A new era of veterinary hospice and euthanasia care

Veterinary end-of-life care (EOLC) has evolved into a vital specialty within our profession, blending medical expertise with emotional intelligence and deep compassion. For decades, euthanasia was often viewed as a single medical event, rather than part of a comprehensive continuum of care that honors the human-animal bond. Today, more veterinarians are recognizing that how we guide families through this final stage can profoundly influence their healing and trust in veterinary medicine.

This growing awareness has created an increased demand for consistency, training, and standards that ensure patients and families experience care rooted in dignity and compassion. At the same time, veterinarians and teams performing this emotionally demanding work deserve structure, community, and recognition for the unique skills required.

Since 2010, Caring Pathways has led the way in establishing high standards for compassionate, high-quality end-of-life care. When the American Animal Hospital Association (AAHA) introduced the End-of-Life Care specialty accreditation (EOLC accreditation), we were honored to be the first to achieve it—affirming that EOLC practices can and should be recognized for their dedication to excellence in patient care, client support, and organizational integrity.

The history of AAHA and the development of the EOLC accreditation

AAHA began in 1933 from a small group of veterinarians who had a vision to elevate the standard of care in veterinary medicine.AAHA is the only accrediting body in North America and prides itself on a strong foundation rooted in community and an elevated standard of care for veterinary excellence. To date, AAHA has grown to over 4,500 accredited practices and we aim to continue our mission and vision every day.

To become AAHA-accredited means your practice and team voluntarily go through an evaluation process that encompasses 46 mandatory standards and over 900 standards that span over 19 sections. AAHA’s standards of care surround best practices in pain management, patient care, continuing education, leadership, and medical records, for starters.

AAHA accreditation means practices go above and beyond to uphold a high standard of excellence not only within the walls, or vehicles, of a practice, but also outside with the veterinary community. AAHA helps our members continue to advocate for our patients and constantly reminds us of the 

About 5 years ago, End of Life Care accreditation began as a center of excellence that an accredited practice could strive for during their evaluation. From there, it grew to become AAHA’s first separate accreditation model outside of traditional accreditation. Within end-of-life care specifically, there are 21 mandatory standards and 16 sections of standards.

AAHA wants to continue to shed light on this aspect of patient care that does not carry the focus it should. We plan to continue to ensure this accreditation remains a focus in the veterinary community.

What it takes: Inside the AAHA EOLC accreditation

A key component for this accreditation is a willingness and a desire to continue to grow and learn outside your comfort zone relating to end-of-life care. This accreditation requires you to deepen your knowledge surrounding your communication and active listening skills.

This accreditation allows you to remove our personal judgement and advocate for patients in a much greater capacity. It is more than a focus on euthanasia, but hospice and palliative care advocacy as well.

There are 3 sections that come to mind for starters: Continuing education, medical records, and patient care. The continuing education section helps provide industry-wide resources to elevate your team's compassionate skills while the medical records and patient care sections offer a plethora of standards to help practices begin to build useful hospice and palliative care and euthanasia templates. They help practices see above and beyond to identify necessary caregiver lines in the sand and goals for their pet.

Veterinary practices are already seeing chronic pain management cases, geriatric cases, quality of life cases, and more, so why not allow the EOLC accreditation to help you and your team create a truly individualized and patient-centered approach to care?

Implementation in the real world and raising the bar

Caring Pathways was among the first organizations to pursue and achieve AAHA’s EOLC accreditation across all of our markets. As a company dedicated exclusively to hospice and in-home euthanasia services, we saw this as both a validation of our mission and an opportunity to refine how we serve families, support our teams, and model best practices for the profession.

The process was comprehensive and introspective. Our teams evaluated every aspect of care—from communication and pain management protocols to grief resources and team support. While the standards were rigorous, they ultimately reinforced the systems we already valued: empathy-driven communication, continuous education, and team wellness. Going through the accreditation unified our markets under a shared framework of excellence and created meaningful conversations about how to maintain compassion while pursuing consistency and quality at scale.

For our doctors and client care teams, accreditation provided a renewed sense of pride and purpose. It underscored that end-of-life care is not a niche service—it is a cornerstone of the veterinary profession’s responsibility to the human-animal bond. Families benefit, too. Accreditation offers them reassurance that the care they receive meets the highest possible standards, both medically and emotionally.

