Quality of Life Scale for Dogs: FAQ for Loving Owners

Dogs become our family members. When you are a dog owner, you are responsible for protecting him, taking care of him, and just being there for him- as you would with any family member. Unfortunately, there may be a time when your dog gets sick or old, and some serious, often heartbreaking decisions may need to be made about how to proceed. The decision to euthanize a dog (or when to put your dog down) is a challenging and complex decision dog owners have to make. You cherish your dog and don't want him to leave you, but simultaneously you also want your dog to have a decent quality of life

Every single pet has specific needs that need to be recognized and respected. "Quality of life" is a way to refer to and discuss the day-to-day lifestyle of a dog who is nearing the end of its natural life. If the basic needs of an ailing or chronically ill dog can be met satisfactorily, then your efforts in keeping your dog alive are justified. This article will discuss some ways to assess your dog's quality of life, if they will be able to enjoy the time they have left in this world fully, or if you should put them down.

Related: Can Dogs Take Human Vitamin Supplements?

Conditions That May Deteriorate A Dog's Quality Of Life 

Most older pets develop one or more medical conditions that tend to get worse as time goes on. Some chronic medical conditions commonly found in older dogs include:

  • Cancer: All types of cancer risks go up with age
  • Deafness: As the eardrum becomes less flexible, hearing deteriorates
  • Blindness: Generally happens gradually due to changes in the lens of the eye
  • Overweight/obesity: Over 50% of senior dogs are over their ideal weight, lowering their overall quality of life
  • Chronic renal disease: Degenerative kidney disease can result in decreased kidneys' ability to filter biological waste from the blood.

Measuring Your Dog's Quality Of Life

Top veterinary oncologist Dr. Alice Villalobos has developed a quality-of-life scale for dogs so that owners can help their beloved animals as their pet's life comes to an end. The quality-of-life scale Dr. Villalobos formulated offers guidelines to assist veterinarians and owners in working in conjunction to maintain a healthy human-animal bond. This scale functions as a tool for measuring the success of a hospice or palliative care plan for a dog with a life-limiting disease, and to improve that care/plan. The quality-of-life scale developed by Dr. Villabos examines seven different categories. Each parameter is scored from 1 to 10, going from worst to best. If a dog scores above 5 in each category, or an average total score greater than 35, it lets us know that the dog's quality of life is still reasonable and that continuing end-of-life care and support is justified. "HHHHHMM" is an acronym for the categories. The letters' list stands for: "Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad." 

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HHHHHMM Quality of Life Scale for Dogs


Acceptable levels of pain control, especially the ability to breathe correctly, are a baseline for pain. Many pet owners are unaware that breathing properly is one of the most crucial pain management strategies. Receiving oxygen at home may benefit an ailing or chronically ill dog, and it may not be as challenging to institute as you think. Other ways of controlling pain may include injectable or oral medication.


Fluid under the skin is a simple, easily-tolerated way to supplement the liquids an ailing dog can drink on his own. This easily-implemented measure can assist an older dog and make him feel better.


Hand-feeding may help dogs who are unable to eat properly or willingly. If this method proves unsuccessful, then a feeding tube may be appropriate, especially if the dog requires oral medication. Another alternative is liquid or blended diets. 


Can the dog be adequately combed, brushed, and kept clean? If the dog has an accident, can it move away from the urine or stool? Is the dog's coat matted? Does it have a tumor that gives off discharge or an odor because it has outgrown its blood supply? Often, dead cells can be cleared away gently with a diluted solution of soap from your veterinarian on a washcloth or sponge. You should work out the details of this kind of palliative care with your vet or vet healthcare team. To prevent bedsores, it is vital to regularly turn bedridden pets around, ensure they have enough padding underneath, and keep them clean and dry. 

Related: Why Dogs Eat Grass


Is the dog able to regularly experience mental stimulation or joy? Dogs communicate through wagging tails and their eyes. Is the dog able to interact with its environment and family members? Help a dog remain engaged in life by placing comfortable beds near areas where the family congregates. Dogs can become depressed when they are separated from their pack because they are highly social animals. 


Mobility devices may be an option for dogs who can no longer get around on their own. In some instances, a sling or harness for support is enough. Other options include four-wheel carts, two-wheel carts, and wagons, depending on how much support is necessary. Mobility devices help a dog remain active. This is especially critical for larger dogs who cannot be easily carried to different locations. If a dog is bedridden, hygiene and mobility go hand-in-hand. When working through mobility issues, you should always consult with your veterinarian. 

More Good Days Than Bad

If the dog seems to not enjoy life, or there are more bad days cumulatively than good days, its quality of life is compromised. Bad days can mean anything from vomiting, nausea, diarrhea, frustration, seizures, unrelenting pain/discomfort, or inability to breathe.

JOURNEYS Quality of Life Scale

While similar to the HHHHHMM scale, many pet owners find the JOURNEYS quality of life scale to be more intuitive to use. Like the HHHHHMM scale, each category is graded on a scale of one to ten, with ten being the best quality of life and one being the lowest. A score of 80 means your pet is healthy and happy, and a score of eight means that they are suffering to the point where you might want to consider humane euthanasia.

