How this instrument works
Dr. Alice Villalobos, a veterinary oncologist, built this scale for a specific situation: a dog with a serious or terminal diagnosis, and a family trying to judge whether hospice care is still doing its job. Rather than one gut-feel impression, it breaks the question into seven categories remembered by the mnemonic HHHHHMM — Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. Each one is scored from 0 to 10, with 10 being the best a dog could be doing in that area.
The seven scores are simply added for a total out of 70. Hurt covers pain control and breathing comfort and comes first in the published guidance because untreated pain overrides everything else. Hunger and Hydration ask whether the dog is eating and drinking enough unassisted, or needs hand-feeding or subcutaneous fluids. Hygiene checks whether the dog can be kept clean, particularly after accidents. Happiness looks for interest and engagement with the household. Mobility asks whether the dog can get up, walk, and posture normally without help. The last category, More good days than bad, is a running tally — once bad days start outnumbering good ones, the scale treats that as a signal in its own right.
The published cutoff is a total over 35 out of 70 — not 35 or higher, but strictly above it — as the line for acceptable quality of life to continue hospice or palliative care. Villalobos designed the scale to be re-run regularly rather than scored once and filed away, since a dog's condition on hospice care can shift week to week. Treat it as a structured conversation aid for you and your veterinary team, not a diagnostic test that makes the euthanasia decision for you.
- Score Hurt first — how well pain and breathing are being managed right now, 0 to 10.
- Score Hunger and Hydration — whether your dog eats and drinks enough without heavy help.
- Score Hygiene, Happiness, and Mobility — cleanliness, engagement, and independent movement.
- Score More good days than bad — your honest read on the last week or two, not just today.
- Read the total out of 70 and whether it clears the strict 35-point line for continuing care.
- Re-score every week or two, or after any real change, and track the trend, not one reading.
Worked example — Biscuit, a 13-year-old Lab in hospice
Biscuit is 13, in hospice care for kidney disease, and her family scores her every Sunday. This week: Hurt 7 (pain controlled on her current meds), Hunger 7 (eating with some encouragement), Hydration 7 (drinking on her own, no fluids needed), Hygiene 7 (occasional help after accidents), Happiness 7 (still greets everyone at the door), Mobility 7 (slower but gets up unassisted), More good days than bad 7. Add the seven sevens: 7+7+7+7+7+7+7 = 49. Since 49 is greater than 35, the scale reads acceptable — hospice care continues.
Four months later, Biscuit has declined. Every category has slipped from a solid 7 down to a middling 5 — pain control now needs more frequent dosing, she needs hand-feeding, and good days and bad days are running about even. The total: 5+5+5+5+5+5+5 = 35 exactly. Because the published rule is strictly greater-than-35, a total of precisely 35 does not clear the line — the scale flags this as the point for a direct conversation with her veterinary team about what the care plan should look like next.
Questions
What does a total score under 35 actually mean?
It means the scale's seven categories, added together, no longer clear the published line for acceptable quality of life on hospice or palliative care. It is not an automatic instruction to euthanize — it is a signal built to prompt a direct conversation with your veterinarian about pain control, feeding support, and whether the current care plan still serves your dog. Many dogs are managed successfully through a low score with adjusted treatment; others are not. The number starts the conversation, it doesn't replace it.
Who created the Villalobos HHHHHMM scale and why?
Dr. Alice Villalobos, a veterinary oncologist who founded the Pawspice end-of-life program, developed it so caregivers and veterinary teams would have a shared, repeatable way to track a seriously ill dog's condition through hospice or palliative care. It appears in her textbook Canine and Feline Geriatric Oncology, co-written with Laurie Kaplan, and is now used widely across veterinary hospice and palliative practice as a standard reference tool.
Is one score enough to decide on euthanasia?
No. The scale is explicitly a monitoring and conversation tool, not a standalone diagnostic test, and a single reading can be skewed by a bad day, a medication timing issue, or caregiver mood. What matters more is the trend across repeated scoring — a stable total in the 40s week after week reads very differently from one that has fallen steadily from 50 to 30 over a month. Bring the score history, not just today's number, to your veterinarian.
How often should I re-score my dog?
Weekly is a common rhythm for a dog in active hospice care, with an extra check-in after any noticeable change — a new medication, a bad night, a sudden loss of appetite. Scoring at the same time of day helps keep readings comparable, since pain and energy often shift over the course of a day. The goal is a trend line you and your vet can review together, not a single verdict from one session.
Can two people scoring the same dog get different numbers?
Yes, and that's expected — Happiness and Mobility in particular involve judgment calls that vary by caregiver. The fix isn't chasing a single "correct" number; it's having the same person score consistently over time where possible, and comparing notes when scores diverge sharply, since a big gap between caregivers often points to something worth discussing with the vet directly.
Why is the cutoff "greater than 35" instead of "35 or above"?
That's how the scale was published and how veterinary hospice teams apply it: a total of exactly 35, the mathematical midpoint of the 0–70 range, is treated as not clearing the line, while anything above it does. In practice, a score sitting right at the midpoint is already a case for closer attention regardless of which side of that line it technically falls on.