Compassionate care for pets: Why some animal lovers are turning to hospice

At first, Alissa Algarin didn't think twice about her dog, Cain, spending more time on the couch than normal. After all, he was getting older.

But then Cain, a pit bull mix, stopped following her to the door when she left and lost all interest in his toys. He also began pacing in a circle around the kitchen.

After some blood tests to rule out other issues, the dog's veterinarian produced a diagnosis -- cognitive dysfunction syndrome -- a condition that Algarin sometimes calls "doggy Alzheimer's."

"What might happen is that his brain might go first, before his body," Algarin says of Cain, now 11 years old. "So it means that I might have to get to a point where I have to put him down."

But she's also not quite ready to say goodbye.

Algarin is one in a growing group of pet owners turning to veterinary hospice care.

Usually provided at home in the time before euthanasia or death, pet hospice is a practice that proponents say has just as much to do with the bond between animal and human as the animal's health. Though pet owners and veterinarians have long been caring for pets at the end of their lives -- even if the practice wasn't then called "hospice" -- the field has gained more acceptance in recent years.

While some may think pet hospice is more of a comfort to pet owners than the actual pet -- one with an especially hefty price tag for those who have already pursued other treatment -- others consider it the best way to part with a beloved companion.

Making the last days count

Algarin and her dog have been through the grieving process before, after she suddenly lost her fiance Mark, who was Cain's original owner. She brought the dog to the funeral home to say goodbye. Cain sniffed his former owner, then slumped into her arms.

"The two of us were like that for weeks," she says.

Algarin moved to her seaside development because dogs are allowed and there's a park nearby where Cain can run around. Yet when Shannon Skevakis meets Cain, she immediately notices there's something amiss. As she walks through Algarin's door, the dog goes out into the hallway of the building and stands there, as if he doesn't know he can return. That's unusual for a pit bull, Skevakis says.

"He just doesn't have the brightness that we typically think of," she says, looking at the dog, his black-and-white face hunched over, snoring. Skevakis, a Woodbridge-based hospice veterinarian with Lap of Love, a national pet hospice network, started her career at a traditional vet clinic in Florida.

"We're taught to fix, to cure, and that's not this business," she says. "There's a realism to it."

Guidelines issued by the American Veterinary Medical Association define veterinary hospice as "care that will allow a terminally ill animal to live comfortably at home or in a facility." Such care, the group says, does not preclude euthanasia. For Skevakis, one of three Lap of Love veterinarians in New Jersey, hospice is a team plan, one made with the pet owner and the dog's regular veterinarian. She numbers among 80 veterinarians in the hospice network, which covers 24 states. Skevakis visits homes throughout N.J., tending to hospice patients as often as necessary until natural death occurs or the pet owner decides to euthanize.

"One of the major things I hear about from owners with their geriatric or chronically ill pet is that by the time that they reach a later stage in their life, it's very traumatic and stressful for the pet and for the family to transport their four-legged family member to the veterinarian's office," she says. Once they get there, they may only have 15 to 30 minutes with the vet.

While in-home hospice visits tend to cost about $100 more than traditional vet appointments, Skevakis, who charges a base fee of $300 for hospice and euthanasia visits, spends an hour with her patients and doesn't order diagnostic tests that can ring up big charges on a regular vet bill.

She performs a physical exam of Cain and takes a history, but her ultimate assessment is based on a quality of life scale, which accounts for the dog's behavior, mobility, incontinence and appetite. This helps Skevakis explain to Algarin how they can know when "it's time." The veterinarian recommends that Algarin use enrichment activities to stimulate Cain's mind and consider an MRI at his regular vet to rule out a brain tumor. She also suggests anti-inflammatory medication in addition to pheromones, joint supplements and tweaks to his diet.

The period of hospice care can vary widely, from days to weeks or months.

"There's never a right time," Skevakis says of deciding when to euthanize. The choice is always up to the owner, but Skevakis operates by a motto -- "Better a week too early than a day too late." The light in Cain's eyes may be dim, but Skevakis thinks it's a good sign that he still seems to like going on walks, especially when pain can manifest in malaise and anxiety.

"One of the things that I always do with hospice is prescribe love," she tells Algarin. "So, twice a day for, you know, 20, 30 minutes," she says. "When you start disconnecting, that's when that bond breaks and then it decreases everybody's quality of life."

Helping families say goodbye

Still, some pet owners and veterinarians may not agree with hospice, thinking the practice prolongs suffering. But in a field where eating and sleeping are primary concerns as opposed to blood work and kidney values, Mary Gardner disagrees.

"Hospice is not about prolonging anything," says Gardner, 43, a hospice veterinarian in the Los Angeles area who grew up in Vineland. "It's actually sometimes making it shorter but making it better." Some clients compile bucket lists for their pets, or plan their last day together as a special send-off.

There are many factors to consider when assessing an animal's quality of life, says Gardner, who co-founded Lap of Love six years ago with fellow veterinarian Dani McVety in Tampa, Fla. "There is so much more than just the pet," she says, and more than the cost of hospice. "It's the emotional budget, it's the physical budget." The very act of lifting a heavy dog can tax a caregiver.

Veterinarians and pet owners have been focused on making sick pets comfortable for years, even if they didn't actively call their methods "hospice," says Lianna Titcombe, 48, a hospice veterinarian in Ottawa, Canada.

"It just hadn't been known in the animal world," she says. "For humans, (modern hospice) started maybe 30 years ago." Titcombe is president of the International Association for Animal Hospice and Palliative Care. The group, founded in 2009, has 400 members, not all of them vets -- some are social workers or veterinary technicians. The association is developing an animal hospice certification program that should be available in June.

There is currently only one veterinary program devoted to hospice in the United States, at the Colorado State University Veterinary Teaching Hospital, says Katherine Goldberg, a veterinarian based in Ithaca, N.Y. who specializes in hospice and geriatric care. Goldberg, 38, a lecturer at the Cornell University College of Veterinary Medicine, co-founded the Veterinary Society for Hospice and Palliative Care in 2013. The longest she's cared for a hospice patient before death was 14 months, she says, which is a hard distinction to make given what she calls the "fuzzy line" between palliative care and hospice care, the former focused on pain and symptom management and the latter on quality of life as death approaches. Some clients will choose palliated natural death for their pets.

"Euthanasia is a gift and a tool and the best thing we can do to relieve pain and suffering in animals when appropriate, but it is not the only way," she says. Yet Goldberg points out that hospice veterinarians can fill a specific need in that regard, given that vets often suffer from "compassion fatigue," or secondary traumatic stress, with some opting to leave euthanasia to other doctors.

Families, too, can struggle with feelings of guilt when making an end-of-life decision for their pet -- "They just want to know that they did everything that they could do," says Coleen Ellis, one of the founders of the IAAHPC.

"We want to give them the permission to mourn," says Ellis, owner of the Pet Loss Center, a kind of funeral home for pets in Euless, Texas. Anticipatory grief, she days, often kicks in as soon as a pet owners receive a diagnosis.

"Is it about the pets or about the people? It's absolutely about the people," she says of hospice. "It's about getting us ready."

Amy Kuperinsky may be reached at akuperinsky@njadvancemedia.com. Follow her on Twitter @AmyKup. Find NJ.com Entertainment on Facebook.