The JOURNEYS scale was created by Dr. Katie Hilst, DVM to help pet owners determine their pet’s level of health and happiness.

Here’s the scale, along with examples of what one, five, and ten points would look like.

J - Jumping and Mobility

Quality of life point examples:

  • One point: Your dog can’t stand or walk without help.
  • Five points: Your dog can move around with pain medication, and they can perform about half of their old activities (half-distance walks, half the time playing fetch, etc.)
  • Ten points: Your dog is fully active and enjoys their normal activities.

O - Ouch and Pain

Quality of life point examples:

  • One point: Your dog seems to be in pain (crying, whining, etc.) even on medication.
  • Five points: Your dog is on pain meds, and they help 75% of the time or more.
  • Ten points: Your dog doesn’t show any signs of pain.

U - Uncertainty and Understanding

Quality of life point examples:

  • One point: Your dog’s medical diagnosis or condition is unpredictable. The problem is prone to sudden catastrophic events, or the diagnosis isn’t fully understood.
  • Five points: Your dog has a condition that changes over time, and it’s currently stable. You and your vet can make treatment adjustments as necessary.
  • Ten points: Your pet is happy, healthy, and has no medical issues.

R - Respiration and Breathing

Quality of life point examples:

  • One point: Your dog suffers episodes of coughing, difficulty breathing, or open-mouth breathing. They aren’t eating or drinking because of their breathing. (If this sounds like your pet, seek immediate medical attention).
  • Five points: Your dog occasionally coughs, wheezes, or can’t tolerate exercise. These episodes are short, and medication helps the issue.
  • Ten points: Your pet doesn’t cough or wheeze and can handle lots of activity.

N - Neatness and Hygiene

Quality of life point examples:

  • One point: Your dog lays in their urine or feces, and it either can’t control its elimination or can’t move afterward. They may have an external mass that you can’t seem to keep bandaged or clean, and they might have pressure sores from being unable to get up often.
  • Five points: You might have to help your dog do his business, but they don’t lie in it. They can hold it in until they get assistance. They may have an external mass, but you can keep it clean, and it’s not infected. They can groom themselves with a small bit of help.
  • Ten points: Your dog can do his business without help, has no medical issues that cause growth, and you can provide easy care to their hygiene needs.

E - Eating and Drinking

Quality of life point examples:

  • One point: Your dog refuses food and water. They might have diarrhea or vomit frequently, and they might constantly be nauseous.
  • Five points: Your dog still eats, however, it’s slower than normal, and they aren’t very interested in food. It might take them several trips to finish a meal, but they still eat their normal food and portions.
  • Ten points: Your dog eats and drinks normally.

Y - Your Capabilities

Quality of life point examples:

  • One point: Your dog causes your constant worry. You don’t understand what’s happening and feel overwhelmed trying to provide for them. You feel like you can’t help them even though you want to.
  • Five points: You understand your dog’s condition and can meet its needs. You might have concerns, but you can manage them.
  • Ten points: You’re completely capable of meeting your dog’s needs and are not worried about providing care for them.

S - Social Ability

Quality of life point examples:

  • One point: Your dog doesn’t spend time with the family anymore. They might hide and become grumpy if bothered. They may not enjoy the attention, or they might be physically unable to get up and spend time with others.
  • Five points: Your dog spends some time with the family, but they aren’t irritable if you bother them in another room. They still happily greet you at the door.
  • Ten points: Your dog enjoys time with you and the family and actively seeks out company and attention.

When Is It The Right Time To Let Go?

A healthy bond with your dog is a two-way street, and when one side of that exchange goes away, it's time for humane euthanasia. Planning for the end of life before that time gets here is essential, and the quality-of-life scale can assist with this sort of planning. You can help your dog maintain a decent day-to-day life experience by using this scale to determine how well your dog's basic needs are being met. The scale can also be used to evaluate the decision to end your dog's life, hopefully relieving regret and anxiety surrounding the decision. 

Related: Benefits Of Vitamin C For Dogs

Saying Goodbye and Getting Back to Normal

If the signs are clear, you’ll need to prepare yourself for taking your pet to get put down. Other than preparing emotionally, you’ll need to decide if you want to take your dog to the clinic or have your vet come to the house. Saying goodbye to your dog is a personal thing, and while we can’t tell you how to do it, we can give you one tip: spend as much time with them as you can and give them plenty of love and affection until the last moment.

Losing a family member is hard, and it will hurt. Don’t be ashamed to admit your feelings and get advice from others you know who have gone through the process. Try to remember all of the good times that you got to spend with your beloved dog. Celebrate their life and reminisce about your favorite trips or hang up your favorite pictures with your pup. Don’t feel rushed to adopt a new dog in their place.

We know it’s difficult, but sometimes putting your dog down is the best option for their well-being. If their quality of life is suffering immensely, it might be time.

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