The short answer
Vets use the HHHHHMM scale: hurt, hunger, hydration, hygiene, happiness, mobility, and more good days than bad, each scored 0 to 10. A total over 35 reads as acceptable quality of life to continue hospice care; trouble breathing outweighs everything else. Score it daily for a week and take the sheet to your vet. The free tool below scores it and prints the week.
Reviewed September 2026 · Sources: Villalobos, Quality of Life Scale (the HHHHHMM Scale), Testoni et al., Validation of the HHHHHMM Scale, Animals (2023)
Before you start
What Pet Quality of Life Scale helps you do
Score your dog or cat on the seven-question HHHHHMM scale vets use, read the total the way the scale does, and print a week sheet for the vet. Score it at the same time every day for a week and read the week, not the day. If hurt or breathing scores low, that's a call to the vet today, whatever the total says.
Read when to put your pet down →Free tool
Pet Quality of Life Scale
the seven questions vets use, scored in plain words.
Nobody "just knows." This is the HHHHHMM scale, built by a veterinary oncologist and used in pet hospice: hurt, hunger, hydration, hygiene, happiness, mobility, and more good days than bad, each scored 0 to 10. Score today, print the week sheet, and take it to your vet.
Hurt
10Is the pet's pain well managed? Can the pet breathe properly? Trouble breathing outweighs all concerns.
Hunger
10Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube?
Hydration
10Is the pet dehydrated? Is the pet drinking enough water without fluids under the skin?
Hygiene
10Can the pet be kept brushed and clean, particularly after eliminations, without pressure sores?
Happiness
10Does the pet express joy and interest? Is the pet responsive to family, toys, and the things they loved? Or depressed, lonely, anxious, bored, or afraid?
Mobility
10Can the pet get up without assistance? Does the pet feel like going for a walk? Is the pet having seizures or stumbling?
More good days than bad
10When bad days outnumber good days, quality of life might be too compromised.
70 of 70
Every slider starts at 10. Move them to where your pet is today.
The scale reads a total over 35 as acceptable quality of life to continue hospice care. The sheet you can print has seven columns, because the point is the week, not the day.
This is the scale, not the decision. Your vet makes the call with you, and a week of scores is worth more in that room than one. For what euthanasia involves and what it costs at home or in the clinic, read when to put your pet down.
Where the scale comes from, and how to read it
The source
Dr. Alice Villalobos, a veterinary oncologist, published the idea in her Oncology Outlook column in Veterinary Practice News in September 2004, built the scale for her 2007 book Canine and Feline Geriatric Oncology, and revised it for the International Veterinary Association of Pain Management's 2011 hospice guidelines. The seven criteria and the line at 35 are hers. The questions on this page are her wording, shortened; the plain-language ends of each slider are ours. Villalobos, Quality of Life Scale (the HHHHHMM Scale), PDF.
It has been tested. A 2023 study in the journal Animals asked 314 owners whose animals had died of chronic, progressive disease to score the scale for the last stretch of life, and found it held together as one measure, with an internal consistency of 0.78. It's a scale, not a lab result, and the authors say so; it's also the only one most vets use. Testoni and others, Animals, 2023.
How to use it
Score it once a day for a week, at the same time of day, on the printed sheet. One bad afternoon scores low and means little; seven columns show the direction. Hurt comes first: the scale says trouble breathing outweighs all other concerns, so a low score there is a call to the vet today, whatever the total. For the other lines, a low score is a question for the vet, and there's often an answer: a different pain medication, fluids under the skin, a sling for the back legs, hand feeding.
What the total means
Over 35, the scale reads quality of life as acceptable to continue hospice care. At or below 35, it reads it as possibly too compromised, and the last line of the scale is the plain one: when a healthy bond is no longer possible, the caregiver needs to know the end is near, and the decision for euthanasia needs to be made if the pet is suffering. A week early is kinder than a day late. What that day involves, at home or in the clinic, and what it costs, is in when to put your pet down. What comes after, the body and the options and the grief, is in what to do when your pet dies and grief after losing a pet. When you're ready to write it down, the pet obituary.
Quality of life questions
What people ask with the slider in their hand.
Short answers. The scale and the study are linked above.
What is the HHHHHMM quality of life scale?
Seven criteria, each scored 0 to 10: hurt, hunger, hydration, hygiene, happiness, mobility, and more good days than bad. Dr. Alice Villalobos, a veterinary oncologist, built it for pet hospice. A total over 35 reads as acceptable quality of life.
What score means it's time to put my dog down?
The scale doesn't give a number for that. It says a total over 35 is acceptable to continue hospice care, and that when the bad days outnumber the good and the pet is suffering, the decision needs to be made. Score a week, then decide with your vet.
How often should I score it?
Once a day for a week, at the same time of day. One bad afternoon scores low and means little. Seven columns show the direction.
Does a low score in one category matter more than the total?
Hurt does. The scale says trouble breathing outweighs all other concerns, so a low score there is a call to the vet today whatever the total. Other low lines are questions for the vet, and there's often something that moves them.
Does this work for cats?
Yes. The scale was written for dogs and cats in hospice, and the 2023 validation study included both. The questions are the same; what a 10 looks like is a cat that jumps up, eats, and finds you.
When to put your pet down →