Pet Quality-of-Life Scale (HHHHHMM): Score It Weekly
When someone you love is getting worse, "how do I know?" is the hardest question there is. This is the scale many veterinarians use — the HHHHHMM scale, developed by Dr. Alice Villalobos — turned into something you can fill in, save, and bring to an appointment. It will not decide anything for you. It gives you a way to look at what you are seeing, week by week, instead of carrying it all in your head at 3 a.m.
Hurt — pain and breathing
Is pain controlled? Is breathing easy and unlaboured?
Constant pain or struggling to breatheComfortable, breathing easily
Hunger — appetite
Are they eating enough, and willingly?
Refusing foodEating normally on their own
Hydration — drinking
Are they drinking enough to stay hydrated?
Not drinking, dehydratedDrinking well on their own
Hygiene — grooming and cleanliness
Can they keep themselves clean, or be kept clean comfortably?
Soiled, matted, unable to stay cleanClean and comfortable
Happiness — joy and connection
Do they still show interest in you, in food, in the things they loved?
Withdrawn, no interest, does not greet youInterested, connects with you
Mobility — getting around
Can they stand, walk and get to where they need to go?
Cannot stand or walk without helpMoves around normally
More good days than bad
Over this past week, which outweighed the other?
Mostly bad daysMostly good days
How to use it
- Score each of the seven areas from 0 (worst) to 10 (best). Score what you have seen over the last week, not just today — a single bad morning is not a whole picture.
- Save the score once a week, on the same day if you can. The trend over several weeks is far more useful than any single number.
- Look for any single area scoring 4 or below: that is usually the most useful thing to raise with your vet, even if the total looks acceptable.
- Bring the summary to your appointment. It turns "she just isn't herself" into something specific you can talk through together.
Questions people ask about this scale
Is 35 really the line?
The guidance usually quoted is that a total above 35 — roughly 5 out of 10 in each area — suggests an acceptable quality of life, while a lower score asks for a serious conversation. Treat it as a starting point rather than a pass/fail line. The scale exists to organise your observations, and no total replaces a hands-on examination by a vet who knows your animal.
Should I score every day?
Weekly is usually enough, and often more honest: scored daily, this tends to measure your anxiety as much as their condition. Pick a day, score it the same way each time, and note it down. If something changes suddenly — a bad night, a new symptom — score again and write down what changed.
Does a low score mean I have to decide now?
No. A low score means the balance has shifted, and that it is time to get help and information — not that a decision is due today. Many people find that sharing the numbers with their vet, and reading our guides on the quality-of-life scale and caring for them in the final weeks, makes the next weeks clearer and less lonely.
If you want to read more
- The quality-of-life scale, explained
- Caring for them through the final weeks
- When today feels unbearable — the SOS tool
If you want more than words
PetLoss is a private, offline companion: write to them, keep a memory timeline, and turn their photos into a keepsake. No account, nothing uploaded.
This tool is a structured way to observe and record what you are seeing. It is not a veterinary diagnosis and it does not replace an examination. If your pet is in pain or struggling to breathe now, contact your vet or an emergency clinic. If you are in crisis yourself, please reach out to a local support line — you do not have to hold this alone.