Quality of Life Assessment

This is one of the hardest decisions you'll ever face. This assessment can help you think it through — but it's not a substitute for your veterinarian's guidance or your own intuition.

0 of 7 categories answered

H

Hurt

Pain management

Is your pet's pain being adequately managed? Can they rest comfortably?

Constant unmanaged pain
No pain, or well-managed
H

Hunger

Appetite

Are they eating enough to maintain their strength? Do they show interest in food?

Refuses all food
Eating normally
H

Hydration

Water intake

Are they staying hydrated on their own?

Severely dehydrated
Drinking normally
H

Hygiene

Cleanliness

Can they keep themselves clean? Are there wounds, pressure sores, or incontinence issues?

Unable to stay clean
Clean, well-groomed
H

Happiness

Joy and engagement

Do they still respond to your voice? Do they have moments where they seem like themselves?

Withdrawn, unresponsive
Responsive, shows joy
M

Mobility

Movement

Can they get up, move around, and find a comfortable position? Do they need help?

Unable to move comfortably
Moves freely
M

More good days than bad

Overall trend

Looking at the last week, were there more days where they seemed comfortable and present than days where they seemed to be suffering?

Mostly bad days
Mostly good days

Complete all 7categories to see your pet's quality of life score and guidance.

Based on the HHHHHMM scale developed by Dr. Alice Villalobos, DVM, DPNAP. Learn more in our quality of life guide.

How this assessment works

The HHHHHMM quality of life scale, developed by veterinary oncologist Dr. Alice Villalobos, evaluates seven key areas of your pet's daily experience to help you assess their comfort and wellbeing. It is one of the most widely used quality of life tools in veterinary hospice care, and it gives families a shared language for one of the hardest conversations.

The seven categories

The scale evaluates Hurt (pain management), Hunger (appetite), Hydration (water intake), Hygiene (cleanliness and wound care), Happiness (engagement with family and surroundings), Mobility (ability to move comfortably), and More good days than bad(the overall trend). Each is rated 1–10.

How to interpret your score

This is not a pass/fail. It's a framework for the conversation with your veterinarian. A total above 35 generally suggests your pet still has an acceptable quality of life. A total between 20 and 34 suggests it's time for a serious conversation about comfort care. Below 20 suggests your pet may be suffering. But the direction of change matters more than the number — a pet whose score dropped from 55 to 38 in two weeks is in a different situation than one who has been at 38 for months.

When to retake

Most veterinary hospice resources suggest repeating this weekly during a decline, or any time you notice a significant change. Some families keep a running log and discuss it with their vet at follow-up appointments.

Limitations

No scale can capture the full picture of your pet's experience. Use this as one input alongside your veterinarian's medical assessment and your own daily observations. It does not replace professional guidance, and it cannot make the decision for you.

About this scale

This scale was developed by Dr. Alice Villalobos, DVM, DPNAP, a pioneer in veterinary oncology and author of Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond. You can read more about her framework in our quality of life guide, and if you're struggling with the decision, the article coping with pet loss guilt may help. When you're ready to explore next steps, our at-home euthanasia page lists verified mobile veterinarians.

Frequently asked questions

There is no single right answer, but most veterinarians agree that when your pet has more bad days than good days, and their suffering cannot be adequately managed, it may be time to discuss end-of-life options. The HHHHHMM scale above gives you a framework for that conversation. Trust your instincts — you know your pet better than anyone.
The HHHHHMM scale is a veterinary tool that evaluates seven areas: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days Than Bad. It was developed by Dr. Alice Villalobos, a pioneering veterinary oncologist, and is widely used in veterinary hospice care. Each category is rated 1 to 10, for a total out of 70.
A score below 35 out of 70 generally suggests reduced quality of life, though no single number should dictate your decision. Scores below 20 suggest significant suffering. But the trend matters more than any one score — if you're seeing steady decline across multiple categories, that's often more meaningful than the total.
Both are valid choices. Natural death can be peaceful for some pets but prolonged and distressing for others — especially when pain management becomes insufficient. Euthanasia offers a controlled, painless passing, usually in under a minute, with you present if you wish. Talk honestly with your veterinarian about what natural decline is likely to look like for your specific pet.
Start by asking your veterinarian for an honest assessment of your pet's prognosis and daily comfort level. Most vets have this conversation gently and often. You can share your quality of life score as a starting point. Ask what options exist for palliative care, at-home hospice, and in-home euthanasia.
No. Choosing euthanasia to end suffering is one of the most selfless acts of love a pet owner can make. You are taking on the pain of the decision so they don't have to. Many veterinarians say the families who struggle most are the ones who wait too long, not the ones who choose compassionately.
Yes. Most veterinarians encourage owners to be present, and many offer in-home euthanasia services so your pet's final moments are in a familiar, safe place. The procedure is quick — a sedative first to deeply relax them, then a final injection while they're unaware. You can hold them the entire time.

Related reading

Deeper reading

When is it time? A gentle quality-of-life guide

The full article, with context from veterinary hospice practitioners.
Care path

At-home euthanasia options

Verified mobile veterinarians who offer in-home end-of-life care.
Grief

Pet loss guilt — you made the right choice

For the families wrestling with whether they did the right thing.