What is the HHHHHMM scale?

The HHHHHMM scale is a quality of life assessment tool developed by veterinary oncologist Dr. Alice Villalobos. It evaluates seven factors: Hurt (pain), Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. Each factor is scored 0-10, with a total possible score of 70.

How often should I assess my cat's quality of life?

For senior cats (11+ years) or cats with chronic conditions, assess quality of life weekly or when you notice changes. For cats in hospice care, daily assessment may be appropriate. Regular tracking helps you identify trends and make informed decisions.

What score indicates poor quality of life?

A total score below 35 (average of 5 per category) is considered below acceptable quality of life. Scores of 28-34 warrant attention, and scores below 21 indicate significant suffering that should prompt an immediate veterinary consultation about all care options.

When should I consider euthanasia for my cat?

Euthanasia may be considered when quality of life is consistently poor despite medical management, when your cat has more bad days than good, or when suffering cannot be adequately controlled. This deeply personal decision should be made in consultation with your veterinarian who knows your cat's specific situation.

Can quality of life improve with treatment?

Yes, many conditions can be managed to improve quality of life. Pain medication, appetite stimulants, mobility aids, and environmental modifications can all help. Regular assessments help track whether treatments are working and guide adjustments to your cat's care plan.

Quality of Life Assessment

Use the HHHHHMM scale to objectively assess your senior or ill cat's comfort and quality of life. Rate each factor from 0-10.

Rate Each Factor

For 'Pain', 0 = no pain (good), 10 = severe pain (bad). For all other factors, higher scores are better.

Hurt (Pain)

Moderate

Is pain being successfully managed?

Pain is well controlled with minimal discomfortSevere pain that is difficult to manage

Hunger

Moderate

Is the cat eating enough to maintain nutrition?

Not eating, requiring hand feeding or feeding tubeEating well with good appetite

Hydration

Moderate

Is the cat staying adequately hydrated?

Severely dehydrated, may need subcutaneous fluidsDrinking normally, well hydrated

Hygiene

Moderate

Can the cat keep themselves clean?

Unable to groom, may have soiling issuesGrooming normally, coat in good condition

Happiness

Moderate

Does the cat experience joy, comfort, or contentment?

Depressed, withdrawn, no interest in surroundingsContent, purring, responsive to affection

Mobility

Moderate

Can the cat move around comfortably?

Immobile or in significant pain when movingMoving normally or with manageable limitations

More Good Days Than Bad

Moderate

Overall, are there more good days than bad?

Mostly bad days with rare good momentsMostly good days with manageable bad moments

Quality of Life Assessment

Rate Each Factor

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