The HHLE Quality of Life Scale
The HHLE Scale was developed by veterinary oncologist Dr. Alice Villalobos to provide a structured framework for assessing quality of life in seriously ill pets. It addresses the most clinically significant aspects of a sick animal's daily experience and produces a numerical score that can be tracked over time, making changes visible rather than relying on subjective impressions alone.
The Seven Categories
H — Hurt: Is pain well controlled? Can the dog breathe without distress? Is analgesia available and adequate? A dog experiencing uncontrolled pain should score 1-3. A dog whose pain is well managed and comfortable should score 7-10.
H — Hunger: Is the dog eating enough to maintain body weight? Is hand feeding, appetite stimulants, or a feeding tube required? Severe anorexia scores 1-3. Eating voluntarily with good appetite scores 8-10.
H — Hydration: Is the dog adequately hydrated? Assess skin turgor (skin tent test), gum moisture, and urine output. Severe dehydration with no interest in water scores 1-3. Good hydration scores 8-10.
H — Hygiene: Can the dog be kept clean and free of sores? Does the condition allow for basic grooming and wound care? Severe, unmanageable hygiene problems score 1-3.
H — Happiness: Does the dog show interest in life? Is there interaction with family, response to favorite things, expression of play or curiosity? A dog showing no response to its environment scores 1-3.
M — Mobility: Can the dog move with reasonable comfort and independence? Assistance devices, physiotherapy, and medications can improve this score. Total inability to move without causing distress scores 1-3.
M — More Good Days Than Bad: Over the past week or two, has the ratio of good days to bad days been favorable? This is the most subjective category and captures the overall trend. Consistently more bad than good days scores 1-4.
Interpreting the Score
- 35-70: Acceptable quality of life. Continue current care while monitoring for changes.
- Below 35: Quality of life is compromised. An honest discussion with your veterinarian about palliative care options and the trajectory of the illness is appropriate.
- Below 25: End-of-life care discussions are typically recommended. Multiple aspects of the dog's wellbeing are significantly impaired.
How to Use This Scale Effectively
Score your dog on the same day each week. Keep a written record and share it with your veterinarian. A single score in isolation is less informative than a trend. A score of 35 that is improving week over week has a different meaning than a score of 35 that has declined from 55 over three weeks.
The scale is a tool for structuring a difficult conversation, not a verdict. It helps articulate, in a shared language with your veterinarian, what you are observing at home. Your vet provides medical prognosis; the HHLE scale provides a systematic window into day-to-day experience.
When to Have the Conversation
Veterinary hospice and palliative care is available in many areas and can significantly improve quality of life while it remains acceptable. Pain management options, appetite stimulants, anti-nausea medications, and mobility aids can each improve individual HHLE subscores. Euthanasia is a compassionate option when quality of life cannot be maintained at a level the owner and veterinarian agree is acceptable. There is no universally correct threshold.
Source
The HHLE Scale was published by Dr. Alice Villalobos in the Veterinary Practice News and is endorsed by veterinary oncology and hospice organizations. It is widely used in palliative and hospice settings in veterinary medicine internationally.