Caregiver Burden: When Loving Hurts

With our pets we also have the burden of deciding to euthanize when appropriate. And that in itself is a heart wrenching decision. Quality of life is a very subjective thing and pet owners may not always know when it’s time. Pet owners do know their pets best but they still may need guidance. And they may end up with guilt if they feel they’ve waited too long. It’s the one conversation that we have the most with families seeking end of life services.

A cross-sectional observational study was done by Spitznagel, Jacobson, Cox, Carlson entitled “Caregiver burden in owners of a sick companion animal: a cross-sectional observational study” This was the first study that examines the toll of caregiving on pet owners. It measured the mental health of owners by monitoring levels of depression, stress and anxiety as well as quality of life enjoyment for the owner. (Comparable measurements have been studied in human caregiving relationships to assess similarities.)

The results showed that caregivers of terminally or chronically ill pets had:

• Greater level of caregiver burden and stress
• Greater perceived stress
• Greater symptoms of depression and anxiety
• Lower on indicators of quality of life and enjoyment

Symptoms of Pet Caregiver Burnout

• Withdrawal from friends, family, and other loved ones
• Loss of interest in activities previously enjoyed
• Feeling blue, irritable, hopeless, and helpless
• Changes in appetite, weight, or both
• Changes in sleep patterns
• Getting sick more often
• Feelings of wanting to hurt yourself or the person for whom you are caring
• Emotional and physical exhaustion
• Irritability

Two reasons why caregivers burn out is because they place unreasonable burdens upon themselves, in part because they see providing care as their exclusive responsibility and they cannot recognize when they are suffering burnout and eventually get to the point where they cannot function effectively. They may even become sick themselves.

What Can Help?

• Mastery: Owners need to feel empowered and knowledgeable. Educating them not only on the disease but also the ways to manage the symptoms is vital.
• Coping strategies: Speaking a counselor is something many would not even consider but they can be a massive resource for the families. Caregiver.org is a great reference site for families.
• Social support: There are many illness specific groups (locally and social media) and recruit family and friends to help—it takes a village to care for a sick pet.
• Respite care: This type of care is common place in human medicine and can be a massive help to a family. Veterinary technicians can play a huge role in this niche.

Anticipatory Grief

The death of a pet is, for many, the worst personal loss they have ever experienced. Complicate the event with the possibility of euthanasia and the emotions can be too much for some pet parents to bare. How, when, and why veterinary professionals can make a difference at such an important time is essential to maintaining not only the human-animal bond, but the doctor-client bond as well. There is no better time to show your clients you care than by helping through the difficult journey of pet loss.

Many people experience what is referred to as ‘Anticipatory Grief’. This is when emotions such as grief, despair, anger occur before the impending loss of a pet. Once an owner learns of a terminal illness or sees the long-term decline of their geriatric pet, their grief emotions can start to manifest and can even make some physically sick. The 5 stages of grief, as described below, can also be present in anticipatory grief. However, this period can also allow pet owners time to do things with their pet that they may have put off in the past and for some, it prompts a conscious closure before the loss.

With the lack of social acceptance of grief over a pet that has passed, it is even more compounded when someone is facing anticipatory grief. They feel that no one understands them or they may even feel ‘silly’ that they are getting so emotional over ‘just an animal’. But most pet owners that love their pets do understand and it is important that this period of grief is recognized, and us as pet professionals assist our clients during this difficult time.

This period of anticipatory grief doesn’t usually take the place of post-loss grief. There will typically still be a degree of grief after the pet has passed.

Regardless if the pet is old or young, if death is sudden or expected, grief is a natural reaction to the loss of that pet. Similar to when a person passes away, many people can experience what is commonly called the five states of grief—although not everyone experiences all of these emotions and there is no set pattern that people follow when grieving.

1.  Denial

2.  Anger

3.  Bargaining (i.e., trying to find an activity or action that either could have helped avoid the loss or that will take it away)

4.  Depression

5.  Acceptance

Pet Lover’s Code

Dr. Alan Wolfelt, Pet Loss expert, has created the ‘Pet Lover’s Code’ which helps owners with the loss of a pet:

1.  You have the right to grieve the death of a pet. You loved your pet. Your pet loved you. You had a strong and profound relationship. You have every right to grieve this death. You need to grieve this death. You also need to mourn this death (express your grief outside of yourself).

2.  You have the right to talk about your grief. Talking about your grief will help you heal. Seek out others who will allow you to talk about your grief. Other pet lovers who have experienced the death of a pet often make good listeners at this time. If at times you don’t’ feel like talking, you also have the right to be silent.

3.  You have the right to feel a variety of emotions. Confusion, anger, guilt, and relief are just a few of the emotions you might feel as part of your grief journey after the death of a pet. Feelings aren’t right or wrong: they just are.

