Feline veterinary hospice offers cats and clients familiar comforts (Part 2): Guiding in-home hospice care and euthanasia planning

Part 1 of this article provides veterinary hospice and palliative care definitions, describes advantages of hospice care, and presents an overview of talking with clients about feline hospice care. Part 2 outlines practical feline home hospice care guidance to share with clients, including when to consider in-home euthanasia services.

Home hospice care guidance for clients

Clients are our partners in providing hospice care for their cats at home. Hospice care plans include assessing the home environment to identify where safety and comfort adjustments are needed, and teaching clients how to safely and gently administer treatments, monitor their cat’s clinical signs and therapeutic responses, and manage nutrition and hydration concerns.

Environmental adjustments

Cats need a comfy and enriched home environment during every life stage, and extra modifications are often necessary during hospice and palliative care.¹ In light of an ailing cat’s abilities, advise clients to help their cats continue to:

• Comfortably eat meals and stay hydrated (easy access to bowls on non-slip mats, slightly elevated feeders if needed).
• Easily get in and out of litter boxes (low entry box with soft, shallow litter).
• Stay clean, comfortable, and safe (grooming assistance, nail care, easily cleanable materials, potty pads or cat diapers, supportive and warm bedding, massage, calming pheromones, pet gates, hiding space, and avoid noxious odors, loud noises, and sudden visual disturbances).
• Reach favorite scratching, lookout, and sleeping areas.
• Enjoy predictable routines and social interactions, without having to compete for resources with housemate pets.

Clinical signs management

Whether their cat has arthritis, renal disease, cancer, gastrointestinal dysfunction, cognitive impairment, heart disease, or another condition, guide clients in identifying clinical signs of and relieving their cats’ discomfort (pain, breathlessness, nausea, inappetence, anxiety). Educate clients about their cat’s medications and the prescribed formulations and administration techniques best suited for the cat and the client’s abilities and preferences. Demonstrate how to accomplish this care.^{1, 2} Teach clients how to assess their cat’s therapeutic responses, signs of decline, and quality of life.

Maintain realistic medication goals and propose practical options. Consider whether injectable analgesics (given at the clinic or by the veterinarian in the cat’s home) would be beneficial to kickstart analgesia and make ongoing oral treatments easier. Avoid medications that require a large volume of administration and those that taste bitter. Instruct clients on tasty treat medication administration and tell them to avoid hiding medications in meals because it may create food aversion.

Nutrition and hydration

Hospice for cats means letting go of disease-specific nutrient math and redefining success by focusing on a highly palatable diet that provides sufficient calories, protein, and water. To many clients’ delight, it also allows them to offer extra treats. Consider and discuss the advantages and disadvantages of placing a feeding tube.¹ Medically address inappetence that stems from pain, nausea, and dehydration. Address dehydration (such as wet food, varied water sources, subcutaneous or intravenous fluid administration). Help clients recognize that eventually, a cat’s refusal to eat is a part of the late end-stage of life, and to avoid distressing their cat by force feeding.

Support the human side of feline hospice

End-of-life caregiving can be intensive, and a primary goal of veterinary hospice care is to honor the human-animal bond and ensure that the client’s relationship with their cat is not strained or broken.¹ Provide follow-ups to initial and ongoing hospice services or consults within 48 hours so timely adjustments can be made.³ Telemedicine communications can help veterinary teams follow up on patients’ clinical status.¹

Allow the client’s bond with their cat to guide their decision-making and the type and amount of caregiving they can provide.¹ Such bond-centered care empowers them to better meet their cats’ and their own needs. Support clients who decline diagnostics and treatment and avoid reinforcing any guilt they may be experiencing.¹ Cat owners may carry guilt and fear of waiting too long to decide on euthanasia because of their cat’s stoic nature. In that case, I tell clients, “Cats don’t show us everything, and that’s not your fault.” Conversely, clients also worry about electing euthanasia too soon, and I remind them, “Your cat’s comfort matters more than attempts to control the disease or attain specific test results.”

Continue to communicate with clients who are not ready to euthanize their cat about their cat’s condition and the importance of ongoing hospice and palliative care. The goals are always to provide comfort and prevent suffering.

Euthanasia: To be at home, or not to be at home?

