The HHHHHMM scale

Dr. Alice Villalobos, a veterinary oncologist, developed the HHHHHMM scale to help families think systematically about their pet's wellbeing. Each factor is scored from 0 (bad) to 10 (good). A total below about 35 suggests quality of life may be compromised.

It's not a diagnostic tool. It's a starting point for a conversation — with your family, with your regular vet, or with us.

• Hurt. Is pain being managed adequately? Can your pet breathe comfortably? Pain that medication isn't reaching is a strong signal.
• Hunger. Are they eating willingly? Have they lost interest in food they used to love? Is eating becoming difficult?
• Hydration. Are they drinking enough? Do they need supplementary fluids under the skin?
• Hygiene. Can they stay clean? Are they soiling themselves, or unable to groom? Are there sores that aren't healing?
• Happiness. Do they still show interest in things they once loved — greeting you at the door, looking out the window, resting on the couch with you?
• Mobility. Can they get up, go outside, use the litter box? Are falls happening? Are they isolating themselves because movement is too hard?
• More — more good days than bad. This is the one that matters most over time. When bad days consistently outweigh good ones, the balance has shifted.

Using the scale

Score each factor 0–10 and add them up. You don't need to be precise — this is a reflection tool, not a test. What usually matters more than the number is the direction. If last month your pet was a 60 and today they're a 40, something has changed, and it deserves attention.

Share your scores with your family. People who love the same pet often see different things, and a conversation anchored to specific factors (*"I've noticed the mobility is worse"*) is easier than a vague sense that something's wrong.

When the scale keeps pulling toward the same answer

There is no right or wrong day to say goodbye. Sometimes families wait; sometimes they decide earlier. Both are acts of love. The scale is not a countdown — it's a way to stay honest with yourself and with your pet about what you're seeing.

If you'd like to talk it through in person, an end-of-life consultation is $175 for an hour in your home with Dr. Erin.

Credit & further reading

The HHHHHMM scale is the work of Dr. Alice Villalobos, DVM — a pioneer of pawspice (hospice for pets). You can read more about her approach in her book Canine and Feline Geriatric Oncology (the lay-accessible chapters) or on the IAAHPC (International Association for Animal Hospice and Palliative Care) website.