End of life hospice care for cats
Hospice care is a type of care provided to a cat with a chronic or terminal illness to relieve pain and symptoms.
What does hospice care involve?
- Supporting the cat and relieving symptoms and pain.
- Pain relief
- Symptom control
- Nutritional support
- Fluid support
- Make adaptations
- Physical comfort
- Emotional comfort
What is hospice care?
Hospice care (sometimes referred to as palliative care) is a multifaceted approach to care for a cat with a life-limiting illness. The aim is to provide a good quality of life, by making the cat as comfortable as possible in the last few days, weeks or months of his or her life. At this point, the goal of treatment focuses on providing comfort, pain relief, and managing clinical signs but not curing the disease.
The American Animal Hospitals Association defines animal hospice care as the following:
A philosophy or program of care that addresses the physical, emotional, and social needs of animals in the advanced stages of a progressive, life-limiting illness or disability. Animal hospice addresses the emotional, social, and spiritual needs of the human caregivers in preparation for the death of the animal and the grief experience.
When is hospice care needed?
Hospice care is needed when a cure is no longer possible for a disease, or where a choice is made to discontinue treatment, these can include:
- At the end of a terminal illness such as cancer
- A decision is made not to proceed with curative treatment for a disease or injury
- After a diagnosis of a chronic disease such as liver or kidney disease
- A decision is made not to pursue treatment for a life-threatening disease
- When the cat and/or the caregiver are unable to cope with the management of a disease (for example, a cat strongly resents receiving medical treatments such as injections or pills)
- Diseases or conditions which severely impact the quality of life, such as advanced arthritis
What does hospice care involve?
The goal of hospice or palliative care is to maximise the cat’s comfort and minimise suffering.
- Manage pain and symptoms
- Provide comfort
- Nutritional and fluid support
- Meet other necessary needs
During this period, it is important to work closely with the veterinarian who can prescribe medications where necessary to relieve discomfort and suffering.
The veterinarian will discuss with you the disease and the expected outcome as well as formulate a treatment plan. The treatment plan will cover all aspects of medical care the cat will require, including medications, nutrition and regular veterinary appointments to monitor the cat.
Cats are hardwired to hide signs of pain and discomfort, and the caregiver must learn to recognise signs of pain.
- Hunched over appearance
- Loss of appetite
- Aggression when touched
- Withdrawal from family
- Changes in personality
- Neglecting to groom
There are several options the veterinarian can recommend to relieve pain.
- A transdermal patch that provides continuous pain relief
- Oral tablets
Never administer human painkillers such as ibuprofen, aspirin or tylenol/paracetamol to a cat. Cats lack the necessary liver enzyme to process these drugs and can be fatal if ingested even in small amounts.
The terminally ill cat can face a range of symptoms such as seizures, nausea, vomiting, pain (listed above). It is up to the caregiver to relay symptoms to the veterinarian who can prescribe the right medication to make the cat more comfortable.
Symptoms of nausea can include lip-smacking, loss of appetite and drooling.
The nutritional requirements of a cat who is near the end of life are going to differ from a healthy kitten or adult cat. Loss of appetite is common side-effect of pain and nausea (which we will cover below).
Ensure the cat receives adequate nutrients, and in some cases, prescription diets to help manage or slow down the progress of a condition.
Hand or syringe feeding carefully warmed foods such as cooked chicken breast or soft canned food can sometimes help. Your cat’s veterinarian can prescribe a high-nutrition food such as Hills a/d. Or, add tasty treats to the top of the cat’s food such as a small sample of tuna, or a gourmet cat gravy such as Dine Creamy Treats (available in sachets from your supermarket).
If you are still struggling to get adequate nutrition into your cat, speak to your cat’s veterinarian. They can recommend a high-calorie gel such as Nutrigel and/or appetite stimulants, or insert a feeding tube if all of the above methods fail. More information on feeding tubes can be found here.
At the very end, the cat will stop eating and drinking completely; this is normal as the cat’s body is shutting down. Do not force the cat to eat, as this can cause an already gravely ill cat to choke.
Dehydration is a common side effect of many life-ending diseases as well as a reduction in thirst due to feeling unwell and underlying conditions such as kidney disease which affect the ability of the kidneys to concentrate urine. Signs of dehydration include poor skin tenting, dull eyes and tacky gums. The veterinarian can teach you how to check for signs of dehydration by lifting the skin at the back of the neck to see how fast it springs back.
If the cat is dehydrated, it will be necessary to administer fluids under the cat’s skin at the back of the neck one to two times a day. This is less daunting than it sounds.
Make adaptations and provide physical comfort:
Set up an area for the cat; it should be close to human interaction, but not a high-traffic area. A bedroom is an ideal place. Keep the bed, litter trays, food and water bowls nearby. If the cat is well enough, regularly put the cat in his or her litter tray and then place back in their bed. I have found all of my cats have remained mobile right up until the end, but those last few days, they were unable to move more than a few feet. Do not expect a cat in the final stages to have to navigate stairs or travel long distances for food, water, or to go to the toilet.
