Rugs and routines: What if Veterinary Occupational Therapy was a thing
Updated: Aug 31
I grew up in a country where older humans would get a visit from the Occupational Therapist, usually after they’d “had a bad fall”. Somewhere over the years, falls would start happening to a person, and another person would have to come and advise them and their carers (whether formal or informal) on how to stop falls from happening.
The ‘Ergotherapeut’ would come to a person’s home to assess the place, and suggest environmental adjustments, such as wider paths for their walking frame (or rollator), handles to hold onto in the shower, and other measures necessary to stay safe and independent. Sometimes this would include prescribing additional home carers (or thuiszorg) who could help with bathing and cooking; other times it meant prescribing physical or social therapies to maintain a good quality of life.
After moving to the UK, I learned that Occupational Therapy (OT) wasn’t only for senior citizens but for anyone who needs support to safely and independently carry out everyday tasks and activities. However, my strongest association with the profession is still the support older people get. I can still remember the changes that were made to my grandmother’s home and routine. She didn’t always comply with advice, and often cancelled her transport to the prescribed social outings. She mostly enjoyed her own company, and that of her dog. These changes did help her stay in her home, living a life of independence, dignity and agency up to two years before her death.
The gap in veterinary gerontology
Veterinary medicine has specialist subjects similar to those in human medicine, such as general practice, internal medicine, oncology, and imaging. These subjects are equally well developed in veterinary medicine, although perhaps not used as frequently due to the high costs and lack of subsidy by the state. We’re also increasingly making use of available therapies such as veterinary physiotherapy, nutritionists, and behaviourists - just as we would see the same kinds of therapists if we are experiencing musculoskeletal or gastrointestinal issues or experience psychological discomfort. With a prescription from the GP vet, we are able to see these specialists and treat our pet’s symptoms.
What we’re not (yet) doing for our pets is accessing functional preventative care from specialists, especially at their later stage in life, to maintain a good quality of life. Sure, we get some advice from our dog’s hydrotherapist about alternative exercise regimes. And perhaps our veterinary team will mention something about adding a supplement to the diet to improve our golden oldie’s cognitive health. But usually these subjects come up after there’s already a disease diagnosed. Some people might have steps next to their sofa and bed for their Dachshund who can’t jump up or down without backbreaking manoeuvres. But usually, people don’t get a systematic, in-depth review of how their environment and routines are inhibiting their senior companion animal from living their best life. So our senior cats and dogs start sleeping more, disengage, or grit their teeth through discomfort.
Why we need Veterinary Occupational Therapy now
For years, I have been advising people with senior or physically or cognitively impaired pets on how to improve their home environment and routines to improve not only their furry friend’s quality of life, but also theirs. I am lucky to be able to spar with veterinary behaviourists and physiotherapists in my professional network, and have also learned that they will touch upon some aspects of occupational health during their treatments, but again, do not have time to go through it all in a deep dive.
I have spent hours in other people’s homes, observing cats’ and dogs’ movements and behaviours and interviewing caregivers about what they're struggling with as their pet ages. I have put myself in their pets’ furry shoes to see why accidents happen, food bowls are left half full, or depression occurs. For instance, did you know that lots of super senior cats will finish their bowl of food if you just keep on turning the bowl around or move the food back into the centre, reminding them there’s still food in the bowl?
I don’t know whether it’s the mechanical process that reminds them there’s food left, their not wanting to stretch their necks, or the attention from the person feeding, but this is one of those tricks I have learned through patience, observation, and spending many hours feeding elderly cats. To this day, the sound of a senior cat licking their lips after a satisfying meal is still my favourite sound in the world.
I have listened to caregivers talk about the daily wash cycles, the ability to cope with the smelly fur, and the middle-of-the night pacing and whimpering.