This model also invites general practices to partner confidently with accredited EOLC providers, knowing their patients will receive care consistent with AAHA’s standards. These collaborations help primary care veterinarians maintain continuity for families while ensuring that end-of-life support is handled with the expertise and compassion this delicate time deserves.

At Caring Pathways, we believe AAHA’s EOLC accreditation is helping to elevate the profession by setting a precedent that compassionate care can and should coexist with clinical excellence.

For practices that are already AAHA-accredited, you can find the EOLC accreditation standards available for download on the aaha.org website. Should you wish to explore applying or ask any questions, simply contact your accreditation pairing, also located on our website.

There are also wonderful Promise posters available via the website as well; if accredited, simply navigate to the Publicity toolbox and select whatever design you wish. We’ve also created special end-of-life care accredited posters for the elite end-of-life care accredited members, complete with personalized, helpful hospice and palliative care tutorials and grief counseling resources for your clients.

They say senior dogs and cats represent 44% of the pet population

. We know that end-of-life care can happen at any age, however, start by focusing on your senior patients. How can you make a lasting impact on their lives and caregivers?

Integrating end-of-life care in your practice is not as difficult as you would think! Consider the following tips and ask your team their 

 behind the patient care you already provide:

Can you focus more on improving your euthanasia? Reflect on what went well or what could have gone better.

While it is not mandatory to have a dedicated comfort room, ask yourself how you would go above and beyond to make them feel comfortable in their most vulnerable time.

What tools are currently at your disposal that could be enhanced, for instance, quality of life scales, disease trajectory resources, daily health logs, mental health & grief support resources.

Can you implement a rating system or perhaps enlist a dedicated euthanasia attendant? If you could create an end-of-life care manual, what would you want it to include?

Remember to showcase this special aspect within your practice. Is it present on your website? Could you have a senior muzzle parking space?

Embrace your practice’s creativity and uniqueness and I guarantee you they will surprise you! Remember, age is inevitable, so let’s help make it as healthy and special as possible.

There are a plethora of wonderful resources pertaining to end-of-life care out there. AAHA has one directly at your fingertips via AAHA Learning: AAHA’s End of Life Care Certificate Program. This extensive, online 14-module course is divided into 3 parts:

Introduction to AAHA/IAAHPC End of Life Care Guidelines

End of Life Care Palliative Care in Practice

Kathleen Cooney, DVM, MS, CHPV, CPEV, DACAW, provides an amazing roadmap and outline for anyone interested in expanding their knowledge surrounding end-of-life care. We highly recommend it!

We also recommend searching for a program or event that suits you best. The best way to become more comfortable in this space is by jumping in with both feet, I promise you will become humbled and illuminated in a way you never thought possible.

Anyone interested in learning more about the AAHA End of Life Care Certificate Program can learn more on the AAHA 

2023 AAHA Senior Care Guidelines for Dogs and Cats. American Animal Hospital Association. December 12, 2022. Accessed November 3, 2025.

Articles

How AAHA’s specialty accreditation is raising the standard.

Elevating end-of-life care

Feline diabetes mellitus (feline DM) has been recognized in veterinary medicine since the 1970s, with a significant increase in prevalence correlated with trends in feline obesity and sedentary lifestyles, particularly noted since the 1990s. While the veterinary field has managed feline diabetes for several decades, it was not until the early 2000s that synthetic long-acting insulin analogs such as glargine (Lantus;Sanofi) and detemir (Levemir;Novo Nordisk) became widely utilized. These formulations have contributed significantly to improved glycemic regulation and quality of life in diabetic feline patients.

In the last 5 years, further advancements have emerged with the introduction of oral hypoglycemic agents, notably the sodium-glucose cotransporter 2 (SGLT2) inhibitors bexagliflozin (Bexacat;Elanco) and velagliflozin (Senvelgo; Boehringer Ingelheim). However, current guidelines generally recommend that these agents be used only after initial management with injectable insulin, due to the potential for complications such as diabetic ketoacidosis if the patient is misclassified or poorly monitored.

