The HHHHHMM Scale
Pet caregivers can use this Quality of Life Scale to determine the success of Hospice care.
Score patients using a scale of 0 to 10 with 10 being ideal.
Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen necessary?
Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
The patient should be brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean.
Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)?
Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be close to the family activities and not be isolated?
Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
When bad days outnumber good days, quality of life might be compromised. When a healthy humananimal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
*Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; scale format created for author’s book, Canine and Feline Geriatric Oncology: Honoring the Human- Animal Bond, Blackwell Publishing, 2007. Revised for International Veterinary Association of Pain Management (IVAPM) 2011 Hospice Statement. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.
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