Dog Quality of Life Calculator
The HHHHHMM Scale for End-of-Life Care Assessment
5
Is your pet's pain managed? Can they breathe easily? (0 = Severe distress, 10 = Pain-free/Easy breathing)
5
Is your pet eating enough? Do they need hand-feeding or a feeding tube? (0 = Anorexic, 10 = Eating well)
5
Is your pet dehydrated? Are they receiving subcutaneous fluids? (0 = Severely dehydrated, 10 = Fully hydrated)
5
Can your pet be kept clean? Do they have pressure sores or incontinence? (0 = Matted/Soiled, 10 = Clean/Groomed)
5
Does your pet express joy? Do they respond to family and toys? (0 = Depressed/Anxious, 10 = Joyful/Engaged)
5
Can your pet get up without assistance? Are they stumbling or seizing? (0 = Immobile, 10 = Fully mobile)
5
When bad days outnumber good days, quality of life might be compromised. (0 = Mostly bad, 10 = Mostly good)
0
Understanding the HHHHHMM Quality of Life Scale
Deciding when to consider hospice care or euthanasia for a beloved pet is one of the most difficult journeys a dog owner can face. The HHHHHMM Scale, developed by Dr. Alice Villalobos, is a clinical tool used by veterinarians and pet owners to objectively assess a dog's well-being. This scale helps remove some of the emotional fog and provides a clear framework for decision-making.
The 7 Criteria of the Scale
Each category is scored from 0 to 10, where 0 is poor and 10 is excellent. A total score of 35 or higher generally indicates that the dog's quality of life is acceptable and palliative care can continue.
- Hurt: Adequate pain control is vital. This includes the ability to breathe properly. If a dog is gasping for air (respiratory distress), this score is automatically very low.
- Hunger: Nutrition is essential. If a dog is not eating voluntarily, are they accepting hand-feeding?
- Hydration: Dehydration can lead to confusion and lethargy. Subcutaneous fluids can often help senior dogs stay comfortable.
- Hygiene: A dog should be kept clean, especially after elimination. If they have bedsores or cannot be kept out of their own waste, their dignity and health suffer.
- Happiness: Does the dog still wag their tail? Do they acknowledge family members? A dog that is "checked out" or constantly anxious may have a low happiness score.
- Mobility: While many older dogs have arthritis, they should still be able to move or be helped into a comfortable position. If a dog can no longer stand, their quality of life drops significantly.
- More Good Days Than Bad: If the bad days consistently outweigh the good ones, it is often time to discuss end-of-life options with your vet.
Interpretation of Results
| Total Score | Meaning |
|---|---|
| Over 35 | Generally acceptable quality of life. Continue with current care and monitoring. |
| Under 35 | Quality of life is declining. Discussion regarding hospice care or euthanasia is recommended. |
| Under 20 | Poor quality of life. The pet is likely suffering significantly. Immediate veterinary consultation is advised. |
Example Assessment Case Study
Imagine "Max," a 14-year-old Golden Retriever with hip dysplasia and kidney disease. His owner scores him as follows:
- Hurt: 6 (Medicated, but stiff)
- Hunger: 5 (Needs encouragement)
- Hydration: 4 (Needs IV fluids twice a week)
- Hygiene: 7 (Incontinent at night, but kept clean)
- Happiness: 5 (Still likes head scratches, but sleeps 22 hours)
- Mobility: 3 (Needs a harness to walk)
- More Good Days: 4 (More bad days than good lately)
Total Score: 34. Since the score is just under 35, Max's owner should begin having serious conversations with their vet about comfort care versus saying goodbye.