Common Questions and Answers:Exploring Hospice and Palliative Care for Your Pet's End-of-Life Journey

FAQs For Pet Professionals

What is animal hospice and palliative care?

Animal hospice is care for animals focused on living life as fully as possible until the time of death (with or without intervention), with an emphasis on the patient’s and family’s needs and on attaining a degree of preparation for death.

Palliative care is the active total care of patients with a life-limiting illness that is not responsive to curative treatment. Control of pain, of other symptoms, and psychological, social, and spiritual problems is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families (The World Health Organization, 1990). Palliative care can go on as long as it is needed, for months and even for years.

Hospice exists to provide support and care for patients in the last phases of incurable disease, or at the natural end of life. Hospice incorporates all of palliative care and is defined as a philosophy, a specialized program of care, and, in some instances, an actual place for the dying.

Hospice recognizes dying as a normal process, whether or not resulting from disease and sees the end of life as an opportunity for growth. Hospice exists in the belief that patients in the last phases of life deserve such care so that they might live as fully and comfortably as possible, and that through appropriate care and the promotion of a caring community sensitive to their needs, patients and their families may be free to attain a degree of mental and spiritual preparation for death that is satisfactory to them.

In most human hospice organizations, services are limited to patients who have decided not to undergo any further curative treatments, and have a limited life prognosis of 6 months or less.

Hospice care for animals has been described as “management of palliative care patients who have progressed such that death will likely occur within a period of days to weeks; however, the distinction between hospice and palliative care for animals has not yet been sharply defined.

What kind of diseases or conditions would warrant hospice or palliative care?

The diseases that most frequently warrant hospice or palliative care for animals are:

  • Cancer
  • Incurable organ failure (kidneys, liver, and heart are common examples)
  • Osteoarthritis
  • Progressive neurological conditions, including dementia
  • Senior pets reaching the end of life

What is the first step when starting hospice care?

Hospice care begins with formulating an individualized plan, based on a comprehensive assessment of the patient’s and family’s needs and taking into consideration:

  • The patient’s diagnosis, prognosis, and available treatment options
  • The family’s values, beliefs, and resources
  • The hospice team’s philosophy and capabilities

What's included in a hospice plan?

There are three components of the hospice plan:

  • Medical care includes recognizing pain and other symptoms, administering medications, anticipating complications, and learning what side effects may be associated with medications and treatments.
  • Nursing care includes reviewing treatments and medications administered by the family, reviewing the patient’s activities of daily living, assessing the patient’s condition, administering medications and treatments, and ensuring that all measures are taken to maximize the patient’s comfort.
  • Support for the family consists of actively listening to owners elaborate on their feelings, validating the family’s experiences and showing empathy; providing information and other resources; and facilitating coping and decision-making.

What services are available to pet parents who want hospice care for their pets?

Services for patients and their families offered by the hospice team may include efforts to:

  • Assess and treat based on how the patient feels, more so than on the patient’s physical appearance or medical test results
  • Aggressively treat symptoms, including (but are not limited to) difficulty breathing, pain, nausea, loss of appetite, dehydration, constipation, diarrhea, and mental distress
  • Recommend nonpharmacologic options when available
  • Aggressively treat secondary problems to determine how far the primary problem has progressed
  • Provide in-home medical and nursing services
  • Communicate empathically
  • Provide 24/7 accessibility for patients who are actively dying or are in need of euthanasia
  • Guide family members to review their opinions and beliefs regarding death and dying
  • Encourage clients to reflect on the options and discuss them with other family members prior to making decisions
  • Consider benefits and costs, physical, psychological and financial, of treatment, diagnostics, and monitoring
  • Provide the optimal physical and social environment to maximize the patient’s comfort
  • Train family members to perform medical and nursing care at home
  • Train family members to assess and monitor the patient’s comfort level and quality of life
  • Encourage realistic expectations for the patient’s remaining lifetime and the process of dying
  • Raise the family’s awareness of the limitations facing proxy decision-makers
  • Help families prepare for the loss by addressing in advance questions like:
    • Where will the patient be during his or her last moments? Who will be present?
    • What circumstances will justify medical assistance to the dying process?
    • Will the pet’s body be cremated or buried? When, where, and by whom?
    • Will there be any ritual or ceremony at the time of or after the pet’s death?
    • How will the pet be memorialized?
  • Offer information about normal and complicated grief
  • Recognize grief — especially anticipatory grief — as a healthy process, and respond compassionately

Who offers animal hospice and palliative care services?

