Peace of Mind for Pet Parents Episode 052: The Missing Middle: Why Animal Hospice Is Rarely Offered — and How to Ask for It

Episode Transcript: 

Karen Wylie: Hello and welcome to Peace of Mind for Pet Parents. I'm Karen Wylie here as always with Gail Pope. Gail, today before we go into our topic, I wanted to pause for just a moment and mention that this is our 52nd episode.

Gail Pope: Oh, God.

Karen Wylie: We have made it an entire year. Our first year.

Gail Pope: Where's the champagne?

Karen Wylie: Seriously, it's a little early even for me on the East coast but it's a full year of weekly podcast conversations that we've done. How does that strike you? How do you feel about it?

Gail Pope: I feel, oh I just got goosey, I guess gratitude is probably the biggest thing I feel because I was so nervous about doing these and just kind of talking about all sorts of things. "What if I make a mistake?" "Oh, it's all so scary", and, "Oh, I'm not good enough. I'm not clever enough." "Or what if she asks me...?"

You know, all of this kind of stuff that sits as my anxiety as it were and yet over 52 episodes, wow! I just feel so much more comfortable. I feel like I stand in my own shoes now. If that makes any sense. You know, I can be who I am and it's okay.

Karen Wylie: Well, who you are is why we love you. It's all that knowledge and experience that you have accumulated over these 30 plus years of taking care of animals.

That was why the idea of doing a podcast with you was such an easy idea to have. To feel like it would be something very positive because although you have certain topics that you are known for, the truth is you cared for so many different animals of many different species and so many different diseases and diagnoses. I knew there was just so much to you and your experiences that we could take a little sliver of it each week and talk about it.

Gail Pope: Well, I can turn that back to you because last year I learned so much from you. You know, we've kind of trodden parallel paths. A little bit different this side, a little bit different that side. You've done this, I've done that but it's such valuable history and it's fascinating. We don't always agree or disagree about everything and that's so good because we learn from each other. "Why did you do that? Wow, that makes sense." You know, that kind of thing. It's interesting, isn't it?

Karen Wylie: It is. It's been very interesting and you're right that although we see eye to eye on so many things, we also have handled things differently. Yet we can be very straightforward.

"Why did you do that? What was going on in your mind when you chose to do that?" 

And neither of us take that as some kind of big confrontation or argument but an opportunity to share. Then we often find some common ground even in our different decisions or different approaches. That definitely lends more options for us in terms of what we talk about in the podcasts or any other educational direction we go in.

Gail Pope: You know, that brings up for me again the word bias. We've talked about that an awful lot but that helps me greatly in my consultations because quite naturally when I'm consulting with people now, I sit on their side. I can see how they're living, dealing, loving, giving, caring ,and worrying and all the different emotions that they have. I understand them and then when they're trying to make various types of decisions, I can look at them from their perspective. I've obviously still got my perspective too and that weaves in alongside but it allows us to have a very open conversation and again to learn from each other.

Karen Wylie: Right. We have covered so much ground in the last year. I mean, I was taking a look at our list of various topics. I mean, we've explored caregiving and the self care that's needed for that. Grief all the way through from anticipatory grief to grief after your pet has died, quality of life— what it is and how to monitor it and track it, spiritual connection, all the different kinds of decision making we need, and how to partner with our veterinarians. We've really covered a whole heck of a lot of ground.

As we move into our second year next week which will be our first podcast of our second year, we're going to begin inviting some guests over next year and expand our conversations with other people's perspectives on these same very important topics.

Gail Pope: I love that.

Karen Wylie: Yes, I think we've established our sense of team in terms of understanding how we're approaching things. I think that'll allow us to facilitate even better interviews, don't you think?

Gail Pope: I certainly do. Well, I mean, you're the miracle worker in interviewing anybody because I guess you've done it for how many years?

Karen Wylie: Oh, my whole professional life since I was 22.

Gail Pope: For you, doing something like this like an interview is like a duck in water, isn't it? You know, it's just habitually easy for you.

Karen Wylie: I love learning how people think about things, how they feel about things, about how and why they approach their life the way they do. Much like you're describing when you work one-on-one with clients, you're finding it very interesting to see things from their perspective as well. Look at that, another thing we have in common— finding it very interesting to learn from other people.

Well, I was thinking that as I was looking at all the different topics that we have been covering, certainly there's been a question or an issue that's really underneath so many of the things we talk about. 

