Pet Quality of Life Scale: The HHHHHMM Assessment Guide
A compassionate, objective tool to help evaluate your pet's wellbeing and guide difficult decisions
When our beloved pets face serious illness or age-related decline, one of the most challenging questions we face is: "How do I know when it's time?" The HHHHHMM Quality of Life Scale, developed by veterinary oncologist Dr. Alice Villalobos, provides an objective framework to assess your pet's wellbeing and guide these difficult decisions with compassion and clarity.
This comprehensive guide will walk you through each component of the HHHHHMM scale, provide real-world examples, and offer an interactive calculator to help you assess your pet's current quality of life. Remember, this tool is meant to complement, not replace, professional veterinary advice.
What is the HHHHHMM Quality of Life Scale?
The HHHHHMM scale is a veterinary assessment tool that evaluates seven critical factors affecting your pet's quality of life. Each letter represents a key aspect of wellbeing:
H - Hurt (Pain Management)
Adequate pain control and breathing ability
H - Hunger (Nutrition)
Ability to eat and maintain proper nutrition
H - Hydration
Adequate fluid intake and hydration status
H - Hygiene
Ability to stay clean and groomed
H - Happiness
Mental awareness and emotional response
M - Mobility
Ability to move and ambulate
M - More Good Days Than Bad
Overall assessment of daily life quality
Scoring: Each factor is rated 0-10, with 0 being worst and 10 being best. A total score above 35 generally indicates acceptable quality of life.
Interactive HHHHHMM Quality of Life Calculator
Rate each factor from 0-10, where 0 is worst and 10 is best. A total score above 35 suggests acceptable quality of life.
Hurt: Is your pet in pain?
Adequate pain control & breathing ability
Hunger: Is your pet eating enough?
Appetite and ability to eat
Hydration: Is your pet staying hydrated?
Drinking water and maintaining hydration
Hygiene: Can your pet stay clean?
Grooming, elimination control
Happiness: Does your pet express joy and interest?
Mental alertness, interaction, response
Mobility: Can your pet move around?
Ability to get up and move
More Good Days Than Bad: Are there more good days than bad?
Overall quality of daily life
Total Score
35/70
Understanding Each Quality of Life Factor
1. Hurt (Pain Management)
Pain is often the most significant factor affecting quality of life. Signs of pain in pets can be subtle and include:
- •Changes in breathing patterns or panting
- •Reluctance to move or difficulty getting comfortable
- •Vocalizing when touched or moved
- •Changes in facial expression or body posture
Veterinary Tip: Modern pain management has advanced significantly. If your pet is in pain, discuss options like multimodal analgesia, alternative therapies, or palliative care with your veterinarian.
2. Hunger (Appetite and Nutrition)
A healthy appetite is crucial for maintaining strength and immune function. Consider these factors:
- •Is your pet eating at least 50% of their normal amount?
- •Do they show interest in favorite treats?
- •Can they eat without assistance or hand-feeding?
- •Are they maintaining their weight?
Case Example: Max, a 14-year-old Golden Retriever with cancer, maintained quality of life for months using appetite stimulants and warming his food to enhance aroma.
3. Hydration
Proper hydration is essential for organ function and comfort. Assess hydration by:
- •Checking skin elasticity (tent test)
- •Monitoring water intake
- •Observing urination frequency and color
- •Checking gum moisture and color
Subcutaneous fluids administered at home can significantly improve quality of life for pets with kidney disease or other conditions affecting hydration.
4. Hygiene
The ability to maintain cleanliness affects both physical comfort and dignity. Consider:
- •Can they control bowel and bladder function?
- •Are pressure sores or skin infections developing?
- •Can they groom themselves or accept grooming?
- •Is their living area clean and comfortable?
Practical Tip: Waterproof bedding, puppy pads, and regular gentle cleaning can help maintain hygiene without causing stress.
5. Happiness (Mental and Emotional Wellbeing)
Mental stimulation and emotional connection are vital for quality of life. Look for:
- •Response to family members and favorite activities
- •Interest in surroundings and alertness
- •Tail wagging, purring, or other signs of contentment
- •Participation in family life, even if limited
Remember: A pet who can no longer do everything they used to can still experience joy. Focus on what brings them happiness now, not what they've lost.
6. Mobility
Movement ability affects independence and quality of life. Evaluate:
- •Can they stand and walk without assistance?
- •Are they able to reach food, water, and elimination areas?
- •Do they show signs of dizziness or disorientation?
- •Can mobility aids (slings, wheelchairs) help?
Success Story: Luna, a German Shepherd with degenerative myelopathy, maintained good quality of life for over a year using a wheelchair and physical therapy.
7. More Good Days Than Bad
This holistic assessment considers the overall pattern of your pet's life. Track:
- •Daily quality using a simple calendar system
- •Ratio of good days to difficult days
- •Trends over time (improving or declining)
- •Your pet's unique definition of a "good day"
Tracking Tip: Use a simple system like smiley faces or colors on a calendar to track daily quality. This visual record helps identify patterns and make objective decisions.
When and How to Use the Quality of Life Scale
Recommended Assessment Schedule:
Initial Diagnosis
Establish a baseline when serious illness is diagnosed
Weekly Assessments
Regular monitoring for chronic conditions
After Treatment Changes
Evaluate response to new medications or therapies
During Crisis Events
Immediate assessment if condition suddenly worsens
Important: Have multiple family members complete assessments independently, then discuss differences in perception. This provides a more complete picture.
Interpreting Results and Making Decisions
Understanding Your Pet's Score
Score 35-70: Acceptable Quality of Life
Continue current care, monitor regularly, enjoy your time together
Score 25-34: Concerning Quality of Life
Discuss options with your vet, consider interventions, prepare for decisions
Score Below 25: Poor Quality of Life
Humane euthanasia should be strongly considered to prevent suffering
"Better a week too early than a day too late" - A compassionate approach to end-of-life decisions
Additional Support and Resources
Professional Support
- • In-home euthanasia services
- • Pet hospice care providers
- • Grief counseling services
- • Quality of life consultations
Decision-Making Tools
- • Daily quality tracking journals
- • Family meeting guides
- • Questions for your veterinarian
- • Bucket list ideas for pets
Honor Your Pet's Memory
When the time comes, preserve your pet's legacy with a beautiful online obituary
Forever free • Share memories • Light virtual candles
Veterinary Disclaimer: This quality of life scale is a tool to facilitate discussion and decision-making. It should not replace professional veterinary advice. Always consult with your veterinarian when making decisions about your pet's health and end-of-life care.