A Caring Pathways client explains the changes she is seeing in her two senior dogs, Ivy and Paisley, during an in-home Comfort Care assessment. Photo courtesy Dr. Chelsea McGivney A gray muzzle or slower gait often prompts an affectionate comment at the veterinary clinic: “Awww, she’s getting old.” Yet that simple observation can mark the beginning of a surprisingly vulnerable period in a pet’s health care. Senior and geriatric pets may gradually fall out of regular veterinary care. Some clients assume changes in mobility, appetite, sleep, behavior, or elimination are inevitable consequences of age and, therefore, nothing can be done. Others anticipate bad news, worrying every visit will lead to unaffordable diagnostic recommendations, or fearing pressure into an end-of-life decision before they are ready. Transportation may become difficult when a large dog can no longer get into the car or a cat becomes distressed by travel. Caregivers may also be managing their own health, mobility, financial, or scheduling challenges. When these barriers accumulate, owners postpone preventive visits. The veterinary team may not see the patient again until anorexia, pain, respiratory distress, collapse, or another crisis forces the caregiver to re-establish care. A thoughtfully designed senior pet program can interrupt that trajectory. It creates a defined pathway through aging–one that emphasizes early identification, practical support, client education, and advanced planning. Rather than treating senior care as a series of disconnected problems, the practice helps the family understand what is happening, what may come next, and what can be done to support the pet. Reframe aging as a life stage (not a disease) The first change is conceptual. Aging is not a failure of treatment, nor is it synonymous with terminal illness. It is a distinct life stage that deserves an individualized health plan. The 2023 American Animal Hospital Association Senior Care Guidelines emphasize that no single age defines every senior patient. Species, breed, size, expected lifespan, health status, and functional changes all matter. The guidelines also describe senior care as multifaceted, encompassing preventive screening, pain management, nutrition, dentistry, behavior, environmental modification, management of concurrent diseases, and support for the caregiver (an often-overlooked aspect of veterinary care).1 This broader view can change the tone of the client conversation. Instead of opening with, “At his age, we are worried about disease,” the team might say, “Now that Max is entering a new life stage, we would like to create a plan that helps him stay comfortable and engaged for as long as possible.” The language matters; it gives the family a reason to return before a crisis develops and presents the practice as a continuing source of guidance, a partnership, not simply the place where difficult news is delivered. Find the patients that are disappearing A senior care program cannot help patients the practice no longer sees. The first operational step is identifying them. Practices can search their records for dogs and cats that meet their chosen senior criteria and have not had an examination within a defined period. Because aging varies among patients, the search should serve as a starting point rather than a rigid medical classification. The record can then be reviewed for chronic conditions, missed rechecks, discontinued medications, mobility concerns, previous fear-of-handling notes, and declined diagnostic recommendations. Outreach should be supportive rather than alarmist. A message such as, “We have not seen Bella recently, and we would love to help you plan for her changing needs,” is more inviting than a generic overdue reminder. It may also help to explain what a senior visit offers: time to discuss changes at home, assess comfort and function, prioritize concerns, and develop options that fit the family’s circumstances and goals. When contacting clients, team members can ask about barriers to bringing their senior pet into the clinic. If the client says getting the pet to the hospital is difficult, the team can explore quieter appointment times, assistance from the car, telehealth when legally and clinically appropriate, or referral to a mobile provider. If cost is the concern, the conversation can shift toward priorities and staged care. If the pet is fearful, the record can be updated with a plan for pre-visit medication, low-stress handling, or a shortened initial visit. Remember access to veterinary care is not determined by cost alone. A 2024 scoping review identified barriers including: affordability, geography, personnel and equipment, communication, transportation, and other practical or social factors.2 Asking, “What would make this visit easier for you and for Bella?” may reveal more than another reminder notice ever could and give the clinic the opportunity to offer personalized support and solutions. Designing a visit for the senior patient A standard appointment is not always suited to an older animal with multiple concerns. Senior visits may require additional time, a quieter environment, thoughtful handling, and space for a thorough conversation with the family. A pre-visit questionnaire can gather information about appetite, water intake, elimination, sleep, mobility, play, grooming, social interaction, cognition, and behavior changes. Clients can be invited to submit videos of the pet walking, climbing stairs, getting up from rest, using the litter box, or navigating the home. These observations may reveal problems that are difficult to reproduce (or even conceptualize) in an examination room. The physical environment matters, as well. Nonslip surfaces, soft bedding, ramps, accessible scales, and examinations performed on the floor can reduce discomfort and fear. For cats, minimizing waiting time and using feline-friendly handling may make continued care more achievable. The Feline Veterinary Medical Association’s senior care guidelines emphasize individualized assessment and the inclusion of caregivers as part of the cat’s health care team.3 The medical plan should distinguish between a healthy senior patient, an older pet with manageable chronic disease(s), and a patient approaching the end of life. Each needs a different type of support. Screening recommendations, diagnostic tests, and visit frequency should be selected according to the individual (patient and family) rather than packaged as an inflexible bundle. Caring Pathways veterinarian Dr. Kristin encourages “Moose” to use a ramp as a mobility aid. Photo courtesy Dr. Chelsea McGivney Introducing preplanning before a crisis Advance planning should not begin only after all treatment options have been exhausted. It can be introduced earlier as a routine