When a pet is aging or living with a serious diagnosis, many families find themselves asking the same question in a dozen different ways: “Are we still doing the right thing?” The emotional part of that question is love. The practical part is uncertainty. You are trying to protect your pet from suffering without rushing a goodbye you are not ready for, and you are doing it while your own heart is already bracing for loss.
This is exactly why veterinarians often recommend quality-of-life scales. Not because a number can replace your bond, but because structure can steady you. A quality-of-life scale is a way to track comfort and function over time, using the kinds of day-to-day observations families already make—appetite, breathing, mobility, hygiene, engagement, and whether there are still more good days than bad. The American Animal Hospital Association explains that quality-of-life scales can help determine when it may be time to say goodbye, and notes that veterinarians frequently recommend the HHHHHMM framework as a practical tool for families.
If you take only one idea from this article, let it be this: a scale is not a verdict. It is a flashlight. It helps you see what is changing, what can still be treated, and what might be asking for a different kind of care. And because end-of-life decisions often come bundled with practical planning—aftercare, cremation options, memorial choices—this guide will also explain how families commonly move from “How is my pet doing today?” to “What do we want to do next?” in a way that feels calm, not rushed.
What a Quality-of-Life Scale Really Measures
Quality of life is not the absence of illness. Many pets live happily with chronic conditions when pain is controlled and their routines still feel like themselves. Quality of life is more about the lived experience of each day: Can your pet rest comfortably? Can they eat without constant nausea? Can they move without repeated falls? Do they still seek connection, or do they seem trapped in their symptoms?
In the AAHA Senior Care Guidelines “tools for end-of-life care” section, the organization acknowledges that quality of life is subjective and influenced by the bond a family shares with their pet, while also noting that using a validated QOL scale may help a client have a more objective view of their pet’s condition. That balance—subjective love, paired with objective tracking—is the heart of why scales help.
The Scale Many Vets Reference: HHHHHMM
The HHHHHMM framework is popular because it is simple, repeatable, and focused on the experiences that matter most to the pet. It is often shared in hospice settings and is available in a printable format. You score each category to create a snapshot, then repeat the snapshot on a consistent schedule to see the trend.
- Hurt: pain, breathing distress, anxiety, and whether medications are keeping discomfort controlled
- Hunger: appetite, willingness to eat, nausea, and whether eating still feels like a positive daily event
- Hydration: drinking, dehydration signs, and whether fluids or supportive care are becoming frequent needs
- Hygiene: cleanliness, accidents, ability to stay dry, skin irritation, and whether grooming is becoming stressful
- Happiness: interest in family, favorite activities, and whether your pet still seeks comfort and connection
- Mobility: ability to stand, walk, change positions, and whether falls or fear of movement are increasing
- More good days than bad: the overall pattern—especially whether the “good day” is still truly good, or just less difficult
Families often worry they will use the scale “wrong.” In practice, there is no perfect scoring. What matters is consistency. If you score “Hunger” today as a 6 and next week it’s a 3, you have learned something real, even if another person might have scored slightly differently. Your goal is not to build a courtroom case. Your goal is to notice change before it becomes a crisis.
How Veterinarians Use Scales in Real Appointments
Quality-of-life tools are not meant to replace your veterinarian’s medical judgment. They are meant to make your daily observations usable. The Ohio State University Veterinary Medical Center’s “How Will I Know?” guide encourages families to repeat quality-of-life scales at a strict interval—every few days, every Tuesday, whatever is realistic—because tracking over time helps you see patterns more clearly.
That trend view helps a veterinarian do three practical things with you.
First, it helps identify which categories are treatable. A declining “Mobility” score might respond to pain control, traction rugs, supportive harnesses, or changes in medication. A declining “Hunger” score might signal nausea that can be managed. A scale can turn “something feels off” into a specific symptom path your vet can address.
Second, it helps reduce “caregiver adjustment,” the very human habit of slowly normalizing decline. Many families do not realize how much has changed until they look back at a month of scores and see the slope.
Third, it helps define what “good” means for your specific pet. A good day for one dog is a slow walk and a nap in the sun. A good day for another is greeting the family at the door and eating with enthusiasm. Your vet can help you translate those favorite-things moments into meaningful markers that can be tracked.
What to Watch For in Each Category
Families often assume the most important category is pain, and in many cases, it is. But end-of-life suffering can show up through breathing distress, nausea, confusion, or panic just as much as through obvious pain behaviors. One reason the AAHA and other veterinary resources highlight structured tools is that they keep you from focusing on one symptom while missing the whole picture.
For “Hurt,” pay attention to breathing, restlessness, trembling, guarding, inability to settle, or a posture that looks like constant tension. If your pet cannot rest, the whole day becomes survival. For “Hunger,” watch whether your pet eats only when coaxed, spits out food, or seems interested but then turns away—a common nausea pattern. For “Hydration,” look at drinking changes and whether dehydration seems to return quickly even after supportive care.
For “Hygiene,” the question is not “Are there accidents?” It is “Are accidents becoming distressing?” A pet who soils themselves and looks confused or ashamed is experiencing a different kind of suffering than a pet who has a manageable, supported routine. For “Happiness,” look for the small signals of recognition and engagement: choosing to be near you, responding to your voice, showing interest in a toy, a treat, or a favorite spot. For “Mobility,” track not just walking distance, but the fear of movement—hesitation, slipping, or repeated falls that make your pet anxious about standing up at all.
And for “More good days than bad,” be honest about whether the good day is still a day your pet would choose. A good day is not simply “no emergency happened.” A good day includes comfort, some appetite, some rest, and some connection.