A cat’s personality and situation; the caregiver’s preferences, resources, and awareness of choices; and the veterinarian’s training, availability, and personal well-being influence whether in-home or in-clinic euthanasia is appropriate.

In-home euthanasia provides a familiar environment where cats are most content and will likely experience less anxiety and stress. It offers a personally meaningful, customizable, and time-relaxed setting for the family, and individualized grief support and aftercare guidance. It avoids stress-related transport to the clinic and an owner’s emotional trip home without their cat. In-home euthanasia may better support clients’ wishes and considerations, allowing them more influence in creating peaceful, planned goodbyes and helping them prepare emotionally.

Reasons for in-clinic euthanasia include urgent situations, clients who want their pet’s familiar veterinary team involved, families who prefer a clinical environment over reminders of euthanasia at home, and pets who are medically or behaviorally unstable and more easily managed in a clinic setting. In addition, some clients may have housing or safety restrictions that preclude in-home veterinary services.

Veterinarians can guide clients in choosing a location, and it hinges on the cat’s quality of life, their stress level in the clinic vs at home, and the cat’s health status. Stable patients allow caregivers time to plan and schedule in-home euthanasia, whereas critical situations require urgency. Help clients make an informed decision as they encounter these difficult circumstances in their cat’s life.

The veterinarian’s role: Guide, not gatekeeper

Many clients become overwhelmed when faced with a decision to euthanize and wonder “is it too soon?” or “am I waiting too long?” Guide clients in assessing their cat’s quality of life in light of their medical conditions and discuss to what degree measures to address their pet’s quality of life have or have not been helpful.

Clients with geriatric and ailing pets have told me they avoid veterinary visits because they don’t want to feel pressure to do more diagnostics. It helps veterinarians to recognize that clients’ cultures, beliefs, resources, and treatment expectations and goals for their cats affect their perspectives on end-of-life care. Addressing quality of life concerns and having goals of care conversations with clients whenever their pets’ health challenges arise, and especially as pets traverse their senior and geriatric life stages, may soften the shock of grim news.

Better deaths start with better conversations

Earlier conversations about cats’ quality of life can help clients accept that their pet is near the end of life and to understand hospice as an option, not a failure. While most veterinary hospice is ideally accomplished in partnership with clients and in their homes where their cats are most comfortable, conversations and therapeutics can and should begin at primary care clinics and specialty veterinary hospitals. Consider partnerships with in-home veterinary hospice services when available.

If clients decide against euthanasia, we discuss how their cat’s medically unassisted death experience may unfold, considering their cat’s condition and clinical signs. I explain what hospice-assisted or palliated death means, and I tell them that as a veterinary hospice practitioner, I’ll assist in extending a pet’s life if we can comfortably and reliably control the pet’s pain and anxiety.¹

Cats benefit from end-of-life care that provides comfort, dignity, and familiarity, and veterinarians can change feline end-of-life experiences by how and when we talk about options for that care. Hospice isn’t centered on length of time remaining, but on quality of remaining time. Veterinary hospice care can help meet our feline patients’ and clients’ needs where they are.

For additional resources on hospice care and services, visit LapofLove.com.

References

1. Eigner DR, Breitreiter K, Carmack T, Cox S, Downing R, Robertson S, Rodan I. 2023 AAFP/IAAHPC feline hospice and palliative care guidelines. J Feline Med Surg. 2023 Sep;25(9):1098612X231201683. doi: 10.1177/1098612X231201683. PMID: 37768060; PMCID: PMC10812026.
2. Taylor S, Gruen M, KuKanich K, X Lascelles BD, Monteiro BP, Sampietro LR, Robertson S, Steagall PV. 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats. J Feline Med Surg. 2024 Apr;26(4):1098612X241241951. doi: 10.1177/1098612X241241951. PMID: 38587872; PMCID: PMC11103309.
3. Monteiro BP, Taylor S, Dowgray N, Eyre K, Gruen M. Feline chronic pain management: the importance of a team approach for optimal outcomes. J Feline Med Surg. 2025 Nov;27(11):1098612X251374161. doi: 10.1177/1098612X251374161. Epub 2025 Nov 10. PMID: 41215486; PMCID: PMC12605920.