As the field continues to grow, my hope is that more and more within the veterinary industry will come to appreciate the profound benefits that exceptional end-of-life care provides to the human-animal bond and the healing process.
Dr. Tyler Carmack, President of the International Association for Animal Hospice and Palliative Care (IAAHPC)
It’s one of life’s many small tragedies that pet lovers often must outlive their animal companions. For many of the estimated 84.9 million households with a pet, the loss of an animal companion is the loss of a family member. Fortunately, a growing trend in hospice and palliative care for animals means that this transition need not be as painful, or as lonely, as it once was.
Hospice is a philosophy of care that views death as a natural process and prioritizes comfort and quality of life over quantity of life in the final stages. In the veterinary world, this often merges with the concept of palliative care: a specialty that focuses on pain and symptom relief, as well as emotional support for the patient and their family. While hospice and palliative care have been part of veterinary practice for some time, it’s only recently that it’s begun to be recognized as its own distinct specialty.
“Animal Hospice and Palliative Care is an interdisciplinary team approach that really focuses on the whole family, and pursuing the best medical and supportive care options for that family and their goals for that pet during its end-of-life,” says Dr. Tyler Carmack, president of the International Association for Animal Hospice and Palliative Care (IAAHPC). “While veterinarians play a leadership role in this field, utilizing mental health professionals, veterinary support staff, and animal care professionals can empower pet families to pursue the treatment options that work best for the family.”
Meet the Expert: Tyler Carmack, DVM, CVA, CVFT, CHPV
Dr. Tyler Carmack is a veterinarian and the medical director of Hampton Roads Veterinary Hospice, which she founded in Virginia Beach in 2011. She received her bachelor’s degree in zoology from N.C. State University before graduating from NC State’s College of Veterinary Medicine.
After veterinary school, Dr. Carmack worked in a variety of settings, including small animal medicine and surgery, ophthalmology, and emergency medicine. In 2012, Dr. Carmack founded the Hampton Roads Pet Loss Support Group to be able to provide a safe, supportive network for those individuals and families requiring additional support as they grieve. She holds certifications in veterinary acupuncture, Chinese food therapy, and animal hospice and palliative care. Dr. Carmack is the President of the International Association for Animal Hospice and Palliative Care (IAAHPC).
Case Study: Colorado State University Pet Hospice Program
One of the first peer-reviewed publications on animal hospice originated from Colorado State University’s Pet Hospice Program, founded in 2003. CSU’s Pet Hospice is a student-run program that trains veterinary students in animal hospice care and then matches them with the family and veterinarian of a terminally ill pet in the local community. The volunteers provide basic nursing services, quality-of-life assessments, end-of-life discussions, and grief support. While the pet’s veterinarian may charge fees for specific services, the Pet Hospice program provides all its services at no cost. So far, the CSU program has had a measurably positive impact on students, veterinarians, pet-owners, and pets.
But it has its challenges, too. Several clients have contacted the Pet Hospice program without already having a professional relationship with a veterinarian; this goes against the program’s workflow, which requires an official diagnosis of an animal’s terminal illness. Furthermore, strong case management is dependent upon a strong veterinarian-client-patient relationship. To meet this challenge, CSU has partnered with an increasing number of local veterinarians and linked to their clinics on the Pet Hospice website.
Another challenge has been coordinating with the often hectic schedules of local veterinarians. To ensure the best possible hospice care, CSU volunteers need to contact an animal’s veterinarian frequently and promptly. One proposed optimization technique has been to have an assigned contact person within a veterinary practice, who can then act as an intermediary.
Another proposed solution, for use in multi-doctor practices, is to involve several veterinarians on a single case, which, when partnered with digital communication, can parcel out responsibility.
The Growth of Animal Hospice Services Nationally
The animal hospice trend grew faster than regulations and standards protecting it. In the early 2000s, pet hospices, unlike human hospices, did not need a license to operate. Technically, anyone could offer pet hospice. This led to concerns from the American Veterinary Medicine Association (AVMA) about possible abuse: untrained individuals purporting to provide pet hospice, but having no training in pain management or other clinical interventions.
Without proper regulations, the best intentions can lead to torturous outcomes. In 2006, a man operating a home-based hospice for sick and geriatric pets had 85 cats and dogs seized from him due to allegations of inhumane conditions. While he wasn’t charged, and the animals were returned, the man stated he did not believe in euthanasia in any case. Such a view seriously conflicts with the tenets of well-rounded and informed hospice care for animals.
The International Association for Animal Hospice and Palliative Care (IAAHPC)
In 2009, the International Association for Animal Hospice and Palliative Care (IAAHPC) was founded by Dr. Amir Shanan. IAAHPC promotes comfort care that addresses the physical, psychological, and social needs of animals with chronic and/or life-limiting diseases. They provide physical, emotional, and spiritual support for an animal’s caregivers. They also educate professionals to advance research in the field of animal hospice and palliative care. In its ten-year history, the IAAHPC’s annual conference has grown from 20 to nearly 400 attendees.
“Our annual conference provides leaders in the field a chance to continually share their work, improve and collaborate, and grow the profession while welcoming those with a new interest in animal hospice and palliative care,” Dr. Carmack says. “This year’s conference [on October 1-4] will be held virtually and we hope that even more veterinarians and veterinary technicians will be able to join us to learn more about this exciting field.”
IAAHPC is a central hub for all things related to the proper practice of animal hospice. Their website hosts educational materials, career opportunities, an FAQ, and a provider directory. IAAHPC also offers veterinary certification for animal hospice to ensure that a veterinarian or veterinary technician is educated, qualified, and competent to perform animal hospice and palliative care.
Often this is something that’s lacking in veterinary programs, but since the certification process began at IAAHPC, a few veterinary schools have begun to consider incorporating the IAAHPC certification curriculum into their programs.
“Certification provides in-depth pain management and medical training for common palliative care issues, but also places heavy emphasis on end-of-life communication skills, psychosocial issues impacting care, end of life decision-making, and business practices,” Dr. Carmack says. “This certification is great for those interested in an introduction to the field of animal hospice and palliative care or for those already in the field looking to elevate their knowledge and skill set for the families they serve.”
In 2016, in association with the American Animal Hospital Association (AAHA), IAAHPC released its end-of-life care guidelines. Taking into account the emotional, social, and physical factors, the guidelines provide practice teams with the framework and tools necessary to develop a comprehensive and collaborative end-of-life plan. They also define the role of each staff member so everyone on the practice team can work together to offer the best-quality medical care.
The differences between human hospice and animal hospice are becoming fewer over time, though each retains their own unique characteristics. IAAHPC and other veterinarians are working to define those differences, and similarities, as this specialty becomes more commonplace.
“As the field continues to grow, my hope is that more and more within the veterinary industry will come to appreciate the profound benefits that exceptional end-of-life care provides to the human-animal bond and the healing process,” Dr. Carmack says. “For many, this involves changing our mindset around senior and geriatric care so that older pets aren’t falling through the cracks when families don’t want to pursue curative care. This ideally will involve the inclusion of the animal hospice and palliative care principles into general and specialty veterinary practices, or referral to a provider who can provide the time, care, and attention that these families need. A referral to a wonderful end-of-life provider can be an invaluable extension of a veterinary practice, and can result in higher client trust, repeat business, and heartfelt appreciation.”