Quality of Life Assessment

A clearer picture of how your pet is doing.

When changes happen gradually, it can be difficult to step back and see how much your pet’s day-to-day life has changed.

This guided assessment looks at seven important areas of quality of life and can help you notice patterns in your pet’s comfort, function and enjoyment.

This is a reflection tool, not a test. A number cannot decide when it is time to say goodbye. The assessment is designed to help you look at the whole picture and have a more informed conversation with your veterinarian.
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Veterinary professional providing gentle care and reassurance

Quality of Life Assessment

Compassionate Paws · Perth, Western Australia

Think about life as it is now.

Score each area from 1 to 10. A low score means your pet is experiencing significant difficulty in that area, while 10 represents the best possible situation for them.

Try to think about your pet’s usual experience over the last two or three days rather than one unusually good or difficult moment. For the final question, think about the overall pattern across approximately the last week.

First, is anything worrying you right now?

These concerns are considered separately from the numerical score. Tick anything that applies at the moment.

Your answers describe a potentially significant welfare concern.

Severe pain, breathing difficulty, collapse or significant distress should be considered independently of the total score. If your pet is currently in significant distress, please contact your veterinarian or an emergency veterinary service promptly.

01 Hurt & comfort

How comfortable is your pet, including their pain and breathing?

Think about whether they can rest and sleep comfortably, signs of pain or distress, persistent panting or restlessness, and whether they can breathe comfortably at rest.

Common signs of pain to look for

Pain is not always obvious, and many pets will not cry or vocalise. Compare what you are seeing with what is normal for your pet.

Movement Slower or hesitant movement, stiffness, limping, difficulty standing or lying down, reluctance to use stairs or jump, slipping, or avoiding normal activities.
Rest and posture Repeatedly changing position, difficulty settling, unusual sitting or lying positions, a hunched or tense posture, or disturbed sleep.
Behaviour Becoming quieter, withdrawn or less social, hiding, seeming unusually restless, irritable or anxious, or losing interest in normal routines.
Touch and handling Flinching, guarding an area, moving away from touch, becoming tense when handled, or reacting in a way that is unusual for them.
Face and expression A tense facial expression, squinting or narrowed eyes, changes in ear position, or appearing less relaxed than usual.
Everyday activities Difficulty eating, grooming, toileting, getting comfortable, following you around or doing activities they would normally choose to do.

You do not need to press, manipulate or deliberately test a painful area. What your pet does naturally at home often tells you more. Short videos of changes in walking, rising, resting or behaviour can also be useful to show your veterinarian.

1 — frequent or severe signs of discomfort; unable to rest, move or settle comfortably despite support 5 — noticeable pain-related changes most days; movement or rest is affected, but reasonable comfort can still be achieved 10 — resting, moving, sleeping and interacting normally for them, with no obvious pain-related change
This area is currently rated very low and deserves particular attention regardless of the overall score.
02 Hunger

How well is your pet eating?

Consider whether they willingly eat enough, still seem interested in or enjoy food, and how much encouragement, hand feeding or other assistance is needed.

1 — eating very little or unable to maintain adequate nutrition 5 — reduced intake with regular encouragement or assistance 10 — eating normally and willingly
This area is currently rated very low and deserves particular attention regardless of the overall score.
03 Hydration

How well is your pet maintaining hydration?

Think about drinking, access to water, signs of dehydration, and whether additional fluid support is needed and tolerated.

1 — hydration is very difficult to maintain 5 — active support is regularly needed 10 — maintaining hydration well
This area is currently rated very low and deserves particular attention regardless of the overall score.
04 Hygiene & toileting

Can your pet toilet comfortably and remain clean and dry?

Consider accidents, incontinence, diarrhoea or constipation, grooming, skin irritation and whether they can reach an appropriate toileting area.

1 — unable to toilet or remain clean without substantial distress 5 — regular help needed but comfort can usually be maintained 10 — toilets comfortably and remains clean
This area is currently rated very low and deserves particular attention regardless of the overall score.
05 Happiness & engagement

Does your pet still experience enjoyment and meaningful connection?

Think about family, affection, favourite foods, walks, sniffing, toys, sunshine, familiar resting places or the individual things that have always mattered to your pet.

1 — very little apparent enjoyment or substantial emotional distress 5 — intermittent enjoyment with noticeable withdrawal 10 — normal interest, enjoyment and interaction
This area is currently rated very low and deserves particular attention regardless of the overall score.
06 Mobility & independence

Can your pet move well enough to meet their basic needs comfortably?

Consider getting up, walking, reaching food and water, toileting, slipping or falling, and how much assistance is required.

1 — unable to move enough to meet basic needs comfortably 5 — regular assistance or substantially reduced mobility 10 — comfortable and independent mobility
This area is currently rated very low and deserves particular attention regardless of the overall score.
07 More good days than difficult days

Looking back over approximately the last week, how does the overall balance feel?

