End-of-Life Planning Checklist for Massachusetts Residents
End-of-Life Planning Checklist for Massachusetts Residents
End-of-life planning in Massachusetts requires four core legal documents: a Health Care Proxy (M.G.L. c. 201D), a Durable Power of Attorney (M.G.L. c. 190B, §§ 5-501 to 5-505), a will, and a MOLST if you have a serious illness. Completing these documents protects your wishes and spares your family from making decisions without guidance. This checklist walks through each category in order of priority.
Why Planning Ahead Matters
Without a Health Care Proxy, Massachusetts law does not automatically give your spouse or adult children legal authority to make medical decisions for you. Without a Durable Power of Attorney, your family may need to go to court to manage your finances if you become incapacitated. Without a will, your assets are distributed under Massachusetts intestacy law, which may not match your wishes.
The time to complete these documents is before a crisis, not during one.
Part 1: Healthcare Documents
Health Care Proxy (Most Important First Step)
What it is: A legally binding document that names someone to make medical decisions on your behalf when you are unable to make or communicate decisions yourself. Under M.G.L. c. 201D, this is Massachusetts's primary advance healthcare directive.
Who can execute: Any competent adult age 18 or older.
Signature requirements:
- Signed by you (or at your direction) in the presence of two adult witnesses
- Both witnesses must sign and affirm that you appeared to be at least 18, of sound mind, and free from constraint or undue influence
- The person named as your health care agent cannot be a witness
- Notarization is not required, though it may help with acceptance by healthcare providers
Official form: The Massachusetts Health Care Proxy Form is available free at mass.gov/doc/download-the-massachusetts-healthcare-proxy-form/download.
Where to store:
- Keep the original where it can be found easily (not in a safe deposit box)
- Give copies to your doctor and health plan for your medical record
- Give copies to your named agent and any alternate agent
- Give copies to family members, clergy, or lawyer
How to revoke: By executing a new Health Care Proxy, by divorce (if your spouse is the agent), or by notifying your physician in writing (M.G.L. c. 201D, § 7).
Checklist:
- Choose a health care agent you trust to honor your wishes under pressure
- Choose an alternate agent in case your first choice is unavailable
- Have a direct conversation with your agent about your values and preferences
- Sign with two qualified witnesses
- Distribute copies to agent, alternate agent, doctors, and family
Living Will / Personal Directive (Supplement to Health Care Proxy)
Massachusetts is one of only three states that does not legally recognize living wills. A personal directive is not legally binding on doctors in Massachusetts. However, it provides strong evidence of your wishes and gives your health care agent concrete guidance.
Write down your specific preferences: under what conditions you would or would not want CPR, mechanical ventilation, artificial nutrition, dialysis, or other life-sustaining treatments. Share this document with your agent and your healthcare providers.
No official state form exists. The National Hospice and Palliative Care Organization (Caring Connections, caringinfo.org) provides a Massachusetts advance directive form.
MOLST (For People with Serious Illness)
What it is: The MOLST (Medical Orders for Life-Sustaining Treatment) is a standardized medical order form approved by the Massachusetts Department of Public Health. It is a real medical order, not just a preference document.
Who it is for: People with serious advancing illness who want their treatment choices documented in a way that emergency responders and healthcare providers must follow.
What it covers:
- CPR vs. Do Not Resuscitate (DNR)
- Intubation with mechanical ventilation
- Non-invasive ventilation (CPAP)
- Other life-sustaining treatments
How to get one: A MOLST is completed by a licensed Massachusetts physician, nurse practitioner, or physician assistant after a goals-of-care discussion with you or your representative. You cannot complete it yourself.
Transition to POLST: Massachusetts is transitioning to the national POLST form in Spring 2027. Until then, MOLST is the valid form. Existing MOLSTs will continue to be honored after the transition.
Official form: mass.gov/doc/molst-form-with-instructions-1/download
CC/DNR Order Verification (Pre-Hospital DNR)
If you have a DNR order and want pre-hospital emergency responders (EMTs, first responders) to honor it, you need a Massachusetts Comfort Care/Do Not Resuscitate (CC/DNR) Order Verification form and/or bracelet. This is the only form that Massachusetts EMS personnel recognize for pre-hospital DNR orders.
