Your dog’s heart disease has progressed to the point that there are no more medicines to try, no higher dosages to give, no more procedures to perform. Or her liver failure has reached a tipping point; the toxins are building up faster in her body than they can be cleared. Or her dementia has crossed a certain line — she interacts with you much less frequently and now spends a lot of her time wandering the house fretfully. That is, the end is near. Her enjoyment of life is diminishing, and she has only weeks, or perhaps even days, before all quality of life has been drained and you will need to make the unhappy decision to let her leave this world.
But what to do in those days or weeks (or maybe even months) leading to the final moment? How do you keep your beloved dog comfortable when nothing else can be done to extend her life but it is not quite time to say good-bye, when she still is relatively pain-free and enjoys being with you, if not all the time, then at least some of it?
More and more pet owners are turning to hospice, a term for keeping a loved one as comfortable and relaxed as possible without any more efforts to extend her life, which would only deepen and extend her pain — and increase her discomfort from having to be dragged back and forth to the clinic for various procedures that often prove debilitating in themselves.
Not all dogs make good candidates for hospice care. Those who are indicating with complete apathy and lack of interest in living that they don’t want to be here anymore would not appreciate keeping you company a little while longer while you adjust to the idea of letting them go. But those with a terminal illness who are becoming sicker all the time yet still appear to relish life, enjoying a good petting session or snuggle, can benefit from the pain control and palliative care that hospice provides (“palliative” meaning to relieve symptoms and provide the best quality of life possible, not combat the disease itself).
Veterinary practices are catching on, to the point that there’s now an International Association of Animal Hospice and Palliative Care (iaahpc.org) with some 200 members, mostly veterinarians — along with some family therapists, for those who may need help around the grieving process.
How does hospice work?
The International Association of Animal Hospice and Palliative Care cites three components of a hospice plan:
Medical care, which includes recognizing pain and other symptoms, administering medications, anticipating complications, and learning what side effects may be associated with what treatments. For instance, a dog may need to be treated for difficulty breathing, nausea, dehydration, or mental distress.
Nursing care, which includes reviewing the treatments and medications administered daily by various family members as well as reviewing the dog’s activities of daily living, assessing her overall condition, and taking all measures necessary for maximizing her comfort.
Social work or family therapy, meaning support for the family that consists of actively listening to pet owners elaborate on their feelings; validating the family’s experiences and showing empathy; and facilitating coping and decision making. This could also include discussions of cost to keep a dog alive balanced against length of time gained and quality of that extra time.
Ideally, a team of professionals will be involved in this multi-pronged effort: a veterinarian, veterinary technician (nurse), social worker or other licensed mental health professional, and in some cases a chaplain. But whatever level of help is available from a participating veterinary practice in your area, the most critical healthcare partner in your dog’s hospice care is you. The place where hospice occurs is your home, so you have to become integrally involved in formulating an individualized plan for your dog that takes both her and your family’s needs into consideration. Moreover, although you are going to have help from your veterinarian’s office, it is going to fall largely upon you to be involved in the initiation of the plan and see it through on a day-to-day and even hour-by-hour basis.
For instance, you may be involved in your dog’s medical needs by administering medications, including pain relievers and other drugs given via injection (the vet will teach you how). Nursing efforts could entail turning, or rotating, your dog every few hours — even during the night — so she doesn’t get bedsores. They might include specialized needs for toilet care, too. A dog who is unable to walk, called a “down dog,” is going to require help relieving herself and with other issues relating to lack of movement. She may also very well need to be cleaned of urine from time to time with aloe baby wipes and towels. Urine is very irritating to skin.
Don’t underestimate your role as family therapist, either, particularly if you have children in the house to whom you need to explain that dying is a natural part of life or an adult loved one who is especially inconsolable.
The cost can be considerable, even though you’ll be doing a lot of the caring and even though the period for hospice doesn’t last as long as it can for a person. In order for your dog to stay comfortable in your home, teaching you how to perform tasks normally relegated to professional veterinary staff can be time- and labor-intensive. The veterinarian may have to make a number of visits to your home, and a vet tech may have to come by on an even more frequent basis.
On the other hand, hospice care does away with the sometimes high cost of aggressive medical care. While a house call from a veterinarian may cost as much as $250, a single overnight stay in the hospital, with blood tests, frequent monitoring, and full-time professional staff, might run as high as $500. In other words, once you’ve made a decision that you will not try to prolong your dog’s life but simply work to make the life she has left as happy and comfortable as it can be, hospice care might reasonably come to be seen as a good financial deal.
The Nikki Hospice Foundation (pethospice.org) certainly says that hospice care allows for a “good” death as well as for “good” grieving. It’s a lot easier to begin saying good-bye to your faithful canine companion in the warmth and comfort of your own home rather than in the relatively sterile environment of a doctor’s office or hospital.
The American Veterinary Medical Association endorses pet hospice, too, and offers guidelines at avma.org.