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Care: Quality of life assessment

Complete a quality of life (QoL) assessment

Quality of life (QoL) for a cat refers to the state of a cat’s life (as we imagine it perceives it) at any given time.  This is a balance between the cat’s positive and negative experiences. A cat with a good quality of life would experience many positive experiences and have few negative experiences.

 

Cats live in the moment. Cats don’t understand the concept of suffering now in order to have a better day tomorrow. We therefore need to appreciate that how they feel in the moment is their quality of life.

A cat’s quality of life can be affected by many things:

  • Its state of health/presence of pain
  • Its emotional state or mood
  • Its environment
  • The presence of other cats
  • The presence of people or other animals
If a cat is depressed this will potentially make everything feel far worse. Poor mental wellbeing can sometimes be overlooked, but evidence from research into human health suggests that brain activity during psychological pain shares similarities to activity during physical pain. The psychological pain associated with severe depression in humans may often be perceived as ‘worse than any physical pain’. Cats can experience behavioural depression; a state of low mood with a lack of interest in their surroundings and things that were previously perceived to be of value. Cats confined in cages for prolonged periods may often become withdrawn and non-responsive – many people caring for unowned cats refer to the cat as being ‘shut down’. Poor mental wellbeing and distress leads to a reduced immune response and increased risk of disease. This contributes to a greatly reduced quality of life.

How to assess QoL

Assessing quality of life in cats is difficult. You need to understand the species and the individual and make an assessment based on what you consider that cat’s experience of life may be. Use the quality of life balance scales above to look at positive and negative sensations and discuss where you feel an individual cat sits on that scale.

Questions to consider about QoL

You can ask the following questions:

  • Can we fulfil this cat’s basic needs now, ie, freedom from pain, safe and predictable environment, food and water etc?
  • What positive emotions or pleasure is this cat currently experiencing?
  • Can we provide the cat with more opportunities to experience positive emotions/pleasure?
  • What negative emotions or distress is this cat currently experiencing?
  • Can we remove the things that cause the cat to experience negative emotions/distress?
  • What kind of quality of life does this cat currently have?
  • What quality of life will this cat have in the future?
Here are some guidelines on quality of life assessments that you may find useful.

Quality of life assessment example

If you discover that the cat’s QoL isn’t good then you need to take steps to improve it as a matter of urgency. There is information in this section about how you can potentially improve a cat’s QoL but the best thing you can always do is get the cat out of the homing centre to a new permanent environment that meets its needs. Always focus on the outcome!!

 

Thank you to Dr Lauren Finka for her contribution to this section


Change the physical environment

Ensure that you have the basics in place:

  • Make sure there are hiding places for the cat to escape from all the strange sights and sounds; the cat may even benefit from the front of its pen/cage being covered
  • Make sure the cat’s litter tray, food and water bowls are positioned as far away from each other as the space will allow
  • Provide the cat with two bedding blankets and, when the top one becomes soiled, put the underneath one on top to maintain a familiar smell and add a new one underneath
  • Make sure that you keep the noise down and ensure that cleaning and feeding is done on a predictable schedule so the cats can anticipate when things might happen
  • Make sure you have privacy screens to block the view of cats facing each other

Maybe consider the following in addition:

  • Is the cat in a busy part of the building? Would it benefit from being moved to a quieter area? It’s usually not advisable to move cats once they are settled but it may be in the cat’s best interests to help it cope better
  • Would it be possible to add further space by adding a shelf or tall object for the cat to perch up high?
  • Would the cat benefit from some challenging feeding opportunities, for example a puzzle feeder for dry food?
  • Does the cat need further hiding opportunities? Maybe an object placed in front of the feeding area or litter tray, for example, so that it can visit both without being observed?

Examples of puzzle feeders that you can make or purchase

Here is an example of what the RSPCA Canterbury and District Centre do:

Opaque paper has been attached to the glass door to give the cat inside some privacy but still enable it to look it.

