Quality of Life Scale

This scale can help one in determining an animal's quality of life and may be helpful for you when considering end of life options. Every animal is an individual and you know your animal best but it helps to look at these elements and make a comparison to how the animal was weeks and months prior. 


Quality of Life Scale (HHHHHMM Scale)
Using a scale of 0 to 10 (0 = Unacceptable, 10 = Excellent), animals may be evaluated for their quality of life.

Score Criterion
0-10 Hurt—Is the patient in pain, including distress from difficulty in breathing?
Can the pet’s pain be successfully managed? Is oxygen necessary?

0-10 Hunger—Is the pet eating enough? Does hand-feeding help? Does the pet require a feeding tube?

0-10 Hydration—Is the pet dehydrated? Are subcutaneous fluids once or twice daily enough to resolve the problem? Are they well tolerated?

0-10 Hygiene—The pet should be kept brushed and clean, particularly after elimination. Does the pet have pressure sores?

0-10 Happiness—Does the pet express joy and interest? Is he responsive to things around him (family, toys, etc)? Is the pet depressed, lonely, anxious, bored, or afraid? Can the pet’s bed be near the kitchen and moved near family activities to minimize isolation?

0-10 Mobility—Can the pet get up without assistance? Does the pet need human or mechanical help (eg, a cart)? Does she feel like going for a walk? Is she having seizures or stumbling? Note: Some caregivers feel euthanasia is prefer- able to amputation, yet an animal with limited mobility may still be alert and responsive, and can have a good quality of life as long as the family is commit- ted to quality care.

0-10 More Good Days than Bad—When bad days outnumber good days, the pet’s suffering is appreciable and quality of life might be too compromised. When a healthy human-animal bond in no longer possible, the caregiver must be made aware that the end is near.

Total: A total of > 35 points is acceptable quality of life for pets.

Adapted from Canine and Feline Geriatric Oncology: Honoring the Human–Animal Bond, Villalobos A, Kaplan L—Hoboken, NJ: Wiley-Blackwell, 2007, with permission. 

Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.

Alice Villalobos, DVM, DPNAP, a renowned veterinary oncologist, introduced “Pawspice”, a quality of life program for terminally ill pets. Pawspice starts at diagnosis and includes symptom management, gentle standard care and transitions into hospice as the pet nears death. Dr. Villalobos developed this scoring system to help family members and veterinary teams assess a pet’s life quality.