Posted April 12, 2019 by Dr. Melissa Mustillo.
As feline veterinary practitioners, we spend much of our time (and love!) caring for senior cats. Eventually comes the time that a cat is facing a terminal condition. Hospice care for cats is an option if your cat is dealing with a situation where a cure is not possible. Our goal is to keep your ill cat with you and enjoying life as long as possible, and there are many things you can do to help.
The most important determining factor is quality of life. This is very subjective, but there are some objective criteria to assess your cat, and to make sure you are doing what is best for him/her. Animals don’t have our abstract concept of death, they only know how they are feeling right now. If there are more good days than bad, if your cat is eating, if pain is being managed, if your cat interacts with you when awake (even if he or she sleeps a lot), continuing care is reasonable. If pain cannot be managed, if your cat is not eating and not interacting, then we have to weigh our wish to keep our cats with us forever compared to what is fair for the cat.
When trying to determine whether to try hospice care for cats, we need to objectively evaluate their quality of life. Quality of life for cats has been defined by hospice-veterinarian Dr. Alice Villalobos as a way to assess physical, mental and social well-being.
Using Dr. Villalobos’ criteria, there are 7 components to evaluate.
Pain management is listed first because if we cannot control pain, then prolonging suffering is unfair to our cats. Pain can be associated with many conditions seen in older cats. We usually try pain medications and monitor response. If your cat improves, then pain medications are needed. And, if the first medication or dose doesn’t help, we can try changing to something else. When our routine medications at safe dosages don’t work, there are alternatives we can try. Other things that support pain management include diet supplements such as glucosamine and omega-3 fatty acids, home modification (easy access to litter boxes, avoiding stairs, ramps to (or lowering) favorite sleeping places, acupuncture and laser treatment. Gentle massage and grooming can also help. So, the first and most important question is: can we adequately control pain and make your cat comfortable?
Appetite stimulants, medication to control nausea, hand-feeding, vitamins, and sometimes fluid supplementation, (see #3 below) can improve appetite. Also, some cats are “social eaters” and feel safer when they know someone is nearby. Try petting your cat and see if this encourages him to eat.
Maintaining hydration is critical, so do whatever you can to encourage water intake. Some cats like pet fountains; some like ice cubes or spring water; some will let you mix water or low-salt broth into canned food. When dehydration is beyond what your cat can manage by drinking, then supplementing with subcutaneous (SQ) fluids is needed. This is where fluids are administered to the cat under the skin to be slowly absorbed by the body. We can teach you how to do this at home. If that is difficult, some clients bring their cats in to the clinic for regular fluid administration. You might also be able to work with a pet-sitter who will come to your home to help with this treatment.
Cats like being clean, but when they don’t feel well, you will notice a dramatic decline in their coat quality. Dental pain or mouth lesions, or stiffness from arthritis can lead to decreased grooming. Help your cat groom by brushing and combing gently. We recommend rubber or plastic, rather than metal bristles, for brushing and combing your cat. Also, your cat’s nails often won’t shed, and they become thickened. Keep the nails trimmed regularly so they don’t get stuck in carpet. Even worse, they can overgrow and become embedded into the foot pad. Finally, check the underside of the tail and use baby wipes if needed to keep the area clean. For long-haired cats, your veterinarian may recommend shaving the hair under the tail and down the back legs, so that stool doesn’t get stuck in the fur.
One client recommended making a list of “pleasures” when your cat is young, then re-evaluating. Can your cat still do these things they used to enjoy? Do they still want to interact with you? Can you minimize challenges with younger cats or dogs, so your cat can enjoy peaceful time with you and without competing with younger and stronger pets?
We already mentioned treating for pain, but even if that is being managed, your cat may be experiencing muscle weakness. This might make it difficult for your cat to go up or down stairs to get to the litter box in the basement, or hop up onto the favorite window seat. What modifications can you make in your home environment to make it easier for your cat to reach essential resources? Moving the litter box to a place your cat can reach easily, using a box with low sides, placing a favorite pad or blanket on the floor near a sunny spot, and making sure the food and water are in easily-accessible places are all helpful adjustments.
#7. More good days than bad
This is when someone other than you can be helpful, because it’s normal to be in denial about our own cat’s decline. But when the balance tips and there are more bad days then good, then it’s time to say goodbye. This is still one of the hardest things ever, and any caring feline veterinarian and their team truly understand your grief.
For more information about what happens when the time arrives, see Final Journey: When to say goodbye to your cat…
But what about after? The grieving process is very individual. Some clients will have two new kittens within days; for others, it takes much longer to even think about getting another cat. Do know that this is a real loss. Anyone who says “It was just a cat” doesn’t have a clue as to how profound your grief may be. If you feel that even with time you are not handling the loss well, please let your veterinarian know. Many have licensed grief counselors they can refer you to. But, we also know that this just means your cat was lucky to have such a caring owner, and they couldn’t have had a better life than the one they shared with you.