The HHHHHMM scale, developed by Dr. Alice Villalobos, helps pet owners and veterinarians objectively assess a dog's quality of life during end-of-life care or chronic illness. Rate each category from 0 (poor) to 10 (excellent).
Is pain controlled? Can the dog breathe easily? Is oxygen required?
Is the dog eating enough? Does hand-feeding help? Is a feeding tube needed?
Is the dog dehydrated? Are subcutaneous fluids necessary?
Is the dog kept clean? Any pressure sores? Can they eliminate without soiling themselves?
Does the dog show joy? Wag their tail? Respond to family and toys?
Can the dog get up without assistance? Do they need a harness or cart?
When bad days outnumber good days, quality of life might be compromised.
Results: /70
Understanding the HHHHHMM Quality of Life Scale
Deciding when to say goodbye to a beloved pet is one of the most difficult experiences a dog owner can face. The HHHHHMM Scale provides a clinical framework to move past pure emotion and look at the objective physical and mental state of your dog.
What do the scores mean?
A score of 35 or higher generally suggests that the dog's quality of life is acceptable and that continuing hospice care or treatment is reasonable. A score below 35 often indicates that the dog's quality of life is declining, and it may be time to discuss end-of-life options, such as euthanasia, with your veterinarian.
The 7 Criteria Explained
Hurt: Adequate pain control is vital. This includes the ability to breathe comfortably. If a pet is struggling for air, it is often considered a 0.
Hunger: If a dog cannot eat enough calories voluntarily, are you able to assist? If they refuse food entirely, their score drops significantly.
Hydration: Dehydration can lead to confusion and malaise. If a dog can't stay hydrated via drinking, are you prepared to give fluids?
Hygiene: Can the pet be kept clean? This is especially important for dogs with incontinence or those who cannot move to avoid their own waste.
Happiness: Does the dog still enjoy being with the family? Do they exhibit curiosity or responsiveness to their surroundings?
Mobility: Can the dog move enough to satisfy their needs? Note: If a dog can move with a harness or cart, they can still score highly here.
More Good Days Than Bad: If there are too many bad days in a row where the pet seems to be suffering, the bond between human and animal is compromised.
Example Scenario
Consider an elderly Golden Retriever with severe arthritis (Mobility: 3) but who is eating well (Hunger: 8), well-hydrated (Hydration: 8), kept clean (Hygiene: 9), and is still happy to see the family (Happiness: 7). If his pain is managed with meds (Hurt: 7) and he has 4 good days for every 3 bad ones (More Days: 6), his score would be 48. This indicates that despite mobility issues, he still has a high quality of life.
Disclaimer: This calculator is for educational purposes only. Always consult with a licensed veterinarian to make decisions regarding your pet's health and end-of-life care.
function calculateQoL() {
var hurt = parseFloat(document.getElementById('hurt').value);
var hunger = parseFloat(document.getElementById('hunger').value);
var hydration = parseFloat(document.getElementById('hydration').value);
var hygiene = parseFloat(document.getElementById('hygiene').value);
var happiness = parseFloat(document.getElementById('happiness').value);
var mobility = parseFloat(document.getElementById('mobility').value);
var moreDays = parseFloat(document.getElementById('moreDays').value);
// Validation
if (isNaN(hurt) || isNaN(hunger) || isNaN(hydration) || isNaN(hygiene) || isNaN(happiness) || isNaN(mobility) || isNaN(moreDays)) {
alert("Please enter a valid number between 0 and 10 for all fields.");
return;
}
// Clamp values between 0 and 10
var scores = [hurt, hunger, hydration, hygiene, happiness, mobility, moreDays];
var total = 0;
for (var i = 0; i < scores.length; i++) {
if (scores[i] 10) scores[i] = 10;
total += scores[i];
}
var resultBox = document.getElementById('qol-result-box');
var scoreDisplay = document.getElementById('qol-score');
var interpretation = document.getElementById('qol-interpretation');
var advice = document.getElementById('qol-advice');
scoreDisplay.innerText = total;
resultBox.style.display = 'block';
if (total >= 35) {
resultBox.style.borderLeftColor = "#27ae60";
interpretation.innerText = "Current Score Suggests Acceptable Quality of Life.";
interpretation.style.color = "#27ae60";
advice.innerText = "A score above 35 indicates that your dog's quality of life is likely sufficient to continue with current palliative care. Continue monitoring these metrics weekly to watch for trends.";
} else {
resultBox.style.borderLeftColor = "#e74c3c";
interpretation.innerText = "Current Score Suggests Quality of Life is Compromised.";
interpretation.style.color = "#e74c3c";
advice.innerText = "A score below 35 suggests that your dog's quality of life may be declining. This is a critical time to consult with your veterinarian about pain management adjustments or to discuss end-of-life options and euthanasia to prevent suffering.";
}
// Smooth scroll to result
resultBox.scrollIntoView({ behavior: 'smooth', block: 'nearest' });
}