Hospice and End of Life Decisions
Hospice Care and End of Life Issues
Because attachment behaviors are the essence of the human-animal bond, owners want to return the unconditional love offered by companion animals, especially senior pets who have become long term family members. Our pets are integral parts of our family and we love them dearly. Seeing them age or develop disease can be very difficult.
What is Hospice?
Veterinary hospice is a family-centered service dedicated to maintaining comfort and quality-of-life for the terminally ill pet until natural death occurs or the family elects euthanasia. Hospice care should be considered when the patient’s life expectancy is considered to be 3 months or less. The goal of hospice care is to provide palliative care that, although not curative, may help increase the time between diagnosis and death. Palliative care focuses on the treatment of symptoms.
How is Hospice Provided?
Hospice care is usually provided in the home with the family. The necessary support to accomplish at home hospice care begins most importantly with a strong veterinary-family partnership. The veterinary staff can demonstrate wound care techniques and how to prevent bedsores by using egg crate mattresses and body rotation. They can provide strategies to prevent self -soiling. Some veterinary staff may be available to do house calls to provide subcutaneous fluids or to give injectable medications.
Hospice caregivers should be prepared to focus on pain assessment and management, maintenance of their pet’s body weight and nutritional status, hydration, respiration, mobility, hygiene and maintenance of a healthy, interactive human-animal bond. Symptoms like urine dribbling, nighttime panting/pacing and lack of appetite can often be managed with simple medications
Other services that can help support patients and pet owners during the hospice period include acupuncture, laser therapy, massage, grooming, in home pet sitting and support groups or “old-dog play dates”.
How do you Measure Quality of Life?
Quality of life is defined as the balance between pleasant and unpleasant feeling states. Unpleasant feelings may be physical such as lack of oxygen, thirst, hunger, disease, nausea, full urinary bladder, itchiness, temperature extremes and pain. Unpleasant feeling states can also be emotional such as anxiety, loneliness, grief, frustration or boredom. Sources of pleasant feeling states include social companionship, mental stimulation and tasty foods. The paramount objective in hospice care is to maximize quality of life by minimizing discomforts and maximizing pleasures. The patient’s needs are always the primary focus of concern.
The HHHHHMM scale is a tool to help an owner/caretaker objectively assess their pet’s quality of life. A total of > 35 points represents an acceptable quality of life.
At some point during hospice care, your pet’s quality of life will become diminished and the decision to consider euthanasia will be appropriate. Although different veterinary hospitals have different approaches, you may have some further end of life decisions to consider. You may or may not want to be present at your pet’s euthanasia. You may want to consider after-life decisions such as home burial (if legally allowed), group cremation or private cremation with the return of your pet’s individual ashes. To memorialize your pet, we can provide imprints of your pet’s paw, or clippings of hair.
Grief and Grief Support
Grieving is a natural part of loss and relief is a natural component of grief. You should not be embarrassed or ashamed about grieving for the loss of an animal. The following are some resources to assist in your grieving process:
The decision regarding the euthanasia of a beloved pet may be the most difficult decision you’ve ever made. There is no perfect choice, but euthanasia may be the best decision under the circumstances. If your pet is suffering and death comes peacefully and painlessly, euthanasia is an ethical, moral and loving choice. We are here to help you with this difficult decision, and to guide you through the process.