Hospice care for a cat is a schedule before it is a decision. The usable part of that schedule is a 5-item check run every 8 hours, each item scored 0 to 3, with a total out of 15 written on the same sheet every time. The score does not pick a drug and does not replace an exam. It produces the 3 things a vet cannot get from a 10-minute conversation: what changed, when it changed, and how fast.
Why the clock is 8 hours
Most prescribed pain plans for a senior cat run on an 8 to 12 hour interval, so a check every 8 hours lands once before a dose window and once in the quiet stretch between. Three checks a day also catch what one daily look misses: a cat scoring 2 at 07:00 and 3 at 23:00 is not stable, it is wearing off between doses. Fix the hours at 07:00, 15:00 and 23:00, keep one sheet in one place, and run 14 days before judging a trend. A 3-day run of 2 or more on the same item is the signal; a single bad afternoon is noise.
The 5 items
Score 0 for normal for this cat, 1 for mild change, 2 for clear change, 3 for severe. Item 1 is resting breathing rate: count chest movements for 30 seconds, double the number, write it down; 16 to 24 per minute is the usual resting range, and 30 or more is a same-day call. Item 2 is posture: how many positions the cat uses to rest, and whether the belly is guarded when lifted. Item 3 is movement: the number of steps from bed to bowl, and whether the cat stops halfway. Item 4 is intake: grams eaten, water taken, and whether food is chewed or swallowed whole. Item 5 is contact: does the cat lean into a hand, accept 10 seconds of chin scratch, or pull away in 2. Five items, about 2 minutes, and no equipment beyond a clock and a kitchen scale accurate to 5 g. The 0 to 4 version of this scoring method, used for earlier stages, is set out in scoring senior cat pain at home.
What 0, 2 and 3 look like
| Item | Score 0 | Score 2 | Score 3 | Checks per 24 h |
|---|---|---|---|---|
| Breathing at rest | 16 to 24 per minute | 26 to 30 per minute | 32 or more, or open mouth | 3 |
| Posture | 3 or more rest positions | 1 position, belly guarded | Hunched, will not lie flat | 3 |
| Movement | 4 m to the bowl, no stop | Stops once, 2 m in | Will not cross 1 m | 2 |
| Intake | 40 g wet food in 10 minutes | Half the portion, 2 sittings | Under 10 g in 12 hours | 3 |
| Contact | Seeks the hand, 30 seconds | Tolerates 10 seconds | Pulls away in 2 seconds | 3 |
A 3-level plan, written by the vet
Hospice pain plans are usually organized in 3 levels, and every level is a prescription decision. Level 1 is the base: 1 veterinarian-prescribed analgesic on a fixed interval, plus positioning, a 5 cm foam pad under the bedding, a litter tray within 3 m of the bed, and the bowl raised 5 cm. Level 2 adds a second prescribed agent or a shorter interval when the same item scores 2 or more at 2 consecutive checks on 3 days running. Level 3 is same-day contact: any item at 3 twice within 24 hours, or 12 hours with no food. Nothing is adjusted at home. Do not split, double or borrow a dose from another cat; a 4 kg cat and a 6 kg cat do not share a tablet, and several common human painkillers are lethal to cats at a fraction of one tablet.
The sheet itself
One line per check, 8 columns: date, time, 5 scores, total. Below it, one note of 5 words or fewer, for example refused breakfast or sat in the hall. A 14-day sheet is 42 lines and takes under 10 minutes a day. Photograph it every 7 days; 3 photos of 3 sheets carry more into the exam room than any account you can give from memory. If 2 people share the care, split the 3 checks so the same person does 07:00 and 23:00, and leave a 5-word handover note on the sheet: ate half, slept left side.
Findings that override the score
Four findings skip the number: open-mouth breathing at any score, a resting rate over 40 per minute, no urine for 12 hours, and 1 collapse. Call the clinic within the hour. Also call if the total climbs 3 points or more in 24 hours, even when no single item reaches 3, and if the cat has taken no water for 24 hours.
What the number cannot do
It cannot separate arthritis from abdominal pain, pain from nausea, or a bad night from a bad week. It cannot authorise a dose change, and it is not a diagnosis. What it does is compress 3 weeks of watching into 21 fixed-format lines that a vet can read in 60 seconds and compare with the last visit. Monthly cost of this kind of care, including the review visits, is worth pricing before the first appointment: see the cost calculator.
Start tonight, in 5 steps
- Print an 8-column grid, 42 lines, and tape it inside a kitchen cabinet door.
- Set 3 phone alarms at 07:00, 15:00 and 23:00 for the first 14 days.
- Weigh the cat once a week on a 5 g scale and add that number to the same sheet.
- Score the 5 items in the same order every time, before food, never after play.
- Book the review at day 14 and take the sheet and the photos with you.
The 3 a.m. waking pattern that often comes first is covered in senior cat night waking. A cat that stops eating for 12 hours needs a vet, not a better spreadsheet.
Frequently asked
How often should a hospice cat's pain be scored?
Every 8 hours, at fixed times such as 07:00, 15:00 and 23:00, for at least 14 days before you read a trend. Three checks a day show whether a prescribed plan is wearing off between doses, which a single daily look cannot show.
Can I change the dose myself if the score gets worse?
No. All 3 levels of the plan are prescription decisions and every change comes from the vet who examined the cat. Do not split, double or borrow a tablet: a 4 kg cat and a 6 kg cat do not share one, and some human painkillers kill cats at a fraction of a tablet.
Which findings mean call the vet the same day?
Open-mouth breathing at any score, a resting rate over 40 per minute, no urine for 12 hours, one collapse, no food for 12 hours, or a total that rises 3 points or more within 24 hours. Any of these overrides the sheet and needs a call within the hour.