Hospice and palliative care services are offered by interdisciplinary professional teams consisting of veterinarians, veterinary nurses/technicians, and social workers. Hospice teams may also include pet sitters, chaplains, pet life specialists, and volunteers from the community. It is important to have a variety of support services available through a team approach because hospice care aims to provide total care, addressing physical, emotional, social, and spiritual needs.

At the present time, there is a great shortage of qualified animal hospice and palliative care providers. IAAHPC is dedicated to relieving the shortage by promoting hospice care and offering training programs for interested professionals. As recognition of the benefits of hospice care for pets becomes more widespread, more providers will offer more animal hospice services.

What are the pet parent's (primary caregiver's) responsibilities?

The pet parent’s primary responsibilities are monitoring the pet’s comfort and quality of life, communicating with the hospice team, and making decisions about the pet’s care.

  • The pet parent is trained to monitor the pet’s comfort and quality of life during the hospice care period and consults with the veterinarian and other professionals to make sure the highest level of comfort can be provided to the pet. The pet parent and animal nurses administer medications and other treatments as directed by the veterinarian. If possible, the pet parent should arrange for help to provide care for all the pet’s needs around the clock.
  • The pet parent communicates her/his own physical, emotional and spiritual needs to the hospice team so that those needs can be met during the hospice experience.
  • The pet parent remains sufficiently informed and involved in the hospice experience to continually evaluate and make decisions about the pet’s care as the pet’s condition changes.

Does choosing hospice necessarily mean that I cannot choose euthanasia for my patient?

The decision to seek hospice care does not necessarily rule out euthanasia. With early intervention with pain and symptom control and client education, many patients can be kept comfortable until an unassisted or “natural death” occurs. In the event that a patient is experiencing unacceptable discomfort or distress, or the family’s needs and decisions warrant, we consider the option for compassionate, appropriately timed euthanasia as the optimal way to relieve suffering and provide comfort.

Hospice recognizes that making decisions for an animal approaching the end of life is the right and responsibility of the animal’s primary caregiver or pet parent. The hospice team helps the decision-makers assess the progression of disease in terms of symptoms and quality of life and helps them make the best decisions.

How do I know if hospice care is the right decision for my patient?

Many pet parents choose hospice care in order to have the time to say goodbye to their companions, to plan for their death, and to ensure that all the decisions about the pet’s needs are guided by their view of the pet’s needs. If you have the resources to support comfort care, the time and desire to care for your patient during the last days or weeks of their life, and a good support team in place, then hospice care may be the right choice.

Written by Amir Shanan DVM

FAQs For Pet Parents

What is animal hospice? What is palliative care?

Both are approaches to care for your animal friend that can be adopted when the goal shifts from cure to comfort. Both involve an interdisciplinary team of providers who offer comprehensive care on the physical, emotional, and spiritual levels and include veterinarians and animal and family services providers. The term “animal hospice” is not a place; it is a philosophy of care that became popularized in the 1970s. Since the 1990s, the hospice model has been applied to also care for our pets, and thus, hospice and palliative care for animals is growing across the US and the world.

Why animal hospice and palliative care for my beloved pet?

In the human hospice experience, families are well-supported and empowered to provide loving care to their loved ones. As a result, they find enhanced coping along the journey and healing from their loss. Many pet parents want the same care for their furry, feathered, and scaled family members as they’ve seen benefit their human loved ones, and so they turn to animal hospice. Pet parents also seek satisfaction in knowing they did all they could to support their animal companion, enhance their bond with them during this time, and create cherished memories.

What kind of diseases or conditions would warrant hospice and/or palliative care?

The diseases and conditions that most frequently warrant hospice or palliative care for animals are:

  • Cancer
  • Organ failure (kidneys, liver, and heart are common examples)
  • Osteoarthritis
  • Cognitive dysfunction, or dementia
  • Senior pets approaching the end of life
  • Failure to thrive
  • Any life-limiting condition that is contributing to an excessive burden of caregiving for a family, or treatments/interventions that are unacceptable to the pet

As a pet parent, what are my responsibilities in providing hospice for my animal friend?

Preparing to care for your aging, ill or dying pet is similar to caring for a child or aged adult. You would take time to learn about your loved one’s condition and ways to ensure the highest degree of comfort possible. You would learn how to monitor your loved one’s quality of life and then regularly communicate with the hospice team. You would make decisions with the guidance of the care team, and then take measures to act on your decisions once the appropriate time came. Along the journey, the well-being and feelings of the human family members would be validated and supported.

How do I know if hospice care is the right decision for me and my pet?

Many pet parents choose hospice care in order to have the time to say goodbye to their companions, to plan for their death, and to ensure that all the decisions about the pet’s needs are guided by their personal view of the pet’s needs. If you have the resources to support comfort care, the time and desire to care for your pet during the last days, weeks, or sometimes months of their life, and a good support team in place, then hospice care may be the right choice for you and your pet.

