HHHHHMM scale assessment
If you're here, you're probably facing one of the hardest parts of loving a dog.
This calculator won't make the decision for you. No tool can, and no tool should. What it can do is give you a clear, honest picture of where your dog is right now, so you can have a better conversation with your vet and with yourself.
Take your time. There are no wrong answers here.
This can be hard.
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HHHHHMM scale · 1 of 7
Is your dog's pain being managed?
Observe breathing, posture, facial expression, response to touch, and vocalizations.
Moderate pain; managed with medication
Observation guide: Signs of pain can include panting at rest, reluctance to move, a hunched posture, glazed eyes, whimpering, or unusual quiet.
HHHHHMM scale · 2 of 7
Is your dog eating enough to maintain body weight?
Notice whether eating is voluntary, needs encouragement, or has stopped completely.
Eating very little; requires encouragement
Observation guide: Hand-feeding or syringe support counts when your dog accepts it calmly. Forced feeding that causes distress does not.
HHHHHMM scale · 3 of 7
Is your dog adequately hydrated?
Check drinking, gum moisture, urine output, and whether skin returns quickly after a gentle pinch.
Reduced hydration; occasional subcutaneous fluids
Observation guide: Skin that snaps back immediately is reassuring. Skin that returns slowly can suggest dehydration and should be discussed with a vet.
HHHHHMM scale · 4 of 7
Can your dog be kept clean and comfortable?
Consider incontinence, pressure sores, matting, wound care, oral discomfort, and bedding comfort.
Requires significant grooming assistance
Observation guide: Dignity in care matters. The question is not whether care takes effort, but whether comfort can still be maintained.
HHHHHMM scale · 5 of 7
Does your dog express interest in life?
Look for response to your voice, favorite places, touch, toys, treats, family, and surroundings.
Some good moments; often withdrawn
Observation guide: A dog who still lights up for something they love is telling you something important. A dog who withdraws from everything is also telling you something.
MHHHHMM scale · 6 of 7
Can your dog move with reasonable comfort?
Consider standing, repositioning, toileting, reaching food and water, and moving to favorite spots.
Needs assistance for some activities
Observation guide: Slings, carts, ramps, and non-slip flooring count when your dog tolerates them willingly and they preserve comfort.
MHHHHMM scale · 7 of 7
When you look at the past week, does your dog have more good days than bad?
Think about the whole week, not only today. Good days should be recognizable, not something you have to search hard to remember.
About equal good and bad days
Observation guide: This is often the most important question. If you are struggling to remember the last truly good day, that matters.
Quality of Life Assessment
42 / 70
HHHHHMM total score
This score calls for an honest conversation with your veterinarian about pain control, palliative care, and what changes would mean the plan is no longer working.
Dimension breakdown
Outer ring = 10
Hurt: 6/10
Signs of pain can include panting at rest, reluctance to move, a hunched posture, glazed eyes, whimpering, or unusual quiet.
Hunger: 6/10
Hand-feeding or syringe support counts when your dog accepts it calmly. Forced feeding that causes distress does not.
Attention needed
No single dimension is at 3 or below right now. Keep watching the lowest areas and bring the full assessment to your veterinarian if you feel uncertain.
Track over time
Support resources
For your dog
For you
HHHHHMM scale
The HHHHHMM scale was developed by Dr. Alice Villalobos, a veterinary oncologist and pioneer in pet hospice and palliative care. The letters stand for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. Each category is scored from 1 to 10, creating a total score out of 70.
The value of the scale is not that it turns love into arithmetic. Its value is that it gives you a shared language when emotion is overwhelming. It helps you notice whether the same concerns keep returning, whether one dimension is dangerously low, and whether the trend is moving toward comfort or away from it.
A total score of 35 is often used as a reference threshold, but it is not a rule that decides for you. A dog below 35 may still have treatable comfort needs, while a dog above 35 may still be suffering if pain, breathing, or fear is severe. Use this result as a conversation starter with your veterinarian, not a final verdict.
Pain guide
Dogs often hide pain. In the wild, visible weakness can be dangerous, and at home chronic pain may become part of a dog's daily pattern. That means obvious crying is not the only sign that matters. A quiet dog who withdraws from touch, changes posture, pants at rest, or stops seeking favorite routines may be telling you that comfort is slipping.