Of course that has to do with hospice but a particular question that I would like us to begin talking about today is:

Why do you think more pet parents have not been offered animal hospice as an option?

We hear from so many clients that it's not been offered other than different treatments or euthanasia. The middle path of hospice is often not broached. It's not brought up. 

So what's your thinking about why pet parents have not been offered animal hospice as an option in care?

Gail Pope: You probably know my answer to that without me even opening my mouth. It seems to be something that I'm saying over and over again, lack of education for veterinarians in this field. 

I think it is improving and more and more people are starting to look. I think, like me in my early days, I never called the work that I was doing hospice, it was end of life care. Well, actually it was living care and the end of life just became part of life.

I think the majority of people that I speak to have that philosophy. They're not familiar with hospice because like the veterinaries, they haven't really learned about it. So they are totally focused on living as well as possible until the end of life— and what does that mean and what do I do?

So I think we all have it in the correct order in our heads. I think it falls apart when the veterinarian discovers that he's reached the end of his toolbox and there isn't anything more he can suggest or do. They fall off the cliff and it's time for a quick decision, a fast choice, and they don't seem to see that there is a choice at that point— sometimes they do. I shouldn't say they don't but you know, there are a lot of veterinarians out there that are working integratively and stepping into the end of life field more.

Karen Wylie: It is especially interesting to me because of course, as you and I have talked about before, I was providing hospice care to my pets. Also, not calling it hospice, just trying to provide the best life for as long as possible for each of my cats or dogs. 

Hospice care itself is not a whole different type of pet care. It's a different philosophy or approach because it's about caring for a living being while they are declining.

But it's not where there's different tests that are run. It's not where, you know, your vet does a completely different exam on your pet when you go every month or every three months or however long your particular process may be. So it's not that hospice care is a whole new product line for veterinary clinics to be advertising.

It's more a philosophy or an approach of being able to support a pet parent, and help them understand what a physical decline is going to be like - and how to support that pet at home.

Gail Pope: No, correct. But you're making me also realize that because veterinarians don't know how to cope well with end of life, we said that they stepped towards euthanasia. I honestly think part of the problem, one that I do hear from consultation clients lately is that they do see a veterinarian who is advertising the fact that they're a hospice veterinarian and they become excited and so they contact them. 

When they do, the conversation is about forming a euthanasia appointment at their home. They're not suggesting end of life care and then a choice for euthanasia. 

Some are but I think many veterinarians are using that "hospice" word kind of alongside euthanasia without having the right kind of education in the middle to understand that end of life chapter. It is a whole chapter of life.

Karen Wylie: Right.

Gail Pope: And it's not, "Oh my goodness, this is a difficult diagnosis. Now we've only got this to choose." There's a plethora of other ways to go.

Karen Wylie: Yes, it's a whole process. It's not an event. As you're mentioning that, I'm reminded of how often our students at Animal Hospice Group have brought this up because, not surprisingly, if someone's going to sign up for a certification in animal hospice they have an interest in learning about it— often because of their own experiences with their own pets.

So at various times as they're going through the program, they may have a pet that is declining and getting older and they're looking around locally and regionally, "What are my resources? Who could I go to get hospice care for my pets?"

It's just truly amazing because it'll typically be looking at their ads and their websites and so forth and somehow they get the understanding that this particular clinic is saying they will do hospice care. 

But when they call, it's really more that they will do a quality of life evaluation to determine if the pet is ready for euthanasia - as opposed to the kind of hospice care and approach that we teach.

It's the numbers that they talk about— they called six of them who didn't really provide hospice care and only found it on the seventh, or they called five clinics and only found it on the sixth. 

So it's those kinds of numbers that we keep hearing that indicate that true hospice care is somewhat difficult to find. 

Again, it's still frustrating for me because it's not a separate product line, or a separate service. It is just a different way to approach life through the final chapter.

One of the things that I think we continually run into when we talk about hospice is the rush to euthanasia to prevent suffering, to prevent pain. 

Of course we don't want suffering and pain for pets in hospice care either. We're just not seeing euthanasia as needed in as many situations, or needed as quickly.

You know, as I was thinking about this topic for us to talk about today, I was reminded of one of my very first discussion groups as a student with Animal Hospice Group all those years ago. 

I was describing one of my frustrations that I have talked about at various times when I see videos on Facebook of, you know, bucket lists that pet parents are providing to their pet. It'll be an apparently healthy dog running around the beach, jumping into the waves, and they're taking the dog for the cheeseburger and the pup cup.