Why do I feel so sad already, when my animal friend was just recently diagnosed? Few people seem to understand what I’m going through.

We know that grief associated with loss begins before the actual death occurs, and the name for this is “anticipatory grief.” These emotions may sneak up on us and affect us in many aspects of our lives. Grief is work! It is never easy, but it can be easier with the support of a team that values “care for the caregiver,” a cornerstone of hospice philosophy. Yes, the ability to think clearly will directly affect how effective you can be in your care for your animal companion. Respite, or some time away from caregiving, can be important to your continued well-being.

We encourage you to reach out to like-minded individuals in your community and online who have experienced similar situations, and “get it.” Look to your local animal shelters, veterinary association, and pet funeral homes for pet loss support groups. Human hospice programs in your community offer grief and bereavement services to the public (interview them for their views on pet hospice first).

If you feel you would benefit from further or additional help, please see our Membership Page for therapists and counselors specializing in pet loss. You can also find more local resources in Directories from organizations like the Delta Society.

We have heard there are gentle alternative therapies we might want to pursue in order to keep our friend more comfortable. What about those?

Complementary therapies have proved excellent adjunctive support for animals approaching the end of life. Holistic or complementary veterinarians may offer any of the following:

  • Traditional Chinese medicine
  • Herbs – Western, Chinese, Ayurvedic
  • Ayurvedic medicine
  • Homeopathy
  • Acupuncture
  • Chiropractic
  • Nutritional therapy and supplementation
  • Laser therapy

Are there other therapies that can contribute to well-being for my animal friend?

Similar to the holistic veterinary modalities above, the following are gentle techniques. Once learned, they can be affordable options to incorporate into your caregiving routine. In offering this special care to your pet, the emotional bond you have with him or her may be enhanced.

Consider talking to your veterinary team about:

  • Massage
  • Warm water therapy
  • Healing Touch
  • Tellington Touch™
  • Acupressure
  • Warm water therapy
  • Reiki
  • Essential oils (aromatherapy)
  • Flower essences

I am concerned about my child’s well-being while he or she prepares to lose his best friend. Should he or she be a part of this process?

Children learn responsibility and love in caring for their family pet. Similarly, aging, illness, and death provide rich lessons about the cycle of life. Just as with their adult caretakers, children can be taught techniques to remain involved with their animal friend’s care so they feel important and even inspired by this tender and memorable time. Depending upon your child’s age and temperament, the advice/recommendation of your hospice team, and your careful preparation, consider allowing them to be present at the time of death. If you would like another opinion about how to assist in their coping and grief work, a child therapist can be considered.

I am overwhelmed with all the decisions and the information confronting me. How do I know when to reach out for help?

Hospice providers encourage caregivers to make a plan that begins with their values, goals, and beliefs for their animals and for their families. A large role of your veterinary team is to provide you with education about your pet’s disease course and what to expect, including indicators of the dying process. With the assistance of your care team, you will be regularly re-assessing quality of life for you and your pet. You will be able to identify mileposts that signal the appropriate time to enact your plan. Just as you have always cared for and nurtured your pet, you will find that during this time your intuition and your intention to make good decisions on their behalf will seem natural in many respects.

How do I make bodycare preparations?

Inquiring about aftercare options in your community and/or making aftercare arrangements ahead of time helps you prepare emotionally and logistically for when the time comes — when you won’t want to be confronted with those decisions. Consider memorializing and paying tribute to your animal companion’s life to promote emotional healing, as well as a richer understanding and validation of your family’s loss. Pet funeral homes have full services to help you do so. You may consider planning a simple ceremony to pay tribute to your pet. You may look to the Web to find remembrance items, from special urns for cremains to jewelry and other options. Post to a memorial website for a more public life tribute.

I would like to learn more about options for death with and without euthanasia. Are both available with hospice care for my animal friend?

Hospice philosophy recognizes that a “good death” may mean different things to different families, and is as individual an experience as birth. Under the care of a qualified veterinarian, both euthanasia and hospice-supported natural death are humane options for our animal companions. Communication with your veterinarian and the rest of the hospice team is important to giving your pet a good death and meeting your own expectations for what that will be like. If you are interested in hospice-supported natural death for your friend, it is essential that you seek out a veterinarian who is comfortable with this kind of dying process. Most important is the understanding that hospice philosophy is inclusive to all modes of dying for animals, both naturally and via euthanasia when needed.

Written by Michelle Nichols, MS, Amir Shanin, DVM, Katherine Goldberg, DVM, and Tina Ellenbogen, DVM. Spring 2013.