What is animal hospice and palliative care?
is comfort care for animals, focused on the needs of both the pet patient and
the whole family. It's about living life as fully as possible until the time
of death [with or without intervention], and on attaining a degree of
preparation for death.
care is the active, total care of animal patients with a life-limiting
illness that is not responsive to or pursuing 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. The ultimate goal is to deliver
this care in the animal's own home and not at a clinic until comfort is no
longer possible, at which time the gift of euthanasia is a true blessing.
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 specialised programme of care, and in some instances, an actual place for the
Hospice recognises 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. 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 organisations, services are limited to
patients who have decided not to undergo any further curative treatments, and
have a limited life prognosis of six 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 warrant hospice and/or
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
What is the first step when starting hospice care?
Hospice care begins with formulating an individualised plan, based
on a comprehensive assessment of the patient's and family's needs and taking
- The patient's diagnosis,
prognosis and available treatment options
- The family's values, beliefs
- The hospice team's philosophy
What's included in a hospice plan?
There are three components of the hospice plan:
- Medical care includes recognising
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 maximise 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 more on
how the patient feels than on the patient's physical appearance or medical
- Aggressively treat symptoms,
including (but not limited to) difficulty in breathing, pain, nausea, loss
of appetite, dehydration, constipation, diarrhoea, and mental distress
- Recommend non-pharmacologic
options when available
- Aggressively treat secondary
problems to determine how far the primary problem has progressed
- Provide in-home medical and
- 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
- Consider benefits and costs,
physical, psychological and financial, of treatment, diagnostics and
- Provide the optimal physical
and social environment to maximise 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 memorialised/remembered?
- Offer information about normal
and complicated grief
- Recognise 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 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 programmes for
interested professionals. As recognition of the benefits of hospice care for
pets becomes more widespread, more providers will offer more animal hospice
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
hospice mean that I cannot choose euthanasia for my patient?
The decision to seek hospice care does not necessarily rule out
euthanasia. Early intervention with pain and symptom control and client
education means many patients can be kept comfortable until an unassisted or 'natural'
death occurs. In the event of a patient experiencing unacceptable discomfort or
distress, or if 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 recognises 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
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 and your practice 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
and edited from IAAHPC website (www.iaahpc.com)
The Hospice Vet - Susan Gregersen, DVM, MBA, MRCVS
Susan qualified in
Copenhagen, Denmark in 1999 and is an in-home hospice and emergency vet. In
2005 she established Vets2Home Veterinary Service which was re-launched in
2012 as Vets2Home - Peaceful Pet Goodbyes - as a fully dedicated in-home
service specialising in palliative medicine, animal hospice and gentle
euthanasia services, helping families say goodbye to their pet in the comfort
of home 24/7. After personal experience from over 9000 home consultations,
Susan is also a columnist, blogger, consultant in optimising end-of-life vet
services, the co-founder and president of the British Mobile Veterinary
Association (BMVA) and an active member of the International Association of
Animal Hospice and Palliative Care (IAAHPC).