What is hospice care?
Hospice care is a very special kind of care that focuses on the quality of life for pets (and their families) who are dealing with an advanced, life-limiting illness. Hospice care provides compassionate care for patients in the last stages of terminal disease. The focus of hospice care is on comfort, quality of life and allowing life to be lived to the fullest. Special attention is also paid to reducing stress, supporting the emotional and physical needs of the patient and family, and encouraging open and ongoing discussion about all of the patient’s needs throughout the dying process.
The basic philosophy of hospice care is to accept death as the final stage of life. It neither hastens or postpones death, and focuses on treating the patient and the symptoms of the disease, rather than the disease itself. Hospice is a family-centric service. The patient and the family are included in all decisions, and the hospice team will work with outside providers when necessary to make sure the needs of the patient and family are being met.
Animal hospice is a newer addition to this field, but it is growing in demand. Currently, the International Association for Animal Hospice and Palliative Care (IAAHPC) is the leading authority in educating, training and certifying animal hospice and palliative care providers. Providers must be veterinarians or licensed technicians (nurses), both of whom are licensed to practice medicine in their perspective roles. The certification process is lengthy, and encompasses over 150 hours of hospice specific education.
Who is involved in hospice care?
At Harmony, our Hospice and Palliative Care Nursing Coordinator is our LVT, Erica. She has extensive training and education in animal hospice from IAAHPC and CAETA, and is currently completing her certification in animal hospice and palliative care. Erica has seven years of veterinary oncology nursing experience as well. When a patient’s family requests hospice or palliative care, Erica and your pet’s veterinarian will work together to ensure your pet is receiving the most comprehensive and multi-faceted care possible. Referrals to other specialists or practitioners can be facilitated as well. We are happy to coordinate with other providers for the benefit of our patients.
When should hospice care start?
Hospice care normally begins when a disease progresses to a stage when it is no longer curable and the patient is expected to survive for six months or less. Many patients enter hospice care when the treatments offered are expected to cause a significant decline in quality of life, create emotional fear or stress or will result in unmanageable side effects. Often, hospice care is started later than is advised because it is perceived as “giving up” on the patient. It’s important to know, however, that active treatment can begin again at any time if better medical options become available. The main focus of hospice is simply to ensure a high quality of life during the final stages of advanced, and generally non-curable, illness.
Is hospice care the same as palliative care?
Hospice care and palliative care are similar, but not the same. They both aim to address quality of life, symptom relief and support the many different needs of the patient. Palliative care, however, can be offered during any stage of a serious illness, even during active treatment- e.g., if a patient is undergoing chemotherapy. It is also used for patients with chronic and painful conditions that require additional lifelong support. Palliative care can be arranged for any patient with a serious illness, regardless of patient age or stage of the disease.
What does hospice care provide?
Palliative care and symptom control
Palliative care may also be called comfort care, supportive care or simply symptom management. It can be given simultaneously or apart from hospice care, and focuses on relieving physical symptoms, stress and pain in order to assure that the patients have all of their needs addressed. The main goal is ensuring that patients are comfortable and able to enjoy a good quality of life by managing side effects. Palliative care is incorporated into hospice care to help patients be comfortable enough to enjoy their final days. This means that we will do our best to minimize any pain, discomfort, nausea or other adverse effects your pet may experience, while trying to ensure they are alert enough to participate in and enjoy their lives.
Additional considerations
Hospice care isn’t just about preventing pain. Many other things can be adapted to help terminally ill patients. This includes nutrition and hydration support and the addition of alternative therapies like laser treatment, acupuncture, Reiki, Traditional Chinese Medicine or massage. Mobility aids, adjustments to the home environment and many other things are also incorporated into hospice planning. Our hospice nurse will make recommendations specific to your pet. These recommendations are flexible and will likely change over time as considerations change, and families will work closely with our hospice team for the benefit of the patient.
Home care and inpatient hospice care
For pets, hospice and palliative care is centered in the home, but it may also include hospital stays as well. Your hospice coordinator can help you make decisions or facilitate in-hospital care. Home visits can be discussed on a limited basis. Video consultations through Skype or similar services are also available.
Spiritual care
Many families have spiritual beliefs that can influence how their pet is cared for during their final days, or may inform how they feel about euthanasia. Our hospice nurse will work with families to find ways to care for patients while respecting all religious and personal beliefs. Hospice care for natural death is also an option, provided the family is willing to administer the appropriate medications to allow the pet to remain comfortable. Other services may include helping families say goodbye, arranging and designing memorial services or finding other ways to honor a beloved pet.