Given the increasing complexity of available treatment options, it is imperative to evaluate each feline diabetic patient holistically, considering not only the pathophysiology of the disease but also the capacity of the caregiver and veterinary team to support ongoing disease management. Historically, feline DM was conceptualized primarily as an insulin-deficiency disorder; however, it is now widely understood to resemble human Type 2 diabetes, characterized by peripheral insulin resistance and progressive pancreatic beta-cell dysfunction.

Client communication and individualized care

Effective diabetes management begins with a thorough and empathetic conversation between the veterinary team and the pet caregiver. Diabetes mellitus is a chronic, multifactorial condition that necessitates sustained client education, regular monitoring, and collaborative decision-making. Many of the clinical signs, such as polyuria, polydipsia, weight loss, and lethargy, are non-specific and may be initially misattributed to other conditions. Thus, clear and early communication is critical for both diagnosis and ongoing care.

Each case must be approached individually, as clients vary widely in their financial capacity, emotional resilience, and physical ability to manage a diabetic cat. Some clients may be comfortable administering injectable medications, while others may have limitations—visual impairment, needle phobia, or handling difficulties with a reactive or fearful cat—that necessitate alternative treatment strategies. Identifying these barriers early can guide the development of realistic, personalized treatment plans.

Successful management of feline DM requires a coordinated, team-based approach. The client service representatives (CSRs) serve as the initial point of contact, often fielding inquiries from owners who may be unaware of the severity of their pet’s condition. Proper training enables CSRs to triage appropriately and escalate potential emergencies to the veterinary technical or clinical team when needed. Additionally, proactive scheduling of follow-up diagnostics and appointments by CSRs is essential for maintaining continuity of care.

Technicians play a critical role in diagnostics, client education, and treatment implementation. Their responsibilities include collecting comprehensive medical histories, performing initial assessments, obtaining diagnostic samples, and supporting the veterinarian in interpreting results. Importantly, technicians often act as the primary educators for at-home diabetes care, such as demonstrating glucose monitoring, explaining insulin administration, or helping troubleshoot challenges related to in-home care and medication compliance.

Veterinarians are responsible for guiding the clinical decision-making process, which includes identifying comorbidities that may influence insulin sensitivity, such as hyperthyroidism, pancreatitis, acromegaly, formulating diagnostic and treatment plans, and communicating prognosis and treatment goals. Tiered care options—ranging from ideal treatment protocols to financially or logistically constrained alternatives—should be presented without judgment, enabling clients to make informed decisions within their means.

Non-compliance in diabetic management is a common challenge and may stem from financial constraints, emotional stress, physical limitations, or misunderstanding of the disease. Rather than viewing non-compliance as failure, it should be approached as an opportunity for problem-solving and improved communication. Open-ended questioning—such as asking clients what they feel capable of managing—can uncover underlying barriers and lead to more sustainable care plans.

Client education should be iterative and reinforced at each visit. Educational materials, visual aids, and follow-up calls or check-ins can reinforce key concepts and provide ongoing support. Empowering clients to monitor their cat’s clinical signs and glucose levels at home increases their confidence and allows for early intervention if glycemic control deteriorates.

An essential aspect of managing feline diabetes is the ongoing evaluation of quality of life—for both the patient and the caregiver. Clients should be counseled that while some cats may enter remission, others will require lifelong management. The emotional investment required should not be underestimated, and periodic reevaluation of the treatment plan may be necessary as the disease progresses or as other comorbid conditions develop.

Clear communication, shared decision-making, and flexibility in treatment approaches are vital. The veterinary team should set realistic expectations and remain responsive to changing circumstances, always centering the conversation on improving the cat’s quality of life and supporting the caregiver’s ability to provide care.

Feline diabetes is a dynamic and increasingly manageable condition, provided that the veterinary team and pet caregiver collaborate effectively. As treatment options evolve, so too must our strategies for communication, education, and client support. By embracing a team-based, client-centered approach, veterinary professionals can improve outcomes for diabetic cats and reduce the burden of care on their owners. Early intervention, continuous education, and a commitment to flexibility are key to successful, long-term management.

Veterinary teams enhance feline diabetes management through personalized care, effective communication, and evolving treatment options for improved quality of life.

