COSMIC LIGHT| End of Life Care for Animals
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Pet parent quality of life assessment form
The HHHHHMM Scale
Pet parents can use this Quality of Life Scale to determine the success of Comfort Care. Score patients using a scale of 1 to 10 with 10 being ideal.
*
Indicates required field
Pet's name
*
Pet's age
*
Pet parent's Name
*
First
Last
Email
*
Phone Number
*
H: HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is breathing increased, rapid, labored or abnormal? Choose One
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
H: HUNGER - Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
H: HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
H: HYGIENE - The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
H: HAPPINESS - 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?
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
M: MOBILITY - 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.)
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
M: MORE GOOD DAYS THAN BAD - 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.
*
1 (bad)
2
3
4
5
6
7
8
9
10 (good)
Quality of Life Total
*
0-35 patient may be suffering, hospice care may not help preserve the quality of life of your pet
>35 patient has an acceptable quality of life for considering hospice care
Submit
Additional fees:
Extended travel, arrangements made outside business hours, aggressive pets
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Cosmic Light | End of Life Care for animals
Copyright 2022
home
About Cosmic Light
Services
Home euthanasia
Home hospice consultation
Pet parent quality of life assessment form
Patient form
Consent form
Testimonials
Resources