Family meetings
Regular meetings or phone calls with the hospice nurse will help keep everyone informed about the patient’s condition, medical needs and what to expect as death approaches. This allows all family members to be heard, share feelings, talk about what is needed and learn about death and the dying process. This is often a source of comfort, support and stress relief for the family.
Coordination of care
Coordination of care also means that should the patient require additional care from other specialized practitioners, or the family need referrals for support services like grief counselors, therapists, support groups, aftercare facilities or specialized pharmacies, the hospice nurse will be available to help make those resources available.
Respite care
Respite care is the coordination of outside helpers to participate in the care of a patient so that the caregivers can have a much needed and well-deserved break. Caring for a terminally ill patient can be all consuming and exhausting, and it’s important that trusted helpers are brought in when necessary. For our pets, this may mean a weekend with geriatric-experienced pet-sitters or a brief in hospital boarding stay. The hospice nurse can help families locate trustworthy caregivers when breaks are needed.
Bereavement care
Bereavement is the period of mourning after a loss. The hospice nurse will work with the family to help them in any capacity desired. This may include referrals to professional counselors, support groups or other organizations, as well as organizing remembrance services or other special memorial events.
What is the euthanasia process and what services are provided?
The term euthanasia means “good death.” It is a gentle way to help a pet pass away before suffering begins, and it allows for a dignified and painless death. The pet will be given a sedative (usually into the muscle or a vein) to help them relax and drift off into a state of deep relaxation and sometimes sleep. They will be feeling very comfortable and calm. A second injection into a vein (or another suitable site) will then follow. This will be an overdose of a barbiturate, which will quickly stop the heart. The process is peaceful and painless, and death generally occurs very quickly.
At Harmony, we provide in-hospital euthanasia in a comfortable room where the family (including other four-legged family members) can gather with the pet. There are couches and chairs and a bed for the pet, which make the space feel a bit more like home. Fear-free techniques will also be employed to make this time as easy and stress-free as possible for the patient. Treats are offered and the staff will attend to the family and patient with compassionate and practiced care. If the family is unable to be present for all stages of the euthanasia process, our staff will be present to take care of the pet. Other requests can be discussed ahead of time as well.
After death, the remains will be transferred to an animal crematory called Agape. Families can request the remains of their pet back in a personalized urn, or have the ashes spread on a farm with other pets that have been cremated communally. Agape offers memorial services and products as well. Families also have the choice to pursue taxidermy, internment in a pet cemetery or to take their pets home for burial. Specific instructions for home burial requirements will be discussed for families choosing this option.
For families looking for in-home euthanasia for their pet, a list of mobile providers will be made available.
How can I begin hospice or palliative care for my pet?
Simple. Contact us! Ask your veterinarian or our Hospice Nursing Coordinator, Erica, to discuss if hospice or palliative care is right for your pet.
Meet our Hospice & Palliative Care Nursing Coordinator, Erica!
After joining the Harmony team in 2021, Erica became Fear Free Certified and is a Certified Compassion Fatigue Professional as well. She completed the CAETA (The Companion Animal Euthanasia Training Academy) Master Training Program in euthanasia best practices and end of life care. She is currently finishing an extensive certification program through IAAHPC (The International Association for Animal Hospice and Palliative Care) in hospice, palliative care and advanced pain management, which requires over 140 hours of hospice specific education and training.
Erica is excited to be developing Harmony’s hospice and palliative care service and will be working closely with Drs Fowler, Kuo and Hagner, to ensure that patients receiving hospice or palliative care- and their families- will have their needs met and be supported throughout this difficult process.
“"Harmony Animal Hospital is an amazing practice filled with compassionate and caring professionals. This review is specifically about the Hospice Service provided by Harmony led by Erica LaFramboise, LVT.
Her empathetic and compassionate approach to end of life care is nothing short of astounding. I have never experienced veterinary care that went so above and beyond that I felt it was as much for me as it was for my dog.
She gently guided us through our pups options and supported us through the process of making difficult choices that saved our dying puppy from experiencing further suffering. Her services were exactly what we needed at a very difficult time and we are forever grateful.
If you and your pet are facing difficulty in the twilight of their life I encourage you to seek out the professional support of Erica and the Harmony Hospice Care team. They will help you explore to how to best care for your pet in that difficult stage of life with specialized care that simply cannot be found anywhere else."”
Joey S.