The cardboard box on the shelf inside the unit also allows for the cat to be hidden but still see outside if needed. There is also a towel on the shelf draped over the edge to give further privacy on the level below


Change the social environment

Think about the following, but you may have other ideas based on your own experience with a particular cat:

  • Some cats are distressed by having others in close proximity, especially in the same pen/cage. Can it be moved to a single-occupancy unit?
  • People can soon get used to the sound of dogs barking constantly when they are working with both cats and dogs, but it is important to remember that the sound and smell of dogs nearby can be very distressing for cats. Can the cat be moved to a pen/cage further away?
  • We still need to visit cats in their pens/cages on a regular basis so we can make this less distressing, particularly for the vulnerable ones, by sticking to a predictable schedule and routine so that they can start to anticipate when you are going to come and what might happen, whether the interaction is positive (eg playtime) or more negative (administering essential medication)
  • Is this cat really friendly towards people and actually needs more contact with them?
  • People can be distressing for some cats, so creating a schedule of minimal intervention can be of great benefit

See what the RSPCA Canterbury & District Animal Centre have done to indicate to volunteers the cats that would not benefit from interaction with people.

The sign on the pen is written as if it is a direct request from the cat ‘No interaction today, thank you’

This is the sign in use

 

Here is what Battersea Dogs and Cats Home (UK) do:

“Three-four days into a cat’s stay, staff will use the information they’ve been able to gather to assess whether the cat needs further support. If they do, the cattery staff create a care plan for the cat. For a scared cat, for example, a care plan focuses on supporting the cat to feel safer and more secure and would typically involve:

Changes to its pen:

  • Adding an igloo bed to hide in
  • Adding a door curtain to the front of the pen door
  • Adding curtains inside the pen
  • Giving the cat more secluded cover at floor level

Changes to its interactions with people:

  • Assigning the cat one consistent carer. The consistent carer carries out cleaning and feeding alongside daily observations and becomes the main point of contact with veterinary staff.
  • Making the cat a ‘do not enter’ cat. This limits the number of people who go into the cat’s pen.

The most important thing is to allow the cat to initiate contact. Staff do not approach the blue sleeping area unless they need to do a visual check of the cat, or the cat is showing signs that they would like to interact but aren’t yet comfortable moving away from their bed”.

Evy Mayes – Feline Welfare Advisor Battersea Dogs and Cats Home


Develop a treatment protocol for any health issues

A cat’s physical health must be monitored closely as it will impact on its ability to cope in a challenging environment such as a homing centre. You may find it helpful to use the information in the physical health section to work with your veterinarian to create a treatment protocol for any health issues that have been identified, with frequent monitoring of the cat’s progress thereafter.

Consider foster care

Foster care is when people, usually volunteers, take unowned cats into their homes and look after them on behalf of organisations or homing centres prior to them finding a permanent home. Sometimes cats go to their permanent homes directly from foster care while others will be returned to the homing centre first.

Sometimes, despite your best efforts and all the modifications you can make to a cat’s environment, it continues to be miserable. Cats vary greatly in their friendliness towards people and their ability to cope with novel environments and experiences, so you need to have further plans in place to help these individuals.

Foster care gives you the opportunity to provide a cat with a home from home and to see how the cat reacts. Having a caring and respectful foster carer to look after the cat in a home environment will enable you to establish its suitability to be a pet, once settled in its temporary home. This can:

  • Enable cats to cope better with the transitional period before they are adopted (or the outcome that best suits their needs has been achieved)
  • Help in the assessment of cats. Cats can be very difficult to assess, for example, is that cat hiding because it doesn’t like people or the environment? If, for example, the cat continues to hide and be fearful when approached this probably suggests that this cat would not be happy as a pet and an alternative lifestyle solution is needed to give them what they need
  • Provide pregnant and nursing queens with a safe and comfortable environment to rear their kittens. Young kittens need positive experiences with other cats, people and even dogs to develop into happy pets and this process is best achieved in an environment that mimics the kind of place where they will ultimately live
  • Help assess cats with a history of problem behaviour, such as house soiling, or specific needs, for example, regular health care for a chronic illness. Being cared for in a home environment will make it easier to establish the specific needs of the individual in as stress-free a place as possible. (Care must be taken with cats that have a history of being aggressive towards people, as you have a duty of care to those volunteers who offer their services to care for these cats and you don’t want to put them at risk of injury)

Don’t forget!

We discussed about knowing your limits and working within your ‘capacity to care’ and when cats are in foster care it is easy to think ‘out of sight, out of mind’ and overlook them when considering the right cat for a potential adopter. Foster carers are not an overspill of the main homing centre and should be included in the total number of cats when considering your capacity. Foster care is not a cattery pen in someone’s garden, it is the opportunity for a cat to live in a normal domestic setting and experience life as a regular pet cat.