Available at mass.gov/lists/molst-and-comfort-care-dnr-verification.
Part 2: Financial and Legal Documents
Durable Power of Attorney (Financial)
What it is: A document that designates an attorney-in-fact (agent) to manage your financial and property matters. "Durable" means it remains effective if you become incapacitated (M.G.L. c. 190B, § 5-501).
Required language: The document must contain language like: "This power of attorney shall not be affected by subsequent disability or incapacity of the principal" or "This power of attorney shall become effective upon the disability or incapacity of the principal" (springing POA).
Notarization: Not required for general financial matters. Required if the POA will be used for real property transactions (M.G.L. c. 222, § 15(b)). Recommended in all cases.
No official state form for general financial POA. Many families work with an attorney to prepare a custom document.
What your agent can do:
- Manage bank accounts and investments
- Pay bills and debts
- File tax returns
- Manage real estate (if notarized)
- Make gifts (if specifically authorized)
What to think about:
- Choose someone you trust completely with your finances
- Consider whether you want the POA effective immediately or only upon incapacity
- Consider naming a successor agent if your first choice is unavailable
- The principal may nominate a conservator or guardian in the POA for court consideration if protective proceedings are later commenced (M.G.L. c. 190B, § 5-504)
Checklist:
- Decide between immediate effectiveness and springing (incapacity-triggered)
- Name a primary agent and a successor agent
- Have the document notarized regardless of whether real estate is involved
- Tell your agent where the document is stored
Will
A will controls how your probate assets are distributed after death. Without a will, Massachusetts intestacy law (M.G.L. c. 190B, §§ 2-101 to 2-103) determines who inherits. This may or may not reflect your wishes.
Key things a will can do:
- Name specific beneficiaries for specific assets
- Disinherit someone who would otherwise inherit
- Name a guardian for minor children
- Name the personal representative (executor)
- Fund a testamentary trust for minor or special-needs beneficiaries
Massachusetts will requirements:
- Must be in writing
- Signed by the testator
- Witnessed by two individuals in the presence of the testator (M.G.L. c. 190B, § 2-502)
What a will cannot do:
- Override beneficiary designations on retirement accounts, life insurance, or POD accounts
- Control assets held in joint tenancy or in a trust
Checklist:
- Draft or update your will with a Massachusetts estate planning attorney
- Name a personal representative and an alternate
- Name a guardian for any minor children
- Store the original will in a safe location that your PR can access
- Consider filing the will for safekeeping with the Probate Court ($75 fee, per M.G.L. c. 262, § 40)
Part 3: Financial Accounts and Beneficiary Designations
Update Beneficiary Designations
Beneficiary designations on retirement accounts (IRAs, 401ks), life insurance policies, and POD/TOD bank and brokerage accounts override your will. These designations pass assets directly to the named beneficiary outside of probate.
Review and update designations after:
- Marriage or divorce
- Birth or adoption of a child
- Death of a named beneficiary
- Any significant change in your wishes
Massachusetts does not have a TOD deed for real estate. If you want to pass your home outside of probate, options include joint tenancy with right of survivorship, tenancy by the entirety (between spouses), a revocable living trust, or a life estate deed.
Checklist:
- Review beneficiary designations on all retirement accounts
- Review beneficiary designations on all life insurance policies
- Add or update POD designations on bank accounts
- Add or update TOD designations on brokerage accounts
- Consider a revocable trust if real estate transfer without probate is a priority
Organize Your Financial Records
Your personal representative will need to find everything after you are gone. Create a document that lists:
- All bank and investment accounts (institution, account number, approximate balance)
- All insurance policies (insurer, policy number, death benefit)
- Retirement accounts (plan administrator, account number)
- Real estate (address, county Registry of Deeds book and page)
- Vehicle titles (location)
- Safe deposit box (institution, location of key)
- Safe combination or location
- Login credentials for online accounts (or instructions for accessing a password manager)
- Location of will, trust documents, Health Care Proxy, and Durable POA
Part 4: Digital Accounts
Document Your Digital Life
Digital accounts (email, social media, cloud storage, cryptocurrency, digital purchases) are often overlooked in estate planning. Many platforms have specific processes for what happens to accounts after death.
