Up until just a few years ago, people had one treatment option for their terminally ill pets–euthanasia–and the average veterinarian thought it better to get it over with sooner rather than later. But if Eleonora Babayants had listened to the veterinarian who advised her to put her dog Lima to sleep immediately, she and Lima would have lost out on their additional three years together. Instead of euthanasia, Babayants elected to care for Lima at home, using a relatively new program for dying pets called “pet hospice.” Pet hospice allows a dying animal to live out the rest of its life at home, pain free and surrounded by its loved ones.

“Human hospice and pet hospice are very similar ideas, because pet hospice is modeled on human hospice programs,” says Kathryn Marocchino, president and founder of Nikki Hospice Foundation for pets, a nonprofit organization that links sympathetic veterinarians with pet owners and provides education and advocacy concerning pet hospice. “The basic tenet is that you live each day until you die, and you make the best of it. And in both humans and animals, making the best of it revolves around pain management,” she says.

Veterinarians who are willing to work with individual clients to provide pet hospice at home can help train owners to deal with many of the day-to-day tasks that make caring for a dying pet so difficult. These include keeping the pet out of pain, teaching owners how to administer medications at home, even shots and IVs, instructing owners on how to keep wounds clean and prevent bedsores, and providing other suggestions to keep the pet comfortable.

“The pet owner needs a vet who is willing to support the owner with anything that may arise when taking care of a dying pet,” Babayants says. “In the case of my vet, she was willing to provide the hospice care for me.” She said, “If it gets to the point where I need to come to the house and help, I will.” Babayants says that although it was a bit intimidating for her, she learned how to give Lima fluids under the skin, administered shots, and learned what signs to look for to keep the dog out of pain. “The owner has to be willing to learn these basic medical techniques, but with the support of a vet who is willing to help, I found I could do anything I needed to,” Babayants says.

Another option for pet hospice care is frequent in-home visits from people trained in end-of-life care, like the veterinary students who participate in the Colorado State University’s College of Veterinary Medicine and Biomedical Sciences Pet Hospice program. From a medical point of view, it can be difficult and scary to have a terminally ill pet at home, according to Co-Team Manager of CSU’s program, Christie Long, “especially if they require a lot of support, like administering fluids for rehydration, giving medications, keeping feeding tubes clean. It’s so stressful for a sick animal to be brought into the clinic, so we can have a much less stressed patient if we can keep the pet comfortable at home.”

CSU’s hospice service is one of the only formal programs in the country to offer structured in-home hospice care, free of charge, but many other veterinarians are willingto work with owners on an individual basis to provide hospice care to pets. Nikki Hospice Foundation for pets offers no in-home services itself, but it offers referrals to a network of willing pet hospice veterinarians across the country.

When to say goodbye
Sometimes pet owners are so subjectively devoted to the idea of keeping their pets alive that they can’t see when it’s time to let go. According to Long, it’s the responsibility of the hospice team to carefully assess the animal’s pain level and encourage owners to make the decision to euthanize when the pet can’t be kept pain free. “One of our standards for accepting a pet into the hospice program is if the animal can be made comfortable at home, because we don’t want to assist you with keeping an animal alive who’s in pain,” Long says. “And sometimes, when the animal no longer can be kept out of pain and has no quality of life, then euthanasia can often be the best gift.” While the CSU team will never force euthanasia, they will withdraw from a case if they feel the animal is suffering needlessly and they can’t persuade the owner to choose euthanasia.

The Nikki Hospice Foundation for pets takes a slightly different approach, advocating for the owners’ right to choose how and when their pet dies, including the right to refuse euthanasia altogether. Marocchino founded the organization out of her own grief at finding no end-of-life assistance when her beloved cat, Nikki, was dying of acute feline kidney failure. Marocchino had taken Nikki to an emergency animal clinic, where vets pressured her to euthanize Nikki on the spot.

Instead of putting Nikki to sleep immediately, Marocchino took her to the University of California Davis, where they also recommended euthanizing the cat. “I had trained as a human hospice volunteer the year before, and so I kept asking if we couldn’t do some kind of home hospice care,” Marocchino says. “I was looking for pain management at home, but there just wasn’t anything they could offer me. So in the end, we made the decision to euthanize her there at UC Davis, on a cold steel table.” Marocchino, extremely traumatized by the event, walked away deciding then and there to help found a pet hospice foundation so that no one would ever have to go through what she had just suffered.

Despite the organization’s stance on freedom to choose euthanasia or not, Marocchino is clear that she personally believes the owner should let go when a pet cannot be kept pain free. “The point isn’t to just extend the animal’s life, it’s only if you can take advantage of that quality time,” Marocchino explains. “If the pet can’t be kept out of pain, or if it’s comatose, then it’s time to let go.” But the main point she makes is that the choice must lie solely with the pet owner–not with the veterinarian or even the hospice providers.

Grief, but no regrets
When you talk to owners who have gone the hospice route, they share one clear trait: They have no regrets. Nancy Haugen, an assistant clinical professor at the University of California at San Francisco School of Medicine, who chose in-home care over euthanasia for her dog, Brinn, says pet hospice allowed her to focus on her dog’s needs and encouraged her to follow her own intuition for his care. “When you can just focus on your own instincts, and on the animal’s instincts, that ends up creating a situation where there’s no regrets,” Haugen says. “Pet hospice gives us permission to trust a really old primitive part of us, and to trust the nature of the dog or cat. It allows a powerful end-of-life experience where there’s sorrow and grief, which is very natural, instead of trauma and regret.”

When Babayants chose the challenging path of pet hospice for her dog, Lima, she had no idea what she was getting herself into. But with the help of her regular veterinarian, Babayants was able to keep Lima comfortable so they could enjoy their final time together. “She had a very happy three years, she didn’t suffer, she ate, she went for long walks,” Babayants says. “The best doctors in the whole world, when they tell you how long your pet has to live, can’t really know for sure. We would have lost those three years together if I’d just put Lima to sleep. When she passed away, I was in terrible grief, but I never felt any regret.”

For more information:
Nikki Hospice Foundation
CSU’s Pet Hospice Program
The American Association of Human-Animal Bond Veterinarians

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