Quality of Life Scale for Cats – The Hhhhhmm Scale

All pet owners will be faced with that dreaded decision at some point in their lives, and while most of us would rather live in denial, there comes a point when putting down your cat is the humane thing to do. Whether due to financial constraints or a terminal illness, over 780,000 cats are euthanized in the US each year.

Quality of Life Scale For Cats – The HHHHHMM Scale

Ideally, the decision to put down one’s cat must be based on quality-of-life factors, and to remove any ambiguity, or sense of guilt, owners can make use of special scales and models aimed at quantifying pet quality of life. The HHHHHMM Scale is one such framework that is increasingly used by veterinarians and owners, in this article we take a deep dive into its workings.

Quality of Life Scale for Cats – A Complete Guide

When evaluating a cat’s quality of life, the HHHHHMM scale is used extensively. This scale is used to determine the overall situation of a cat and whether it’s appropriate to put them down. Here are some factors that go into assessing a cat’s quality of life.

A cat’s quality of life (QOL) is an important indicator of its welfare, and the HHHHHMM scale helps in objectively determining QOL by assessing factors such as Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and ‘More Good Days Than Bad’.

An objective review of your cat’s quality of life, with the help of these factors, can help guide your decisions with your cat’s overall wellbeing in mind. If you can come up with the right scores on each of the above-mentioned factors, you should have the right course of action on hand.

Using the Hhhhhmm Scale

For the HHHHHMM scale, you can use a range of 1-5. A score of 1 represents a life full of pain and hunger, while a score of 5 represents an ideal life with no suffering. 

Quality of life scale for cats
Infographic property of Petmd.com

The HHHHHMM Scale is:

Pain: _________ 

Hunger: _________ 

Hydration: _________ 

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Hygiene: _________ 

Happiness: ________ 

Mobility: ________________

More good days than bad: ________________

If you are getting consistent scores in the 4s or 5s, then your cat’s quality of life is probably good enough that euthanasia isn’t necessary at the time. However, if you’re consistently seeing scores below 3 for any of these categories, then euthanasia may be warranted.

The Hhhhhmm Scale


The way that cats express their pain also varies widely depending on their personality type, age, and overall health status (both physical and mental). 

For example: while some cats will yowl loudly when they are hurting themselves (like biting into electrical cords or jumping off tables), others may “hiss” at people instead of crying out openly; still, others might meow loudly or purr softly while nursing an injury or illness like arthritis or cancer.

Quality of Life Scale For Cats – The HHHHHMM Scale

The level of pain can be assessed by the cat’s behavior, physical exam, blood tests, x-rays, and CT scans. These methods are useful to determine if a cat is in pain or not. 

The presence of these examinations is highly recommended for any pet that is ill or injured as this will allow for a more accurate diagnosis and treatment plan.


Hunger is a sign of an underlying health problem. If your cat is hungry, he or she needs to see a vet. A cat that is constantly hungry may not be getting enough calories or protein in his or her diet. 

Talk to your veterinarian about adjusting the amount and type of food you are feeding your cat and encourage them to get blood work done on their own as well.


Look at your cat’s gums. If they look pale or are sticky to the touch, your cat may be dehydrated.

Take a look at how much urine is in their litter box. If it looks like there’s been little or no urine outside or inside the box, that could be signs of dehydration as well. Your cat might be dehydrated if it seems to be panting or have sunken eyes. 

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Hygiene is a key factor in a cat’s quality of life. Hygiene is defined as the ability to keep clean and tidy, and it is proven to be an indicator of overall health. If your cat appears dirty or smelly, then this could mean more than just poor personal hygiene!

Cats with poor hygiene can suffer from diseases such as scabies, ringworm, and tapeworms. These conditions can result in hair loss, sores on the body, and skin irritation which can lead to further health problems if left untreated. 

In addition, cats who are not able to keep themselves clean may also have issues with other aspects of their lives including social interaction or eating properly.


The happiness of your cat is as important to his quality of life as the physical health of his body. Happiness is a feeling, but it has physiological effects on the body. When they are happy, their brain releases endorphins and oxytocin, which are neurotransmitters that make you feel good and reduce stress. These hormones can also help increase the number of white blood cells in your bloodstream so that you have more protection against infections. The expression of emotions in cats, such as happiness and disgust, are the same as in humans.


To assess a cat’s mobility, you’ll need to take it for a walk. Some cats will walk on their own and others will need some assistance. The key is to make sure that your cat can complete the task at hand without injury or undue stress. 

If your cat was previously mobile but now has trouble moving around due to old age or illness (or even just because!), please consult your veterinarian immediately regarding options like physiotherapy sessions – which are designed specifically for improving mobility among pets who’ve lost some type of motor function due to age or diseases such as arthritis, cancer, etc.

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“More Good Days Than Bad”

How do you know if your cat is having a bad day? Owners of bonded cats—those with a deep connection to their pets—are better able to gauge what constitutes an especially good or poor day for those cats than they are for other felines. 

For most cats, a bad day might mean nausea, vomiting, diarrhea, seizures, frustration, unrelenting pain or discomfort—or an inability to breathe.

A Complete Guide to End of Life Decisions for Cats

If your pet is suffering from an untreatable condition, such as cancer or heart disease, it is time to consider ending their life peacefully. The decision can be painful and difficult for both the owner and the pet, but it is important to choose the best option for your companion’s quality of life.

Even if they are not suffering from anything terminal, old age factors result in significant deterioration in the cognitive, and motor functions of felines. Most owners will realize this themselves even without any external scales, however, it’s best to take the final call in consultation with your veterinarian.

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In conclusion, the HHHHHMM scale is a useful tool for determining whether or not it is time to put your cat to a night of final sleep. 

It’s also a good way of measuring the overall quality of life for those who are unsure if their cats are suffering from illnesses related to old age such as kidney failure or cancer.