The dog quality of life scale is a seven-part assessment that scores your dog’s current life across Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days Than Bad. It was created by veterinarian Dr. Alice Villalobos. Below, you can score your dog’s week and see what the total means.
1 of 7 · Hurt
How well can your dog breathe, and is their pain controlled with the medications they’re on?
Seven questions about this past week, not today and not the dog they used to be. Pick a number for each. You’ll see the score at the end.
Question 1 of 7. 0 answered.
What the score means
Seven areas, each scored one to ten, so the week lands somewhere between 7 and 70. The result names the week rather than grading the dog, and it changes with what pulled the score down.
- 61–70 A good week
- 50–60 Mostly well
- 38–49 A mixed week
- 25–37 A hard week
- 7–24 A week of struggle
Sixty-one and up means keep the sheet and stop bracing for a while. The fifties mean one area is slipping and is worth watching. The forties mean start keeping sheets. Below 38 is where families book the vet conversation, with the sheet in hand. None of it is a verdict, and the vet is the one who can tell you what it means for your dog.
When to use this scale
Most families come to a scale like this after something has shifted. Often it’s a diagnosis, or a vet visit where the word hospice came up for the first time. Sometimes it’s smaller than that, a morning where the dog didn’t get up for breakfast and you stood in the kitchen and noticed you weren’t surprised.
The scale earns its keep in the slow declines, where every day looks like the last one and you can’t tell anymore whether this week is worse than last month. It also helps in the weeks after a diagnosis, when the treatment is working or isn’t and you need some way of saying which. And a lot of people fill it in the night before a vet appointment, so they can walk in with something more than “she seems off.”
You don’t need to be in crisis to use it. Some people score an old dog once a month, for years, just to have a record. The scale works best when there are several of them to lay side by side.
What the seven dimensions mean
Hurt
Pain is the first thing the scale asks about, and the hardest to see. Dogs hide it. Look at the breathing when they’re resting, whether they flinch when you touch the usual places, whether the medication the vet gave is still doing its job by evening.
Hunger
Eating on their own, from the bowl, without being coaxed. Hand-feeding counts as a lower score, not a zero. A dog who eats only chicken from your palm is telling you something about the week.
Hydration
Drinking from the bowl, or getting fluids under the skin from the vet or from you at home. If they’re being given fluids and staying hydrated, score that honestly. If they’re refusing water and not getting fluids, that’s low.
Hygiene
Whether they can stay clean. When a dog can’t get up, they lie in what they’ve done, and that is its own kind of suffering. If you’re washing them every day and they still have sores, that is what a low score here looks like.
Happiness
Do they lift their head when you come in. Do they still want the toy, the window, the other dog. Is there still a tail. This one is about whether the dog you know is still in there, on most days.
Mobility
Getting up, walking to the bowl, going outside. A dog who needs a sling or a harness to stand can still have a middling score here if they want to move and can, with help. A dog who no longer tries is lower.
More Good Days Than Bad
The last question is the plainest one. Over the past seven days, were there more good days than bad? When the bad days start outnumbering the good, that ratio is the thing vets ask about first.
The score is not a verdict
The score is not a permission slip, and it is not a verdict. Some families score a 24 and choose to wait; others score a 50 and know. The number doesn’t make the decision. It gives you a way to see the week clearly when every day has started to feel the same, and it gives you something to put on the table at the vet’s office so the conversation starts from what you’ve both seen rather than from what you’re afraid of. Families who use this tend to score once a week and bring the sheets in. The vet is the medical partner. This is the seeing tool.
If you’re already after the loss, a permanent memorial page is where many families put their dog’s name and photo. And for families further along in the loss, the Rainbow Bridge tradition may help.
About Dr. Alice Villalobos and the HHHHHMM scale
Dr. Alice Villalobos is a veterinary oncologist and the founder of Pawspice, a program for hospice care in animals. She published the HHHHHMM scale in her book Canine and Feline Geriatric Oncology (Wiley-Blackwell), after years of using it with families in her own practice. The letters stand for the seven dimensions above, and the original version asks owners to score each from 1 to 10, with a total above 35 suggesting that quality of life is acceptable enough to continue hospice care.
Veterinary hospice programs around the world have used her scale since. The interactive version on this page is Rainbow Memorial’s, built to make her framework usable at a kitchen table rather than only in a clinic. The dimensions and their meaning are hers. The questions, the readings, and the printable sheet are ours, and nothing here replaces what your own vet will tell you when they examine your dog.
Questions people sometimes ask
What score means it’s time to say goodbye?
There is no such score. The scale is a framework for seeing the week; the decision is yours, made in partnership with your vet.
How often should I score my dog?
Weekly is common. Some families score daily during a hard week and weekly otherwise. Whatever helps you see the pattern.
Is this scale for cats too?
The HHHHHMM framework was designed for dogs and cats. This page is written for dogs.
Can I bring this to my vet?
Yes. That is what many families do. Download the PDF and hand it to your vet at the appointment.
Why does this exist?
Because seeing a week in numbers is different from remembering it in feelings. When every day feels the same, the scale gives you something to point at.
If the loss has already come
Some people find this page the week after, not the week before, looking for proof that they read the signs right. If that’s you, there are poems written for the day a dog passes, including one for the people who had to make the choice. And if you’re the friend or the sister rather than the owner, there’s a page on how friends and family can help.