From mobility support to hygiene to pain management, these hospice products help improve quality of life for palliative patients at home.

A pet’s end-of-life journey can be extremely taxing for the client, both emotionally and physically. People are concerned about the suffering their pets may experience, and want to extend and improve their quality of life for as long as possible. We often see clients shift their approach from cure to comfort, with a focus on care from the time of a terminal diagnosis until the end of the patient’s life.

A growing niche in veterinary medicine focuses on hospice and palliative care within a home-based setting. Clients are asking for a transition to home-based end-of-life (EOL) care – at this point, they no longer want to take their pets to a brick-and-mortar veterinary hospital. They may have already received a terminal diagnosis, or have seen such a decline in their pets’ quality of life that they just want to “keep him home and comfortable”. The growing trend towards in-home hospice and palliative care has generated a surge in products designed to improve a pet’s quality of life and aid in the management of his care.

Benefits of in-home care

There are many benefits to in-home care — the most significant being a reduction in stress for the patient. A pet is naturally more comfortable in his home environment and, as a veterinarian, I can more accurately assess his comfort or pain without the added stress caused by transport to a veterinary clinic.

I can also assess the pet’s environment and make recommendations for improving his comfort, while at the same time helping to ease some of the challenges an owner may face with EOL care.

Mobility support

Mobility issues are among the most common concerns we see in our aging canine population, whether due to osteoarthritis, neurological conditions/degeneration or other disease processes. Any non-carpeted areas in the home can be a challenge to navigate and increase the risk of injury. There are many products on the market to help with mobility – the best will be dependent on the pet’s environment and his tolerance level. For example, dogs who hate having their feet touched may not be candidates for certain footwear or related products. I have found the following to be very helpful:

1. Slip preventives

a) Buzby’s Toe Grips for Dogs – These small, durable rubber rings fit onto a dog’s toenails. The rubber engages with the floor, giving traction for the paw. A small dab of super glue may be applied to the Toe Grips for added security in pups who drag their feet.

b) Pawfriction – This non-toxic adhesive is applied to the pads of the feet to prevent slipping on floors. It is easy to apply and well-tolerated by dogs. The frequency of reapplication will depend on the dog’s activity.

2. Harnesses

a) Help ‘Em Up Harness – This harness is not only comfortable for the dog, but is easy and comfortable for the owner to use. Front and back harnesses may be used separately or together. Definitely one of my favorite mobility aids.

b) The Walk About Back End Harness — Another tried-and-true harness that’s helpful for dogs with limited hind end mobility. With any harness or sling-type product, care must be used when fitting the dog, and frequent checks made to watch for any rubbing or sores.

3. Wheelchairs/carts

While wheelchairs may not be for everyone, they can provide both physical and mental stimulation for some dogs, which can be invaluable.

a) K9 Carts and Eddie’s Wheels – Both these companies offers durable high quality carts and wheelchairs for dogs.

b) Handicappedpets.com — For times when a pet is not in a cart or wheelchair, the Drag Bag protects the hind limbs and chest from scraping against the ground. Incidentally, HandicappedPets.com is a wonderful resource for both veterinarians and clients; the website features many products to help pets and owners with a variety of conditions that affect aging animals.

4. Strollers

Mental stimulation is so important for aging pets. For dogs who can no longer go for walks, a stroller-type product can help get them outside for fresh air and mental stimulation. A growing number of products with different features and price ranges are available to dog owners.

a) Booyah – This company makes several different types of pet stroller.

b) Pet Gear – They also have a variety of strollers, along with other products such as ramps and stairs that may be helpful for dogs with limited mobility.

5. Footwear

For dogs that will tolerate footwear, a number of options may help in a variety of environments. Not only are we concerned with slipping on smooth surfaces, but we also need to protect the feet from dragging wounds or pressure sores. It’s important that clients realize they need to monitor the condition of their pets’ feet and not leave the booties/socks on for extended periods of time.

a) Neopaws and Woodrow Wear – Both these companies make reliable products.

6. Mats and rugs

Many homes with geriatric dogs have an assortment of non-slip carpet runners and rugs across the floors to prevent slipping. Interlocking foam squares/tiles may be helpful, since their design allows them to go around corners, down hallways, etc. As a bonus, they are easy to clean. You can find them online or in home improvement box stores. Strategically-placed mats or non-slip rugs are helpful not only for navigating slippery floors, but also for jumping up and off of furniture. A well-placed mat or rug sometimes gives a pet enough confidence to jump on and off his favorite chair.

7. Navigational aids

We often see challenges in patients who are blind and have difficulty navigating their environments. Muffin’s Halo Guide for blind dogs is an aid that helps blind dogs maneuver without risk of injury. Tracerz are scent-based markers used to help a blind dog navigate his surroundings and reduce confusion within the home.

Pain management

While not home hospice products per se, integrative therapies are invaluable when managing palliative care in companion animals.