When the Scale Should Not Be the Only Deciding Factor
Families sometimes cling to a single number because it feels safer than trust. But quality-of-life tools are meant to support judgment, not replace it. The Merck Veterinary Manual notes that the HHHHHMM scale is a commonly used tool to help guide discussions and decisions about euthanasia, emphasizing that it is part of decision-making rather than a standalone rule.
There are also situations where one severe issue can outweigh a “decent” overall score. If your pet is struggling to breathe, cannot be made comfortable even with medication adjustments, or is experiencing repeated crises that cause panic, it is reasonable to talk with your veterinarian urgently. The Ohio State “How Will I Know?” guide addresses the reality that a peaceful natural death at home is uncommon for many pets and that distressing changes can occur during the dying process, which is part of why early planning matters.
How to Use a Scale Without Turning Your Home Into a Hospital
The most sustainable way to use a scale is to make it small. Pick a schedule you can keep. Many families do every three days or once a week. The moment you feel you “should” do it daily, it can become emotionally exhausting and stop being useful.
It also helps to add one sentence of context each time you score. Not a novel—just a note like, “Ate half breakfast, paced at night, slipped on tile once,” or “Needed help standing, but took treats and sat in sun.” That sentence is often what makes the numbers meaningful in a vet appointment.
If your household includes multiple caregivers, have each person score independently once in a while. You are not looking for agreement as a sign of love. You are looking for information. Sometimes the person who is with the pet less often sees change more clearly. Sometimes the primary caregiver sees subtle suffering more clearly. Both perspectives matter.
Planning Ahead Is Part of Loving Them Well
Even when an end-of-life decision is still weeks or months away, many families feel relief when they understand what comes next. Planning does not force the timeline. It simply removes the pressure of having to make unfamiliar choices on the worst day.
If your pet’s journey may end with cremation, learning the basics now can help you stay present later. Funeral.com’s guide on how much does cremation cost for pets explains what affects pricing and why ranges vary so widely. If you are planning for a person as well—or you are simply trying to understand the broader landscape—cremation is now the majority choice in the U.S. The National Funeral Directors Association reports that the U.S. cremation rate is projected to reach 63.4% in 2025 and rise to 82.3% by 2045. CANA reports a U.S. cremation rate of 61.8% in 2024 and publishes ongoing trend data.
As cremation becomes more common, more families are asking practical questions about memorial choices—especially what to do with ashes, how to create a home memorial, and how to share a small portion with family members who are grieving differently.
Memorial Options Families Commonly Choose
For many families, the first priority is simply bringing their pet home in a way that feels dignified and personal. Funeral.com’s pet urns for ashes collection includes a wide range of styles and sizes, and the guide Pet Urns for Ashes: A Complete Guide for Dog and Cat Owners walks through sizing and common decisions in a calm, step-by-step way.
If you want a memorial that feels more like a portrait than a container, many families gravitate toward pet figurine cremation urns, especially when the pet’s presence was a daily comfort and you want a tribute that looks like it belongs in the home.
If multiple people want a personal tribute, or you plan to keep only a small portion at home, pet keepsake cremation urns are designed for sharing. For human memorials, the same idea shows up as keepsake urns, and in-between capacities are often found in small cremation urns that hold meaningful portions. When a family wants a main memorial plus smaller tributes for siblings or adult children, this “main plus keepsakes” approach is often the most emotionally sustainable. Funeral.com’s guide on how to choose a cremation urn explains how families build a plan that fits home display, sharing, or later scattering.
For some people, the most comforting memorial is something wearable. Cremation jewelry holds a tiny symbolic amount, and cremation necklaces are among the most common choices because they keep the tribute close without requiring a visible display. If you want a concrete example of what “wearable memorial” looks like in real life, a simple pendant such as the Textured Rectangle Pendant, 14K Gold-Plated Cremation Necklace shows how many pieces are designed: discreet, secure, and meant for everyday wear. For a deeper explanation of how these pieces work and how little ashes they typically require, Funeral.com’s Cremation Jewelry 101 guide is a helpful starting point.
Keeping Ashes at Home, Water Burial, and Eco-Friendly Plans
Many families want time before making a permanent decision, which is why keeping ashes at home is so common—both for pets and for people. If you are considering that option, Funeral.com’s guide on keeping ashes at home covers practical safety and emotional considerations, including what to do if different family members have different comfort levels.
Others know they want a nature-based ceremony. If water burial is part of your plan, it helps to understand how biodegradable options are designed to behave on the water and what families typically experience during the ceremony. Funeral.com’s guide water burial explains the process and what to expect. For families seeking an earth- or water-friendly memorial option, biodegradable and eco-friendly urns for ashes are designed for gentle return to nature and can be part of a broader plan for what to do with ashes.
A Gentle Bottom Line
If you are using a quality-of-life scale, it means you are trying to do something profoundly loving: making decisions from care rather than panic. You are giving yourself a way to watch the story of your pet’s comfort with clearer eyes, and you are building a shared language you can bring to your veterinarian when the conversation gets hard.
When the scores trend down, it does not mean you failed. It means the illness is progressing, and it is asking for a different kind of protection. Sometimes that protection is a new medication plan. Sometimes it is hospice support. Sometimes it is choosing a peaceful goodbye before a crisis steals the gentleness from the moment.
And when you are ready for the practical steps, know that you do not have to decide everything at once. Families often move through planning in small pieces: learning about pet cremation urns, browsing pet urns and pet urns for ashes, considering whether cremation urns or cremation urns for ashes at home feels comforting, exploring keepsake urns for sharing, and deciding whether cremation jewelry or cremation necklaces might help them feel close in the months after loss. That is not being morbid. That is steady funeral planning for a bond that mattered.
