What is hospice care? Also known as pawspice care, this is essentially what you are doing when you have an elderly or a very sick cat with no hope of getting better, and you are just trying to give them a good quality of life for the short time that you have left. This does not include trying to fix your cat, it just means that you are trying to keep your cat comfortable. Even with hospice care, there is a very good chance that you will have to make a decision at some point of whether or not to euthanize.
What all may be involved? With hospice care, you have a cat that is no longer healthy and vibrant. They may have problems moving around due to illness or advanced arthritis. They may have problems getting enough food and water into them. They may not be able to make it to the litter box anymore and have 'accidents'. They may have problems seeing or hearing. They may need multiple medications and daily treatments. They are unlikely to get better, and in fact, will just continue to decline until you will have to assess when to stop. However, they will have enough quality of life, that you feel that you are able to help them live as long as possible with some dignity.
This will most commonly be from arthritis, but can also be caused by chronic illness or a trauma of some kind. You may need to assist your cat in getting around your home. Ways to do that? For beds and couches that your cat may enjoy spending time on, but that they are no longer able to jump onto, you may need to build ramps covered with carpet, so your cat can access these areas without too much effort. If your cat has chronic pain, such as arthritis, you may need to administer medications such as glucosamine and non-steroidal anti-inflammatories. If your cat has lost the use of their back legs, you may need to towel walk them periodically, fit them with a pet wheelchair (although these don't work nearly as well with cats as they do with dogs), or provide a surface that they can easily drag themselves around on.
Eating and drinking
If your cat has advanced dental disease and is not a candidate for anesthesia, or if your cat has cancer in their mouth, you may need to offer foods that are easier to eat such as wet or puréed foods. If your cat has had chronic upper respiratory issues resulting in loss of ability to smell, you may need to offer stinky foods like fish, or warm-up foods in the microwave first to release the smell of the food. If your cat is nauseated as a result of kidney or intestinal disease, you may need to administer anti-nausea medications and appetite stimulants. If your cat is to the point that you are having to syringe or hand feed them, and you do not anticipate an improvement in their appetite at any point, you may need to assess if the stress of force-feeding is worth it. If your cat is not drinking enough water and is perpetually borderline dehydrated, you may need to add a little water to their moist food, give them water flavored with tuna juice or low salt chicken broth, or even give them subcutaneous fluids on a regular basis.
If your cat is having a hard time making it to the litter box, then you may need to get additional litter boxes and place them closer to your cat, in some cases with lower sides that your cat can get into and out of. If your cat just plain cannot make it to the litter box, you may need to get disposable diaper pads and place them in multiple areas on the floor around your cat. If your cat has become incontinent but is otherwise enjoying a quality of life, you may want to consider having your cat wear pet diapers. As long as you change the diapers at least twice daily and use pet wipes to clean your cat during diaper changes, they can do very well for a long time with these.
Difficulty seeing or hearing
If your cat is losing their vision due to old age illnesses, you may need to 'baby proof' your home so that your cat doesn't fall off the edge of the stairs or in some other way hurt themselves. You will need to keep your furniture in the same place and be mindful to keep things off of the floor so that your cat doesn't perpetually trip on things. You may need to move food and water closer to your cat, or have additional food and water bowls. You may also need to obtain additional litter boxes for your cat, so they don't have to travel far to find them. If your cat is losing their hearing, you may need to be careful about how you approach your cat so as not to scare them. You can thump the floor as you approach your cat or walk around your cat giving them a wide berth and approach them from the front. You may need to pet and handle them more as they won't hear you talking to them, to keep them from feeling isolated.
Medications and treatments
Your cat may need multiple medications and treatments to be administered to keep their quality of life up. You will have to weigh the stress of administering these treatments versus the quality of life that they receive from them. If your cat is constantly hiding from you because they think you are going to pill them or give them subcutaneous fluids, then it may not be worth it. You can also talk to your veterinarian about alternative medications. Some medications may be able to be compounded into flavored liquid or treats, or even into a transdermal paste that you can apply to the skin of your cat's ears that is absorbed through the skin. Sometimes an injection can even be far less stressful to administer daily, and we can show you how to do so.
In the end, hospice care is a temporary thing that can last just a few days to several months or even a few years. The goal of hospice care is to give your cat as long a time as possible with you but while keeping up a good quality of life at the same time. You are going to be the best judge as to your cat's quality of life, and if you can do everything that will be required for hospice care. However, at some point, you will need to make a decision as to when to call it quits and help your cat end their suffering.