Michelle Nichols, MS
AHELP Project Director and Co-founder
Most of us don’t wish to think about the approaching death of our pet. How many of us have tried to conveniently forget that it won’t happen (denial) or that NOT thinking about their declining health will make the reality go away (avoidance)?
Elaine Lam and Mone Mone enjoy quiet time together. (photo: Elaine Lam)Read more
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What is animal hospice? What is palliative care?
Both are approaches to care for your animal friend that can be adopted when your goal shifts from cure to comfort. Both employ an interdisciplinary team of providers who offer comprehensive care on the physical, emotional and the spiritual levels to include veterinarians, animal and family services providers. As a field, the term “animal hospice” is not a place, it has been a philosophical approach that became popularized in the 1970’s. Since the 1990’s the hospice model has been applied in caring for our animal companions and thus, hospice and palliative care for animals is growing in popularity across the U.S. and in the world.
Why animal hospice and palliative care for my animal friend?
In the human hospice experience, families are well-supported and empowered to provide loving care to their loved one. As a consequence, they enjoy enhanced coping along the journey and then subsequent healing from their loss. Many of us want the same care for our furry, feathered and scaled family as we saw benefit for their human loved ones, and so we turn to animal hospice.
Though it's common for many to find the heightened responsibilities of hospice a challenge, through the guidance of the hospice care team, families can also gain confidence in their caregiving skills. With the family no longer in pursuit of the cure for their furry family member, they can all enjoy heightened quality of life, which can in turn, allow the animal patient to be here longer and more comfortably. Families have more time to fulfill their bucket list, and coping with new normals, all the while emotionally preparing for their precious farewell. Caregivers find satisfaction in knowing they did all they could to support their loved one, enhanced their bond with them during that time, and made cherished memories of their last days here with them. Though challenging, looking back they realize they followed their "path of least regrets" and healing from their loss often goes more smoothly.
What kind of diseases or conditions would warrant hospice and/or palliative care?
A hospice or palliative care approach is commonly chosen in animals with:
- organ failure [kidneys, liver and heart are common examples]
- cognitive dysfunction (dementia)
- general "slowing down" or chronic conditions that are worsening
- any life limiting condition that contributes to an excessive burden of caregiving for a family
- a recommendation for interventions like surgery that are unacceptable to the family's wishes
As a caregiver, what are my responsibilities in providing hospice?
Imagine or recall the measures you take in caring for a child or an older adult... preparing to care for your aging, ill or dying pet is similar. 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 your his or her condition with the hospice team. You would make decisions under the guidance of the care team, and then take measures to act on your decisions once the appropriate time came. Along the journey, you would be encouraged to share your own feelings about your continued well being, including a regular self-assessment of your own quality of life. Care for the caregiver is a must!
What kind of a veterinarian should our animal companion see now?
Think creatively to find a veterinary team who suits your animal's needs and is supportive of your wishes. If you like your veterinarian, there is no need to leave his or her care. You will want one who can make housecalls and can spend time with you on the phone and/or by email. If he or she isn't equipped to accommodate those needs, a hospice-focused veterinarian could be a good choice to add to your team.
When interviewing a hospice-focused veterinarian, ask what training, continued education and experience he or she has had in end-of-life care. Performing home euthanasia is just one service offered by a hospice focused veterinarian, so ask what else they offer. It's perfectly reasonable to have a hospice-focused veterinarian working alongside your trusted, regular veterinarian. This shared care teamwork approach doesn't mean expenses will go up. In fact, choosing comfort at home over curative therapy means that trips to the clinic decrease over time. As time goes on and intervention decreases, many families find that this approach is just as affordable
Complementary therapies have proved as excellent adjunctive support for animals approaching end of life. Ask your veterinary team about the potential to improve well being by the following holistic or complimentary veterinary services:
What is all this about a Team Approach?
Since physical comfort of the animal patient is paramount to continue hospice care, veterinarians who can do housecalls are naturally at the core of the team. Best practices speak to the need for emotional and spiritual “care for the caregiver” so families find benefit from mental health professionals, chaplains, and spiritual counselors. Pet sitters skilled in senior care are important logistically, and of them, veterinary technicians who come to the home to nurse the animal patient, and/or teach and assist the family to do so themselves are ideal. As our animals’ life energy diminishes, the gentler, alternative therapies are so effective in preserving quality of life. Other team members’ services that can contribute to comfort for both the animal and the family are: massage and bodywork, aromatherapy, homeopathy, energy work, acupressure, flower essences and music therapy.
