“Is it time?” is the hardest question about loving a senior dog. Ask it early and you may wonder about the good days you cut short. Ask it late and you may wonder about the suffering that went on too long. Neither worry means you got it wrong.
There's no blood test for it. No imaging study. The only way through it is to watch carefully, write it down, and let the pattern show you what a single bad afternoon can't.
The scale that gives the watching a shape
Dr. Alice Villalobos, a veterinary oncologist who spent most of her career in end-of-life care, published a framework for exactly this kind of watching. She called it the HHHHHMM Quality of Life Scale: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days Than Bad. It appeared in Veterinary Practice News. The AAHA, the American Animal Hospital Association, references the scale in their end-of-life care guidelines as one of the most widely used decision tools available to families and veterinarians.
The scale isn't a formula that tells you the day. It's seven questions to ask every day, scored 1 to 10, so the answer isn't “I think she's worse” but “her mobility dropped from a 7 to a 3 over two weeks, and here's the day it changed.”
Hurt is often the hardest factor to score, because dogs don't always show pain the way people expect. The Merck Veterinary Manual, the reference textbook most clinicians use, describes behavioral changes like reduced activity, loss of interest in routine, and social withdrawal as among the earliest and most missed indicators of pain in dogs.
The daily check-in
A daily check-in takes five minutes after dinner. Score each of the seven factors 1 to 10. Don't analyze in the moment. Write it down and look at the weekly trend on Sunday. That seven-day view is what you bring to the recheck appointment. It replaces “I think he's doing worse” with “his mobility went from 6 to 3 over two weeks, and here's when it changed.”
Four signals to watch in the weekly trend:
- A single factor dropping more than 3 points in one week.
- Three or more factors declining in the same week.
- Two consecutive weeks where bad days outnumber good.
- One factor stuck at 2 or below with no improvement after a vet adjustment.
Weight belongs alongside the scoresheet. Unexplained weight loss in a senior dog with a chronic condition is its own signal, separate from the seven factors. Weekly weigh-ins, same time of day, same scale, show what a single reading at the vet can't. The quality-of-life tracker on this site walks through the scoring in more detail. If you're starting a scoresheet for the first time, that's a good place to begin.
If your dog is also managing a diagnosed condition like chronic kidney disease or cancer, the scoresheet becomes more important, not less. The disease has its own trajectory. The scoresheet tracks the dog. And if you're unsure whether what you're seeing is a crisis or a bad afternoon, the emergency triage guide can help you sort it.
Veta's daily check-in records energy, appetite and mood, one per pet per day, and weight history is charted over three-month and one-year ranges, so the pattern is visible when you need it, not reconstructed from memory in a 15-minute exam room. A notebook kept by hand works too. The tool doesn't matter. The consistency does.
Questions about the quality of life scale
How do I score the HHHHHMM scale?
Each of the seven factors gets a score from 1 to 10, where 1 is the worst and 10 is the best. Score once a day, ideally at the same time. Don't overthink the number. If mobility looked like a 5 yesterday and a 4 today, write 4. The precision comes from the trend, not from any single entry. After a week, add up each day's total. A declining weekly total over two or more weeks is the signal, not a single bad score on a Tuesday.
What counts as a 'good day' versus a 'bad day'?
A good day is one where your dog engaged with the things that make them themselves: food, a person they love, a place they like to rest, a sound they used to respond to. A bad day is one where most of those signals are absent or the dog seems to be enduring the day rather than participating in it. The threshold is personal to your dog.
Should I involve my vet in the scoring?
Bring the scoresheet to every recheck. Your vet can help calibrate what you're seeing, especially for pain. Dogs don't show pain the way most people expect, and a vet who sees the weekly trend can often identify a decline you're too close to notice. The conversation changes when you hand your vet a page of numbers instead of a vague feeling that things are getting worse.
Does the scale work for cats?
The seven factors apply to cats, but the observable signals are different. Cats hide pain and illness more aggressively than dogs, which means the hygiene and happiness scores require closer watching. A cat who stops grooming is communicating something a dog's coat might not. A cat who withdraws from a favorite perch is the equivalent of a dog who stops greeting you at the door. The framework is the same. The things you're watching for are species-specific.
What if my family disagrees about whether it's time?
This is one of the most common sources of grief in the process. The scoresheet helps because it moves the conversation from feelings to observations. Two family members can look at the same dog and feel differently about whether today is a bad day. But if both are scoring independently and the numbers converge on the same decline, the discussion shifts. Some families assign different factors to different people. The point isn't agreement on a feeling. It's agreement on what you're both seeing.
How long should I track before making a decision?
There's no minimum. Some families track for months because the decline is gradual and the scale helps them see what's changing. Others start the scoresheet when a crisis makes the question urgent, and track for two or three weeks to confirm what they already suspect. If you're starting now because you're worried, two weeks of daily scoring usually gives enough data to see the direction. If the trend is flat or improving, keep tracking. If it's declining and the last column, More Good Days Than Bad, has flipped for two consecutive weeks, that's the conversation to have with your vet.
Write down appetite, energy and mood every day
Veta's daily check-in records energy, appetite and mood, one entry per pet per day. Anything else you notice goes in as a dated observation, next to the vet visits and medications.
Written by the Veta Editorial Team. We don't diagnose or prescribe. We explain what your vet's records are telling you and which questions are fair to ask. A veterinarian has not reviewed this page, and the plan your own vet set for your pet comes first. How we write and source our pages.