“Pet hospice is not a place, but a philosophy of care”

Edie Jarolim

 

Hospice or palliative care house call appointment

Initial 1 hour visit:

  • Initial assessment
    • Basic information about you and your pet: you can fill out a new client/patient form here, or after I arrive.
    • Detailed history taking and review of past medical records (please try to have a copy of records available)
    • Comprehensive physical exam
    • Home environment as it related to your pet's medical condition
    • Quality of Life (for your pet AND your family)- we will assess this together, since it is very subjective
  • Individualized planning
    • In depth discussion of your wishes, and treatment goals/planning
    • Administration of treatments as needed
    • Medication instructions and prescriptions (during visit or through a pharmacy)
    • Education and guidance to carry out treatment plans (re-assessments, pain management, medications, nutrition, environmental enrichment, mobility enhancement, etc...).  I will be sure that you are comfortable with all parts of our plan during my visit. 
    • Referral to other caregivers if needed (laser therapy, acupuncture, etc...)
    • Planning for potential emergencies
    • Scheduling follow up visits by me or a veterinary technician as needed
  • Discussion about end of life plans- a difficult but necessary discussion to have ahead of time. 

After the initial visit

  • I will send you a summary of our initial visit and an individualized daily symptom and treatment journal tailored specifically for your pet.  It is designed to be very simple to record information.  Brief daily journaling is an excellent way to detect even small changes in your pet's condition.  In the journal, you will record the following daily notes:
    • Basic functions (appetite, activity level/attitude, urination, defecation, thirst)
    • Symptoms of illness (pain, weakness, loss of appetite, diarrhea, vomiting, etc...)
    • Quality of Life (QoL) score using a QoL Scale (download and more information here)
    • Other notes that may be specific to your pet
  • Schedule follow up care as needed
  • Continued communication via email or phone

What is palliative care?                                                                                                                 

  • Palliative care is a philosophy, and its purpose is to manage the symptoms of disease without curing the condition.  Nevertheless, it's important to diagnose the cause of illness because knowledge of the disease process directs our treatment plan.  Although our goal is not to continue aggressive testing and treatment, sometimes limited testing is necessary to monitor progression of disease during the palliative process.  Some palliation is more aggressive in the short term (for example tumor-reduction surgery, radiation, placement of feeding tubes, or short hospitalizations to re-stabilize).   Initial short-term interventions should not be discounted because they can lead to very long-term reduction in discomfort and pain.  
  • Patient needs become more challenging over time, so the best palliative care is flexible, individualized, anticipates symptom progression, and considers family circumstances and resources.  Management of discomfort and pain always comes first.  Palliative care is not about giving up and is not a last resort.  It is a kind, gentle, modified approach to standard of care. Prepare for the worst, and expect the best.
  • Some patients will only live a short time after their life-limiting diagnosis, and move on to hospice and end of life care quickly.  Others can live much longer with palliative care while maintaining a good quality of life. 

What is hospice care?                                                                                       

  • Hospice is supportive care in the final phases of terminal disease, or when age-related changes have reached a point where it is recognized that death is coming soon.  With hospice, dying ceases to be the enemy.  It recognizes that death is a part of life and it avoids aggressive treatment and testing.  The hospice goal is neither to hasten death nor prolong dying, but to provide pain management, comfort care, and quality of life until a loved one is ready for either a natural or assisted death (euthanasia).  Palliative care is the most important part of animal hospice care, because it provides that comfort care.  It is about quality, not quantity of life, and can be delivered anywhere.  It recognizes the significance of meaningful time between the pet and the family, and honors the pet's will to live (or lack thereof). 

 

Tools for care

Treatment is chosen based on your pet's known medical condition, and the symptoms he or she is showing.  Some things we may need to manage include: dehydration, pain, anxiety, vomiting, diarrhea, inappetance, weakness or incoordination, hygiene, and listlessness.  For pets who are used to being active, even boredom is something that needs to be addressed.  Some of the tools we consider:

  • Pain medication
  • Fluid therapy
  • Appetite support
  • GI support for vomiting, nausea, and diarrhea
  • Antibiotics for chronic infections
  • Massage
  • Physical therapy
  • Bandaging wounds
  • Anxiety medication
  • Mobility devices
  • Special bedding
  • Hygiene aids
  • Environmental enrichment
  • Referral for acupuncture, massage, or other complimentary treatments

Quality of Life

The Villalobos Quality of Life (QoL) Scale scores 7 parameters from 1–10. A score above 5 in each category or an overall score of 35 or greater generally implies an acceptable QoL. Scoring is important but trends are more accurate. Evaluate score daily, and dropping scores carefully. If the score drops in a particular category, "fine-tune" that aspect of care, if possible.

The 7 parts of the QoL score use a mnemonic: HHHHHMM

  • Hurt (includes breathing difficulty)
  • Hunger
  • Hydration
  • Hygiene
  • Happiness
  • Mobility
  • More good days than bad

Using a quality of life scale and assessment can be very helpful for families.  This is something you could consider taking a few minutes every day to do.  It's a great way to monitor trends in your pet's health status.  If your pet's quality of life begins to suffer, you will know how, and can often address problems with modifications to treatment and care.

Communication with your regular veterinarian

  • Working closely with your regular veterinarian is important. I fully support long lasting relationships between a family and their veterinarian. In order to offer the highest quality of care for your pet, it is important for me to understand previous medical care. Medical record sharing and close communication with your veterinarian is the best way to achieve that.  If possible, please be prepared with a copy of your pet's medical record at the time of my visit.

Palliative and hospice care resources                                                                                                                    

  • I've provided links to websites and articles about hospice, euthanasia, grief, and general veterinary information, along with a FAQ under the resources menu on this site. 
  • Please feel free to let me know if you have questions about anything, or if there's something else you'd like information about