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 your friend’s loss begins much before the actual death occurs, and the name for this is “anticipatory grief”. These emotions sneak up on us and affect our effectiveness in many aspects of our life. 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 time away, from your declining pet can be important to your continued well-being.
Look for animal lovers in your personal circle of friends and family, keeping in mind that they may not see things as you do. Especially in this case, but also for more support, we encourage you to reach out to like-minded individuals in your community and online who have been through similar situations and “get it”. Consider our Animal Caregiver Support Circles that meet twice monthly in Seattle and in Kirkland. Look to your local animal shelter and pet funeral homes for loss support groups. Human hospice programs in your local hospital offer grief and bereavement services to the public at large (interview the program to discover their views on animal hospice first). Look on the Web for phone help lines, chat rooms and forums. Usually provided on a donations-basis, they can offer an occasional listening ear or might even expand your base of ongoing support. If your coping diminishes and you need further help, look for therapists and counselors specializing in pet loss, interviewing them first to be sure your views match with theirs.
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 might feel important and even inspired by this tender and memorable time. Depending upon your child’s temperament 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 could be considered.
I am overwhelmed with all the decisions and the information confronting me. How do I know “When”?
Hospice providers encourage caregivers to make a plan that begins with their values, goals and beliefs for their animal and for their family. A large role of your veterinary team is to provide you with education about your pet’s disease course, to include indicators of the dying process. With the assistance of your care team, you will be constantly assessing quality of life for you and your animal companion. With your beloved’s decline 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 them, 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.
I can deal with burial, cremation and memorialization once the time comes...
Making aftercare arrangements ahead of time helps you prepare emotionally for the time comes. At that tender time, you won’t want to be confronted with those decisions. Depending upon what you choose, you will want to consider a way to keep cremains or the way you will bury the body. In most cities you can find pet cremation centers and pet funeral homes who will take care of all the arrangements are gaining in popularity, too. Pet cemeteries are less common but can be found. Look into precautions and local regulations if you wish to bury on private property. If it's of interest, you may look into green burials and more environmentally friendly options to traditional cremation. To conserve a great deal of money, you might consider group cremation but be aware you won't get the ashes back.
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 being born. Under a care team comprised of a qualified veterinarian and multi-talented providers, both euthanasia and hospice-assisted natural death are humane options for our animal family members. Good communication between your veterinarian and the rest of the hospice team is important to giving your animal companion a good death and meeting your own expectations for what that will be like. Especially if you are interested in hospice-assisted natural death for your friend, it is essential that you seek out a veterinarian who is comfortable with this kind of dying process. You may also ask that your veterinarian consult with a veterinary hospice care provider if there is not one in your area. Most important is the understanding that hospice philosophy is inclusive to all modes of dying for animals.
I'm so sad now that my beloved animal companion is gone. What can I do to feel better?
Using ritual to honor your animal companion’s life can promote emotional healing and enrich your family's validation of the loss. Once you are ready to share, you might be surprised at the support your community offers and even finding comfort in their words and actions. You could write a tribute to go into an email announcement or use online tools to make a video from pictures showing his or her remarkable lifetime. Plan a celebration of life or a ceremony while you sprinkle ashes in your friend's special spot. Look to the Web for resources, where you will find memorial websites and items of remembrance like jewelry and other art that will incorporate the cremains. There is literally something for everybody!
What should I do if I'd like to explore animal hospice and palliative care further?
Share your wishes with your veterinarian and ask how s(he) feels about a hospice and palliative care approach. Many veterinarians haven't been taught it in school and at the time of this writing, there are no textbooks and few resources in the scientific literature. If they are interested in learning more, refer them to the International Association of Animal Hospice and Pallliative Care Practice Guidelines published in 2012. (www.IAAHPC.org). They may also refer to the Guidelines due to be published in March 2016 by the American Animal Hospital Association (www.AAHA.org), whose accreditation ensures excellence in the profession. It's reasonable to seek a second opinion you aren't satisfied with your veterinarian's ideas. In the greater Seattle area, consider reaching out to our local community who wants the same for their animal family member as you do. Regardless of your geographical region, you can find professionals of all backgrounds on the IAAHPC.org Service Providers page.