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An end-of-life planning checklist for families in the United States should include advance directives, a health care proxy or durable power of attorney for health care, a living will, funeral preferences, financial and estate documents, expected-death-at-home instructions, death certificate planning, Social Security notification, Medicare, IRS final tax steps, and state-specific requirements.
When someone you love is seriously ill, in hospice, receiving palliative care, or approaching the end of life, it can feel difficult to prepare for what comes next. Many families avoid the topic because they do not want to seem negative or make the person feel like hope is gone. But planning ahead is not about giving up. It is about reducing confusion, protecting the person’s wishes, and helping family members make decisions with less panic later.
End-of-life planning does not mean every detail has to be settled. It simply means gathering the documents, preferences, contacts, and instructions that may be needed if the person becomes unable to speak for themselves or after death occurs.
In the United States, this planning is especially important because many steps are state-specific. Advance directive forms, death certificate rules, expected-death-at-home procedures, probate, Medicaid estate recovery, and funeral regulations can vary depending on where the person lives or where the death occurs.
Start with advance directives and decision-making authority
One of the most important things to clarify is who can make medical decisions if the person becomes unable to communicate. In the U.S., this is usually handled through advance care planning documents such as an advance directive, health care proxy, durable power of attorney for health care, or living will.
A health care proxy or durable power of attorney for health care names someone the person trusts to make medical decisions if they cannot speak for themselves. A living will describes the kinds of treatments the person would or would not want if they were seriously ill, near death, or unable to recover. Medicare explains advance directives as commonly including both a health care proxy and a living will.
The exact forms and names vary by state, so families should not assume one document works everywhere. A good first step is to ask whether the person has completed an advance directive, where the document is stored, and whether their doctor, hospice team, hospital, or care facility has a copy.
This conversation can be simple. You might ask, “If things changed quickly, who would you want making decisions for you, and where would we find your paperwork?” Even one calm conversation can prevent confusion later.
Understand POLST, MOLST, and medical orders near the end of life
Some people near the end of life may also have a POLST, MOLST, or similar medical order form. These forms are different from a general advance directive. They are usually used when someone is seriously ill or near the end of life and specific medical decisions may need to be followed by emergency responders, doctors, nurses, or care teams.
The National Institute on Aging explains that POLST or MOLST forms are typically created when someone is near the end of life or critically ill and understands specific medical decisions that may need to be made.
Not every state uses the same form or the same name. Some states use POLST, some use MOLST, and some use different medical order forms. If the person is in hospice, palliative care, long-term care, or receiving serious illness care at home, ask the care team whether this type of form is appropriate and where it should be kept.
This is especially important if the person does not want CPR, hospitalization, intubation, or certain life-sustaining treatments. Families should not try to guess what paperwork is needed. The care team can explain what applies in that state and care setting.
Gather important legal, financial, and personal documents
After a death, families may need to contact funeral homes, banks, insurance companies, government agencies, pension providers, attorneys, accountants, mortgage providers, and utility companies. These steps are much easier when important information is already organized.
The most useful documents to gather include the will, trust documents if any, durable power of attorney, health care power of attorney, advance directive, living will, Social Security number, birth certificate, marriage certificate or divorce papers if relevant, military discharge papers if applicable, insurance policies, pension or retirement account information, recent tax returns, bank and investment details, property or lease documents, vehicle ownership, and contact information for the executor, attorney, accountant, financial advisor, and key family members.
You do not need to settle the estate before death. The goal is simply to make sure the right people can find the right information when they need it.
It is also helpful to know where the original will or trust documents are stored. A photocopy may be useful for reference, but the original document may be needed later by the executor, personal representative, or attorney.
Talk about funeral, burial, cremation, and service wishes
Funeral planning does not have to mean choosing every song, flower, reading, or photo in advance. For most families, the most helpful thing is to understand the person’s broad preferences.
It helps to know whether the person prefers burial, cremation, body donation, a traditional funeral, memorial service, celebration of life, religious service, graveside service, or a small private gathering. It is also helpful to know whether there is a preferred funeral home, cemetery, place of worship, veterans cemetery, cultural tradition, or family custom that should be respected.
Budget is also worth discussing gently. Families often overspend after a death because they are grieving, tired, and afraid of making the wrong choice. Knowing the person’s general wishes ahead of time can make it easier to choose arrangements that feel respectful without creating unnecessary financial stress.
In the United States, families also have consumer rights under the FTC Funeral Rule. The FTC says funeral homes must give consumers a General Price List when they ask about funeral arrangements, and consumers have the right to choose only the goods and services they want, with some exceptions.
That matters because families can compare prices, ask about direct cremation, ask about basic services, and avoid feeling pressured into decisions they do not understand.
Prepare for an expected death at home
If someone may die at home, ask the hospice team, palliative care team, doctor, nurse, or care coordinator what the process is in your state.
An expected death at home is usually handled differently than a sudden or unexpected death. If the person is enrolled in hospice, the family may be instructed to call the hospice nurse first. If the death is expected and the proper medical orders are in place, the process may be calmer and more straightforward than calling emergency services without a plan.
This is one area where families should not guess. Ask directly: “Who do we call first if death happens at home?” Also ask whether 911 should be called or avoided in your situation, what happens if death occurs overnight, who will pronounce or confirm the death, when the funeral home can be contacted, and whether any state-specific forms or medical orders need to be visible in the home.
The exact process can vary by state, county, hospice provider, and care setting. Having clear instructions ahead of time can make the final hours and the first hours after death much less confusing.
