Cat Quality of Life Calculator
Rate each of the seven HHHHHMM criteria on a 1-to-10 scale to get a total quality-of-life score for your cat. The scale was developed by veterinary oncologist Dr. Alice Villalobos and is widely used by vets, hospice teams and pet owners to guide decisions about ongoing care, palliative treatment, or humane euthanasia. A score above 35 is generally considered acceptable for continuing a care program. Your result updates as you type, and the steps panel shows exactly how the total is reached.
What is the HHHHHMM Quality of Life Scale?
The HHHHHMM scale was created by Dr. Alice Villalobos, a veterinary oncologist, as a practical tool to help pet owners and their veterinarians assess whether a seriously ill cat has an acceptable quality of life. The name is an acronym for the seven domains it measures: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. Each domain is scored on a 1-to-10 scale, where 1 represents the worst possible state and 10 represents optimal function. The seven scores are added together to produce a total out of 70. A total above 35 is considered acceptable for continuing a hospice care or treatment program. The scale is widely adopted by veterinary oncologists, palliative care specialists, and hospice programs around the world, and is regularly used by pet owners at home between vet visits.
How to score each of the seven criteria
Hurt covers both physical pain and respiratory comfort. A score of 10 means pain is absent or very well controlled by medication and breathing is easy; a score of 1 means pain is severe and breathing is laboured. Hunger reflects nutritional intake: a 10 means your cat is eating well and maintaining weight; a 1 means complete refusal of food and significant weight loss. Hydration scores how well your cat is taking in fluids, whether by drinking, eating wet food, or receiving subcutaneous fluids from a vet. Hygiene assesses coat condition and whether your cat is kept clean and free of sores from lying in waste; caregivers can improve this score through regular gentle brushing and bedding changes. Happiness evaluates mental engagement: does your cat still respond to family members, seek interaction, or show interest in favourite spots or toys? Mobility rates how freely your cat can move, reposition, and reach the litter box; aids such as ramps and orthopedic beds can help. More good days than bad is the most holistic item: consider the past week or two and judge whether the majority of days involved comfort and enjoyment or suffering and distress.
Using the score to guide care decisions
The HHHHHMM score is a structured starting point for a conversation with your veterinarian, not a final verdict. A total below 36 does not automatically mean your cat must be euthanised, just as a score above 35 does not mean everything is fine. Context matters: a cat with a score of 32 that responds well to new pain medication may climb above 35 within days. Equally, a cat whose score is consistently 38 but whose "more good days" criterion has been falling for three weeks may be declining even though the total looks acceptable. Re-score weekly, note which criteria are changing and in which direction, and share the trend with your vet. This gives your care team much richer information than a single snapshot reading.
Limitations and when to call your vet
The HHHHHMM scale is a subjective tool - two caregivers scoring the same cat on the same day may produce slightly different totals, and that is normal. It does not replace a clinical examination, blood work, imaging, or the professional judgement of a veterinarian. Certain conditions, such as feline cognitive dysfunction, uncontrolled seizures, or severe organ failure, can be difficult to capture fully in a 7-item scale. If your cat's score is below 36, or if any single criterion is a 1 or 2, or if you notice rapid deterioration over a few days, contact your veterinarian promptly rather than waiting for the next routine appointment. Emergency or out-of-hours services should be contacted if your cat is in obvious distress, unable to breathe comfortably, or unable to move at all.
HHHHHMM Scale score interpretation
| Total score | Band | Recommended action |
|---|---|---|
| 7-35 | Not acceptable quality of life | Urgent vet consultation - consider palliative or end-of-life care |
| 36-69 | Acceptable quality of life | Continue care; address any criterion scoring below 5 |
| 70 | Excellent (purrfect) quality of life | Maintain current care plan; re-score weekly |
Score bands as defined by Dr. Alice Villalobos. Each of the 7 criteria is rated 1-10; totals range from 7 to 70.
Frequently asked questions
What is a passing score on the cat quality of life scale?
A total score of 36 or above (out of 70) is generally considered the threshold for acceptable quality of life under the HHHHHMM system. A score between 36 and 69 suggests care is worth continuing, though criteria scoring below 5 warrant targeted attention. A score of 70 is considered excellent. Scores of 35 or below suggest quality of life is not currently acceptable, and a prompt veterinary consultation is advised.
How often should I use this calculator?
Score your cat at least once a week if they have a serious illness, and re-score within 48-72 hours of any significant change: a medication adjustment, a new symptom, a hospitalization, or an obvious shift in behaviour or appetite. Keeping a brief written or spreadsheet log lets you and your vet see trends that a single score cannot reveal. A falling trend across two or three consecutive weeks is often more meaningful than the absolute number on any one day.
Can I use this calculator for a healthy cat?
Yes, though the scale was designed for cats facing serious illness. For a healthy cat, most criteria will naturally score 8-10, producing a total in the high 50s or 60s. The tool becomes most valuable when a cat is elderly, chronically ill, recovering from surgery, or has received a serious diagnosis. It gives caregivers and vets a consistent framework rather than relying entirely on subjective impressions.
My cat scored below 35 - does that mean I have to euthanise them?
No. A score below 36 means quality of life is not currently acceptable at this moment, which should trigger an urgent conversation with your veterinarian about what can be changed. Often, adjusting pain medication, adding appetite stimulants, or providing subcutaneous fluids can raise several criteria within a few days. However, if the score remains low despite optimised medical care, and especially if most days are distressing rather than comfortable, euthanasia may be the most compassionate option. That decision belongs to you and your vet together.
Who created the HHHHHMM scale?
The scale was developed by Dr. Alice Villalobos, a veterinary oncologist and founder of Pawspice, a quality-of-life-focused hospice program for pets. She published the scale in the textbook "Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond" (2004). It has since been adopted widely in veterinary oncology and palliative care, and adapted for use by pet owners between clinical visits.