Feline diabetes mellitus: Advancements in treatment and the role of the veterinary team

Feline diabetes mellitus is most often type 2, which is insulin-resistant diabetes associated with chronic hyperglycemia and obesity. ¹ Unlike type 1 diabetes, type 2 is largely preventable. Diet plays a critical role not only in prevention but also in ongoing management.

Preventing diabetes: Focus on targeting obesity and carbohydrate restriction

With more than 61% of cats classified as overweight or obese, veterinarians are on the front lines of a preventable epidemic. A key contributor is free feeding dry kibble, a common practice among cat owners. Continuous access to food encourages overeating, weight gain, and eventual insulin resistance.

Rather than focusing solely on the diagnosis of obesity, veterinary teams can guide clients by doing the following:

Educating clients on how to assess a cat’s body condition

Emphasizing the health benefits of an ideal body condition score (BCS)

Connecting obesity with the risk of diabetes mellitus 

Providing actionable strategies, such as the following:

Switching from free feeding to meal feeding

Replacing food bowls with food puzzles to encourage natural hunting behavior and slow intake

Transitioning to wet or fresh foods, which are typically lower in carbohydrates

Using accessible analogies to reinforce the messages, such as “All-you-can-eat buffets aren’t healthy for cats or humans.”

Management after diagnosis: Nutritional strategy matters

Following a diabetes diagnosis, nutrition remains a cornerstone of care. Alongside insulin therapy or oral hypoglycemic drugs, dietary modification can improve glycemic control, reduce the risk of complications, and enhance the cat’s quality of life.

Veterinary teams could practice the following

Schedule a nutritional consultation post diagnosis, not just an insulin administration demonstration, with a veterinarian or veterinary technician trained or experienced in nutrition.

Recommend low-carbohydrate, high-protein diets.

Educate clients on the importance of discontinuing free feeding and establishing consistent mealtimes.

Offer practical weight loss tips for cats.

Although some diabetic cats experience weight loss before diagnosis, the goal is to have them reach an ideal BCS, not return to their previous weight. Overfeeding after diagnosis can worsen insulin resistance and delay stabilization.

Practical, preventive nutrition saves lives

Prevention is key. Educating clients early on about appropriate feeding practices, weight management, and lower-carbohydrate food options can dramatically reduce the risk of type 2 diabetes. For cats already affected, dietary changes are often one of the most impactful interventions that veterinary teams can offer to improve glycemic control, insulin responsiveness, and long-term treatment outcomes.

Gottlieb S, Rand J. Managing feline diabetes: current perspectives. 

2022 Pet Obesity US Prevalence Survey. Association for Pet Obesity Prevention. Accessed September 10, 2025. https://www.petobesityprevention.org/2022

Dantas LM, Delgado MM, Johnson I, Buffington CT. Food puzzles for cats: feeding for physical and emotional wellbeing. 

. 2016;18(9):723-732. doi:10.1177/1098612X16643753

Brooks W. Diabetic cat diet. Veterinary Partner. February 11, 2010. Updated November 4, 2023. Accessed September 10, 2025. https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952919

. April 24, 2025. Accessed September 10, 2025. https://www.dvm360.com/view/practical-weight-loss-in-cats

Feeding practices, weight management, and low-carbohydrate food choices can significantly improve long-term health and treatment outcomes for cats with diabetes.

The role of diet in feline diabetes mellitus 

California has joined 6 other states in banning cat declawing for nonmedical reasons. According to the American Veterinary Medical Association (AVMA), the move faced objections from the California Veterinary Medical Association (CVMA), which argued that veterinarians should retain the ability to perform the procedure, using their professional judgment to decide on a case-by-case basis.

Assembly Bill No. 867 (AB 867), signed on October 9, 2025, by California Governor Gavin Newsom, prohibits declawing, tendonectomy, or any type of claw removal on cats, except for therapeutic reasons. Under the law, veterinary professionals who perform any of these procedures for any reason other than for a medical purpose may face fines or have their license or registration revoked, suspended, or denied.

"Signing AB 867 into law is a win for cats, ethics, science, and every advocate who dug in their claws," Danielle Bays, senior analyst for cat protection and policy at Humane World for Animals, said in a state press release.

