It's Saturday morning. The dog's asleep on the rug by the back door, which is where he sleeps now. You've got a coffee, a piece of paper, and a printout of seven letters your vet sent home last Tuesday: H, H, H, H, H, M, M. The paper is faintly coffee-stained from sitting on the counter all week. You're about to score your pet's quality of life for the first time, and you don't know what the number is going to do to you.
The scoresheet in front of you is the Villalobos scale. Dr. Alice Villalobos, a veterinary oncologist in Southern California, developed it in the early 2000s as the central tool of what she named Pawspice, a hospice-oriented model of care for pets with life-limiting illness. She published it in her book Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond in 2007, and it's now taught inside the veterinary hospice and palliative-care curriculum administered by the International Association for Animal Hospice and Palliative Care, which you'll see written as IAAHPC once you start reading further. The scale is her work. Any version you see in a clinic, a pamphlet, or a tool like this one traces back to that source.
One thing to get straight before you pick up the pen. The scale is a structured lens for a conversation you're already having with yourself about your pet's last stretch. It doesn't make the decision. The total at the bottom of the sheet isn't a line the pet crosses when the number drops. It's a line you use to see the stretch clearly, so you can talk about what you're seeing with the vet who knows your pet. Nothing you're about to score tells you what to do. What it tells you is what you're looking at.
What the scale is, in plain terms
Seven dimensions, each scored from zero to ten. The letters stand for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. The total runs from zero to seventy. A total of 35 or above is the range most clinicians and hospice teams treat as supporting continued care. Below 35, the conversation with your vet shifts from optimization to orientation: are we seeing the same slope, and what do we do about it.
The seven dimensions were chosen because they cover the day-to-day experience of being a pet. Hurt and Mobility are the body. Hunger, Hydration, and Hygiene are the routines of being a body. Happiness is the relational dimension, whether the pet is still present with the people and animals they love. And the last M, More good days than bad, is the honest question: across the week, how much of the pet's life feels like a life they're living, not one they're enduring.
The scale doesn't tell you what a three on Hurt means for your specific pet. That's your job and your vet's. What the scale gives you is a repeatable structure, so the score you write down this Saturday compares cleanly with the score you write down next Saturday. Trend beats snapshot. A pet who's been holding at 50 for three months and drops to 42 over two weeks tells you something that the 42 alone never will.
Why Dr. Villalobos developed this, and what it's for
Dr. Villalobos has been practicing veterinary oncology for over four decades, and the scale emerged from her clinical observation that owners of pets with advanced cancer or geriatric disease were consistently making end-of-life decisions without a structured way to observe their pet's condition between visits. She has written that the scoresheet was designed to reduce the experience of a family making the call on a single bad day, which is the worst day to make it. A weekly structured score gives a family months of orientation before the hard conversation becomes unavoidable. That's the whole thesis.
The scale is taught inside clinical curricula alongside the American Animal Hospital Association's end-of-life care guidelines, which frame the veterinary team's role as supporting the owner's decision rather than owning it. The AAHA guidelines walk through the dimensions of the quality-of-life conversation: pain, function, appetite, dignity, and the family's capacity for caregiving. The Villalobos scale is the scoring instrument that makes that conversation specific. The AVMA's euthanasia guidelines, in turn, address the clinical procedure itself and the standards the profession holds for how it's performed. These three sources together (Villalobos's scale, AAHA's end-of-life care framework, and AVMA's euthanasia guidelines) are the current US veterinary-profession consensus on how the decision gets supported.
The scale is widely used by hospice-oriented practices, including the mobile vets who do at-home euthanasia and the IAAHPC-credentialed hospice teams. In my decade in clinic I saw the scoresheet handed to families in two main settings: at a recheck for a pet in chronic-care for kidney or cardiac disease, and at the first conversation after a terminal diagnosis where hospice was a live option. Both uses are correct. The scale isn't a late intervention.
How clinicians actually use it
A hospice or palliative-care vet will usually ask the family to score the scale at home, weekly, starting the week of the diagnosis or the week the conversation about hospice begins. The family brings the scoresheets to each recheck. The vet reads them alongside the physical exam and the labs. When the trend drops by five points across two weeks, the vet usually steps the conversation forward: which dimensions are driving the drop, which are fixable with medication or routine adjustment, and which are signaling that the disease is advancing beyond the comfort plan in place.
The clinician's read of the scale won't be identical to the family's. A vet will often adjust the hydration score after a physical exam catches a subtle skin-turgor change; the family scored based on water-bowl behavior, which is a valid signal but an incomplete one. The clinician may also flag a mobility score the family has rationalized. A dog who's no longer climbing the stairs to bed is easy to accommodate around, and the family's mobility score often reads higher than the dog's actual function. None of this is a critique of the family's observation. It's the exchange the scale is designed to produce.
What the score means, in context
The published interpretation is straightforward. A total of 35 or above is read as acceptable to good quality of life. Below 35, the conversation shifts. That threshold isn't really a threshold. It's a starting line for a clinical conversation that's already in progress by the time the score drops that low. No vet I've worked with, and no hospice team I know, treats the 35 as an automatic trigger. It's where the conversation becomes specific.
Two patterns matter more than the total. The first is the trend. A stable 38 that holds for three months is a different picture than a 48 that drops to 38 in four weeks. Both totals are the same; the stretches look nothing alike. The second is dimension asymmetry. A total of 40 composed of a 2 on Hurt and a 9 on Happiness tells you something specific: pain isn't controlled, and the pet's relational life is intact, which is a fixable picture. A total of 40 composed of a 9 on Hurt and a 2 on Happiness tells you something different: the pet's body feels fine and their interior has gone quiet. The second picture is often harder for a clinician to address, and it's where the hardest conversations live.
Read each dimension. Don't only read the total. That's the single most common mistake I saw in the scoresheets families brought to Angell, and it's the mistake this tool's interpretation text is written to prevent.
How to run it at home
Once a week. Same day, same time, same person when you can. Saturday morning is a common choice because it sits outside the workweek and gives the scorer room to think. The score takes about ten minutes if you're honest with yourself, about five if you already know what you're seeing. Don't try to score on a bad day or right after a rough night. The week is the unit, not the moment.
Run the scoresheet with the person in the household who knows the pet best, even when that's not the person reading this page. Scoring alongside a spouse, a grown child, or a long-term pet sitter improves accuracy and protects the scorer from carrying the observation alone. Many families find the second pair of eyes catches the week they'd stopped seeing clearly. If disagreement turns up, write down both scores and bring both to the vet. The gap is information.
When you finish, write the date and the total somewhere you'll see it next week. A paper notebook works well. The notebook did the real work for most of the families I watched run this scale. A pinned note on your phone works. An email to yourself works. The tool below will format the scoresheet for copy-paste into any of those surfaces.