Resolving these issues can not be done in a 15-minute consultation. It takes a couple of longer conversations, multiple times over several weeks. People need time to implement the simple interventions first, such as raising a food bowl, putting down rugs, and keeping food, mood and loo diaries to notice patterns. They need to feel there’s quality to their pet’s life to be gained (or maintained) with or without support from allopathic medicine, before we can dive in further and explore what systematic changes need to be made.
It starts with explaining to a caregiver why eating from a food bowl on slippery kitchen tiles is uncomfortable for arthritic joints. And showing them that mental stimulation is still possible and paramount to keeping a pet engaged. The old nose still works perfectly - even if the limbs don’t. We can then start to protect the human-animal bond by finding ways to include the deaf and snoozing dog in our evening TV-watching sessions. And we can protect the animal’s dignity and the human-animal bond by helping them with their hygiene routine, and anticipating when they need to relieve themselves - or finding ways to keep them clean even if we miss a cue.
I have witnessed this approach, subsequent advice and lightbulb moments improve many families' quality of life.
So, one of my missions in life is to make Veterinary Occupational Therapy (VOT) an established profession.
Not just when a dog has had their equivalent of “a fall”, but as a precautionary service when a cat or dog hits a certain age. Just as we neuter them by the time they hit puberty*, I believe we need to reevaluate the best way to care for this particular animal as they reach senior age.
How do we make Veterinary Occupational Therapy ‘a thing’
If we would apply common veterinary profession sense, the standard way of making VOT ‘a thing’ is creating an additional certification for veterinary surgeons or veterinary nurses. I personally strongly disagree with the notion that such advice should only be given by veterinary (and symptom-oriented) trained professionals. I think huge progress could be made by someone who is able to see the mixed-species family as an entity, where tweaks can be made to all of the parts’ functioning to maintain equilibrium. Having a veterinary background isn’t the only route there. Being able to observe and communicate with various species is much more important, as is having a basic understanding of human and non-human animal behaviour.
I see two options for this specialist subject to develop:
Adding VOT training to the (human) Occupational Therapist’s standard curriculum, similar to what is currently happening within Veterinary Social Work, or what is already an established framework in Veterinary Physiotherapy. This would be particularly useful for senior people with senior pets - a common combination.
Creating a separate, established Veterinary Occupational Therapy profession, which includes training on animal physiology and behaviour, veterinary gerontology and human psychology.
Naturally, the VOT would not work in isolation. In fact, greater progress can be made if the veterinary and human care silos would open up (more), and disciplines work alongside each other to support a family. Because caring for a companion animal in the later stages of life can be all-consuming, tiresome, and emotionally heavy. Just like an OT, the VOT will also support the caregivers (or mantelzorgers). This is where my vision for interdisciplinary support for the palliative veterinary patient and family comes in. You can find out more about my research on this topic here.
Creating a VOT framework based on the five domains would be the next step: nutrition, physical environment, health, behaviour and mental state. For instance, in my coaching for Autumn Animals, caregivers of senior and chronically ill pets and I discuss how to improve their family’s quality of life, based on the following pillars:
Physical
Psychological
Emotional
Spiritual
These pillars include the five domains and inform the session’s conversations; each time we assess which takes priority. I also include a session on end-of-life planning. This session isn’t just about what happens at the end. More importantly, it covers what is needed in the meantime to make sure we get to that preferred ending.
How Veterinary Occupational Therapy improves the pet’s life
On a very basic level, VOT can improve the pet’s wellbeing by taking away friction, such as addressing discomfort and adjusting an environment that isn’t suitable for old bodies. I also see that it creates a better quality of life because it gives an older animal back agency and dignity; they get the opportunity to execute species-specific behaviours, and stay clean (with or without help).
On a much deeper level, I believe that VOT has the ability to improve the animal’s welfare because a pet is seen by their caregivers. They are not considered “naughty” for pooping outside the litter box, or “lazy” for dragging their feet on walks. Caregivers are being taught that the young puppy or kitten that used to do zoomies is gone - but in return they now have a companion whose personality has matured and who still has some life in them, as long as they are given the opportunity to shine. New meaningful routines can be created that can be just as enjoyable as playing with feather toys or going on hour-long hikes. Different, not less valuable.
