Human Hospice/Animal Hospice
Are they the same or different?
Posted May 17, 2018
GUEST POST by Gary Gardia, MEd, MSW, LCSW
[A note from Jessica Pierce: After a very interesting conversation a couple of weeks ago with my colleague, Gary Gardia, about the differences between human and animal hospice, I asked if he would like to contribute a guest post on the topic. Gary has a unique perspective because he has worked in both worlds. You can find out more about Gary at the end of this essay.]
The pioneers of the modern hospice movement began with the thought, “There has got to be a better way to care for people who are dying." And what is this “better way?" We decided early on that people need to be seen as more than just a body with a disease. We know that people are complex beings with physical, psychological, emotional, social, and spiritual components that all come together to make up the whole person. With this knowledge, we also know that including members of this person’s circle of support is crucial. While it is important to address the pain and symptoms associated with the illness, it is equally important to “treat suffering” in all of its forms. One of the concepts used to describe this approach to care is called treating “total pain."
A common descriptor that has been used for many years is “Hospice is a special way of caring." We know that most people in this country die in hospitals and nursing homes, which means that hospice is not the only provider of end-of-life care. End-of-life care is not exclusive to hospice and likewise, caring for people at the end of their lives does not necessarily mean they are receiving that “special way of caring” provided by hospice.
So, what is palliative care? Here is a very brief historical perspective: With the advent of the Hospice Medicare Benefit came a tightening of hospice admission regulations and criteria. Medicare did not want to provide reimbursement to care for people who were not dying, or, not dying soon enough (blunt but true). For example, a person with congestive heart failure could die within days but might also, just as likely, live for several more years. When people lived way beyond six months, was this still hospice and should Medicare provide reimbursement for this ongoing care? It became confusing and difficult for everyone. But physicians became frustrated when their referrals were turned away and some eventually said, “We will create our own model and call it ‘Palliative Care'. ” The notion was that once a person was diagnosed with a serious and potentially life-limiting illness, they could receive aggressive comfort care regardless of the outcome or course of treatment.
How does this all translate into care for our beloved animal companions? A couple years ago, I did a presentation at a conference and said, “All veterinary clinics provide end-of-life care. That does not mean all veterinary clinics provide hospice care.” This statement kicked-off my sometimes bumpy journey of discovery. First, it is important to acknowledge that the evolutionary process for human hospice began way back in the 1960’s, and while animal hospice certainly incorporates many of these time-tested guiding principles, it is still a relatively young movement. In addition, there are some inherent challenges for animal hospice. Here are just a few:
- There is no centralized reimbursement source for animal palliative care/hospice such as Medicare in the human hospice world.
- While pet owners can purchase insurance, most do not and most insurance providers do not cover palliative care or hospice specifically.
- Many veterinary clinics are not staffed to provide services such as grief counseling, support groups, psychosocial/spiritual counseling and guidance, home visits, volunteer support (which still takes staff time and money), and in some cases cannot or do not provide emergency care themselves.
- There are some who feel that animal euthanasia and hospice care are equivalent. In my opinion, they are not. Euthanasia may be one of the services an animal hospice provides, but by itself would not be considered an all-inclusive approach to hospice care.
- Many clinics feel that the interventions provided during office visits are sufficient in every situation--a “one size fits all” approach. Many pet owners want and/or need more when they are dealing with the serious or terminal illness of a beloved animal companion.
- Veterinarians most often do not receive substantive training in “counseling” as part of their normal course of study. While some are good at providing supportive interventions, when we are talking about serious illness, dying, and death, many pet owners can benefit from interventions that go well beyond “emotional support.”
In short, veterinary clinics, for the most part, do not have the resources to provide the full range of either palliative care or hospice services to the degree we experience in the world of human healthcare.
It is important to keep in mind that human hospice started as an all-volunteer movement. The Medicare Benefit did not become nationally available until 1986 and even then, many hospice programs refused to become Medicare certified because they did not want to deal with (or to be limited/restricted by) the regulations and oversight. There are still all-volunteer hospice programs out there today and many Medicare-certified programs utilize “professional volunteers” such as physicians, nurses, social workers, psychiatrists/psychologists, massage therapists, psychotherapists, etc. (Note: Medicare requires that 5% of all patient care hours must be provided by volunteers).
So, maybe one good place to begin for animal palliative care and hospice is with volunteers. As I said earlier, volunteers need to be recruited, trained, retained, and supervised, and that is not likely going to be free. Certainly, a volunteer could coordinate all of this but a paid volunteer coordinator would be preferable. In addition, just as with employees, there are liability concerns for everyone “working for” the organization. It would be important to ensure that liability insurance extends to actions or omissions of volunteers, or that a separate policy is obtained to cover volunteers.
Palliative care and hospice truly is a special way of caring for an animal who is ill and for members of the animal's circle of support. Moving from providing supportive interventions to taking a more skillful approach to meeting psychosocial/spiritual needs of family members means raising the bar for “counseling.” Evidence-based approaches that are a good fit for animal palliative care and hospice are:
- Motivational Interviewing: to establish person-centered goals and plans that people are actually motivated to achieve.
- Cognitive Behavioral Therapy: interventions to help redirect faulty thinking and identify behaviors that assist in achieving (rather than distracting from) achieving goals/plans.
- Mindfulness: teaching/interventions to assist people to stay in the moment and reduce anxiety-producing stress and dread.
- Family meetings skills: to maximize buy-in and support from additional members of the family (or the person’s support system) in order to get everyone on the same page and headed in the same direction.
- Evidence-based grief/loss interventions: ditch Kubler-Ross and utilize up-to-date and research-supported approaches. Know how to identify complex and complicated grief and know when and how to refer.
Bottom line: both human and animal hospice movements are in their infancy and there is so much to learn. Human hospice these days is struggling, and many have become what I call “compliance obsessed” – sometimes losing sight of a primary focus on patient/family care. Animal hospice can use human hospice theories and philosophies as a guide, but there are many practical challenges to overcome. But … as long as we all remain focused on providing the best possible care as our ultimate goal ... we will get there together.
More about Gary Gardia, MEd, MSW, LCSW:
Over 34 years ago, Gary began his hospice career as a volunteer. Since then he has worked in many capacities leading a variety of teams and departments including volunteers, social workers, bereavement, and education.
Gary holds Master’s Degrees in both Education and Social Work and is a Licensed Clinical Social Worker. He received the National Hospice and Palliative Care Organization’s (NHPCO) Heart of Hospice Award for developing innovative programs to meet the needs of caregivers and the bereaved. He is also the recipient of the national social work organization Social Work Hospice and Palliative Network (SWHPN) 2015 Award of Excellence in Professional Education.
Gary is a frequent presenter and keynote speaker at state and national conferences and works as a consultant for various businesses and healthcare organizations. He is also working in private practice palliative care in Ruidoso, NM.