Cat Quality of Life Scale & Calculator
This free cat quality of life calculator is built on the veterinarian-developed HHHHHMM scale (with a JOURNEYS option) to turn how your cat is doing into a clear score, and doubles as a compassionate checklist for when you're asking "is it time?". Cats are particularly good at concealing pain, so it's built to be repeated over time — the trend reveals what a single day can't. It supports your decisions; it doesn't replace your veterinarian.
The HHHHHMM Quality of Life Scale by Dr. Alice Villalobos, as described by VCA Animal Hospitals. Each of the 7 categories is scored 1–10 (10 = best), for a total out of 70. VCA says a total above 35, or a score above 5 in every category, suggests quality of life is acceptable enough to continue end-of-life care and support.
1. Hurt
Is pain controlled? Can your cat breathe easily? VCA says cats hide their pain extremely well and will become very still if breathing is a problem. Hiding, a change in posture or facial expression, and stopping grooming (or over-grooming one spot) are among the signs WSAVA lists.
2. Hunger
Is your cat eating enough? Reduced appetite is on WSAVA's list of pain signs in cats, and nausea can cause it in advanced kidney disease. Note if you're relying on appetite stimulants or syringe-feeding.
3. Hydration
Is your cat drinking enough? In later-stage kidney disease cats can't drink enough, and subcutaneous fluids are a treatment your vet may use. Note if they're needed to keep hydration up.
4. Hygiene
Can your cat be brushed, combed and kept clean, and is the coat matted? VCA says cats are very sensitive about keeping themselves clean, and with an oral tumor or back pain they may not be able to groom and may need help.
5. Happiness
Is your cat still interacting with family and their surroundings? VCA notes that cats communicate with their eyes as well as by purring. Hiding and less willingness to interact are both on WSAVA's list of pain signs in cats.
6. Mobility
Can your cat get around, and reach food, water and the litter box? If not, VCA says it may be time to consider a mobility device, and that cats are surprisingly accepting of wheeled carts if pain is well managed.
7. More good days than bad
VCA says quality of life is compromised when there are too many bad days in a row, or when a cat seems 'turned off' to life. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, pain or discomfort, or an inability to breathe.
Score all 7 factors to see your interpretation.
Track trends over time on the App Store →One score is a snapshot. The trend is the truth.
A single number can't tell you which way things are heading. SteadyTails logs your pet's quality of life over time and shows the trend — so you, your household, and your vet see the real picture, not just one hard day. Available now on the App Store.
Free to download · iOS 16+ · Android version coming soon
How to use this scale
Score from evidence, not from a cuddle
A calm cat isn't necessarily a comfortable one: WSAVA notes that cats in pain can stay very still, and some appear to sleep when they are not resting. Before scoring, check the concrete things: what the litter tray looked like, how much of the bowl went down, whether she got onto her usual perch.
Pool what the household saw
Cats spread their day across people and rooms, so no single person sees the whole picture. Have each caregiver score independently — someone noticed the skipped meal, someone else noticed the new hiding place.
Bring the record to your vet
WSAVA notes that cats don't generally move or engage with clinic staff the way other animals do, which makes pain harder to assess in an exam room. A dated series of scores from home gives your vet something the consult can't.
The HHHHHMM factors explained
The HHHHHMM Scale (Dr. Alice Villalobos) rates seven areas of comfort from 1 to 10 (10 is best). Here's what each one means for your cat.
1. Hurt
Is pain controlled? Can your cat breathe easily? VCA says cats hide their pain extremely well and will become very still if breathing is a problem. Hiding, a change in posture or facial expression, and stopping grooming (or over-grooming one spot) are among the signs WSAVA lists.
2. Hunger
Is your cat eating enough? Reduced appetite is on WSAVA's list of pain signs in cats, and nausea can cause it in advanced kidney disease. Note if you're relying on appetite stimulants or syringe-feeding.
3. Hydration
Is your cat drinking enough? In later-stage kidney disease cats can't drink enough, and subcutaneous fluids are a treatment your vet may use. Note if they're needed to keep hydration up.
4. Hygiene
Can your cat be brushed, combed and kept clean, and is the coat matted? VCA says cats are very sensitive about keeping themselves clean, and with an oral tumor or back pain they may not be able to groom and may need help.
5. Happiness
Is your cat still interacting with family and their surroundings? VCA notes that cats communicate with their eyes as well as by purring. Hiding and less willingness to interact are both on WSAVA's list of pain signs in cats.
6. Mobility
Can your cat get around, and reach food, water and the litter box? If not, VCA says it may be time to consider a mobility device, and that cats are surprisingly accepting of wheeled carts if pain is well managed.
7. More good days than bad
VCA says quality of life is compromised when there are too many bad days in a row, or when a cat seems 'turned off' to life. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, pain or discomfort, or an inability to breathe.
Prefer a different framework? The calculator above also offers the JOURNEYS Scale (Dr. Katie Hilst), an 8-factor alternative scored out of 80.
Why cats are harder to score than dogs
VCA says cats are very adept at disguising illness, and WSAVA's pain guidelines say cats, as both predator and prey, are particularly good at concealing pain by showing fewer behavioral signs. Chronic-pain changes can be gradual and subtle, easiest to spot for someone who knows the cat. That is why a repeated score beats a single impression. These are the signals worth checking.
The litter tray is your most honest data source
WSAVA lists litter-box use among the activities to track in chronic pain. Volume, frequency, straining, missing the tray, or a cat who stops using it altogether are all things you can observe. Cornell notes that as the kidneys lose the ability to concentrate urine, cats may urinate larger volumes and drink more. Merck says a urinary blockage in a male cat is a medical emergency needing immediate veterinary attention, with signs including repeated unsuccessful attempts to urinate and crying out in the litter box. Call your vet; it is not a scoring question.