• I have found that animals are quicker to relax during acupuncture treatments when they’re at home instead of a brick-and-mortar practice. I try to integrate acupuncture into the majority of my hospice cases.
• Laser therapy is another valuable tool for managing pain. With proper training, in fact, small handheld laser units may be rented to the owner to allow for more frequent laser therapy sessions.
• Using pulsed electromagnetic field therapy, the Assisi Loop can also be an important tool in the pain management toolbox. It’s also something that clients can use at home on their own.

Cognitive dysfunction, anxiety and sleep disturbances

These problems affect a large number of our geriatric patients and become a quality of life issue, not only for the pet, but for the human family as well. While many medications and supplements may help manage these issues, some in-home products are also useful.

Anxiety may arise from a combination of senility and loss of senses. Any time we see symptoms of anxiety and cognitive dysfunction, it’s also important that we reassess pain management to rule out discomfort as a contribution to the behaviors. Pheromone-containing products such as Feliway for cats and Adaptil for dogs may help ease anxiety and are available in a number of different forms (sprays, diffusers, collars, etc.).

As pets age, they may undergo a change in sleeping preferences and habits. Seeing a pet curled up in a cozy bed is very comforting to a client. The choices in bed styles, shapes and price points seem endless, so it’s helpful for us as veterinarians to offer clients guidance in selecting beds based on the needs of their pets. I have seen many situations where an owner is disappointed because their geriatric dog won’t use the fancy $200 orthopedic memory foam dog bed they purchased for him. It may be that the dog finds it difficult to navigate the bed; he doesn’t feel steady walking on it to lie down, so he often lies on the floor instead. A thinner bed may actually be more comfortable for these dogs.

Temperature may also dictate where a pet chooses to sleep; many dogs seek heat or coolness and many old kitties prefer warmth. K&H produces a variety of cooling and heated beds for both dogs and cats. Some of the heating beds are pressure sensitive so will only warm up when the animal is on the bed. I love recommending these beds to owners who have thin, geriatric cats.

Hygiene concerns

Hygiene can be an issue in aging pets for a variety of reasons. Fecal and urinary incontinence, inappropriate elimination, pressure sores and tumors may all compromise hygiene. Educating clients on the care of wounds and sores is critical in managing these cases.

A variety of diapers and belly bands are available for dogs. When using diapers for fecal incontinence, or for female dogs in general, care must be taken to keep the surrounding hair and skin as clean and dry as possible, to prevent urine scald or infection. HandicappedPets.com has a wide variety of diapers and belly bands to keep pets clean. They also offer the SleepPee bed for incontinent dogs. The design helps keep these dogs clean and dry as they sleep.

We may also see inappropriate elimination in feline patients due to disease processes such as kidney failure or diabetes, as well as mobility constraints. The old kitty who has trouble going up and down stairs may need access to a litter box on all levels of the house. Sometimes, cutting down the side of the litter box can make it easier for the cat to get in and out.

Conclusion

I have had general care veterinarians ask me how I deal with compassion fatigue. My honest answer is that I experienced much more compassion fatigue while in general practice. As a mobile hospice/end-of-life care veterinarian, I get to see the best of the human-animal bond every single day, and experiencing it within a home-based setting makes it more intimate. And thanks to the growing number of products designed to help owners maintain and improve their pets’ quality of life, we’re able to make recommendations to sustain the bond we’re so privileged to witness.

Being a mobile hospice veterinarian

One of the biggest challenges I have faced as a mobile hospice/end-of-life care veterinarian is a lack of awareness of our services. Many people do not realize these in-home services are even an option! We have worked hard to cultivate relationships with our local primary care veterinary clinics – we want to work with them, not against them, in order to offer hospice/EOL services to their clients.

The mobile hospice practice model is unique because our business needs are somewhat different from those of a general mobile veterinary practitioner. We need to send out notices of euthanasia to primary care veterinarians to let them know we helped their clients say goodbye to their pets. We need to correspond with local crematoriums to arrange aftercare for pets, and complete tasks such as sending off sympathy cards. We need to track our hospice cases based on trajectory of illness. We do not do vaccinations, so don’t need a system to send out reminder notices. A business software program called REX was specifically designed to meet all these needs for the mobile hospice/EOL care veterinarian. Desktop, tablet and iPhone versions all integrate to manage the practice.

DVM Center is a specialized client support company that helps end-of-life care veterinarians answer their phones and schedule visits. They also offer social media support and startup services for veterinarians launching their own EOL care practice.

The field of hospice/EOL care as a whole is growing and becoming recognized as its own specialty. In 2016, the International Association for Animal Hospice and Palliative Care (IAAHPC) launched a rigorous 16-month certification program, so veterinarians and licensed veterinary technicians may now become certified in Animal Hospice and Palliative Care. I believe this additional education and training is added assurance for primary care veterinarians that our advanced training has value for their clients and pets.