When you’re trying to decide whether your pet is still living a life worth living, your own judgment can fail you in two opposite directions.
You can underestimate their suffering — telling yourself they’re still doing okay because the alternative is too painful to face. Or you can catastrophize the changes — convinced things are worse than they are, paralyzed by fear of waiting too long.
Quality of life scales exist to interrupt both of those failures. They give you a structured way to look honestly at what your pet is experiencing — not by removing emotion, but by giving emotion something solid to push against.
This guide walks through the two most widely used pet quality of life scales, explains how to actually use them, and includes a downloadable scoring sheet you can use at home or share with your veterinarian.
Why scales help (and why they don’t replace judgment)
A scale is a thinking tool. It works by forcing you to look at your pet through specific categories — pain, eating, mobility, social engagement — rather than through the haze of how you’re feeling on a given day.
But a scale isn’t an oracle. It can’t tell you with mathematical certainty when it’s time. It can show you patterns. It can highlight what you’re noticing and what you might be missing. It can help structure a conversation with your veterinarian.
Used the right way, scales make the impossible question slightly less impossible. They don’t make it easy. Nothing makes it easy.
The HHHHHMM Quality of Life Scale
The most widely used pet quality of life scale was developed by veterinary oncologist Dr. Alice Villalobos. Each category is scored from 1 to 10 (1 being worst, 10 being best). The total possible score is 70.
Here’s the full scale, with practical guidance for how to think about each category:
HURT — Adequate pain control, including breathing ability
Is your pet’s pain effectively managed? Can they breathe without effort? Are their movements comfortable, or do they hesitate, vocalize, or guard certain body areas?
A score of 10 means no observable pain or breathing issues. A score of 1 means severe, uncontrolled pain or significant breathing distress.
For a pet on pain medication, ask honestly: is the medication working? Or has the dose stopped being enough?
HUNGER — Is the pet eating enough? Does hand-feeding help?
Is your pet eating enough nutrition? Is mealtime an interest, or has it become a struggle? Are you having to coax, hand-feed, or syringe-feed?
A score of 10 means normal, willing eating. A score of 1 means refusal of food despite intervention. Hand-feeding occasionally is fine; daily reliance on it usually signals decline.
HYDRATION — Is the pet dehydrated? Does it need fluids?
Is your pet drinking adequately? Are they showing signs of dehydration despite drinking? Are subcutaneous fluids being given regularly?
A score of 10 means well-hydrated without intervention. A score of 1 means severe dehydration despite efforts.
HYGIENE — Brushed and cleaned. Free from pressure sores
Can your pet stay clean? Are they soiling themselves with awareness or distress? Do they have pressure sores from inability to change position? Has grooming stopped or become inadequate?
A score of 10 means normal hygiene maintained. A score of 1 means significant soiling, severe matting, or pressure wounds that aren’t healing.
HAPPINESS — Does the pet express joy and interest?
Does your pet still respond to family members, favorite people, beloved routines? Do they show interest in their environment? Do they greet you, follow you, engage?
A score of 10 means full engagement and visible joy. A score of 1 means total withdrawal, no apparent interest in anything.
This is one of the harder categories to score because it forces you to compare your pet’s current self to who they used to be.
MOBILITY — Can the pet get up without assistance? Can it walk? Is it experiencing seizures or stumbling?
Can your pet stand on their own? Walk to where they need to go? Eliminate without help? Are they falling? Stumbling? Experiencing seizures?
A score of 10 means normal mobility for age and condition. A score of 1 means complete inability to move without help, frequent falls, or active seizures.
MORE — More good days than bad. When bad days outnumber good days, quality of life is compromised
This is the integrative category. Looking at the past two weeks honestly, are good days winning? Or has the balance flipped?
A score of 10 means consistently good days. A score of 1 means almost every day is bad.
Interpreting the score
A score of 35 or above generally suggests quality of life is acceptable, though declining areas should be addressed.
A score under 35 generally suggests quality of life has declined to a point where euthanasia should be seriously considered.
But — and this is important — the conversation matters more than the number. A pet with a 40 who scores low in two specific areas might warrant immediate intervention in those areas. A pet with a 30 who is otherwise stable might benefit from another week of comfort care before any decision.
Use the score as a structured way to think, not a verdict.
