support Hotline: www.vet.cornell.edu/org/petloss/

• CDs of the first and second International Symposia Veterinary Hospice Care Proceedings: www.pethospice.org/FISVHC%20CDs.htm

• Colorado State University Argus Institute Pet Hospice Program: www.argusinstitute.colostate.edu/PHabout.htm

• International Association for Animal Hospice and Palliative Care: www.iaahpc.org

• National Hospice and Palliative Care Organization: (Human Hospice Care) www.nhpco.org/i4a/pages/index.cfm?pageid=5953

• Pet Hospice Care Articles: www.dvm360.com

• Veterinary Clinics of North America: Pet Hospice and Palliative Care, Elsevier publishing. Editor, Tami Shearer, DVM, May 2011: http://linkinghub.elsevier.com/retrieve/pii/S0195561611000271

Typical veterinary hospice services

• Pain recognition and treatment

• Bandage and wound care

• Intravenous and subcutaneous fluids

• Supplementary nutrition

• Management of incontinence

• Care of intravenous or urinary catheters

Karyn Gavzer, MBA, CVPM, is a veterinary business consultant and nationally known writer and speaker. She says her job is to help practices "go and grow" with training, marketing and new ideas. She is a Certified Veterinary Practice Manager, an adjunct instructor for AAHA, and a founding member of VetPartners (formerly the Association of Veterinary Practice Management Consultants and Advisors).