Quality of Life Scale for Dogs: The HHHHHMM Score, How to Use It, and What to Do With the Number

Written by Marc Brannigan, Co-Founder & CEO of HempMy Pet. Last updated 13 October 2026.

The HHHHHMM Quality of Life Scale

Developed by veterinary oncologist Dr. Alice Villalobos for animal hospice ("pawspice") care, and now the most widely used quality-of-life tool in veterinary practice. Score each line 0 to 10, where 10 is ideal.

The original scale, with Dr. Villalobos' own notes on each criterion, is published by Veterinary Practice News. Add the seven scores. Above 35 is acceptable. Below 35 is the conversation.

How to Actually Use It

Most owners score it once, in a bad week, and never again. That is the least useful way to use it. Here is the way vets intend it.

One criterion can override the total. The Ohio State guide makes this point plainly: unrelenting pain or real difficulty breathing can mean poor quality of life even when the other scores look fine. A dog scoring 50 with a 1 on Hurt is not a dog with an acceptable quality of life. Read the lines, not just the sum.

Two Other Tools Vets Reach For

The HHHHHMM scale is the one most people mean, but it is not the only one, and the other two are simpler.

• The good-day / bad-day calendar. From the Ohio State University Veterinary Medical Center's "How Will I Know?" guide. Mark every day on a wall calendar as good or bad — nothing more sophisticated than that. When the bad days start outnumbering the good, the picture is clear in a way that memory never is, because memory keeps the good days and lets the bad ones blur.
• The five favourite things. Write down three to five things your dog loves — the ball, the car, the evening walk, greeting you at the door, breakfast. If they have stopped doing three or more of them and nothing you or your vet have tried brings them back, that is the signal. This is the test many vets give clients verbally, and it is the one that tends to cut through.
• The Ohio State worksheet itself rates specific statements — "does not want to play," "is panting even while resting," "does not greet me" — from 1 (always) to 5 (never), alongside an overall comparison to how they were at diagnosis. It has no numeric cutoff on purpose. The guide is explicit that a vet can help you see clearly but cannot make the decision for you.

What to Do With a Falling Score

A low or falling score is not a verdict. It is a list of specific problems, several of which have specific answers.

Go back to the line that dropped. Hurt and Mobility are the two that fall first in most senior dogs, and they are also the two with the most options — a vet pain plan, weight management, traction on hard floors, ramps, an orthopedic bed, physiotherapy, and in some dogs a supplement. We set out the early signs and five real stages of arthritis and what the consensus guideline actually recommends at each stage. Hunger often responds to warming food, hand-feeding, or treating nausea. Hygiene is frequently a mobility problem in disguise. Happiness in an old dog is sometimes pain, sometimes cognitive change — sundowning and night-time restlessness have their own rule-out lists.

Re-score two to four weeks after any change. If Hurt went from 3 to 7 because the pain plan worked, you have your answer. If nothing moves it, you have a different answer, and the scale has done its job either way.

The Five Stages of Arthritis in Dogs →

Where Hemp Fits — and Where It Doesn't

We sell hemp for dogs, and we have a direct stake in this question, so here is the full picture.

Of the seven criteria, hemp has published canine evidence for exactly one pair: Hurt and Mobility, in dogs with chronic joint discomfort. All five published canine trials in the 2023 systematic review were osteoarthritis trials, and four of the five were positive. One of those five was our own 90-day study at Colorado State University — 37 dogs enrolled, 32 completed, 30 of them showed a benefit on veterinary pain assessment, and 94% of owners reported their dog's quality of life had improved. That owner quality-of-life measure was a separate question from the pain scoring, which is why we can say it here with a straight face.

For the other five criteria — hunger, hydration, hygiene, happiness in the sense of cognitive engagement, and the balance of good and bad days — hemp has no canine evidence we can point you to, and we will not pretend otherwise. A dog whose score is falling because of kidney disease, heart failure or cognitive decline needs a vet plan for that condition, not a supplement.

So the honest use: if your dog's Hurt and Mobility lines are the ones dragging the total down, and your vet agrees joint discomfort is the cause, full-spectrum hemp is a reasonable thing to add to the plan and to re-score against in a month. Serving works from body weight — the serving guide has the chart — and if your dog is on carprofen, gabapentin or any other medication, read what the canine research shows about combining them and talk to your vet first.

Side effects are mostly mild — drowsiness, loose stool, and a liver-enzyme change seen in three of the five published trials. Every published finding is in hemp and CBD side effects in dogs.

Signs Your Senior Dog Still Has a Good Quality of Life

Slowing down is not the same as suffering. Most of what follows is a 7 or 8, not a 10, and that is fine.