 "California's declaw ban is more than a good law—it's a moral milestone, ending a practice that never belonged in a humane world.”

The primary method for onychectomy, commonly referred to as cat declawing, involves amputating the third phalanx of each cat’s toes. In humans, the procedure would be the equivalent of having the last knuckle removed from every finger.

The procedure is a controversial one in the veterinary community. Studies have linked the surgery to complications such as infection, pain, hemorrhage, and anesthetic complications.

 Onychectomy is also associated with an increased likelihood of behavioral changes such as biting, aggression, and litter box avoidance.

Research has also found that declawed cats are more prone to developing back pain and having residual bone fragments.

According to the AVMA, the CVMA opposed AB 867 throughout the legislative session, arguing that the surgical procedure should remain within a veterinarian’s discretion rather than be legislated.

 The AVMA echoed the importance of professional discretion, writing, “The AVMA also emphasizes the importance of respecting a veterinarian's professional judgment when it comes to performing surgical procedures on individual patients.”

The American Animal Hospital Association and the Feline Veterinary Medical Association (formerly the American Association of Feline Practitioners) both oppose elective declawing and advocate for nonsurgical alternatives.

Illinois, New York, Maryland, Virginia, Massachusetts, and Rhode Island have also banned feline declawing. Washington, DC; Austin, Texas; Denver, Colorado; Madison, Wisconsin; Pittsburgh and Allentown, Pennsylvania; and St Louis, Missouri, have also banned the procedure.

“AB 867 marks a historic milestone for animal welfare by banning cat declawing,” Alex Lee, California State Assembly member, said in a state press release.

 “This important legislation shows our commitment to protecting our cat companions. After years of pushing to make this a reality, I’m proud to see California create a more compassionate society for our feline friends by moving away from this inhumane practice.”

Nolen RS. California latest state to ban cat declawing for nonmedical reasons. American Veterinary Medical Association. October 30, 2025. Accessed October 31, 2025. https://www.avma.org/news/california-latest-state-ban-cat-declawing-nonmedical-reasons?utm_source=delivra&utm_medium=email&utm_campaign=todays-headlines-news

California Legislature. Assembly Bill 867 (Lee), Veterinary Medicine: Cat Declawing. Chapter 479, 2025–2026 Regular Session. Approved October 9, 2025. Accessed October 31, 2025. 

https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202520260AB867

California bans cat declawing. News release. Office of Assemblymember Alex Lee. October 10, 2025. Accessed October 31, 2025. 

https://a24.asmdc.org/press-releases/20251010-california-bans-cat-declawing

Martell-Moran NK, Solano M, Townsend HG. Pain and adverse behavior in declawed cats. 

 2018;20(4):280-288. doi:10.1177/1098612X17705044

The new California bill prohibits any form of claw removal in cats except when performed for therapeutic reasons. 

California joins growing list of states banning cat declawing

Tasha McNerney, BS, CVT, VTS (Anesthesia & Analgesia), CVPP, takes a deep dive into anesthesia in this latest installment of Pet Connections

Easing pets into anesthesia

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia and Analgesia) discusses centers on induction agents to facilitate a rapid and smooth transition from consciousness to unconsciousness in veterinary patients, preparing them for intubation and maintenance on inhalant anesthesia in this most recent installment of Pet Connections. 

Below is a full transcript, edited lightly for clarity.

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia and Analgesia)

: Hey everyone, it's Tasha McNerney and I am here to talk to you guys today about induction agents. So induction agents are drugs that we give intravenously, sometimes intramuscularly, and the purpose of these drugs is that we want to produce a rapid and smooth transition from consciousness to unconsciousness, and then we want the ability to intubate our patients and maintain them on inhalant anesthesia. 

Now, the goal of these induction agents is to very quickly achieve that level of unconsciousness, that loss of reflex muscle relaxation, but we also don't want to do it so fast that we interrupt their cardiovascular or respiratory function. Key about induction agents here is that this is going to be a fast process. Usually, these agents are administered IV, fairly rapidly. Common examples of the ones that you're going to use in practice are going to be things like propofol, maybe alfaxalone, maybe a combination of ketamine and a benzodiazepine, or even a drug like etomidate. The choice is really going to depend on what you have available at your clinic, and the timing of the procedure, the level of pain anticipated, [and] whether or not you're including something like ketamine prior to giving your propofol. That'll all be determined by the actual patient and the procedure being done and their ASA status. 