The JOURNEYS Scale
A newer alternative, the JOURNEYS Scale (developed by Dr. Katie Hilst) covers similar ground with seven categories:
- J — Jumping or mobility
- O — Ouch (pain)
- U — Uncertainty (anxiety, confusion)
- R — Respiration (breathing)
- N — Neatness (hygiene)
- E — Eating and drinking
- Y — You (the owner’s emotional capacity)
- S — Social ability
The JOURNEYS scale’s distinguishing feature is its inclusion of the owner’s emotional capacity (Y) and recognition of social ability (S) as separate from happiness. Some families find it more comprehensive; others find HHHHHMM clearer.
Both scales are valid. Use whichever resonates more.
The “favorite things” tracking method
For families who find formal scoring too clinical, here’s a simpler approach:
Make a list of the three to five things your pet loves most. Their specific things — not generic dog or cat behaviors, but their personal joys. The morning walk. The spot on the couch. The greeting at the door. The 5pm treat. Watching the back yard.
Now check in on that list every few days. How many of those things does your pet still do, with anything resembling the joy they used to bring?
When three to five favorite things are gone — not just diminished, gone — quality of life has fundamentally shifted.
This isn’t a substitute for the formal scales, but it’s often what families end up using day-to-day. It cuts through the rationalization that creeps in when you’re scared.
How to use scales day-to-day without obsessing
A few practical suggestions:
Score weekly, not daily. Daily scoring tends to amplify normal fluctuations and increase anxiety. Weekly check-ins capture the actual trajectory.
Score with another household member if possible. Two people scoring independently and comparing notes often surfaces things one person missed.
Track the trend, not just the number. A score that’s declining slowly week over week tells you something different from a score that’s stable, even if both are around 35.
Bring the score to your veterinarian. A documented scoring history is one of the most useful things you can bring to a quality-of-life consultation. It gives the vet a baseline and helps identify what’s changing.
Don’t let the scale paralyze you. If the score is consistently below 30, you don’t need another four weeks of scoring to confirm what you already know.
When to involve a veterinarian in scoring
If your scores are consistently borderline (in the 30 to 40 range), that’s a strong indication that an in-home consultation with a veterinarian who specializes in end-of-life care would be helpful. They can:
- Confirm or refine your scoring
- Identify quality-of-life issues you may not have noticed
- Adjust the comfort plan to address declining categories
- Help you understand the trajectory more clearly
A comprehensive consultation is built specifically for this kind of conversation. The visit is in your home, where your pet behaves naturally, and the focus is on assessing quality of life and building an honest plan.
Downloadable scoring sheet
A printable scoring sheet for the HHHHHMM scale is available at the bottom of this post. You can use it weekly, save scores over time, and bring the history to your veterinarian.
[Download the HHHHHMM Quality of Life Scoring Sheet (PDF)]
FAQ Section
What is the HHHHHMM Quality of Life Scale? The HHHHHMM scale was developed by veterinary oncologist Dr. Alice Villalobos and is the most widely used pet quality of life assessment tool. It scores seven categories from 1 to 10: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad.
How do I score my pet’s quality of life? For each of the seven HHHHHMM categories, score your pet from 1 (worst) to 10 (best) based on what you’re observing. Total scores range from 7 to 70. A score under 35 generally suggests quality of life has declined significantly.
What score means it’s time to euthanize? There’s no exact cutoff. A total below 35 generally indicates significant decline that warrants serious consideration of euthanasia, but the scale is meant to inform a conversation, not make the decision for you. Trends over time matter more than any single score.
Can I use the scale for cats? Yes. The HHHHHMM scale was designed for both dogs and cats. The categories apply equally well to either species, though specific signs (like a cat’s withdrawal from grooming) may need cat-specific interpretation.
How often should I assess quality of life? Weekly is usually about right. Daily scoring tends to amplify normal fluctuations and increase anxiety. Weekly check-ins capture the actual trajectory.
What’s the difference between HHHHHMM and JOURNEYS scales? Both are valid quality of life tools. HHHHHMM is older and more widely used. JOURNEYS adds explicit attention to the owner’s emotional capacity and separates social ability from happiness. Use whichever resonates more — neither is “better” in any objective sense.
Can my veterinarian help me score the scale? Yes, and they should. Bringing your scoring history to a veterinarian is one of the most useful things you can do. An in-home consultation with a veterinarian who specializes in end-of-life care is particularly helpful for borderline scores.
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