The HHHHHMM Scale
Pet caregivers can use this Quality of Life Scale to determine the success of Pawspice care. Score patients using a scale of: 0 to 10 (10 being ideal).
HURT - Adequate pain control & breathing ability is of top concern. Trouble breathing outweighs all concerns. Is the pet's pain well managed? Can the pet breathe properly? Is oxygen supplementation necessary?
HUNGER - Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube?
HYDRATION - Is the pet dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake.
HYGIENE - The pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean.
HAPPINESS - Does the pet express joy and interest? Is the pet responsive to family, toys, etc.? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be moved to be close to family activities?
MOBILITY - Can the pet get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, but an animal with limited mobility yet still alert, happy and responsive can have a good quality of life as long as caregivers are committed to helping their pet.)
MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The decision for euthanasia needs to be made if the pet is suffering. If death comes peacefully and painlessly at home, that is okay.
*A total over 35 points represents acceptable life quality to continue with pet hospice (Pawspice).
Alice Villalobos, DVM, DPNAP, a renowned veterinary oncologist, introduced “Pawspice”, a quality of life program for terminally ill pets. Pawspice starts at diagnosis and includes symptom management, gentle standard care and transitions into hospice as the pet nears death. Dr. Villalobos developed a scoring system to help family members and veterinary teams assess a pet’s life quality, The HHHHHMM Quality of Life Scale. The five H’s stand for: Hurt, Hunger, Hydration, Hygiene and Happiness. The two M’s stand for Mobility and More good days than bad. The QoL scale is also a helpful decision making tool to assist pet lovers in the difficult process of making the final call for the gift of euthanasia to provide a peaceful and painless passing for their beloved pet. Available for download here.