part of senior care. For a stable patient, preplanning may simply mean identifying the pet’s favorite activities, establishing a functional baseline, discussing likely changes associated with a diagnosis, and deciding which signs should prompt a call. As the disease progresses, the plan can become more specific: whom to contact after hours, which symptoms constitute an emergency, whether hospitalization is consistent with the family’s goals, and where the family would prefer euthanasia to occur if it becomes necessary. Quality-of-life tools can support these conversations, but they should not replace clinical judgment or an ongoing dialogue. Trends over days and weeks are often more informative than a single score and can be part of an objective quality-of-life conversation. A shared calendar or log can help the family recognize changes that are otherwise difficult to see when caregiving is continuous. Preplanning reduces the number of decisions that must be made during panic or grief. It also reassures clients that discussing the end of life does not mean the veterinary team has stopped caring. On the contrary, it demonstrates a commitment to comfort, dignity, and continuity. Build a pathway, not a package A senior program is sometimes presented as a discounted examination and laboratory panel. Although bundled services can be convenient, a true program is more than a package; it is a repeatable care pathway. That pathway may include: A standardized quality of life assessment that sets an individualized baseline and will identify trends A written list of the family’s goals and primary concerns Recommended screening based on species, age, health status, and risk Pain, mobility, cognition, nutrition, and behavior assessments A home-environment review A clear recheck and communication schedule Education about expected changes and warning signs A plan for palliative, hospice, or end-of-life support when appropriate The client should leave knowing what the veterinary team has discovered on their examination and diagnostics, which concerns have priority, what can be monitored, and when to call. A one-page care plan may be more useful than a long discharge document filled with unfamiliar terminology and medical jargon. When the ideal diagnostic or treatment plan is not feasible, the conversation should not end. Practices can offer a spectrum of reasonable options, explain what information each option may provide, and document the family’s decisions. A staged plan might address pain or nausea first, schedule laboratory testing later, and use a technician follow-up call to assess response. The goal is not to lower medical standards; it is to preserve a therapeutic relationship and find the best achievable next step. Measure whether the program is working A senior program should be evaluated by more than enrollment or revenue. Useful measures might include the number of overdue senior patients re-engaged in care, completed follow-ups, earlier identification of pain or chronic disease, and the percentage of patients with documented mobility, cognition, and quality-of-life assessments. Practices can also monitor urgent visits among enrolled patients, client feedback, team confidence, and whether end-of-life preferences were discussed before a crisis. Missed appointments and declined recommendations should be reviewed for patterns. If clients repeatedly cite transportation, fear, cost, or confusion, the program should evolve in response. Not every benefit will fit neatly into a spreadsheet. A client who knows whom to call, a cat who can be examined without escalating fear, or a family that avoids an unplanned emergency may represent the program’s most meaningful successes. Senior feline Prince receives accommodation during a home evaluation. Photo courtesy Dr. Chelsea McGivney Senior medicine is not defined only by how long a pet lives. It is also reflected in comfort, function, connection, and the family’s ability to make informed decisions. When a practice builds a visible pathway through aging, clients no longer have to navigate that stage alone. The invitation is not merely to bring an old pet back for another appointment. It is to continue the relationship with: a plan for today, an understanding of what may come tomorrow, and support for every decision along the way. Use the entire veterinary team Senior care is well-suited to a team-based model. Veterinarians remain responsible for diagnosis and medical decision-making, but credentialed veterinary technicians and other team members can play substantial roles in education, history collection, mobility and quality-of-life assessments, follow-up, and care coordination–within applicable laws and practice protocols. Consistency is essential. If one team member describes a pet as “doing great for his age” while another expresses urgent concern, the client may not know what to believe. The practice should establish shared language for discussing aging, pain, cognitive change, caregiver burden, palliative care, and euthanasia. This shared language will give clients confidence that every member of the veterinary team understands and cares about what’s going on with their senior pet. Team training can include role-play for difficult conversations. For example: “What changes have you noticed that you have been attributing to age?” “Which parts of caring for her are becoming more difficult?” “What does a “good day” look like for him now?” “What are you most worried we might find?” “Would it help to discuss a range of options before you decide?” “If a crisis happened tonight, what would you want to be prepared for?” These questions invite the client into the decision-making process without assuming what the family can manage or what outcome it wants. Chelsea McGivney, DVM, MBA, attended veterinary school at Colorado State University. She has practiced general medicine, emergency medicine, and in-home end-of-life veterinary care. Currently, Dr. McGivney is the executive director of operations of Caring Pathways, a multi-practice in-home end-of-life veterinary company focused on providing compassionate hospice and palliative care, as well as in-home euthanasia at life’s end. References Dhaliwal R, Boynton E, Carrera-Justiz S, et al. 2023 AAHA Senior Care Guidelines for Dogs and Cats. Journal of the American Animal Hospital Association. 2023;59:1–21. doi:10.5326/JAAHA-MS-7343. Pasteur K, Diana A, Yatcilla JK, Barnard S, Croney CC. Access to veterinary care: Evaluating working definitions, barriers, and implications for animal welfare. Frontiers in Veterinary Science. 2024;11:1335410. doi:10.3389/fvets.2024.1335410. Ray M, Carney HC, Boynton E, et al. 2021 AAFP Feline Senior Care Guidelines. Journal of Feline Medicine and Surgery. 2021;23(7):613–638. doi:10.1177/1098612X211021538.