Have a look at what the RSPCA Canterbury & District Animal Centre does to remind everyone that the cats in foster are still very much available for adoption. They dress empty cattery pens to look like houses (with the clever use of cardboard) and put the photo of the cat in a prominent place so nobody forgets them.

Empty pens are dressed to show that cats are being cared for in foster homes

These cats are in foster care

 

‘Super fosterers’

Super fosterers are sometimes referred to as ‘whole house’ fosterers – people who have no other pets but are happy to be trained to care for cats that need their special and undivided attention. So, what are the qualities required to be a super fosterer?

  • No other cats or dogs
  • Capable of spending time as necessary on chores and general cat care
  • Experience with cats but eager to learn and willing to receive training
  • Property where the cat could have safe access to most areas
  • Flexible regarding the needs of each cat
  • Willing to report back regularly
  • Cat-secure home
  • Adult only household or plus older children
  • Any age
  • Available transport

Benefits of whole house foster care

There are challenges though. It can be very difficult to recruit the right people to become potential foster carers and retaining them is hard too. it is not uncommon for people to fall in love with one of their foster cats and to adopt them, rendering them unable to continue being a foster carer. It’s also a challenge to communicate with foster families, to ensure they feel valued and supported, with so many other pressing jobs to do within your homing centre. However, foster carers are extremely valuable and a significant way to ensure good welfare for unowned cats, so here are some ideas to keep foster carers happy:

  • Consider having a mentor programme, where an experienced individual gives them support and guidance
  • Provide hands-on training so that everyone has the confidence to care for their cats well
  • Provide plenty of resources to further add to the information that they have
  • Give them easy access to supplies, such as food and litter
  • Help them to take good quality photographs and videos of the cats to promote them to potential adopters, who often appreciate seeing cats in homes interacting with people in normal situations
  • Have regular events and use your website and social media to promote foster cats and recruit more foster carers
  • Trust and value the input of your foster carers
  • Allow them direct communication with prospective owners if they are happy to do so
  • Give them a genuine and important role in the process with some accountability regarding the cat’s outcome
  • Give them recognition; it pays to praise them for the wonderful work they are doing from time to time!

Find the right outcome for the cat as a matter of urgency

The following series of questions can form the basis of your discussion about each individual cat when you are deciding the cat’s outcome (more about ‘outcome’ in the next section). From the moment a cat arrives, and even before the cat comes in, you should have some idea of the kind of environment that would suit it, based on the cat’s previous experience. You can then re-evaluate the cat’s needs during its stay if necessary, but the priority is always to focus on getting the cat out of the homing centre.

You will find that not all the questions listed below are relevant to every cat in your care or even to your homing centre’s policies. You may wish to adapt this list – add some more questions that you feel are more meaningful to your situation or leave out some that you don’t find useful or don’t reflect the kind of situation you encounter. The important thing is to talk with your colleagues, discuss every cat and don’t be afraid to ask questions that might be difficult to answer.

These questions work well if they are answered honestly and reasons are given for objections raised to any decisions that may be made based on those answers. This can be a very positive process as it enables all members of the team to have input and it may result in innovative ideas being employed to find homes for individuals with very specific needs.

Each cat should be discussed, using documented records for the individual. The emphasis should always be to improve the situation for each cat, for example, how can we enable this red cat to be homed as an absolute priority?

Everything that is discussed has to be balanced with realism regarding what types of homes are likely to be found. The perfect prospective owner may walk through the door at any time or you may find the ideal alternative lifestyle but, unfortunately, this may not happen, so educated decisions (ie likelihood versus probability) need to be made.

The action required will probably be apparent once you have answered the questions below. It should be made clear which individual or team is responsible for taking any necessary action or carrying out any decisions.