Then they're taking them for euthanasia because it's supposedly better to do it on a good day than a bad day. 

I remember sharing that in one of the discussion groups and our mutual friend, Dr. Tina Ellenbogen DVM spoke up because she was hearing me and she said, "You know, Karen, I've heard you say that a couple different times and I've thought about it. Do you know that veterinarians take an oath in every state when they get their licenses and it calls for preventing suffering? 

That in all 50 states, there's some kind of wording about preventing suffering. So I think one of the reasons, again, you know, why more pet parents are not offered animal hospice as an option is because the interpretation of what preventing suffering means...

Gail Pope: You're making me think of another avenue now and that's the world of human hospice. Let's take that word out of it but use “end of life” for humans. Now again, there's still that little rift you hear, or we hear very often from the human world that hospice isn't offered early enough.

It needs to start up to six months before but again, that's improving. That's improving all the time. But in the animal world, we don't look, we don’t embrace all of us: veterinarians, everyone included. We don't look at the human world enough to see how it works there, with or without euthanasia being quite so obviously chosen in the animal world.

Because in the human world, doctors do their best to save the life, to keep the life comfortable. That transitions from the early stages of "Save the Life", and do everything to fix. 

But then when they can't in the human world, they're really learning to actually make a transition into doing their best with love, extending life, and controlling any pain from the chronic illness.

You know, sometimes people "graduate" from that end of life chapter and they go and live it. Think how often BrightHaven saw that in the days that we started to work in that way. It made all the difference. It just enhanced the love, it enhanced the joy, and it enhanced the life of the animal.

Karen Wylie: Yes and enhanced the support that the animal felt. Certainly in human hospice, those levels of support are increased as well.

Gail Pope: Yes.

Karen Wylie: So, in human hospice, the services also provide support to the families, not just the animal patient, of course. That support continues after the physical death of the human patient. 

Whereas in our animal care world, most of the support ends once the decision of cremation is made— cremation or burial. There's not a lot of services that are provided by a veterinary clinic for the pet parent who has lost their pet.

Gail Pope: Well, you could step back further because there's not as much support. I mean, in the human world, there is more support during the end of life chapter— especially in the world of actual hospice care. We don't have that kind of support in the animal world because I think, well, there are many reasons …but people don't jump in to help someone who's caring for an animal approaching the end of life. The caregiver is tired out, exhausted, not getting enough sleep, and very often the people around them don't understand. You know, "It's only your dog, it's only a cat."

You know, they don't necessarily jump into help and the caregiver doesn't necessarily feel able to ask for help. Whereas it would be a lot easier for many people to say, "Oh, you know, it must be a terrible burden for you caring for your mom. Can I do some shopping for you or something?" But they don't step in like that in general for animals. 

Karen Wylie: I think you're absolutely right. The glimmer of hope I see in those kinds of situations, it still has to be paid for. In that we've seen pet sitters begin offering lunchtime care where they will check in on your pet if you're working full time. 

Or you're going to go out of town for a weekend for, you know, a family member's graduation or christening or whatever it is that you feel you’ve GOT to go to. "But what am I going to do about my pet who's okay right now and stable but what if...?"

Then we have some pet sitters that are beginning to specialize in geriatric pets and that kind of thing. You're still having to pay for that service and find someone who offers those specific services in your locale to get it. 

Part of that is, I guess, the shift in pet parenting that you know 20, 30 years ago, a lot of dogs were still chained out in the yard at a doghouse. Now we're sleeping with them and they're sharing parts of our meal as we eat. They are true family members now.

Sometimes I'm not entirely sure that the veterinary, I guess, I want to say industry, certainly veterinary training has adapted to the new or the current needs of pet parents— the more contemporary needs. I sometimes feel like their services are...

Gail Pope: We need to go back to school and start learning and see.

Karen Wylie: Well, again, it's not that they need to learn new skills. They can use all the skills they currently have. Yes. It's just the approach to it, allowing it that seems to be the issue. 

So what do you think pet parents can do to interact with their vets and ask about hospice as a possibility?

Because of course, it's not always going to be a possibility depending on the disease, the trajectory, the diagnosis, a pet's condition. You know, there's going to be different answers for different pets.