Normal aging may slow a dog down. Pain changes the emotional quality of the day. An older dog may move slowly but still engage with life. A dog in pain often pulls away from life: fewer greetings, fewer choices, less curiosity, and less light in the eyes. When in doubt, ask your veterinarian to do a pain-focused exam.
Comfort care
Palliative care does not mean giving up. It means the main goal becomes comfort, dignity, and good moments. It can happen alongside active treatment, or it can become the main plan when cure is no longer possible.
Ask your vet about NSAIDs such as carprofen or meloxicam, gabapentin for nerve pain, and whether medication timing or combinations need review.
Orthopedic bedding, non-slip flooring, ramps, raised bowls, and keeping food, water, and toileting access on one level can reduce daily strain.
Warm food to increase aroma, offer small frequent meals, ask about nausea control or appetite support, and discuss fluids when hydration is slipping.
Keep familiar routines, reduce noise and stress, offer gentle touch if welcomed, and create small good moments around the things your dog still enjoys.
The hardest decision
There is no perfect moment. There is no decision that will feel completely right. What there is: the knowledge that choosing a peaceful death over prolonged suffering can be one of the most profound acts of love a person can offer.
Most people fear two things at once: acting too early and taking away possible good time, or waiting too long and allowing unnecessary suffering. That conflict is not weakness. It is what love feels like under pressure.
Some vets suggest the "last good day" question: imagine your dog's best day in the last month. Is that day still possible? If the answer is no, or you cannot remember when that day was, it may be time for a more direct conversation.
Grief after losing a pet is real grief. The pain you feel is proportional to the love you gave. Be gentle with yourself.
Tracking
A single score can be shaped by one unusually good or unusually bad day. A trend shows whether comfort is holding, improving, or declining. That trend can be one of the most useful pieces of information you bring into a veterinary appointment.
Try scoring at the same time each week. Add short notes about eating, sleep, medication, favorite moments, accidents, or anything that changed. If a new treatment begins, score more often until you know whether it is helping.
What to bring to the appointment
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FAQ
The HHHHHMM scale is a seven-dimension quality of life assessment developed by veterinary oncologist Dr. Alice Villalobos. It scores Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad from 1 to 10, for a total score out of 70. A score of 35 or higher is commonly used as a reference point for acceptable quality of life, but it is not an absolute rule.
Important signs include uncontrolled pain, difficulty breathing, inability to eat or drink, loss of interest in people or routines, inability to stay clean or reposition, and more bad days than good. The HHHHHMM scale gives structure to those observations, but your veterinarian should help interpret what they mean for your dog.
Below 35 is the traditional concern threshold, but no single score should make the decision alone. Trend over time, very low scores in a single dimension, pain control, breathing, appetite, hydration, and your veterinarian's exam all matter. A dog above 35 can still be suffering, and a dog below 35 may still have treatable comfort needs.
Watch posture, breathing, facial expression, willingness to move, reaction to touch, sleep changes, and behavior. Dogs may hide pain, so quiet withdrawal, glazed eyes, panting at rest, reluctance to lie down, or a hunched stance can matter as much as crying or limping.
Palliative care focuses on comfort and quality of life rather than cure. It can include pain medication, nausea support, appetite help, fluids, bedding changes, non-slip flooring, mobility aids, hygiene support, and routines that reduce fear or stress.
There is rarely a perfect moment, and fear of acting too early or too late is very common. If pain cannot be controlled, your dog cannot eat or drink, breathing is difficult, or bad days clearly outnumber good days for two or more weeks, it is time for an honest conversation with your veterinarian.
The process usually starts with a sedative so the dog becomes calm or asleep. A second medication then stops the heart, typically within seconds. Many clinics and some in-home services allow family to stay close. Your vet can explain exactly what to expect before anything happens.
Pet loss grief is real grief. Feeling sadness, guilt, anger, numbness, or doubt is normal. Support can come from your veterinarian, pet loss hotlines, grief counselors, online groups, and people who understand the bond you had with your dog.
Yes. Many veterinarians recognize the scale, and bringing a completed assessment can focus the appointment. It helps turn emotional observations into a shared discussion about comfort, pain control, trend, and next steps.
Weekly is reasonable for stable chronic illness. Daily or every few days is better when the condition is changing, after a new diagnosis, after medication changes, or when you are trying to understand whether good days still outnumber bad days.