End of Life Treatment: Veterinary Hospice & Euthanasia

What is Veterinary Hospice?

As veterinarians we often deal with chronic, terminal illnesses and cats who are at the natural end of their lives. Hospice care provides comfort and care to our feline patients who are dealing with end stage disease or end of life issues to help improve their quality of life in their final days, weeks or months. Hospice care will continue until the cat dies naturally or by euthanasia. The care focuses on your family and your pet’s needs, so each patient will be handled differently. Hospice care, while keeping your cat comfortable and happy, will give you time to prepare for your cat’s death. It is important that family members know that they will be an integral part of the care of their cat, along with the veterinary team. We encourage you to also seek support from friends, family, and support groups to help you through end of life decisions and grief.

Veterinary hospice’s number one concern is for the comfort of your cat. You will have regular and frequent contact with our veterinary team. We will provide you with education and support during your cat’s end of life period and after your cat’s passing.

Some of the most common conditions we see that would require veterinary hospice care include cancer, heart disease, chronic kidney disease, arthritis, geriatric pets at the end of life, FIP, or any condition that is causing a burden on the family caregivers or your pet. Hospice care can happen during any life stage from kitten to senior cats.

Assessing Quality of Life

Assessing your cat’s quality of life is an ongoing process and can change rapidly, sometimes hour by hour. It is important to discuss quality of life concerns with your veterinarian and keep us updated of any changes or concerns you may have regarding your cat. Some of the common criteria we recommend monitoring includes:

Pain control: Cats can hide their pain very well, and signs of pain can be subtle. Some signs of pain include behavior changes, lack of grooming, not using the litter box, or hiding. You and your veterinarian need to be confident that your cat’s pain is well controlled in order to be certain that hospice care is right for your pet.
Appetite: Any changes to your cat’s eating habits should be monitored. Do they not like their usual food? Eating less or picking at their food? No interest in favorite treats or people food? Not eating at all? Proper nutrition is vital to good veterinary hospice care. We can help you develop a sound nutritional plan to help get your cat to eat.
Hydration: Cats may drink less or, if very ill, may not drink at all. Hydration is extremely important. We can help you with learning how to administer subcutaneous fluids at home or even place a feeding tube to administer fluids and food. Each case is evaluated individually and a plan developed that works best for your family and your cat.
Breathing: Your cat should be breathing comfortably and regularly at home. Breathing fast, with effort or open mouth breathing requires immediate veterinary care.
Incontinence/hygiene: Cats like to be clean. Matted or unkempt fur can be uncomfortable. If your cat has difficulty grooming you may need to bathe or brush them daily. If they are urinating or defecating themselves, they need to be kept clean to prevent infections and sores.
Happiness/Mental capacity: Is your cat doing the things they normally like to do? If your cat is hiding, and not enjoying their normal daily activities this may be a sign of diminishing quality of life.
Mobility: Is your cat having trouble jumping/walking/moving? Is your cat’s mobility limited? We may not be controlling their pain well enough, or their quality of life is diminishing.
Response to Treatment: If we are working together to improve your cat’s quality of life, but they are not responding to our intervention, this is a concern.
Are the good days outnumbering the bad days: We recommend keeping a log or a journal to record your observations.

Here are links to good Quality of Life scales that you can fill out as needed and may be useful. We encourage you to share your observations with the veterinary team.

https://vmc.vet.osu.edu/sites/default/files/documents/how-will-i-know_rev_mar2024ms_0.pdf

https://www.felinegrimacescale.com/

https://catfriendly.com/life-stages/quality-of-life-and-end-of-life-care/

Palliative Care

Palliative care is the care you as the care givers will be doing in order to improve your cat’s quality of life under the guidance of the veterinary team. Palliative care will help manage your cat’s symptoms so they will feel better, but it will not cure their disease. Palliative care includes:

Pain control: Pain medications, physical therapy, acupuncture
Anxiety control: Behavior modification, medications
Hygiene care/Control Infections: Bathing, grooming, antibiotics
Nutritional support: Proper nutrition, vitamins, supplements, fluids
Nausea control/Appetite stimulant: medications, acupuncture

Part of palliative care is knowing when it becomes too much for you or your cat. Hospice care can become a burden for you and your cat. Our goal is not to have your cat run and hide from you, or begin to resent you because you are medicating them. We strive for a balance of care and comfort. Our team can assist you here in the hospital, or come to you and your cat in your home. Our number one goal is your cat’s comfort.

