Wednesday, July 29, 2015

The HHHHHMM Quality of Life Scale for Cats

A badge featuring Jewel with rainbow hearts. It says, "Jewel Forever."
Euthanasia.  It's the subject nobody wants to think about, let alone talk about.  Yet it's one of the most important and difficult decisions you will ever face as a pet parent.  How will you know when it's the "right" time to help your precious fur baby go to the Rainbow Bridge?  Unfortunately, there's no cut-and-dry answer to this question.  However, using a quality of life scale might help you assess your cat's well-being objectively, which can help you with this incredibly difficult decision.


Dr. Alice Villalobos, a veterinary oncologist, developed the HHHHHMM scale to give owners and veterinarians an objective way to evaluate the success of palliative or hospice care for a cat.  Using this scale, pet parents and veterinarians can work together to assess a pet's well-being and make adjustments to palliative or hospice care when appropriate.  

The scale uses seven parameters to measure your cat's quality of life.  Each parameter is scored on a scale of 1 to 10, with 1 being the worst and 10 being the best. 

Hurt: Does your cat have adequate pain control?  This can be so hard to assess as cats are so good at hiding their pain.  

Some signs that your cat is in pain include: 

  • Limping.
  • Licking one spot on his body repeatedly.  A cat with cancer experiencing pain may lick his tumor repeatedly.
  • Your kitty's posture is different or unusual.
  • Your kitty spends more time resting and interacts with you less than usual.
  • Your cat sometimes trembles or shakes while resting.
  • Your kitty's breathing is labored, exaggerated, or abnormal.  Your cat's ability to breathe comfortably is essential.
  • Your companion protects or guards one part of her body and will snap if you try to touch it.
  • Your cat rests with his eyes open all the time and seems uncomfortable. 
I could always tell when Jewel's arthritis was really hurting her despite the pain management program we had her on.  She would sit with her back feet right by her front feet so that she wasn't putting any weight on her back legs.  It was absolutely heartbreaking for me to see her in pain, and it was definitely a major factor in my decision to help her to the Rainbow Bridge.

If you think your cat is in pain, please talk to your veterinarian about what options are available to treat it.  Oral and injectable medications are available to help control pain. 

A calico cat sitting outside among some trees.
Hunger: Is your cat willing to eat?  Have her eating habits changed?  Does she refuse to eat her normal food?  Will she eat the "good stuff," like treats or human food?

Refusing to eat is one of the most obvious signs that your cat isn't doing so well.  Fortunately, there are several options to help your cat eat.  Talk with your veterinarian about the various options.  Is your cat nauseous?  Many cats with chronic renal failure also suffer from acid reflux.  Kitties taking antibiotics sometimes feel nauseous.  If your veterinarian rules out nausea or acid reflux, you might want to consider trying an appetite stimulant, such as Mirtazapine or Cyproheptadine.

You can also try hand-feeding your cat.  If that doesn't work, syringe feeding or getting your kitty a feeding tube may be an option.

Hydration: Hydration is as important as eating is for cats.  Sick cats are at risk of becoming dehydrated, especially if they are vomiting or have diarrhea.  Cat dehydration can be serious and should be treated right away.  

There are several things you can do to encourage your cat to drink.  For instance, place several water bowls around the house so he doesn't have to walk far to drink water.  Get a pet fountain; many kitties enjoy fresh flowing water.  Try adding an ice cube to the water bowl.  You can read more about how to encourage your cat to drink in my post, "Eight Ways to Get Your Cat to Drink More Water."  Subcutaneous fluids (fluids under the skin) and intravenous fluids are treatment options if your cat becomes dehydrated.  
An orange cat laying on a brown carpet.

Hygiene: Can your kitty keep herself clean?  Cats are very sensitive about cleanliness, but if they are in pain, they may not be able to groom themselves.  You can help your cat stay clean by brushing her regularly and using cat bath wipes or waterless shampoo made specially for cats.  For the last several months of her life, I helped Jewel stay clean by giving her baths with cat wipes.  She didn't mind it too much, and I'm sure she felt better after a little grooming assistance.

Happiness: Is your companion still interacting with you and other family members?  Is he experiencing any joy in life?