A cat who stops grooming may not feel well
WSAVA lists stopping grooming, or over-grooming one spot, among the signs of pain in cats, and Cornell notes that cats with advancing kidney disease can look unkempt and lethargic. A dull or matted coat, or one spot groomed bare, belongs in the Hygiene and Hurt scores.
Hiding is withdrawal, not preference
WSAVA lists hiding and reduced willingness to interact among the signs of pain in cats. A new hiding place, sleeping under the bed instead of on it, or dropping out of the household's routine is a change in the Happiness category. Owners often score it generously because the cat still seems calm.
Posture and the face carry information
VCA notes that cats become very still if breathing is a problem. WSAVA notes that cats in pain may curl up with a tense abdomen, and that a comfortably sleeping cat is usually in a relaxed or normally curled position. The Feline Grimace Scale, validated for acute pain, scores ear position, eye narrowing, muzzle tension, whisker position and head position. Pulled-apart, outward-rotated ears, squinted eyes, a flattened muzzle, forward whiskers and a head held below the shoulders all score higher.
Lost height is lost mobility
WSAVA's chronic-pain checklist for cats asks about movement, jumping, play, litter-box use, grooming, rest and social interaction. A cat who no longer takes the windowsill, breaks one jump into two, or picks the sofa over the top of the bookshelf has changed their routine. Score what she still chooses to climb.
Weight loss deserves a number, not an impression
Cornell lists weight loss among the signs as kidney disease advances. A long coat can hide it, so weigh your cat on a regular schedule and run your hands along the spine and hips each time you score.
A cat who stops eating needs a call to the vet
Reduced appetite is on WSAVA's list of pain signs in cats, and International Cat Care notes that nausea and vomiting are more common in advanced kidney disease and can cause a cat to lose their appetite. Merck notes that anorexia or food deprivation can set the stage for hepatic lipidosis, a potentially lethal liver disease, in overweight cats, and that the outlook is best when cats are seen early. Don't wait it out.
Frequently asked questions
When is it time to put your cat down? (checklist)
Work through the seven HHHHHMM categories above as a checklist: uncontrolled pain or trouble breathing, not eating or drinking, dehydration, inability to stay clean, withdrawal from the family, loss of mobility to reach food, water and litter, and more bad days than good. Because cats are particularly good at concealing pain, appetite loss and hiding are especially worth noting. No single answer decides it — a low or falling score is the signal to talk with your veterinarian soon about comfort and what's kind.
Kidney disease in cats — when is it time to euthanize?
Chronic kidney disease (CKD) is progressive, and with most cats there is a gradual decline, so quality of life, not the lab numbers alone, should guide the decision. Cornell and International Cat Care describe the later signs: more urine and thirst, loss of appetite, nausea and vomiting, lethargy, an unkempt coat, and weight loss. VCA notes that in later stages cats can't drink enough and that fluids given under the skin can improve quality of life. Scoring your cat regularly makes the trend visible. Share that record with your vet, who can assess the CKD stage, adjust comfort care, and help you judge when quality of life is no longer acceptable.
What is a good quality of life score for a cat?
On the HHHHHMM scale (7 categories, 1–10 each, 70 total), VCA says a score above 5 in each category, or a total above 35, suggests quality of life is acceptable and that it is reasonable to continue end-of-life care and support. VCA publishes the same scoring for cats. The scale doesn't say more about lower scores, so treat a total of 35 or below as a prompt to talk with your vet. It's a conversation-starter, not a verdict, and with cats the trend over repeated assessments matters more than any single score.
How often should I assess my cat's quality of life?
Lap of Love suggests having several family members use its quality of life tools daily or weekly. Pick a schedule, keep to it, and involve the whole household. Cats are particularly good at concealing pain, so a consistent record is often the first thing to reveal a gradual downward trend while there's still time to adjust comfort care with your vet.
Is this a validated medical test?
No. HHHHHMM and JOURNEYS are conversation tools for families and veterinarians. Dr. Villalobos noted in 2011 that there were no clinical studies of end-of-life quality of life assessment in pets. For arthritis pain in cats, WSAVA lists validated owner questionnaires such as the Feline Musculoskeletal Pain Index, and the Feline Grimace Scale is validated for acute pain only. Neither scale here is on WSAVA's list, so ask your vet about those if pain is the question.
Does this calculator replace my veterinarian?
No. It's a structured, nonjudgmental way to reflect on your cat's comfort and to bring an organized record to your vet. It does not provide veterinary advice, diagnosis, or treatment. Your veterinarian can weigh your scores against your cat's specific diagnosis and comfort options.
Sources
- Villalobos HHHHHMM Quality of Life Scale (via VCA Animal Hospitals)
- Hilst JOURNEYS Quality of Life Scale
- Lap of Love — How will I know it's time?
- WSAVA — 2022 guidelines for the recognition, assessment and treatment of pain
- Villalobos AE — Quality-of-life assessment techniques for veterinarians (2011)
- VCA Animal Hospitals — Quality of life at the end of life for your cat
- Evangelista et al. — Development and validation of the Feline Grimace Scale (2019)
- Cornell Feline Health Center — Chronic kidney disease
- International Cat Care — Chronic kidney disease in cats
- VCA Animal Hospitals — Chronic kidney disease in cats
- Merck Veterinary Manual — Noninfectious diseases of the urinary system of cats
- Merck Veterinary Manual — Feline hepatic lipidosis