• They still want the things they always wanted — even if the walk is half the block now.
• They eat and drink without coaxing and are holding their weight.
• They are curious — the window, the doorbell, the smell on your shoes.
• They sleep — genuinely, through most of the night, not pacing it.
• They get themselves outside to go to the toilet, even slowly.
• They greet you. A tail, an ear, a look up. The small version still counts.
• Most days are good days. Not all. Most.

A dog ticking most of these with a score in the 40s or 50s has a good life. Scale the walks, add the ramp, sort the pain, and let them tell you how much they want to do.

When to Call the Vet

Today, if:

• Breathing is laboured, or they are panting at rest and it does not settle
• Pain is not controlled by what has been prescribed
• They have not eaten or drunk in more than a day
• They cannot get up on their own

This week, if:

• The total has dropped more than a few points since the last score
• Any single criterion is at 3 or below
• Bad days have started to outnumber good on the calendar
• They have stopped three or more of their five favourite things

Bring the score sheets. A vet looking at four dated scores can see a trajectory that no single appointment shows. Many practices also offer a dedicated quality-of-life consultation, and hospice-trained services such as Lap of Love exist specifically for this stage.

Frequently Asked Questions

How do you determine quality of life for a dog?
Most vets use the HHHHHMM scale: score Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More-good-days-than-bad from 0 to 10 each and add them up, with a total above 35 of 70 considered acceptable. Alongside it, keep a good-day/bad-day calendar and a list of your dog's five favourite things. Score on a normal week for a baseline, have each family member score separately, and repeat on a schedule — the direction of the number tells you more than any single score.

What quality of life score means it's time?
Below 35 on the HHHHHMM scale is the threshold Dr. Villalobos set for the conversation — but there is no single number that makes the decision. One criterion can override the total: unrelenting pain or laboured breathing means poor quality of life even if the rest looks fine. And a falling score should first send you back to the line that dropped, because Hurt and Mobility in particular often have answers. The decision is yours, with your vet's help; the scale makes it clearer, not automatic.

Can a dog's quality of life score improve?
Yes, and that is half the point of scoring. A dog whose Hurt dropped to 3 because of untreated arthritis can go back to 7 with a proper pain plan; a dog whose Hunger fell because of nausea can recover it once the nausea is treated. Re-score two to four weeks after any change. If the number moves, you found the problem. If it does not, you have learned something just as important.

How do dogs say goodbye?
Dogs do not have a goodbye behaviour, and reading one in can mislead you in both directions. What owners usually describe — withdrawing, sleeping more, seeking you out more, going off food, or a sudden "good day" after a run of bad ones — are signs of how the dog feels, not a message. Score them rather than interpret them. The good-day/bad-day calendar exists precisely because a single memorable day, good or bad, is not the picture.

What is the 3-3-3 rule for dogs?
It is about adoption, not end of life: roughly three days for a newly adopted dog to decompress, three weeks to learn the routine, and three months to feel at home. It turns up on this search because Google groups dog rules together. It has nothing to do with the quality-of-life scale.

Does CBD improve quality of life in dogs?
The only canine evidence is for joint discomfort — the Hurt and Mobility lines. In our own 90-day university trial, 94% of owners reported their dog's quality of life had improved, and that was a separate question from the veterinary pain scoring. There is no canine evidence for the other criteria, and a dog whose score is falling from kidney disease, heart failure or cognitive decline needs a plan for that condition, not a supplement. If the joint lines are the problem, it is reasonable to add hemp and re-score in a month.

How often should I use the quality of life scale?
Weekly for a dog with a serious diagnosis, monthly for a healthy senior, and once now for a baseline if you have never done it. Put it in the calendar — the owners who get the most from it are the ones with four or five dated sheets, because that is when the trend becomes visible.

Is a slow old dog a dog with a poor quality of life?
No. Slowing down is normal aging. The scale is deliberately about whether they are still eating, drinking, clean, comfortable, interested and mobile on their own terms — a dog who walks half the block, naps more and still greets you at the door is scoring well. The questions to ask are whether they are in pain, and whether they still do most of the things they love.

The Short Version

Score seven things from 0 to 10 — Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, More good days than bad. Above 35 is acceptable. Score it on a normal week, have everyone score separately, and repeat on a schedule, because the direction matters more than the number. A falling score is a list of problems, and Hurt and Mobility — the two that usually fall first — have real answers.

Hemp belongs in exactly one part of that conversation, the joint comfort part, and that is where the evidence sits.

Hemp for Hip & Joint Mobility → All Hemp for Dogs

Arthritis in Dogs · Sundowners in Dogs · Old Dog Restless at Night · Hemp for Senior Dogs · Serving by Weight

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. This article is general information, not veterinary advice. If your dog is unwell, contact your veterinarian.