The seven factors
The HHHHHMM scale looks at Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and whether there are More good days than bad. Scoring each from 0 to 10 turns a vague, painful feeling into something you can track and talk through. Many families fill it in over several days to see the trend.
How to read your score
A total above about 35 out of 70 suggests an acceptable quality of life worth supporting; below that, or when one factor like pain simply can’t be controlled, it’s time for an honest conversation with your veterinarian. There’s no perfect number — you know your dog best, and your vet can fill in the medical picture.
Frequently asked questions
- What is the HHHHHMM quality of life scale?
- The HHHHHMM scale was developed by veterinary oncologist Dr. Alice Villalobos. It scores seven factors — Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad — each from 0 to 10. A total above about 35 out of 70 is generally considered an acceptable quality of life.
- What score means it might be time to say goodbye?
- There is no single number that decides. A total consistently below 35, or any single factor that can’t be managed (like uncontrolled pain), is a strong signal to talk with your veterinarian. The scale is meant to inform that conversation, not replace it.
- How do I know if my dog is suffering?
- Watch for ongoing pain, refusing food and water, loss of interest in family and favourite activities, difficulty moving or getting up, and more bad days than good. Tracking the score over several days often shows a trend more clearly than a single day.
- Should I use this instead of seeing a vet?
- No. This tool helps you organize your observations, but your veterinarian can assess pain, suggest treatments or palliative care you may not know about, and guide end-of-life decisions with medical insight the calculator can’t provide.
💙 This tool supports reflection and is not veterinary or end-of-life advice. Please make quality-of-life and euthanasia decisions together with your veterinarian, who can assess pain and offer options such as palliative and hospice care.