Quality of Life Assessment

HHHHHMM Scale

Score each category from 1 (very poor) to 10 (excellent) based on your honest observation of your pet today. A total score above 35 generally supports an acceptable quality of life. This tool is a guide — not a substitute for a conversation with your veterinarian.

H — Hurt

Pain management

Is your pet's pain successfully controlled? Consider reluctance to move, flinching when touched, labored breathing, hiding, or changes in posture. A score of 10 means no apparent pain; 1 means severe, unmanaged pain.

1 — Severe pain 10 — No pain

H — Hunger

Appetite and nutrition

Is your pet eating enough to maintain body weight? Consider whether they still show interest in food, whether they can eat without pain or difficulty, and whether hand feeding is required.

1 — Not eating 10 — Eating well

H — Hydration

Water intake

Is your pet drinking enough? Signs of dehydration include sunken eyes, dry or tacky gums, and loss of skin elasticity. Subcutaneous fluids may be supporting hydration in some cases.

1 — Severely dehydrated 10 — Well hydrated

H — Hygiene

Cleanliness and dignity

Can your pet be kept clean and comfortable? Consider incontinence, the ability to groom, pressure sores, and whether your pet is distressed by loss of control over basic bodily functions.

1 — Unable to stay clean 10 — Clean and comfortable

H — Happiness

Engagement and joy

Does your pet still show interest in life — interactions, toys, their favorite people, or activities they once enjoyed? Persistent hiding, withdrawal, and anxiety are signs to weigh carefully here.

1 — Withdrawn, no interest 10 — Engaged and happy

M — Mobility

Movement and independence

Can your pet move enough to reach food, water, a resting spot, and outdoors or the litter box? Consider whether assisted movement is required and whether they show distress when trying to move.

1 — Cannot move independently 10 — Fully mobile

M — More good days than bad

Overall day-to-day experience

Looking at the past two weeks as a whole — are good days the majority? A 10 means almost every day is good; a 1 means almost every day involves suffering. Be honest about the pattern, not just the best days.

1 — Mostly bad days 10 — Mostly good days

Borderline

Your pet's quality of life is at the threshold. Some days may still be good, but the overall picture warrants a serious, honest conversation with your veterinarian about what comes next.

Scores above 35 generally support acceptable quality of life. Scores below 35 suggest quality of life may be compromised.

Talk to Dr. Grace — (626) 240-5000

HHHHHMM Quality of Life Scale developed by Dr. Alice Villalobos, DVM. Adapted for use as an educational tool. This assessment does not replace veterinary evaluation.