Senior care
Quality of life
The HHHHHMM scale, how to score it, and how to use it kindly.
Veterinarian Dr. Alice Villalobos, a pioneer of pet hospice care, created the HHHHHMM scale to help families and vets talk about quality of life as dogs age or face serious illness.1,2 Each category is scored 0–10, where 10 is ideal.2
| Category | Ask yourself |
|---|---|
| Hurt | Is pain controlled? Can they breathe comfortably? Trouble breathing outweighs everything else. |
| Hunger | Are they eating enough? Does hand-feeding help? |
| Hydration | Are they drinking enough, or do they need fluids? |
| Hygiene | Can they stay clean? Are sores or soiling under control? |
| Happiness | Do they show joy and interest, or seem anxious, bored or afraid? |
| Mobility | Can they get up without help? Any falls or stumbling? |
| More good days than bad | When bad days outnumber good ones, quality of life may be too compromised. |
In Dr. Villalobos’s framework, a total above 35 (out of 70) represents acceptable quality of life for continuing comfort-focused care.2 She also notes that more than 3–5 bad days in a row tends to go along with a score below 35.1
Use it for trends, not verdicts
The senior care guidelines point out that most online quality-of-life scales haven’t been scientifically validated,3 and Dr. Villalobos says the same about research in this area.1 The most useful thing is doing it regularly and bringing the history to your vet. The guidelines also suggest marking good and bad days on a calendar.3
Sources
- Quality of Life to the End of Life: We Owe It to Them! — Alice Villalobos, DVM, DPNAP — The Latham Letter
- Quality of Life Scale (HHHHHMM), reprinted with permission — Alice Villalobos, DVM
- 2023 AAHA Senior Care Guidelines for Dogs and Cats (JAAHA 59:1) — Dhaliwal R, et al., American Animal Hospital Association
Sources checked September 2026. This guide is general education, not veterinary advice for a specific dog.