There are 5 basic feline needs to focus on to improve palliative care at home:

Safe place:
- Whenever possible, provide at least 2 resting options in different locations, as well as hiding options (such as high-sided beds or carriers). These should be placed in areas where the cat spends most of its time. If the cat has mobility problems, also consider pet steps or ramps to facilitate reaching common resting areas that are more elevated.
Multiple and separated resources:
- Food, water, litter boxes, and resting areas should be dispersed throughout the home and spaced at least a few feet apart. There should be at least one resource per cat. Sometimes tension can develop between cats as one gets more frail. In those situations, a visual barrier (like a wall) can help reduce competition. Avoid placing resources where cats might corner each other.
- Litter boxes should be kept away from food, water, and resting areas. There should be multiple boxes available in areas that are easily accessible (avoid putting all boxes in the basement). For cats with mobility issues, ideally use boxes with one side that is lower to allow easier entry.
- Scratching posts: Cats over 14 years old tend to prefer horizontal posts due to age-related arthritis, and may prefer carpet over sisal rope or cardboard. If your cat is having difficulty using a scratching post, their nails may grow in thicker and more rapidly. These cats benefit from more regular (monthly) nail trimmings at home or in a vet office to reduce overgrown nails or discomfort.
Play and predatory behavior:
- If your cat is still interested, interactive play is recommended at least twice a day. Cats in palliative care may no longer chase wand toys, but can still enjoy the interaction and watching a toy move.
Social interaction:
- Cats in palliative care often want increased interactions with their people. Massage and grooming can be a great way to provide this. For cats having a hard time grooming themselves and developing heavier mats, a sanitary clip at your vet will help keep them clean and comfortable.
- Giving medications should be a positive experience and occur at calm times. See below for a link to information on administering medications.
Respecting a cat’s senses:
- Cats have a very sensitive sense of smell, which is connected to emotion. Consider heating wet food or adding flavor enhancers to improve appetite. Avoid strong smells (such as cleaning products, perfumes, smoke, incense, or scented candles).
- Avoid loud noises and sudden movements. Provide environments that are quiet or use cat-specific music to decrease stress.

When it is Time

Euthanasia is always a difficult decision, and there is no right answer as to when the perfect time may be; however our trained veterinary team is here to help guide you through the process. It is always better to plan ahead and discuss the euthanasia process with your veterinarian before the time comes. Euthanasia is meant to allow your cat to pass without pain or anxiety. This can be scheduled during regular appointment times in our office, or can be scheduled ahead of time in your home as a housecall. If we are closed, and you are experiencing an emergency, we recommend Dr. Brad Bates of Lap of Love. He can perform a euthanasia in your home and can be reached at 267-317-8110.

During the euthanasia your cat will receive a sedative. If you prefer to give a sedative at home before bringing your cat into the hospital, we can arrange to dispense the medication before the appointment for you. After the sedative, we administer an injection of a quick acting anesthetic that is painless and will stop the heart. Your cat will pass peacefully. You may elect to stay for the entire procedure, part of the procedure, or leave your cat with us. It is a very personal decision and we encourage you to do what is most comfortable for you. Family members are welcome, and we encourage you to bring someone for support if you are able.

After the euthanasia, The Cat Hospital of Media offers cremation services through Abbey Glen. You have the option of having your cat’s ashes returned to you or not. The ashes are returned in a beautiful cedar box, or if you prefer we can arrange a custom urn.

Losing a pet can be difficult, and not everyone will understand your grief. Everyone here at The Cat Hospital of Media understands what you are going through, and we are here to support you however we can. We may not always be available when you need us, so we encourage you to reach out to friends or family members who have also experienced the loss of a pet, or you may also seek out one of these local pet loss support groups (more groups can be found online as well):