Induction is almost always administered together with oxygenation, if it's not overly stressful for the patient, and then it's rapidly followed by intubation and then delivery of 100% oxygen and your inhaled anesthetic gasses. 

You've probably all seen this play out before, because you're probably familiar with giving propofol as a main induction agent in your practice. 

All right, now let's talk a little bit about propofol, because propofol is one of the most common induction agents that we use in veterinary medicine. Now, the great thing about propofol is it's very rapid. Not only is it rapid in its onset, right? It works within seconds when you give it [through] IV, but also it's rapid in its metabolism, which means it has a very rapid redistribution and metabolism, so those patients recover pretty quickly from a propofol induction or single bolus of propofol. It allows for a very smooth induction and smooth recovery as well, and usually is associated with less of a like hangover effect than maybe some other induction agents, like a ketamine Valium induction. 

Now it should be administered slowly, because if you administer it too fast, you're going to see some of those negative side effects, mainly apnea, right? And we don't want that in our patients. Also, something to consider about propofol is it does have a vasodilatory effect, so it may not be the best choice in patients that already are experiencing something like septic shock or who are very hypovolemic, but for the most part, propofol is a really nice induction agent, and we like to maybe add in some ketamine and do maybe a ketofol induction. But because it has such a rapid onset and a rapid redistribution, it makes it almost a perfect choice for a lot of patients that you're going to put under anesthesia.

Videos

Discover the essentials of veterinary induction agents, focusing on propofol's rapid effects and safe administration for anesthesia in pets.

Online pet products retailer Chewy will be acquiring SmartEquine, a horse health and wellness business, from animal health technology and services company Covetrus. Chewy and Covetrus have entered into a definitive agreement that is expected to close before the end of 2025, pending customary closing conditions and regulatory approvals. Terms of the agreement have not been disclosed.

SmartEquine—formerly known as SmartPak, prior to a July 2025 rebrand—is a supplier of more than 70 health and wellness supplements for horses in 17 categories, including joint and immune system support, muscle recovery, and digestive balance. Specialist services for customizing supplement plans are available to assist customers. The business also sells a variety of equine equipment and riding gear, such as tack and blankets, toys and treats, as well as equestrian apparel for riders.

“We are thrilled to welcome SmartEquine to Chewy,” Mita Malhotra, president of Chewy Health, said in a news release.

 “Together, we’ll bring even greater expertise, convenience, and care as a trusted destination for the equine community.”

SmartEquine aligns with Chewy’s current subscription model and is poised to strengthen the company’s recurring revenue base, and the acquisition will help accelerate its expansion into more profitable health and wellness spaces, according to Chewy. Additionally, its mix of products will be enhanced with a broader offering of equine supplement products, and it anticipates an opportunity to increase its share of the “passionate and underserved” segment of equine health and wellness customers.

For Covetrus, the acquisition agreement allows it to focus more on its core business of helping veterinarians improve practice performance and patient care through technology-enabled solutions. “By concentrating on its integrated software, services, and distribution platform, Covetrus will continue to advance tools that streamline operations, enhance efficiency, and strengthen veterinary practices worldwide,” company officials wrote in a news release.

Chewy to acquire SmartEquine, expanding leadership in the equine health category. News release. Chewy. October 30, 2025. Accessed October 31, 2025. 

https://investor.chewy.com/news-and-events/news/news-details/2025/Chewy-to-Acquire-SmartEquine-Expanding-Leadership-in-the-Equine-Health-Category/default.aspx

Covetrus announces agreement for Chewy to acquire SmartEquine. News release. Covetrus. October 30, 2025. Accessed October 31, 2025. 

https://www.prnewswire.com/news-releases/covetrus-announces-agreement-for-chewy-to-acquire-smartequine-302600058.html

One of a kind. SmartEquine. Accessed October 31, 2025. 

https://www.smartpakequine.com/content/about-us

The business, formerly known as SmartPak Equine, is currently owned by Covetrus.