An animal can play a significant role in an individual’s final days of life whether by providing comfort or enabling family members to get to his/her bedside by indicating the end is near. Such is the case with Oscar, a cat who lives in Steere House Nursing and Rehabilitation Center, Providence, R.I.

Dr. David M. Dosa, a geriatrician and assistant professor of medicine at the Warren Alpert Medical School of Brown University, published an article in the New England Journal of Medicine based on his observations of the proximity of Oscar to patients who are facing the end of life.

Dosa and staff at the nursing home have noticed that Oscar will sit with a patient who is nearing the end of life. Oscar has presided over the deaths of 25 residents, according to the article, and staff now take the cat’s prolonged visits with patients as a queue to call their families.

While this story has been the subject of many discussions and news reports, Dosa did not expect the sensationalized media attention that surrounded his story. The doctor’s goal in writing the article was to tell a unique story but also stress the importance of end-of-life care.

"I wrote the article because I wanted to tell people about a truly remarkable story occurring in an environment that few people know anything about. I also wanted to tell readers about the importance of end- of-life care – even if it is delivered by a cat," Dosa told hospice letter.

"More often than not, this care has nothing to do with IV tubes and intensive care unit beds, but rather a simple connection with those important to us," he said.

A Comfort To Patients

For patients in nursing homes and hospice, having pets around provides comfort because they can serve as a reminder to many of the comfort of their own homes.

"In general, I believe pets provide comfort for people – whether they are terminally ill or not. Many people are animal lovers prior to their illness and there is good data to suggest that pets in places like nursing facilities help to maintain a semblance of a ‘home-like’ environment," Dosa told hospice letter.

"There is evidence that pets in nursing home facilities help to improve mood and mitigate depression," he added. "From my own experiences, it is clear that most patients appreciate the attention that animals provide and the simplicity of the interaction. Their involvement helps patients – at least temporarily –forget their surroundings."

Pets’ Predictions, Reactions During Owner’s Final Days, Hours

Hospice professionals shared related stories when asked of their observations of pets through the online Hospice Executive Discussion Group, sponsored by hospice letter.

For example, Leslie Baker, RN, CHPN, of Unity Hospice Care, said she has had a couple of experiences with hospice patients and their pets at the time of death.

One particular experience she shared involved an elderly man who lived in a small mobile home with his wife and dog. Upon arriving at the home at the time of his death, Baker observed the dog lying in bed with the patient.

"As I approached the bed the dog raised its head and whimpered," she explained. "I spoke to the dog and stroked his head. I took care of the gentleman with the dog never moving. I waited with the wife for the funeral home to arrive and she explained to me that whenever her husband would get cold, the dog would sense this somehow and try to position itself on the coolest part of his body. During the wait, the dog kept moving himself over different areas of the gentleman’s body in an effort to keep him warm."

When the funeral home arrived, Baker said the dog began whimpering and continued to so until she left the home, 30 minutes after the body had been removed.

"Since that time I have noticed many pets that become very protective of their family members as the end approaches," Baker said. "I don’t know if these animals would do so with anyone else but with their owner they certainly did."

A Broader Message

There is a deeper message to Dosa’s article than what has sometimes been perceived in the media and by the general public. It stresses the need for individuals to make their end-of-life care wishes known.

"As a patient recently told me, I’d rather die with a cat in bed with me than alone in a hospital bed with tubes running in and out," Dosa said. "If more people think about this and speak with their doctors about end- of-life wishes, then I think this piece has relevance beyond the media sensationalism of ‘the death cat.’"

The story also addresses the importance of care of the chronically and terminally ill and the need for sufficient funding, Dosa noted.

"I think nursing home care and hospice care is markedly underfunded and is in jeopardy as Medicare/Medicaid costs go up," he said. "As a society we think very little of nursing home care –we avoid it at all cost because we are fearful of it. Nevertheless, there is some amazing medicine practiced in nursing homes nationwide often with little public appreciation."

Dosa also said that research in dementia needs to be strengthened. "Terminal dementia is really a tragedy and more needs to be done to improve treatment options."

Addresses: Dr. David Dosa, The Warren Alpert Medical School of Brown University, Box G-A, Providence, RI 02912; (401) 863-3330, http://med.brown.edu/. Steere House Nursing and Rehabilitation Center, 100 Borden St., Providence, RI 02903; (401) 454-7970, www.steerhouse.org. Leslie Baker, Unity Hospice Care, 2366 Oak Ridge Circle, De Pere, WI 54115; (920) 338-1111, www.unityhospice.org. The New England Journal of Medicine, 860 Winter St., Waltham, MA 02451; (800) 843-6356, www.nejm.org.