Quality-of-life guidance

How to know when it’s time

There is rarely one clear sign. Looking at your pet’s comfort and happiness day by day can make an overwhelming question feel a little more manageable. This simple checklist can help you notice changes and talk them through with your veterinarian.

Written and reviewed by Dr. Ruth Eriksson, VMD · Updated October 2026

Checklist for dogs Checklist for cats

The HHHHHMM scale

Seven areas of your pet’s well-being

Many veterinarians use the HHHHHMM Quality of Life Scale, developed by veterinarian Dr. Alice Villalobos, to look at a pet’s well-being in seven areas. Each area is scored from 0 to 10, where 10 is ideal.

Hurt

Is pain well controlled? Can your pet breathe comfortably?

Hunger

Is your pet eating enough on their own, or only with coaxing or hand-feeding?

Hydration

Is your pet drinking enough, or needing extra fluids to stay hydrated?

Hygiene

Can your pet stay clean and comfortable, without soiling or sores from lying down?

Happiness

Does your pet still show interest, enjoyment, and connection with the family?

Mobility

Can your pet get up, move around, and reach the places that matter to them?

More good days than bad

When hard days begin to outnumber good ones, quality of life may be slipping.

Dr. Villalobos suggests that a total score above 35 out of 70 may indicate an acceptable quality of life when good supportive care is in place. The score is a guide, not a verdict. It is meant to support your judgment and your conversations with your veterinarian, not to make the decision for you.

How to use it

Using the checklist

Score your pet at about the same time of day, every day or every few days, so changes are easier to see.
If others in your family know your pet well, have each person score separately, then compare.
Use the good day / hard day tracker to see the overall pattern over two weeks.
Keep the sheet handy for your next veterinary visit, or when you call Dr. Ruth.

If your pet is in pain or distress right now, please don’t wait for a score. Contact your veterinarian or, after hours, your nearest emergency veterinary hospital.

Printable checklists

Quality-of-life checklists for dogs & cats

Type in your scores and the total adds up automatically, or print a blank copy to fill in by hand.

Calm GoodbyesYour Mobile Vet

Quality-of-Life Checklist: Dogs

Pet’s nameDateScored by

Score each area from 0 (poor) to 10 (ideal).

Area	What to look for	Score 0–10
Hurt	Panting or restlessness at rest, trembling, whimpering, trouble getting comfortable, labored breathing.
Hunger	Eating less or refusing food, needing hand-feeding or coaxing, losing weight.
Hydration	Drinking much less, dry or sticky gums, needing fluids under the skin.
Hygiene	Accidents indoors, a soiled or matted coat, urine scald, sores from lying down.
Happiness	Less tail wagging or greeting, losing interest in walks, toys, or family; seeming withdrawn or anxious.
Mobility	Struggling to stand, slipping or falling, avoiding stairs, shorter walks, needing support to get up.
More good days than bad	Looking at the past week or two, are good days still outnumbering hard ones?
Total	Add the seven scores (out of 70)

A total above 35 may indicate an acceptable quality of life with good supportive care. Lower or falling scores are a good reason to talk with your veterinarian.

Good day / hard day tracker: mark ✓ for a good day or ✗ for a hard day

1234567891011121314

Questions? Call or text Dr. Ruth or a team member: 484-301-0891 · info@calmgoodbyes.comAdapted from the HHHHHMM Quality of Life Scale by Alice Villalobos, DVM

Calm GoodbyesYour Mobile Vet

Quality-of-Life Checklist: Cats

Pet’s nameDateScored by

Score each area from 0 (poor) to 10 (ideal).

Area	What to look for	Score 0–10
Hurt	Hiding, a hunched posture, squinting, sensitivity to touch, fast or open-mouth breathing.
Hunger	Skipping meals or eating very little, losing weight. Cats that stop eating can become very sick quickly.
Hydration	Drinking much less, dry or sticky gums, needing fluids under the skin.
Hygiene	No longer grooming, a greasy or matted coat, missing the litter box.
Happiness	Less purring or seeking company, hiding more, no interest in favorite spots or play.
Mobility	No longer jumping up to favorite places, wobbly walking, trouble reaching the litter box.
More good days than bad	Looking at the past week or two, are good days still outnumbering hard ones?
Total	Add the seven scores (out of 70)

A total above 35 may indicate an acceptable quality of life with good supportive care. Lower or falling scores are a good reason to talk with your veterinarian.

Good day / hard day tracker: mark ✓ for a good day or ✗ for a hard day

1234567891011121314

Questions? Call or text Dr. Ruth or a team member: 484-301-0891 · info@calmgoodbyes.comAdapted from the HHHHHMM Quality of Life Scale by Alice Villalobos, DVM

Here when you need support

You don’t have to decide alone.

If you’re unsure what the scores mean or what you’re seeing at home, call or text Dr. Ruth or a team member. They can talk it through with you and help you understand your options.

Call 484-301-0891 Text Dr. Ruth

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