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How do I know when it's time?
Score your dog from 0 to 10 in seven areas: hurt, hunger, hydration, hygiene, happiness, mobility and more good days than bad. On the HHHHHMM Quality of Life Scale by Dr. Alice Villalobos, a total over 35 suggests quality of life is still acceptable with good comfort care. Pain and breathing come first. Use the result to start an honest talk with your vet.
Score these 7 areas from 0 to 10
- Hurt: Is pain under control? Is breathing easy?
- Hunger: Is your dog eating enough, even with help or hand-feeding?
- Hydration: Is your dog drinking enough, or getting fluids?
- Hygiene: Can your dog be kept clean, dry and free of sores?
- Happiness: Does your dog still show interest in family, toys and surroundings?
- Mobility: Can your dog get up and move enough to enjoy the day, with help if needed?
- More good days than bad: Over the last week, have good days outnumbered bad days?
A total over 35 out of 70 suggests acceptable quality of life with good comfort care. Pain or breathing trouble that cannot be controlled matters more than any total.
Frequently asked questions
How do I know when it is time to put my dog down?
Watch whether pain and breathing can be controlled, whether your dog can still eat, drink, stay clean and move, and whether good days still outnumber bad ones. Ohio State suggests listing your dog's favorite things: when your dog can no longer enjoy them, it may be time to talk about euthanasia with your vet.
What is the HHHHHMM quality of life scale?
A scale created by veterinary oncologist Dr. Alice Villalobos. You score Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad from 0 to 10. A total over 35 out of 70 is considered acceptable quality of life for hospice care.
Is a score of 35 or less a rule?
No. It is a guide to help you see the whole picture and talk with your vet. Pain or breathing trouble that cannot be controlled matters more than any total.
Should I wait for a crisis before deciding?
Thinking about it early helps. Ohio State's Honoring the Bond program notes that decisions can feel forced if you wait for a crisis, and that many families say they waited too long.
Related care guides
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- Bladder infection (UTI) symptoms: Straining, frequent peeing, blood or smell: what fits a UTI and when it is an emergency.
- Leaking urine? Incontinence check: Sort leaking from infection, thirst, memory or mobility problems, with next steps.
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- Dog dementia (CCD) checklist: Confusion, night pacing, accidents and memory changes in older dogs.
- Arthritis and pain checklist: Everyday signs that an older dog is sore, and what helps at home.
- Printable weekly health tracker: Log weight, appetite, water, sleep and accidents for your vet. No sign-up.
Sources: Dr. Alice Villalobos: Quality of Life Scale (HHHHHMM) · The Ohio State University Honoring the Bond: How will I know?
Educational only. Not a substitute for your veterinarian. Updated October 2026. SILVERPAW is operated by ILYESHOPI LLC.