The HHHHHMM Scale
Quality Of Life Worksheet
Use a scale of 1-poor to 10-best.
Over 35 points is considered an acceptable quality of life. Under 35 points is unacceptable and medical care must be improved or euthanasia considered.
Quality of Life Scale1
Score patients using a scale of 1 to 10.
Answer EVERY question.
HURT – Adequate pain control, including breathing ability, is first
and foremost on the scale. Is the pet’s pain successfully managed? Is
HUNGER – Is the pet eating enough? Does hand feeding help? Does
the patient require a feeding tube?
HYDRATION – Is the patient dehydrated? For patients not drinking
enough, use subcutaneous fluids once or twice daily to supplement
HYGIENE – The patient should be brushed and cleaned, particularly
after elmination. Avoid pressure sores and keep all wounds clean.
HAPPINESS – Does the pet express joy and interest? Is the pet
responsive to things around him or her (family, toys, etc.)? Is the pet
depressed, lonely, anxious, bored or afraid? Can the pet’s bed be
close to the family activities and not be isolated?
MOBILITY – Can the patient get up without assistance? Does the
pet need human or mechanical help (e.g. a cart)? Does the pet feel
like going for a walk? Is the pet having seizures or stumbling?
(Some caregivers feel euthanasia is preferable to amputation, yet an
animal who has limited mobility but is still alert and responsive can
have a good quality of life as long as caregivers are committed to
helping the pet.)
MORE GOOD DAYS THAN BAD – This is my favourate because it is more of a feeling. This when bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
TOTAL= A total more than 35 points is acceptable
Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN,
09/2004,for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006.