Ask the care team practical questions
Families often focus on medical updates, but practical questions matter too. Before the final days become intense, ask the care team what to expect, who to call, and what support is available.
It is helpful to know who your main contact is during the day, who to call after hours, what signs may mean death is getting closer, and what symptoms should be reported immediately. If the person is at home, ask what supplies, medications, or equipment should be available, and what happens to that equipment after death.
You can also ask about hospice support, social work, spiritual care, grief counselling, caregiver respite, veterans support, or community resources. These supports may not remove the pain of the situation, but they can make families feel less alone and less unsure about what is normal.
A practical question to ask is: “What should we do if something changes quickly?” This can help the family understand when to call the care team, when to seek urgent help, and what is expected as the person gets closer to death.
Understand death certificates and state vital records
After someone dies in the United States, families usually need certified copies of the death certificate for government agencies, banks, insurance companies, pension providers, property matters, and estate tasks.
USA.gov explains that families should contact the vital records office in the state where the death occurred to learn how to order a certified death certificate. It also notes that certified copies are often needed for tasks such as notifying government agencies, closing or transferring bank and credit card accounts, and claiming life insurance or pension benefits.
The funeral home often helps start the death certificate process, but the rules and timelines vary by state. Families should ask how many certified copies they may need, what the funeral home provides, what must be ordered separately, and whether the state has restrictions on who can request copies.
A helpful step before death is to make a list of likely organizations that will need proof of death. This can include Social Security, life insurance companies, pension providers, banks, mortgage companies, investment accounts, and property-related offices.
Make a U.S. after-death notification plan
Some tasks cannot be completed until after death, but families can still prepare a contact list. In the United States, this should include personal contacts, financial institutions, and government agencies.
Families may need to notify the Social Security Administration, Medicare, the IRS, banks, credit card companies, insurance companies, retirement plans, pension providers, an employer or former employer, mortgage provider, landlord, utilities, phone providers, subscription services, and professional advisors.
Many agencies and programs will need the person’s Social Security number and certified copies of the death certificate. For Social Security and Medicare specifically, a funeral director can often report the death to Social Security if given the deceased person’s Social Security number, or families can contact Social Security by phone or in person.
Families should also know that survivor benefits or a lump-sum death payment may be available in some situations. The Social Security Administration has information on survivor benefits and the lump-sum death payment, but eligibility depends on the person’s work history and family situation.
Prepare for IRS and estate-related tax steps
Taxes are not usually the first thing families want to think about, but it helps to know that federal tax responsibilities may continue after death.
The IRS says a surviving spouse or representative generally files the deceased person’s final income tax return, noting that the person has died. The IRS also says the final return should report income up to the date of death and claim eligible credits and deductions.
Depending on the estate, there may also be estate income tax issues, prior-year returns, refunds, or other filings. The person handling the estate may be called an executor, administrator, or personal representative, depending on the state and situation.
Families do not need to figure this out alone. If the person had an accountant, attorney, financial advisor, or estate plan, write down those contacts now. If the situation is more complex, professional help may be needed later.
Consider Medicaid, veterans benefits, and other special situations
Some families may also need to prepare for benefits or rules that only apply in certain situations. If the person received Medicaid, there may be state Medicaid estate recovery rules after death. Medicaid.gov explains that states must seek recovery from the estates of certain deceased Medicaid enrollees, although there are important limits and hardship protections.
If the person was a veteran, spouse of a veteran, or dependent of a veteran, the family may need to look into veterans burial benefits, survivor benefits, military discharge paperwork, or burial in a veterans cemetery. If the person died while living abroad, different U.S. consular reporting steps may apply.
These situations are not relevant for every family, but they are worth identifying early. A simple note such as “received Medicaid,” “veteran,” “retired federal employee,” “union pension,” or “life insurance through employer” can help the family know what to investigate later.
Store everything somewhere easy to find
The most useful end-of-life plan is one that people can actually find. Once documents, wishes, and contact details are gathered, place them in a folder, binder, secure digital file, or shared location. Then tell at least one trusted person where it is.
This folder does not need to be perfect. It can include advance directives, health care proxy documents, a living will, POLST or MOLST forms if applicable, funeral wishes, hospice or care team contacts, financial information, insurance details, government benefit information, property documents, passwords or account instructions where appropriate, and a list of people or organizations to notify.
It is also helpful to include a simple summary page at the front. That page can list the person’s full legal name, date of birth, Social Security number, primary doctor or hospice contact, health care proxy, executor or personal representative, preferred funeral home, and where key documents are stored.
A family does not need every answer in advance. Even partial organization can make the hardest days feel less chaotic.
Final thoughts
End-of-life planning is not about making a painful situation easy. It is about making it less confusing.
When someone is in hospice, palliative care, or nearing the end of life, families are often carrying grief, fear, responsibility, and love all at once. A simple plan can help everyone focus on what matters: understanding the person’s wishes, gathering the right information, and reducing rushed decisions later.
For families in the United States, the most helpful plan includes both personal wishes and practical U.S.-specific details: who can make medical decisions, where the advance directive is stored, whether there is a living will or POLST/MOLST form, what funeral preferences are known, how death certificates are obtained in the state, and which agencies or financial organizations may need to be contacted after death.
If someone you love is seriously ill, Maeve can help you organize the decisions, documents, questions, and next steps before everything becomes urgent. Maeve creates a personalized funeral planning guide based on your family’s situation, including what to prepare, what to ask, and what choices may need to be made.
You do not have to figure everything out alone. A little preparation now can make the hardest days feel less chaotic.
Start planning with Maeve.