If the cat has stopped grooming, gently brush the coat to prevent mats. This is especially important in longhaired breeds.
Pressure sores can develop in cats with limited mobility, provide a soft bed with plenty of padding.
A gravely ill cat will need to be kept in an environment in which the ambient temperature is easy to regulate (with a heater or air conditioner), as seriously ill cats are not efficient at regulating their body temperature, nor can they move to a warmer or cooler area.
Cleaning up after the cat:
Fecal and urinary incontinence are common towards the end. Regularly check the cat for signs of wetness and clean immediately to prevent urine or fecal scalding. Nobody wants to lie in their own mess, and that includes a terminally ill cat.
If an accident does occur, clean the area with an unscented baby wipe or a warm, damp cloth to avoid urine or fecal scalding which can lead to serious pain and infection. When cleaning the anal area, wipe away from the genitals to avoid transferring bacteria to the genitals. Watch for signs of urine scalding, with symptoms of redness, raw skin and pain in the area.
Place plastic sheeting between the bed and a blanket, or a puppy training pad on top of the blanket to stop the bed becoming soiled.
Provide emotional comfort:
Every cat is different in the level of comfort they want. Some clingy cats seek out solitude towards the end; other cats want and need the comfort of their human companions. Let the cat lead the way. Keep a close eye on cats who want solitude without being intrusive. For the cat who wants to be near people, let them. Spend time with the cat, talking, gently stroking and comforting him or her.
Can the cat be around other household pets?
This depends on how well the cat gets along with other members of the family as well as the cause of the illness and the health status of the visiting cat.
It is nice for bonded cats to remain together; this can provide both cats with companionship and comfort. Seek veterinary advice if the unwell cat has an infectious disease that could be transferred to the visiting cat. Dying cats already have a compromised immune system, so the visiting cat must be in good health with no parasites or infectious diseases. If either cat shows signs of stress, separate them. If you are at all unsure, speak to your veterinarian.
Keep boisterous pets away, especially towards the end when health mobility seriously declines. Be alert, if either pet seems uncomfortable, separate them.
Signs a cat is in the active phase of dying
Hospice care can last for months, weeks or just days. But there will come a point where the cat enters the active phase of dying. The body has begun to shut down, and death is imminent.
- Noisy or laboured breathing
- Unkempt coat
- Loss of appetite and thirst
- Weight loss
- Sleeping more, some cats may have restless sleep patterns due to discomfort
- Decrease in urination and bowel movements
- Drop in body temperature
For more detailed information, please read our article on signs a cat is dying and how to care for them.
Care for the caregiver
Take time to look after your physical and emotional well-being. You will be overwhelmed with appointments, medical terms, medications, and caring for the cat, and it is easy to forget to take care of yourself, but it is vital to prevent burnout.
When to euthanise
Palliative care is designed to provide physical and emotional comfort to the cat, however, there will reach a point where palliative care is no longer effective, and euthanasia must be considered. This is a decision which ultimately must come from the cat’s carer, but with the guidelines of a veterinarian. Sometimes our emotions can cloud our judgment, but at this time, we must put the cat’s needs ahead of our own emotions.
Quality of Life assessments are available to help veterinarians and caregivers determine the quality of life of the terminally ill cat. Dr. Alice Villalobos, a veterinary oncologist, has created the “HHHHHMM” Quality of Life Scale which consists of several questions the veterinarian marks from 0-10.
- HURT-Adequate pain control and breathing ability is the top concern. Is oxygen supplementation necessary? Score 0-10.
- HUNGER-Is the pet eating enough. Does he/she need a feeding tube? Score 0-10
- HYDRATION– Is your pet dehydrated? We can teach you to give fluids under your pet’s skin at home 1-2 times daily. Score 0-10
- HYGIENE– Your pet must be brushed and cleaned, especially after eliminations. Avoid Pressure sores with soft bedding. Score 0-10
- HAPPINESS– Does your pet express joy and interest? Is your pet depressed, anxious or afraid? Try moving the pet bed closer to family activities. Score 0-10
- MOBILITY– Can your pet get up with assistance? Is the pet having seizures or stumbling? A pet with limited mobility can still be alert, happy and responsive. Score 0-10
- MORE GOOD DAYS THAN BAD– When bad days outnumber good days, a healthy human-animal bond may not be possible. If your pet is suffering, a euthanasia decision may be the best decision, so the end is peaceful and painless. Score 0-10
Ultimately, it falls on the caregiver (with the guidance of a veterinarian) to make the final decision. We must always put our own feelings aside and do what is best for the cat.
Questions to ask:
- Is the cat still enjoying life?
- What will the cat miss out on if he or she is not here tomorrow?
- Is the cat in pain?
- Is the cat still participating in daily activities he or she used to enjoy?
Having been down this road many times, and having kept one cat alive for too long, I can tell you this, a week too early is better than a day too late.
The grieving process begins before the cat has passed away. No two people are the same, some experience guilt, most experience sadness, and loneliness, and it is not uncommon to feel relief once the cat passes. That doesn’t take away from your love of the pet, but caring for a terminally ill family member (and that includes pets) is emotionally and physically draining.