Towards the end of my cat’s life, I found out he didn’t mind being showered because it meant him feeling clean, and being blow-dried after. He had always been an immaculately clean cat. I once tried washing him in the shower when he was younger after an unfortunate dip in a muddy pond. I still have the scratches on my body to show for it. But as the hooks on his tongue wore away and daily brushing or sponge baths couldn’t keep him dignified and hygienic enough, I tried washing him in the sink at first. We quickly moved to the walk-in shower (which he walked into himself), and although he didn’t enjoy the shampooing, he tolerated it and immediately started purring when it was time to start drying. As he had become deaf in old age, he didn’t mind the sound of the hair dryer, and the heat warmed up his little old body. Washing and drying became a regular routine in our final few months together, and Lewis maintained an immaculate appearance until the day he died because of this.
How Veterinary Occupational Therapy improves the caregiver’s life
I have supported many families who weren’t sure whether their pet had arrived at the end of their life; something in them said they hadn’t tried everything in their power. Often these pets hadn’t even been prescribed allopathic or other modes of pain relief for their aching bodies. Their vets had only treated the acute disease at hand, often organ failure, and sent the family home with my clinic’s contact details for when it was time to schedule euthanasia. The caregivers would tentatively call us to discuss costs and timing in preparation for the real event, usually distressed that the only next option was the end.
Often, I would suggest they first request pain relief from their GP-vet. Sometimes I would offer a quick home visit to see if I could help them make the final days, weeks or months more comfortable.
Back then, and in my current coaching approach, my starting point is always to treat chronic pain to improve the quality of life for a senior pet. Recognising certain behaviours, or a lack of, takes some time and seeing in person (or hearing caregivers describe it during a virtual consultation). Not everybody can do this, because not everybody recognises pain behaviour in different species. Cats and dogs don’t cry out in pain; they are much more subtle. Sometimes people just need a translator.
I will then do a quality of life assessment with the family, so they can discuss - as a family - what their line in the sand actually is. They can use this starting conversation in the future to help them decide together when the time has come. This offer is already a huge relief to caregivers, not having to struggle through that final “will we or won’t we” moment alone. The quality of life assessment will also give the opportunity to make minor adjustments to make life easier right away for the animal, such as decreasing the living space, ensuring they have grip underfoot, offering easier access to toilet breaks or the litter box and bringing food and water closer to them.
In addition to the practical advice and support, having another person on your side who actually takes the time to listen and make sense of certain behaviours and struggles can feel like the breath of air most caregivers really need when they are in the thick of it. This person doesn’t have to have seen it all. I sure haven’t. But I have seen enough cases to share that what worked for this pet might also work for that one. Or recognise that certain behaviours indicate the early stages of a comorbidity.
Most caregivers would agree that they don’t want their pet to “suffer”. I don’t like to use that word, and prefer to use “being in discomfort”, but we mean the same thing. We want them to not feel pain. The easiest first step is to recognise it and treat it with pain relief and physical adjustments.
Being able to witness your beloved pet feel more comfortable moving around relieves the burden of worry: worry about whether you’re not doing enough, or worrying about extending their suffering.
I can’t prescribe pain relief, nor would a VOT (unless they are a licensed veterinarian). But empowering a caregiver to keep a diary or list of observations, and take that to their GP-vet and be the advocate for their animal’s needs, might be an even better solution. Both for the pet - and the caregiver.
Giving back a good quality of life for a pet automatically changes the quality of life of the whole family. This gives breathing room to discuss what is important. Such as staying mindful of what’s in front of them right now (a loving pet with life and love in them) whilst also working towards an ending that is dignified and at the right time - for them.