4.  You have the right to be tolerant of your physical and emotional limits. After the death of a pet, your feelings of loss and sadness will probably leave you feeling fatigued. Respect what your body and mind are telling you. Get daily rest. Eat balanced meals. And don’t allow others to push you into doing things you don’t feel like doing.

5.  You have the right to experience “griefbursts.” Sometimes, out of nowhere, a powerful surge of grief may overcome you. This can be frightening, but it is normal and natural.

6.  You have the right to make use of ritual. After a pet dies, you can harness the power of ritual to help you heal. Plan a ceremony that includes everyone who loved your pet.

7.  You have the right to embrace your spirituality. At times of loss, it is natural to turn to your faith or spirituality. Engaging your spirituality by attending church or other place of worship, praying, or spending time alone in nature may help you better understand and reconcile your loss.

8.  You have the right to search for meaning. You may find yourself asking, “Why did my pet die? Why this way? Why now?” Some of your questions may have answers, but some may not. Ask them anyway.

9.  You have the right to treasure your memories. Memories are one of the best legacies that exist after the death of a special companion animal. Instead of ignoring your memories, find ways to capture them and treasure them always.

10.  You have the right to move toward your grief and heal. Reconciling your grief after the death of a pet may not happen quickly. Remember, grief is best experienced in “doses.” Be patient and tolerant with yourself and avoid people who are impatient and intolerant with you.

Neither you nor those around you must forget that the death of a beloved pet changes your life forever.

Memorializing Pets

When we lose a loved one, our lives are forever changed. Those pets become a part of our life story and will leave an impression on everyone they touched. Our society honors many events such as birth, graduation, marriage as well as death and many of the ways we honor our loved ones (furry or skin) is steeped in tradition. Creating a memorial has a positive effect on many people dealing with loss and allows them to appreciate the life and memory of the lost one.

There are so many ways that people can memorialize their pet and this can help us celebrate what was and to start mourning that loss. It also diverts some negative emotions and turns them into a positive goal—to tell their pet’s story and show people how much they loved them.

Honoring Their Memory

Honoring a lost pet is an important part of both the grieving and healing process. Below are some ideas we can provide owners to help them to honor their pet once their time together has come to an end:

• Start a scrapbook with photos, drawings and/or stories.
• Plant a tree in your backyard—you may even want to choose one as a family that ‘reminds’ you of the pet. For example, a snowball bush for a white, fluffy dog/cat or a big, oak tree for a working breed dog.
• Plant flowers yearly in a flower bed and take that time to reminisce and remember the pet. Each family member can pick their own flower and prepare one story about the pet to share with the others.
• Make a tribute table with items that remind you of your pet; pictures, toys, a collar or leash, favorite stick or mementos from various trips together. This can be a particularly useful when small children are in involved in the grieving process.
• Have all family members wear something that reminds them of the pet. For example, get all shirts to match the same color as the pet’s favorite collar, get a picture of your pet on a nightshirt, a ring with the pet’s birthstone or engrave the pet’s name in a locket.
• Make each family member a small pillow out of the pet’s favorite blanket or bandana.
• Hold a memorial service—let your child take part in the planning as much as possible (older children can do the planning/inviting independently).
• Make a donation in the pet’s name and let your child choose the charity.
• Write a letter or a ‘will’ from the pet—this will serve as a nice family activity to share and a forum for memories and stories.
• Have all family members write (or if they are too young, you can do it for them) a letter to the pet to express their feelings or perhaps things they wish they could say to the pet.
• Keep a list of all the things your pet did that made you smile or laugh. Your family can experience the joy your pet brought to their lives now and for years to come.
• Keepsakes: There are many companies that specialize in creating personalized treasures like stone markers, sculptures, paintings, jewelry, even diamonds that can all incorporate the cremains of your pet.
• Lap of Love offers a special memorial page online where families can share the memory of their companion.

Summary

Owning a pet can bring so much joy into our lives but when they become sick and require a lot of specialized care giving—it can become stressful to an owner. As the veterinary team, we can help families recognize their burnout and provide tips and tools to help them manage and cope better. A wonderful website to recommend to families dealing with caring for a sick or aging pet is: petcaregiverburden.com

Dr. Mary Gardner writes and speaks for professional and lay audiences on geriatric medicine, assessing quality of life, hospice, and end of life care. A University of Florida graduate, she discovered her niche and now is the co-founder and CTO of Lap of Love, which has more than 130 veterinarians around the country dedicated to veterinary hospice and euthanasia in the home. 

Want to hear Dr. Gardner speak? She will be presenting 7 talks at Wild West Vet, October 23-26, in Reno, NV. View all of her sessions here.