Veterinary hospice offers cats and clients familiar comforts (Part 1): Familiarize clients with veterinary hospice

Part 1 of this article provides definitions of veterinary hospice and palliative care, describes the advantages of hospice care, and presents an overview of how to talk with clients about feline hospice care. Part 2 outlines practical feline home hospice care guidance to share with clients, including when to consider in-home euthanasia services.

A bond that bolsters veterinary hospice care

Since the early 2000s, the veterinary profession has grown in and embraced providing hospice and palliative care services for companion animals, and I’m grateful to have been a part of it since we started Lap of Love in 2009.^1-4

Cats who have a life-limiting disease diagnosis can receive hospice care, wherein medical interventions focus on comfort and quality of life rather than on curative treatments.⁴ Hospice also includes addressing caregivers’ needs in ways that may require supplemental support from emotional, mental, and spiritual care professionals. Palliative care is a component of regular medical care and hospice care for patients with curable and incurable conditions, focusing on alleviating clinical signs and improving comfort. ⁴

Client demand for veterinary hospice and palliative care services has blossomed with the ever-expanding human-animal bond, as well as veterinary medical advances and progress in our understanding of animal behavior and cognition. All these factors likely contribute to the improved health spans and increased life spans of veterinary patients.⁵ Veterinarians have the fortunate opportunity to successfully manage pets’ chronic, progressive conditions well into their patients’ senior years and throughout end-of-life care. Veterinary hospice shifts a patient’s care from treating their disease to treating their quality of life. So, if you haven’t already, set up a hospice program in your clinic. It’s a straightforward and gratifying component of practice, and veterinary hospice includes many components of patient and client care that you already provide.

Familiarity breeds cat contentment

Social media often features confident cats and clients who share adventurous travels and sporty activities, yet many of the feline patients veterinarians see and the cats we know are wary homebodies. Genetics, kittenhood experiences, and major life events mold each cat’s temperament and personality.

In general, cats prefer the security of their known territory, which includes the sights, sounds, and smells of familiar inhabitants (people and housemate pets) and furnishings. Cats also learn and anticipate predictable feeding and activity routines, which promote their sense of safety and environmental control. They may perceive abrupt changes and novel places, people, and handling as survival threats.

The veterinary profession has widely adopted and promoted minimal-stress patient-handling and restraint techniques and cooperative care, which extend to species-specific modifications to clinic design and related environmental enhancements.^6-11 Cats’ fear and anxiety can stoke adverse physiologic consequences, including immunosuppression and vulnerability to infection, gastrointestinal disturbance that leads to inappetence and hepatic lipidosis, and urinary tract dysfunction.¹² Fear and anxiety can amplify pain, and pain can trigger fear and anxiety.⁴ A stress response in anxious cats during veterinary clinic visits may interfere with laboratory test results, diagnosis, and treatment.¹³ Similarly, diseases themselves cause cats’ distress. As veterinarians identify and manage cats’ physical ailments, we’ve implemented ways to better meet cats’ emotional and environmental needs in the clinic while also emphasizing the importance of clients meeting their cats’ fundamental needs at home.

Despite our best feline-friendly efforts, some clients may still skip in-clinic veterinary care because of their cat’s aversion to carriers, car sickness, fear at the clinic, rejection by housemate pets afterward, or a cumbersome commute or inadequate transportation. Neglecting veterinary care is concerning in each of a cat’s life stages, including as cats near the end of life.

Telemedicine consultations and in-home veterinary assessments may be beneficial supplemental options in cats’ health care and may meet clients’ needs when they might not otherwise seek veterinary care.^14,15 Practices may wish to consider whether offering or connecting clients to virtual or in-home veterinary services will enhance clients’ perceptions of their practice, alleviate appointment scheduling pressure, and boost their teams’ morale. Veterinary teams’ well-being is a crucial consideration when providing end-of-life patient care and support for bereaved clients.^16,17

Communicating about hospice for cats

Clients may not understand the severity of their cats’ conditions, nor that their cats may be near or at the end of life when they present them for evaluation.¹⁸ Many families want their ailing pet to live as long and as comfortably as possible, but they may not understand what that entails or feel powerless to provide it. Relieving a terminally ill patient’s pain and anxiety while helping clients prepare for their pet’s death are major components of veterinary hospice care. It is a health care option that offers clients a path to making the most of their remaining time with their pet. This typically requires a lengthy conversation with clients to help them understand the likely progression of their pet’s serious illness, explore their values, and identify goals for their pet’s care. It includes discussing quality of life and agreeing on the parameters that indicate their cat no longer has a good quality of life.^17,19

Guide clients in how to assess their cat’s quality of life (eg, comfort, appetite, weight, hydration, mobility, elimination ability, interest in activities, social interaction, surroundings) in light of clinical signs associated with their condition (eg, pain, nausea, dyspnea, thirst, anxiety, boredom). Such discussions with clients may go more smoothly when the veterinarian has provided continuity of care and is familiar with their cat.¹⁸ Begin these conversations by asking whether and how much the client would like to learn about their pet’s condition and prognosis.⁴

Some clients think of hospice as “giving up” on their pet and inducing death by stopping all medical intervention. I explain to clients that the goal of veterinary hospice is to alleviate their pet’s bodily and emotional stresses, and that although we’ll no longer attempt curative treatments (that the client has declined, or that are not expected to achieve a cure and may diminish their pet’s quality of life), we’ll continue to provide the medical and environmental support that addresses their pet’s symptoms and the family’s resources (their capabilities related to financial, physical, time, and emotional commitments). I explain that hospice is not euthanasia or medically unassisted death, and that the goal of hospice is to prevent patient suffering, assist patients in having a comfortable end-of-life experience, and give families more time to share meaningful moments with their pet that they might otherwise miss.

Center on clients as partners in hospice care

Home hospice and palliative care involve guiding clients on the following:

• Accurately assessing their cat’s physical and behavioral cues, especially signs of pain

• Safely and respectfully handling their cats
• Gauging how well cats will accept medical care
• Providing positive experiences when administering therapies
• Making necessary home environment adjustments (easy access to food, water, litter box, safe spaces, comfortable bedding, and appropriate ambient temperature)
• Providing appropriate social interactions and predictable routines
• Evaluating quality of life for cats
• Assessing the caregivers’ quality of life
• Understanding anticipatory grief (distress clients may experience upon acknowledging their pet has a terminal illness and as their pet’s quality of life declines) and providing resources to support them
• Planning for their cat’s euthanasia and aftercare

Clients should realistically evaluate whether they can:

• Administer the medications their cat needs
• Continue to have a positive relationship with their cat
• Positively affect their and their cat’s quality of life
• Provide a home environment that adequately meets their cat’s fundamental and condition-associated needs

When cats have life-limiting conditions, veterinary hospice and palliative care can continue to support the bond owners have with their cats and may substantially improve cats’ and clients’ quality of life during the end-of-life stage.

In Part 2 of this article, I highlight practical guidance on feline home hospice care to share with clients, including considerations for in-home euthanasia services.

For additional resources on hospice care and services, visit LapofLove.com.

References

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3. Dhaliwal R, Boynton E, Carrera-Justiz S, et al. 2023 AAHA senior care guidelines for dogs and cats. J Am Anim Hosp Assoc. 2023;59(1):1-21. doi:10.5326/JAAHA-MS-7343
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