How Veterinary Occupational Therapy improves the veterinary team’s life
The VOT can be the veterinary team’s eyes and ears on the ground. Similar to behaviourists who can spot that a dog is showing unwanted behaviours likely due to a medical condition, a VOT can send a patient and their caregiver back to the GP-vet with a list of topics that seem to influence the pet’s quality of life and agency. With more and better information about how the patient is actually functioning in the home environment (without the additional benefit of adrenaline masking symptoms you get during a clinic visit) and the reasons that might be behind this, better quality conversations can take place, leading to better informed decisions.
I believe that most veterinary teams love to work with caregivers who are engaged in the care of their senior pet. It’s like having someone on both the vet’s and caregiver’s side, but ultimately on the pet’s side, who can help build that trust in the interdisciplinary care team - even if they’re not part of the same company. They will ensure caregivers go to the vet for medical advice, rather than Google or AI, and, from my experience, improve caregiver compliance and increase their trust and satisfaction with the veterinary team.
As mentioned earlier, these kinds of consultations take longer than the general 15-minute workup during which a vet also has to do sales, quoting, and prescribing. I believe that most veterinarians came into the profession to give their patients the care they need and deserve, but time and a swamped calendar are not on their side.
This type of care involves sitting with the caregiver and the patient, asking questions and follow-up questions, seeing the environment or creating the space for them to describe the environment whilst you visualise it - and putting yourself in the patient’s shoes. It takes proactive follow-up so that iterative changes can be made until the environment is just right. It takes proactive checking in to ensure that the quality-of-life score, which is slowly creeping down, doesn’t plummet. And it takes thinking out of the box and using the materials available in a family’s environment.
Adjusting a home and routine doesn’t mean people have to fill up Amazon’s shareholders’ pockets. Upside-down crates make for perfect raised food bowl stands for cats. A shaggy old rug that the dog might have had an accident on a few times (and caregivers are going to throw away soon anyway) makes for a great sniffari-mat. And the book collection of a well-read family creates a perfect step-up for smaller dogs and cats, as long as they are covered with anti-slip matting.
Adding another discipline to veterinary care will not take away a patient (and their caregiver’s money) from the clinic. Instead, care, conversations and compliance will change. I must say it again: different, not less valuable. And I’m pretty sure that working as an interdisciplinary team to guide a family through their pet’s autumn of life, witnessing the patients feel more comfortable and supporting empowered caregivers, will provide the best contextualised care possible and will add to the veterinary team’s job satisfaction as well.
Next steps to make Veterinary Occupational Therapy happen
I would love to speak with people who are working in human OT and are interested in adding a pet element to their portfolio and with people who know something about creating new professions and the curriculum that comes with it. If you are this person, or know someone who is, do get in touch for a chat.
If what I described above sounds like something you feel you, or a patient and their family might need, feel free to send them my way. Or if you would like to discuss a case with me to see if and how I can help, I offer a free 15-minute discovery call, which you can book here.
* I use this as a figure of speech as I recognise that optimal timing of neutering continues to change due to what we continuously learn about different species and breeds
Sies.
About me
My name is Sieske Valk (pronounced as Sees-kuh Falk). Most people call me Sies. I started my career as a veterinary nurse in the Netherlands. Following a short stint as a social science researcher in climate change adaptation, I set up an animal home-care company in London called Sies Petcare. This grew into Autumn Animals, the UK’s first holistic palliative and hospice care organisation. Trained as an end-of-life doula for companion animals, I supported numerous families through the autumn and winter of their companion animal’s life and what comes after.
I currently focus on three pillars within ageing pet care under the brand Autumn Animals:
Coaching pet caregivers with ageing pets, writing about caring for ageing companion animals and research about interdisciplinary palliative care for companion animals.
If you’d like to know more about Autumn Animals, visit autumnanimals.com.
I live on a farm with my husband, Jamie, in beautiful Devon, and have a Lewis-shaped hole in my heart.
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