Facebook/Meta: Allows you to designate a Legacy Contact who can memorialize your account or request deletion.
Google: Inactive Account Manager lets you designate what happens to your Google data.
Apple: The Digital Legacy feature (iOS 15.2+) allows you to designate a Legacy Contact.
Cryptocurrency: If you hold cryptocurrency, your heirs need the private keys or seed phrases. Without them, the assets are unrecoverable. Store this information securely and ensure someone you trust can access it.
Checklist:
- Create a digital inventory of all accounts
- Designate legacy contacts where platforms allow
- Store credentials securely (password manager with emergency access, or sealed envelope with attorney)
- Document cryptocurrency holdings and key storage
Part 5: Funeral and End-of-Life Preferences
Express Your Wishes in Writing
Your family will be grieving and making decisions under time pressure. Writing down your preferences removes a significant burden.
Questions to answer:
- Burial or cremation? (Massachusetts requires a 48-hour waiting period before cremation, per M.G.L. c. 114, § 44)
- If cremation, what should happen to the ashes?
- Religious or secular service?
- Preferred funeral home (if any)
- Visitation preferences
- Obituary wishes
- Any pre-arrangements already made (pre-need contract)
Note: Aquamation (alkaline hydrolysis) is not currently legal in Massachusetts as of 2026. Green burial is legal; home burial requires multiple government approvals.
Pre-need funeral contracts: If you choose to pre-fund funeral arrangements, the funeral home must provide you with a Buyer's Guide before signing (239 CMR 4.00). Understand whether the contract is revocable or irrevocable. Irrevocable pre-need funeral trusts may affect MassHealth eligibility.
Checklist:
- Write down funeral and disposition preferences
- Share preferences with family and your health care agent
- Consider whether pre-funding arrangements makes sense for your situation
- If you want a home burial, research the approval process early; it requires Board of Health and local government approval
Part 6: Massachusetts-Specific Issues
MassHealth Planning
If there is any possibility of needing nursing home or long-term care in the future, MassHealth planning deserves attention now. Key facts:
- 5-year lookback: Transfers of assets within 60 months before applying for MassHealth long-term care benefits may create a penalty period of ineligibility (130 CMR 520.019(D))
- $2,000 asset limit: Individuals in long-term care facilities may keep only $2,000 in countable assets to qualify for MassHealth
- Estate recovery: MassHealth recovers costs from probate assets after death for members who were 55+ when receiving covered services (M.G.L. c. 118E, §§ 31-32)
- Hardship waivers and pooled trusts can provide some protection. Consult a Massachusetts elder law attorney
Estate Tax Threshold
Massachusetts estate tax applies to estates over $2,000,000 (M.G.L. c. 65C). If your total estate (home, retirement accounts, life insurance, investments) approaches this threshold, consult an estate planning attorney. Strategies like gifting, irrevocable trusts, and charitable giving can reduce the taxable estate.
Complete Planning Checklist
Healthcare documents:
- Health Care Proxy executed with two witnesses
- Personal Directive (living will) written and shared with agent
- MOLST completed with physician (if serious illness)
- CC/DNR bracelet/form obtained (if DNR is in place)
Legal and financial documents:
- Will executed with two witnesses
- Durable Power of Attorney executed (notarized)
- Beneficiary designations reviewed and updated on all accounts
- Real estate transfer strategy considered (trust, joint tenancy, or accept probate)
Records and organization:
- Financial account inventory prepared and stored safely
- Digital account inventory prepared
- Credentials accessible to trusted person
- Location of all documents communicated to agent/PR
Funeral and care preferences:
- Funeral and disposition preferences written down and shared
- Pre-need arrangements considered
Massachusetts-specific:
- MassHealth lookback period considered if long-term care is a possibility
- Estate tax threshold reviewed if estate may exceed $2M