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Pet quality of life and hospice care

What are pet quality of life and hospice care? Are you trying to determine life choices for your pet and want a little bit of help figuring out if your pet is suffering too much or if there is something more you can do?

Every dog and cat parent comes to a time when they have to consider pet quality of life and end of life decisions. It is a very emotional time and it’s hard to trust oneself in making decisions about their loved one. 

Far too many people feel rushed into an end of life decision at an emergency clinic. There are options for your pet in his or her final stage. It’s also important, to be honest with yourself and your family members about your feelings and spiritual beliefs to help you choose a path you will be at peace with.

Hospice Care

Pet hospice care is an option that allows for a gentle transition with the highest level of physical, emotional and spiritual care for the patient. It’s keeping your pet comfortable at home and providing nursing care to ease pain and allowing a natural transition to spiritual life.

Some veterinarians offer this as an extension of their services with in-home visits. Talk to yours to see if it’s an option or ask for referrals. When selecting one to work with, ask what percentage of the patients under their hospice care have a natural transition versus those who have euthanasia administered.

Not every pet parent has the capability of offering this level of care for an extended period. Work or family obligations could be too demanding at some point. It can also be very tough emotionally.

Always be honest with yourself and follow what you know in your heart is the best thing to do for everyone involved. Do not let anyone rush you into a decision, regardless if it is your veterinarian or a family member. Take the time to make your own decision. Sitting quietly and having an open-hearted spiritual conversation with your pet can also help in decision making.

Alice Villalobos, DVM, a leader in veterinary oncology and Director of Pawspice, a hospice and oncology consulting clinic in Southern California came up with a wonderful resource to help in gauging your pet’s comfort and quality of life. This is to help you determine if it is appropriate to continue with hospice care for your dog or cat or if suffering is at the point that it is inhumane.

Determining Quality of Life

The HHHHHMM Quality of Life Scale is a scoring system of 1-10 in 7 different categories. The Acronym stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More (good days than bad). Assessment can be done monthly, weekly, daily or even by the hour, when appropriate. 

Rank each category between 1-10 with 10 representing the category is not an issue. Add all seven categories together. The highest possible score is 70. A score above 35 indicates that the animal is maintaining an acceptable quality of life and it is appropriate to continue with hospice.

HHHHHMM Quality of Life Scale


What is your pet’s pain level?  Does your dog or cat whipper or cry out? Is the pain manageable with medication, laser, massage, hydrotherapy and/or acupuncture? Or is the pain at a point where nothing is working? Difficulty breathing trumps all other concerns. An animal that is having difficulty breathing, that cannot be eased, should not have to suffer through an agonizing death. Is the animal on oxygen support?


How is your pet’s appetite? Is he eating without coercion? Does feeding by hand or adding bone broth help? What about eating pureed food? Does your pet take in enough calories to meet his resting energy requirement (RER)? Is a feeding tube necessary? Is there nausea and vomiting? If so, can it be controlled with medication such as Cerenia or the homeopathic remedy, Nux Vomica? Remember that if your pet is feeling nauseous, even the smell of food can turn his stomach.


Is your pet drinking enough and maintaining hydration? A simple pinch test of the skin at the back of the neck helps determine is your pet is dehydrated. Skin that snaps back quickly is hydrated. The slower it is to go back to normal, the more dehydrated the pet is.

Subcutaneous fluids can help with hydration. Two teaspoons of fluid per pound are considered adequate. Pets who eat a moisture-rich diet will consume less water, which is normal.

Bone broth is a good way to get fluid into your dog’s body. Shaving ice and adding a little tuna water will also entice your pet to take in fluids. Switching it up and offering different liquids may be helpful. Electrolytes such as Skratch hydration mix are also helpful. The lemon-lime flavor of Skratch is best to use. Mix 1/2 scoop of the powder to 3 cups of water and offer a little, or use a syringe and put directly into your pet’s mouth.


Is your pet to eliminate without assistance? Is elimination regular and without pain? Keeping your pet clean after eliminating is important. How is the bedding? If the animal is bedridden, turning regularly will help with bedsores. Are wounds staying clean and healing?


Does your pet show happiness? Is he/she happy to see you when you get home? What about showing interest in things? Do ears and eyes perk up or does he seem depressed? Do the two of you connect? Happiness is a great healer. The more you can do to perk your dog up, the more he will be able to help himself heal.


Is your pet able to get up out of a laying down position without assistance? Can your dog go for short walks without falling? Does a cart, mechanical device or sling help? 


Is your pet having more good days than bad? Keep a journal of a good day and bad. Is your dog having more good days or bad days? What are you using as a measurement for each? 

Follow your heart

Choosing to care for your animal to the end, is a beautiful, difficult and rewarding choice. Make your intention clear and follow your heart. Totally natural death is not always the best decision.

Stay dedicated to the best care possible for your pet. But at the point where your animal is suffering to a point that is not acceptable, be open to what your heart is telling you. Having a backup plan that you are comfortable with and that you have thought through, will bring much-needed comfort during this time of transition.

Take care of yourself

It’s important during this difficult time to take time to care for yourself. Have someone who can provide respite care from time to time so you can get a massage or have coffee with a friend. If that isn’t possible, set aside 20 minutes a day to close your eyes and meditate. When we give so much of ourselves, restoring our energy is vital for our wellbeing and for our pets at well.

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