Quality of Life Scale for Dogs and Cats

When a dog or cat is aging or ill, the hardest question is also the simplest one: how are they really doing? This free assessment walks you through seven honest questions that veterinarians use to understand a pet’s quality of life. It takes about two minutes, and nothing you enter is stored or shared.

Nothing you enter is stored or shared.

This scale is a reflection tool, not a diagnosis. Scores are one part of a bigger picture that you and your veterinarian understand best. Adapted from the HHHHHMM Quality of Life Scale, Villalobos, A., Canine and Feline Geriatric Oncology (2007).

What is the HHHHHMM Quality of Life Scale?

The assessment above is based on the HHHHHMM Quality of Life Scale, developed by Dr. Alice Villalobos, a veterinary oncologist and a pioneer of animal hospice care.

The seven H’s and M’s stand for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. Together, these seven areas of daily life paint an honest picture of how a pet is doing.

Each area is scored from 0 to 10, for a total of 70. In Dr. Villalobos’s framework, a total score above 35 generally suggests an acceptable quality of life. The scale was designed to give families and veterinarians a shared, concrete language for a conversation that is otherwise almost impossible to have. It replaces “I just don’t know” with something you can see, track, and talk about together.

The Seven Factors, Explained

Hurt

Pain control comes first, and breathing comes before everything. A pet struggling to breathe is in a kind of distress that outweighs every other measure on this scale. For most aging pets, the question is whether pain is well managed, whether through medication, rest, or the routines you’ve built around them.

Hunger

Is your pet eating willingly? Hand-feeding counts. But needing to be coaxed through every meal, or turning away from lifelong favorites, is a signal worth taking seriously. This is especially true in cats, where even a day or two of not eating can become its own medical problem.

Hydration

Dogs and cats can quietly slide into dehydration as they decline. Here’s a simple check: gently lift the skin between the shoulder blades. It should spring back quickly. If it settles slowly, or if your pet needs fluids to stay hydrated, score this one honestly.

Hygiene

Can your pet stay clean and comfortable? For dogs, that means being able to keep out of their own waste and free of pressure sores. For cats, watch grooming. A cat who has stopped keeping their coat clean is telling you something they can’t say any other way.

Happiness

Does your dog still greet you at the door, still care about the tennis ball, still thump a tail at the sound of your voice? Does your cat still seek out your lap, still claim the sunny windowsill? Joy looks different in every animal, but its absence is usually easy to feel, even when it’s hard to admit. Withdrawal, isolation, and anxiety all belong in this score.

Mobility

Can your pet get up and move on their own, or with only a little help? For cats, the question is whether they can still reach their food, their litter box, and their favorite places. For dogs, it’s whether they can stand, walk, and still want to go, even if the walks have gotten short.

More Good Days Than Bad

This is the summary question, and often the clearest one. Think honestly about the last week or two. A bad day means pain, nausea, frustration, or distress outweighing comfort. When bad days begin to outnumber good ones, quality of life may be too compromised, and it’s time for an honest conversation with your veterinarian.

How To Interpret Your Score

A score above 35 out of 70 generally suggests your pet’s quality of life is still acceptable. But a single number matters less than the trend. A dog who scores 48 this week and 41 two weeks later is telling you more than either number alone. That’s why we suggest re-taking this assessment every week or two once you’ve started noticing changes, and why the printable version below has space to track scores over time.

Two more things are worth knowing. First, no scale can weigh how much your pet loves their life or how much you love them. It measures comfort and function, and it works best as a starting point for conversation, not a verdict. Second, if any single category has dropped to a very low score, that matters more than a passing total. This is especially true of Hurt. A pet in unmanaged pain needs help now, whatever the other six numbers say.

Download the printable version

Some families prefer paper: something to fill out at the kitchen table, track week over week, and bring to a vet appointment. Others use it to include everyone in the household, because this decision is rarely one person’s alone.

You’re welcome to print it, share it with family, or pass it along to anyone walking this road with a pet they love. Veterinary practices, shelters, and rescues are welcome to share or link to this page and the worksheet freely.

When To Talk With A Veterinarian

If your pet’s score is trending down, if any single area has become a daily struggle, or if you simply can’t tell anymore, that uncertainty is itself a reason to talk with a professional. A veterinarian can often improve several of these scores with pain management, appetite support, and small changes at home. And when comfort can no longer be maintained, they can help you understand what a peaceful goodbye looks like, so the decision is made with clarity instead of crisis.

Dr. Ray at Zen Dog Veterinary Care provides gentle, unhurried in-home euthanasia throughout Manhattan, Brooklyn, Queens, the Bronx, and Westchester, and is certified by the Companion Animal Euthanasia Training Academy (CAETA). If you’d like to talk through what you’re seeing, with no pressure and no obligation, you can call or text (917) 725-2755, or send a message.

Frequently Asked Questions

What is a good quality of life score for a dog or cat?

On the HHHHHMM scale, a total above 35 out of 70 generally suggests an acceptable quality of life. The trend over time matters more than any single score. A steady decline across several weeks tells you more than one number ever could.

How often should I use the quality of life scale?

If your pet is stable, once every few weeks is plenty. If you’ve started noticing changes, weekly assessments help you see the trend clearly and catch a decline early, when there’s the most a veterinarian can do about it.

Who created the HHHHHMM Quality of Life Scale?

It was developed by Dr. Alice Villalobos, a veterinary oncologist, and published in her 2007 book Canine and Feline Geriatric Oncology. It has since become one of the most widely used quality of life tools in veterinary medicine.

Does this scale work for cats as well as dogs?

Yes. The seven categories apply to both, though the signs look different. Cats hide pain and show decline through grooming, appetite, and withdrawal more than dogs do. The tool above adjusts its guidance depending on which you choose.

Can a quality of life scale tell me when it's time to euthanize my pet?

No tool can make that decision, and this one doesn’t try. What it can do is replace a fog of worry with a clear, honest picture, and give you and your veterinarian a shared starting point for that conversation.