 

TLA – suggested outcome questions

QUESTION ACTION RELEVANT TO RED, AMBER OR GREEN?
OUTCOME
What, if anything, can be done to improve this cat’s wellbeing or prospects of finding a suitable home? Discuss with colleagues and consider all ideas carefully, even if it is something you haven’t done before
Is there anything further that can be done to make this cat a more attractive/appealing prospect for a future owner? If so, what would that be? Consider advertising or novel campaigns, focusing on a specific feature of the cat, eg a sad background story
What have you done in the last 24 hours to find a suitable owner for this cat? If nothing, is there a reason why? Red cats are reassessed daily and the emphasis should always be on getting them out of the homing centre as a matter of urgency
Is every effort being made to find a suitable owner for this cat? If not, what else could be done? You may need to enlist the help of others who may have some new and interesting ideas. Have you explored options outside your local area?
Have any specific ‘special needs’ for a home been identified and can they realistically be met? Consider a specific campaign if you are looking for a home, person or family who could fulfil those needs
What is the preferred outcome for this cat in one month, 6 months, 1 year? How likely is it that this outcome will occur in this case? If the preferred outcome is likely what reason is there for it not to have occurred up to this point? If the preferred outcome is unlikely, what else could be done for this particular cat that has not already been considered and discounted? Discuss with colleagues and explore every option but be honest and realistic about the chances of things changing; using the excuse of “let’s give it one more week” if you are not doing anything extra to find the right outcome for the cat will just further add to the cat’s suffering
Is there any outcome that has been discounted previously that may now be an option? If so, what would make it appropriate now? You may have thought something was not an ideal solution. Revisit it and be sure that you were right to discount it; would it suit this cat?
How long has this cat been in the homing centre? Is there sufficient capacity within the homing centre to accommodate this cat while it is waiting for a home? Is this cat preventing other cats from being taken in and homed? The longer the cat stays, the more cats will be prevented from entering the homing centre and starting their journey to a better, permanent destination. Is this fair to either this particular cat or the other cats in need?
What do you consider the cat’s quality of life to be at this moment? Potentially in the future? Do a QoL assessment, discuss with your veterinarian
What, if anything, would help you make the decision regarding an appropriate outcome for this cat? Enlist the help of your colleagues and your veterinarian
If euthanasia on welfare grounds is an option for the cats in your care, then the following questions may be relevant:
If TNR was not appropriate for this cat, has euthanasia been considered? Have you explored this option by speaking to the person who brought the cat in (or someone within the local community)? It may be possible for someone to commit to feed and monitor the cat in its familiar surroundings
Do you feel you have justification for keeping this cat in the homing centre?

What justification do you have, for the cat’s welfare, to keep it alive?

It is important when the cat’s welfare and QoL are at stake to present any justifications you may have in a logical and objective way, eg I have someone offering this cat an alternative lifestyle but they are currently building a structure to give the cat shelter so will not be able to take it for another week
If you wait another day will the situation be any different? If not, then is there a good reason not to act now? It is easy to prioritise your own distress at this stage, understandably so, but the welfare of the cat must be paramount. Sometimes it may be helpful to ask a colleague who hasn’t been caring for the individual cat, to assist in the decision making.
Is there any support, information or guidance that would help you make an informed decision? Seek guidance from your veterinarian, the CFH website or other reputable sources about decision-making when all possible options for a particular cat have been explored. Failing to make a decision and just allowing the cat to continue suffering is something that should be avoided at all costs. On occasions, the extra pressure leads to a suitable outcome being found for the cat, eg an alternative lifestyle opportunity
If you have decided upon euthanasia then what lessons can you learn from this cat’s outcome? Look at the cat’s situation: could it have been helped in its original environment? If it was so unsuitable for a home, even an alternative lifestyle, what was the benefit of admitting the cat into the homing centre in the first place? If it was suitable for an alternative lifestyle but you just couldn’t find one, what steps can you take in the future to recruit more of these homes?
Are all members of the team being supported (post euthanasia)? Even if the euthanasia was the right decision for the cat, it is still a difficult and distressing outcome for the team. Ensure that everyone has a chance to express their sadness and talk about what has happened. Making positive changes for the future care of similar cats is a way of learning from a euthanasia outcome and reducing the need to make such decisions in the future.

 

Do the best you can

You may be reading some of the content on this page and thinking ‘I can’t do that’ or ‘I wish it was that simple!’ We know that life is complicated and when you are dealing with cats (and people) nothing is black and white. Following Cat Friendly principles is all about doing the very best you can under difficult circumstances. So, if you read something and think ‘impossible!’ then maybe consider what you could do instead that would have a positive impact. We know we cannot achieve perfection as it isn’t a perfect world.

Be pragmatic and be satisfied with ‘good enough’ when the ideal seems impossible.

 

> Outcome: Meet the needs of the individual

Our thanks to the Pet Plan Charitable Trust for their support in the development of this website

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