When Jewel began to decline, I sat down and thought about the things that made her the happiest in life - eating treats, getting to eat a bit of people food with us at dinnertime, and curling up for a comfortable snooze in one of our kitty kubes.  Another major factor in my decision to help Jewel over the Rainbow Bridge was that she was no longer enjoying the things that made her the happiest.  Likewise, determining what makes your cat the happiest and assessing whether he is still enjoying these things may help you with your decision.

Mobility: Is your kitty able to move around on her own?  If she can't, there are various interventions you can try depending on what is causing her immobility.  For instance, if your companion is having trouble walking due to arthritis, you can talk with your veterinarian about pain management.  Using pet stairs, low-sided litter boxes, and raised feeders can also help arthritic cats.  Mobility devices are very helpful to some kitties as well - as long as their pain is being managed well.

A rainbow over a pond. There is a tree in the foreground.
More Good Days than Bad: Every kitty, especially those with chronic illnesses, will have bad days.  However, a cat's quality of life is compromised when he has more bad days than good ones.  Bad days will look different for each cat.  A bad day could consist of vomiting, diarrhea, unrelenting discomfort or pain, an inability to breathe, seizures, nausea, and/or an inability to get around on one's own.

When using the HHHHHMM Quality of Life Scale, rate each parameter on a scale of 1 to 10, with 1 being the worst and 10 being the best.  A total score of 35 or more constitutes an acceptable quality of life.

While this scale may help you measure your companion's quality of life objectively, you will ultimately need to do what you think is best for your beloved friend.  He will let you know when he is ready to go to the Rainbow Bridge.  As difficult as it may be, try to keep your heart open to receiving his message.  Helping your kitty cross the Rainbow Bridge is the last gift of love you can give him.



  1. Very important information that I pray none of us needs for a long time.

  2. Thank you for touching on such a difficult subject. It is such a heartbreaking decision, but I think as pet parents we know in our hearts. ♥

    1. I agree. Your baby will tell you when it's time.

  3. It's a very difficult topic, fraught with deep emotions. I knew in my heart that Annie was ready to go, but my head kept saying what if we try this or try that and so it was a few days longer before I was able to let her go. I really don't want to think about it, though, for the boys, it makes me almost physically sick. Very hard, even when you know it's the only kind and merciful thing to do.

    Thanks for stopping by; purrs and peace to you all.

    1. I can totally relate. I kept second-guessing myself with Jewel. She told me loud and clear when it was time, but I wanted to try anything to keep her around longer.

      I can't think of Carmine or Lita ever going, either. It makes me cry to even think about it. I don't want to imagine that day. I hope it is many, many years before either of us has to think about this.

  4. This used to be the Pawspice but she's updated it. Lots of good info but we can always use more. It's sometimes hard to put a subjective # on a behavior but it helps.

  5. Quality of life is the one decision TW always thinks about. That’s how she’s always made that terrible decision. She’s rather do it too early than too late because she thinks of the cat rather than herself. Most cats are too vain to let you know it’s time until they’ve suffered needlessly.

    1. You have a wonderful mom, CK. I agree with her - I'd rather do it a little early than too late when a kitty is suffering so much.

  6. My human says that in the last months of Sparkle's life, using a quality of life scale was very helpful, and helped her make rational, not emotional decisions. When it was Sparkle's time to go, she couldn't deny it.

  7. Yep, that's sure a difficult topic, but you handled it so nicely. Thanks.

  8. It really is a difficult topic, but one that needs to be discussed.

  9. You did a great job with a very difficult topic, Sierra. Quality of life is always the most important thing to consider with our pets.

  10. We used a scale like that for two of our now angel kitties too. Though mommy didn't know about this official scale.

    Minko still has excellent quality mostly, just needs to get himself edging...sigh...

  11. Thank you for providing this information. I found it invaluable when I wrote Purr Prints of the Heart and was honored to have Dr. Villalobos provide testimonial. Purrs from Deb and the Zee/Zoey Gang

  12. It is good that this is here. I re-read it and I am saving. xox It's the worst time of my life when these places in our fur babies lives have arrived.