What is animal hospice and palliative care?
Animal hospice is care for animals, focused on the patient's and family's needs; on living life as fully as possible until the time of death [with or without intervention]; 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 of psychological, social and spiritual problems, is paramount. The goal of palliative care is 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 definitely 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 and/or palliative care?
The diseases that most frequently warrant hospice or palliative care for animals are:
- Incurable organ failure [kidneys, liver and heart are common examples]
- 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 of 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.
- Aggessively 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. Respond compassionately.
Who offers animal hospice and palliative care services?
Hospice and palliative care services are offered by interdisciplinary professionals 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 wide-spread, 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 mean necessarily 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 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