Gail Pope: Of course. Again, I think I've probably said it a million times but the more we, as pet parents can educate ourselves so that we know the right questions to ask our vet, so that they see the light and they realize, "Wait, yes, I could help with that", or "I can advise my client and they could do X, Y or Z."

I mean, let's face it, caring for a being towards the end of life, especially with the help of a veterinarian, because you've then got your medical side covered on the one side - that you feel comfortable and secure in— whether it's conventional or not. 

Then on the other side, the veterinarian could very easily step into the role of support— of emotional support and understanding what their caregiver is going through at this time.

Let's face it, many practitioners actually haven't experienced the end of life beyond choosing euthanasia. So they don't have the experience at the moment to really answer the questions and feel supportive because I suppose it comes down to fear of death as much as anything, doesn't it? You know, from both sides.

If you're human, you have to have this fear of the unknown somewhere inside, even if it's just this much. It has to be there for all of us, doesn't it?

Karen Wylie: Well and even if it's not fear of death itself, the fear of the decline that takes place in watching it happen as we talked about last week. That's certainly a factor for all of us, even as many times as I've been through it when I'm dealing with the reality and seeing it. It's just kinda like...

Gail Pope: It's tough.

Karen Wylie: It's always so tough to watch. Of course, as you're saying, vets may not have had many opportunities to provide hospice care to their own pets because they may have chosen euthanasia earlier than would've allowed them to see a longer length of hospice care. 

They're not trained in much of this emotional support. I think the mobile euthanasia vets are trained in it for the time of the euthanasia appointment. Everything I hear, and it doesn't matter what franchise or whether it's private, you do generally hear really supportive and positive comments about veterinarians providing that particular service in your home for your animal, who do seem to have been trained in the emotions and the grief process, and know what to say, and know what not to say.

Then it's a time issue too. For a veterinarian to really deal with the emotions that we would be feeling about losing a pet and understanding what's happening to them as they're declining, that kind of conversation takes more time than the 10 or 15 minutes that might be allocated. So that's going to be a stumbling block as well.

But hospice is— I'm trying to think about how to take our conversation and bring it a little bit more to a close here. 

Although you and I could go on for a long time talking and we do but of course hospice care is not doing nothing. Sometimes people think that, "Oh, you've given up, you're not going to be doing anything."

Well, you may not be anticipating a cure but it sure doesn't mean you're doing nothing. 

There's so much that can be done and you're also not refusing euthanasia. You're not being a bad client. 

You are just looking for that middle ground, that middle path that would allow more time to focus on quality of life monitoring, making sure that the pain and suffering is not an issue, learning more about that so that you can take action if at any point it does become an issue.

Gail Pope: Well, it's a time to express love. It's a time to realize that you can grieve with your animal or your human before they die. You can say the things that you wish some people would hear all the time, "Oh gosh, I wish I told her that."

But you can have those conversations. Your animal speaks any language you like. 

We are the ones who find it difficult to understand them but spending time with them, spending time crying— they're all important things that we need to have time to do - so that when the animal passes, it can be a gentle and kind experience. 

And of course, if you have a spiritual belief that the soul leaves the body and goes on, that's even more supportive and comforting.

Karen Wylie: Absolutely. The time aspect of hospice is what makes it such a wonderful alternative or middle path because time is a gift. 

However much time we can have with them and show the love that we have for them, there's nothing like it. When you've been able to go through an illness and a decline and the physical death and loss but you're able to feel that you handled everything pretty well and that you did have time and you were able to express the love that you felt. It certainly helps your grief process.

Gail Pope: And there you are. There's your ending for today. It's all about love.

Karen Wylie: Oh, there you go.

Gail Pope: And baby steps.

Karen Wylie: Oh God. Well, I hope that more families would choose the hospice path. Not every family's going to choose it. Not every pet's physical condition or diagnosis will allow it but it certainly can be explored more than it typically is. 

As we begin our second year of podcast conversations next week…

I know we'll be talking so much more along the way about hospice care and end of life. We'll be bringing some new voices and guests into these conversations as well. We hope that more pet parents will feel informed, empowered, and supported as we continue these conversations because when we approach end of life care with education and collaboration with our vets, love is never rushed.

See, I was able to end on love too. 🙂

Gail Pope: Beautiful. I like that.

Karen Wylie: Thank you for being with us for the last episode of our first year of podcasting. We hope you'll be with us next week as well. Thanks. Bye-bye.

Gail Pope: Bye-bye. Take care.