The HHHHHMM Quality of Life Scale

The HHHHHMM scale will help you evaluate your pet’s quality of life during Pawspice (palliative care).

For each Quality of Life marker below, click a score from 0 to 10.
Then, add up all responses. A total above 35 points is an acceptable Quality of Life for terminal pets to remain in Pawspice care.
0 represents the worst score, and 10 the best.
HURT                                                   0  1  2  3  4  5  6  7  8  9  10 
What is your pet’s pain level? Adequate pain control, including breathing ability, is first and foremost on the scale. Is breathing difficult? Is Oxygen necessary? If your pet is desperate for breath, this takes all priority and Pawspice should end. Is your pet's pain recognized and successfully managed with adequate pain medications that provide comfort?
HUNGER                                                 0  1  2  3  4  5  6  7  8  9  10 
Does hand-feeding help maintain weight? Does your pet require a feeding tube?
HYDRATION                                            0  1  2  3  4  5  6  7  8  9  10 
For pets not drinking enough water, provide sub cutaneous fluids once or twice daily, to supplement fluid intake.
HYGIENE                                               0  1  2  3  4  5  6  7  8  9  10 
Your pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores by using soft bedding. Keep all wounds clean on a daily basis.
HAPPINESS                                            0  1  2  3  4  5  6  7  8  9  10 
Does your pet express joy and interest? Is he responsive to things around him (family, toys, etc)?  Is he depressed, lonely, anxious, bored or afraid?  Keep your pet's bed near family activity areas so he won’t be or feel isolated.
MOBILITY                                                0  1  2  3  4  5  6  7  8  9  10
** Score each question below 0=No, 10=Yes. Add up and divide by 5. 
Can your pet get up without assistance? ___
Does he feel like going for a walk? ___
Is he happy, not depressed? ___
Can he get around without assistance, human or mechanical help, or a cart? ___
Is your pet free from trembling, seizures or stumbling? ___
MORE GOOD DAYS THAN BAD               0  1  2  3  4  5  6  7  8  9  10 
Do bad days outnumber good days? If so, quality of life might be too compromised to continue life. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The final decision must be made if a pet is suffering so that death can come peacefully and painlessly.

The HHHHHMM QoL Scale above was originally published in Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, by Alice Villalobos, DVM, DPNAP, with Laurie Kaplan, MSC (Wiley-Blackwell, 2007). Adapted by Dr. Villalobos for So Easy to Love, So Hard to Lose: A Bridge to Healing Before and After the Loss of a Pet by Laurie Kaplan (JanGen  Press, 2010).