A good day should mean your pet was genuinely comfortable and able to experience some of the things that matter to them, rather than simply being a day when nothing went badly wrong.

1 — almost every day has been difficult 5 — roughly equal good and difficult days 10 — almost every day has been genuinely good
This area is currently rated very low and deserves particular attention regardless of the overall score.

A little more to think about.

These questions do not change the numerical score. They are included because quality of life cannot be fully represented by a number.

Your overall score will appear here.

Choose a score for each of the seven areas above.

Your quality-of-life picture.

/ 70

Look at the number — but also look beyond it.

The total can help give structure to what you are seeing, but the individual areas that scored lowest can be just as important as the overall number.

At least one area is currently rated 3 or below.

An overall score can hide significant difficulty in one particular area. We recommend paying particular attention to that part of your pet’s quality of life and discussing what you are seeing with your veterinarian.

What does the total mean?

In the HHHHHMM framework, a total above 35 out of 70 has traditionally been used as a reference point for acceptable quality of life while continuing hospice or palliative care.

This should not be treated as a euthanasia threshold. A score of 35 or below is a reason to look more closely at your pet’s comfort and discuss what you are seeing with your veterinarian. Severe pain, breathing difficulty or significant distress matter regardless of the total.

Keep this assessment to compare later.

Use your browser’s Print option and choose Save as PDF. Your saved copy will include the Compassionate Paws logo, assessment title, pet details, date, selected scores, overall score and your optional notes.

On a computer, you can usually open Print with Ctrl + P on Windows or Command + P on Mac.

Evidence behind this assessment.

This assessment uses an established veterinary end-of-life framework as its scoring backbone and draws on contemporary research into canine and feline quality of life.

What is the HHHHHMM Quality of Life Scale?

The scored part of this assessment is based on the HHHHHMM Quality of Life Scale developed by veterinary oncologist Dr Alice Villalobos for animals receiving palliative and end-of-life care.

The seven areas are Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More Good Days Than Bad.

The purpose of a tool like this is not to make the decision for you, but to provide a more structured way of thinking about changes that may otherwise be difficult to see.

Villalobos A. Quality of Life Scale — The HHHHHMM Scale. Veterinary Practice News.

Has the HHHHHMM scale been studied?

A peer-reviewed 2023 study evaluated the HHHHHMM scale in 314 companion-animal owners. The study used a 1–10 response scale for each of the seven areas.

The scale demonstrated good internal consistency. The initial one-factor model had partially adequate fit, while a modified model showed good fit.

This supports use of the scale as a structured quality-of-life tool, but does not mean that one numerical score can determine whether euthanasia is appropriate for an individual animal.

Testoni I, De Vincenzo C, Campigli M, et al. Validation of the HHHHHMM Scale in the Italian Context. Animals. 2023;13:1049. PMID: 36978590.

Why consider more than physical illness?

The AAHA/IAAHPC End-of-Life Care Guidelines describe quality of life as involving physical, social and emotional wellbeing.

Their end-of-life considerations include pain, breathing, eating and drinking, elimination, mobility, interaction, environmental comfort and emotional wellbeing.

American Animal Hospital Association and International Association for Animal Hospice and Palliative Care. End-of-Life Care Guidelines for Dogs and Cats.

What does broader quality-of-life research show?

A 2022 review identified nine published generic quality-of-life instruments for dogs and cats. Activity, interaction and appetite appeared repeatedly across different tools.

The review also found considerable variation in how veterinary quality-of-life tools have been developed and validated. No generic instrument in that review had been validated across every psychometric property considered.

Fulmer AE, Laven LJ, Hill KE. Quality of Life Measurement in Dogs and Cats: A Scoping Review of Generic Tools. Animals. 2022;12:400. PMID: 35158723.

What does newer dog and cat research add?

Contemporary canine quality-of-life research supports a multidimensional approach rather than relying on one clinical sign alone.

Recent feline research has similarly validated quality-of-life dimensions including activity, relaxation, mobility, appetite and sociability.

Lavan RP et al. Development and Validation of a Canine Health-Related Quality of Life Questionnaire. Animals. 2023. PMID: 37893979.

Albergante L et al. A new generic feline quality of life questionnaire: development and validation. Journal of Feline Medicine and Surgery. 2026. PMID: 42363431.

Important limitation

This Compassionate Paws web assessment has not itself undergone independent psychometric validation.

It uses the established HHHHHMM framework for the numerical score, with explanatory wording informed by veterinary end-of-life guidance and quality-of-life research.

It is intended to help families notice patterns, monitor change and have more informed conversations with their veterinarian. It does not diagnose illness and cannot determine on its own whether euthanasia is appropriate.

You do not have to interpret this alone.

If this assessment has raised questions or you are uncertain about what you are seeing, please get in touch. We are happy to talk through your concerns and help you consider what may be most appropriate for your pet.

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