Time to Plan: the “UP-side to Anticipatory Grief” - Part I
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)
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Start recruitingQuestions and Concerns about End of Life care for Animals
"What is animal hospice? What is palliative care?"
We often use palliative care and hospice care interchangeably because both focus on comfort rather than cure. Palliative care can be employed at any stage of the patient's disease process. Hospice care, technically a form of palliative care, is used when the patient is terminally ill and no longer pursuing curative treatments.
These terms were first used in human healthcare before being applied to veterinary care. Due to insurance standards, hospice care specifically applies when the patient is expected to live less than six months. Most families opt for euthanasia for their pets before the end of life, making it more complicated to predict companion animals' lifespans accurately due to less available data.
Palliative and hospice care involve an interdisciplinary team of veterinarians and family service providers offering comprehensive physical, emotional, and spiritual care. When applied to animals, we consider the social well-being of the animal, recognizing the strong "human-animal bond" between the caregiver(s) and their pet.
"Why choose animal hospice and palliative care for my pet?"
In human hospice care, families receive support and empowerment to provide loving care, which enhances their coping skills and subsequent healing. Many of us desire the same compassionate care for our furry, feathered, and scaled family members, so we turn to animal hospice and palliative care.
While the responsibilities of hospice can be challenging, families gain confidence in their caregiving skills with the guidance of the hospice care team. By focusing on comfort rather than cure, families and their pet can enjoy a higher quality of life, allowing the animal to live more comfortably and potentially longer. This approach provides more time to fulfill bucket lists and adapt to new normals, while also preparing emotionally for a precious farewell.
Caregivers find satisfaction in knowing they did all they could to support their loved one, strengthening their bond and creating cherished memories during their pet’s final days. Though challenging, this "path of least regrets" often makes the healing process smoother and more meaningful.
"What kind of diseases or conditions warrant hospice and/or palliative care?"
A hospice or palliative care approach is commonly chosen in animals with:
- cancer
- organ failure [kidneys, liver and heart are common examples]
- arthritis
- 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 animal hospice care?"
If you have found this site, you likely already provide a high level of care for your animal family member. Caring for an aging, ill, or dying pet is similar to caring for a child or an older adult. Fulfilling the following responsibilities will allow you to provide compassionate and effective hospice care for your pet:
- Educate Yourself: Learn about your pet’s condition and ways to ensure their highest comfort.
- Monitor Quality of Life: Regularly assess your pet’s well-being and communicate with the hospice team.
- Make Informed Decisions: Work with the hospice team to make care decisions and act on them promptly.
- Self-Care: Regularly assess your well-being and ensure you care for yourself. Care for the caregiver is essential!
- Daily Nursing Care: Be prepared to be available most of the day for your pet's needs or arrange for a secondary caregiver, such as a housemate or neighbor, to help. If your budget allows, consider hiring a skilled pet sitter regularly.
"What kind of a veterinarian should our animal companion see now?"
Choose a veterinary team that suits your pet's needs and supports your wishes. If you like your current veterinarian, you don’t need to leave their care. However, you may want someone who can make house calls and communicate via phone or email. If your vet can't meet these needs, consider adding a hospice-focused veterinarian to your team.
When interviewing a hospice-focused veterinarian, ask about their training, continuing education, and experience in end-of-life care. Home euthanasia is just one service they offer, so inquire about other services. Collaborating with a hospice-focused vet alongside your regular vet is reasonable and doesn't necessarily increase costs. Choosing comfort care at home often reduces clinic visits, making it affordable.
Complementary therapies are excellent adjunctive support for animals approaching the end of life. Ask your veterinary team about the potential to improve well-being by the following holistic or complementary veterinary services:
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"What is all this about an Interdisciplinary Team approach?"
Since the physical comfort of the animal patient is paramount to continuing hospice care, veterinarians who can do house calls are naturally at the team's core. Best practices speak to the need for emotional and spiritual “care for the caregiver,” so families benefit from mental health professionals, chaplains, and spiritual counselors. Pet sitters skilled in senior care are important logistically; veterinary technicians who come to the home to nurse the animal patient and/or teach and assist the family in doing so themselves are ideal. As our animals’ energy levels diminish, gentler alternative therapies effectively preserve quality of life. Other team members’ services that can contribute to comfort for the animal and the family are massage and bodywork, swim therapy, aromatherapy, homeopathy, energy work, acupressure, flower essences, and music therapy (chanting, sound baths, or recordings).
"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 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. Consider that respite, time away from your declining pet, can be important to your continued well-being so you can return to them recharged and refreshed.
Look for animal lovers in your circle of friends and family, considering they may not see things as you do. Especially in this case, we encourage you to reach out to like-minded individuals in your community and online who have been through similar situations and “get it.” 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 (interview the program to discover their views on animal hospice first). Less formal sharing can be found in social media private groups, especially on Facebook. Look for phone help lines, chat rooms, and forums. While some are paid services, others are provided on a donations-basis and can be worthwhile as an additional listening ear or 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. AHELP can offer you referrals to practitioners who can help you find ways to handle your grief.
"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 pets. Similarly, aging, illness, and death provide rich lessons about the cycle of life. Just as with 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. A child therapist could be considered if you would like another opinion about how to assist in their coping and grief work.
"I am overwhelmed by all the decisions and 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 their family. Your veterinary team's main role is to educate you about your pet’s disease course, including 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 can 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 to come. You won’t want to be confronted with those decisions at that tender time. 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 that will take care of all the arrangements, also gaining popularity. Pet cemeteries are less common but can be found. Consider precautions and local regulations if you wish to bury on private property. If it's interesting, you may look into green burials and more environmentally friendly options to traditional cremation. Many choose group cremation to conserve considerable money but be aware that you won't get the ashes back.
"I want 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 expectations for what that will be like. Especially if you are interested in hospice-assisted natural death for your friend, you must 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 no one is in your area. Most important is the understanding that hospice philosophy includes 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 rituals 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 your community's support and even find 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 something for everybody!
"What should I do if AHELP Project services aren't for me but 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 have yet to be taught it in school, and at the time of this writing, there are no textbooks and few resources in the scientific literature. If they want to learn more, refer them to the International Association of Animal Hospice and Palliative 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 to be more satisfied with your veterinarian's ideas. In the greater Seattle area, consider contacting our local community who want 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.