Quality of Life Assessment Form
Instructions: For each variable there is an assigned value of 10 points with an example for scores of 1, 5 and 10 as guidance. Use your judgment to decide how your pet scores.

Example: E – Eating and Drinking, if your pet “only eats treats” you may assign a value of 2 or 3 — higher than 1 which is not eating at all, but less than 5 which is eating slightly less of their regular food than is normal for them. This is a subjective process, although in general a higher score is better.

A score of 80 is a happy, healthy pet, a score of 8 is a pet that is suffering. A low score on any of the measures may be a reason to consider euthanasia. Most clients find me in the 40 range.

This form, Journey's Pet calculator, was originally created by Dr. Katie Hilst, DVM and modified by www.caradelarosa.com to better serve the needs of our clients.
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Jumping or Mobility:

Scale points to consider:
• 1pt: Your pet cannot walk or stand without assistance.

• 5pt: Your pet can move around as long as he/she has their pain medication. They can do about half the activities they did when they were healthier, or can get about half the distance on a walk, or spend half the time doing their activities (sunbathing, chasing a Frisbee, swimming, playing) as they used to.

• 10pt: Your pet is fully active and enjoying all their activities.

Type the number in the space below.
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Ouch or Pain (Silent Pain is a Factor):

Scale points to consider:

Note: Many animals will hide pain or weakness
as a survival trait. Most animals will NOT whine, whimper or indicate a pain response. The signs of pain are much more subtle and include: trembling, excessive licking of joints, restlessness/inability to settle down, stiffness, slowness when sitting/lying down or getting up from resting position, reluctance to be touched on body, heat radiation from specific points on body, hiding, inappetence and nausea.

• 1pt: Your pet seems painful (not willing to move, less social, trouble laying down/getting up etc),even while taking pain medication.

• 5pt: Your pet is on pain medications and they are

helping at least 75% of the time.

• 10pt: Your pet appears to be pain free.


Type the number in the space below.
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Uncertainty & Understanding : Factors that affect YOU

Scale points to consider:

• 1pt: Your pet has a diagnosis (medical condition)
that cannot be predicted. You may not understand the diagnosis, or the problem may be prone to sudden, catastrophic events. (Consider hiring a support professional with navigating this diagnosis.)

• 5pt: Your pet has a medical condition that can
change over time, is currently stable, and you are
able to monitor it (with the help of your veterinary
team & end of life professional) and make
adjustments when necessary. You understand
what to watch for, the treatment plan, and when
your pet needs medical attention.

• 10pt: Your pet is happy and healthy; there are no medical issues beyond routine preventative care.

Type the number in the space below.
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Respiration & Breathing

Scale points to consider:

• 1pt: Your pet has severe episodes of difficulty breathing, coughing or open mouth breathing. They are not eating or drinking in an effort to breathe. At this point you should seek immediate medical attention for your pet.

• 5pt: Your pet has occasional bouts of coughing, wheezing, or exercise intolerance. They are short (less than 2 minutes) and they are on medication from your veterinarian that can be adjusted to help.

• 10pt: Your pet has no coughing, wheezing, or exercise intolerance.

Type the number in the space below.
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Neatness & Hygiene

Scale points to consider:

• 1pt: Your pet spends time laying in their urine and/or feces and/or catbox. They may be unable to control their elimination, or be unable to move after elimination. Your pet may have an external tumor or mass that is bleeding, foul smelling, and infected, and you are unable to keep it clean and/or bandaged. Your pet may have pressure sores (bed sores) from lying down and being unable to move. They no longer are able to groom themselves.

• 5pt: Your pet may need assistance to urinate/defecate but they do not spend time lying in their waste. They are able to hold their urine/feces until they get assistance. They may have an external tumor or mass, but it can be kept clean and/or bandaged and it is not infected. They groom themselves, but may need assistance in some areas (example-rear end).

• 10pt: Your pet can urinate, defecate, and groom themselves without assistance. They have no medical issues that are causing them to have a bad odor. You can provide any care issues to address their hygiene (baths, trip to the groomer, anal gland expression, teeth cleaning, etc.)

Type the number in the space below.
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Eating & Drinking

Scale points to consider:
Note: Nausea is a major contributing factor to inappetence. The signs of nausea are subtle and include: licking lips, drooling, acting hungry, then walking away, burping, stomach sounds, eating plants/grass in an attempt to induce vomiting. Many pets confuse the sensation of an upset stomach with hunger.

• 1pt: Your pet is refusing food and water. They may be vomiting or having diarrhea (or both). They may be nauseous. Cats may “hang out” at the water bowl, next to it, or with their heads hanging over it. They may appear interested in food or water, then walk away. 
You have tried medications for nausea and they are not longer helping.

• 5pt: Your pet is eating more slowly, and is not as interested in food as they used to be. They may go back several times before they finish a meal. They are eating slightly less than usual, but are eating their regular food. 

• 10pt: Your pet is eating and drinking normally.

Type the number in the space below.
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Your own QoL as Caregiver

Scale points to consider:

• 1pt: You are constantly worried about your pet. You may not understand what is happening to them. You feel overwhelmed and stressed trying to provide for their needs. You may feel you are unable to provide for their needs physically, emotionally, or financially. You may be worried about how they will fare when you are away on an upcoming trip. There may be tension in the family and disagreement on how to proceed. You are not able to sleep, your day is becoming consumed with cleaning chores (i.e. multiple loads of laundry from pet messes), you are unable to leave the house or go to work due to your pet's caregiving needs.

• 5pt: You understand your pet’s condition, and are able, with some effort, to meet their needs. You may have concerns, but they are manageable.

• 10pt: You are easily able to meet your pet’s needs, and not worried about any aspect of their care.

Type the number in the space below.
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Social Ability

Scale points to consider:

• 1pt: Your pet does not spend time with the family. Your pet is isolating, hiding or lying in unusual places. Their personality has shifted and now seems more agitated, irritable, snappy, may nip or bite if startled, moved or touched. Some pets that do not enjoy being petted may not seem to care if they are petted. If your pet once loved brushing or pets, they now move away or reject the attention.

• 5pt: Your pet spends at least half the time with the family. They are not irritable or snippy. They happily greet you when you come home (greeting can be expressed without movement).

• 10pt: Your pet enjoys you, the family, and others (including other animals they may know), greets you at the door when you arrive home, and seeks out company.

Type the number in the space below.
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Please add up your responses and type the total below.

Please add any additional information you would like me to know.
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Cara DeLaRosa offers remote and in-person quality of life assessments and animal hospice support for your animals. This online calculator is only one part of the equation. Cara specializes in building an end of life road map to assist you in navigating the most difficult choice any human every has to make on behalf of their beloved animal.

In cases where family members are in disagreement about the animal's status, Cara will meet with all family members to achieve alignment in regards to the animal's needs.

If you’d like to learn more about her services, please book a complimentary 20 minute discovery call:

https://calendly.com/cara_delarosa/discovery-call


If you’re ready for support, book an hour long QoL assessment:

https://calendly.com/cara_delarosa/qol_1hr

Warmly,

Cara DeLaRosa
Certified Pet Loss Grief Coach
Veterinary End of Life Specialist
Reiki Master & Intuitive Healer
(707) 331-4841
www.caradelarosa.com

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