End-of-Life Planning Checklist for Pennsylvania Residents
End-of-Life Planning Checklist for Pennsylvania Residents
Planning ahead in Pennsylvania requires understanding several state-specific rules that differ from most other states. Pennsylvania is one of only five states with an inheritance tax, so tax planning is essential for nearly every family. The state uses a combined advance directive form, requires notarization for financial powers of attorney, and does not allow transfer-on-death deeds for real estate. This checklist covers every document and decision you need, with the specific Pennsylvania statutes and execution requirements.
Part 1: Healthcare Documents
Advance Health Care Directive (Combined Living Will + Healthcare POA)
Pennsylvania uses a single combined document called the Advance Health Care Directive that includes both a living will and a healthcare power of attorney (20 Pa.C.S. Chapter 54, enacted by Act 169 of 2006).
Living will portion (20 Pa.C.S. Section 5442): Provides written instructions for end-of-life treatment. Becomes operative when you are determined to be incompetent and have an end-stage medical condition or are permanently unconscious (Section 5443).
Healthcare power of attorney portion (20 Pa.C.S. Section 5452): Appoints a health care agent to make medical decisions when you cannot. Effective immediately upon execution unless the document specifies otherwise, though the agent can only act when you are incompetent (Section 5454).
| Detail | Requirement |
|---|---|
| Signing requirements | Signed by you (or another person at your direction), dated |
| Witnesses | Two witnesses, each 18 or older |
| Notarization | NOT required, but recommended for cross-state recognition |
| Witness restrictions | A witness may not be the person who signed on your behalf. A healthcare provider may not sign on your behalf if it provides healthcare services to you |
| State form | Example combined form at 20 Pa.C.S. Section 5471. No Commonwealth agency may prescribe a mandatory form (Section 5433) -- any document meeting statutory requirements is valid |
| Divorce effect | If your marriage is dissolved after execution, any designation of your former spouse as health care agent is automatically revoked (Section 5430) |
How to revoke: A living will may be revoked at any time and in any manner, regardless of your mental or physical condition (Section 5444). A healthcare POA may be revoked while of sound mind by written document or verbal notification (Section 5459).
POLST (Physician Orders for Life-Sustaining Treatment)
The POLST is a medical order, not an advance directive. It is designed for individuals with serious illness and is completed based on a physician-patient discussion.
| Detail | Requirement |
|---|---|
| What it covers | Section A: CPR (attempt vs. DNR) / Section B: Medical interventions (comfort, limited, or full) / Section C: Artificially administered nutrition |
| Who signs | The patient (or surrogate) AND a physician, physician assistant, or CRNP |
| Where to get it | PA Department of Health (pa.gov/agencies/health, EMS Resources section) |
Out-of-Hospital DNR Order
Separate from the POLST, Pennsylvania allows an out-of-hospital do-not-resuscitate order (20 Pa.C.S. Sections 5481-5488). This is a written order from an attending physician directing EMS to withhold CPR outside a hospital. Patients may wear a DNR bracelet or necklace that EMS providers must honor. The order does not affect other medical treatment -- comfort care and pain management continue. Revocable at any time, in any manner (Section 5485).
Mental Health Advance Directive
Pennsylvania allows a separate mental health advance directive (20 Pa.C.S. Chapter 58, Act 194 of 2004). This can include a Mental Health Declaration (written instructions) and a Mental Health Power of Attorney (appointing an agent). Both require two witnesses and may be combined into a single document (Section 5808). Notarization is not required. Divorce automatically revokes designation of a former spouse as agent (Section 5838).
Part 2: Financial and Legal Documents
Financial Power of Attorney
20 Pa.C.S. Chapter 56 governs financial powers of attorney. A critical distinction: all powers of attorney are presumed durable in Pennsylvania unless the document specifically states otherwise (Section 5601.1).
| Detail | Requirement |
|---|---|
| What it does | Authorizes an agent to handle your financial affairs |
| Signing requirements | Signed by you, two witnesses (each 18+), and notarization REQUIRED (Section 5601) |
| Witness restrictions | A witness may not be the agent, the notary, or the person who signed on your behalf |
| State form | Statutory form at 20 Pa.C.S. Section 5602 with specific powers you can individually select |
| Third-party acceptance | Third parties must accept a valid POA and may be liable for refusal (Section 5608.1) |
| Agent duties | Must act in good faith and in your best interest (Section 5601.3) |
| Springing option | May be drafted to become effective only upon incapacity |
Where to store: Original in an accessible location (not a safe deposit box). Copies to your agent, financial institutions, and attorney. If the POA covers real estate, consider recording it with the county Recorder of Deeds.
Will
A will in Pennsylvania must be in writing and signed at the end by the testator (or another at the testator's direction). Pennsylvania recognizes self-proved wills with a self-proving affidavit (20 Pa.C.S. Section 3132.1), which streamlines probate.
Why a will matters in Pennsylvania:
- Without a will, Pennsylvania intestacy law controls who inherits (20 Pa.C.S. Chapter 21)
- A will names your executor, avoiding the Register of Wills' discretion in appointment
- A will can waive the bond requirement for the executor
- A surviving spouse may elect against the will to take one-third of certain property (20 Pa.C.S. Section 2203)
See our guide on how probate works in Pennsylvania for detail.
Part 3: Beneficiary Designations
Beneficiary designations override your will. Review these regularly.
| Asset Type | Key Details |
|---|---|
| POD bank accounts | 20 Pa.C.S. Chapter 63 allows POD designations; funds transfer at death without probate |
| TOD securities | 20 Pa.C.S. Chapter 64 allows TOD registration; securities transfer directly at death |
| Retirement accounts | Name a beneficiary with the plan administrator; spousal consent required for 401(k) if naming a non-spouse |
| Life insurance | Generally exempt from inheritance tax when payable to a named beneficiary (72 P.S. Section 9111(h)) |
Pennsylvania does not allow TOD deeds for real estate. Options for avoiding probate on real property include joint tenancy with right of survivorship, tenancy by the entirety (married couples), life estate deeds, or a revocable living trust.
Inheritance tax impact: Even though POD and TOD assets bypass probate, they are still subject to Pennsylvania inheritance tax at the applicable rate.
Part 4: Inheritance Tax Planning
Because Pennsylvania taxes inheritances on every dollar (no exemption threshold), tax planning should be part of every estate plan.
| Rate | Who Pays |
|---|---|
| 0% | Surviving spouse, charities |
| 4.5% | Children, grandchildren (step-children qualify without formal adoption) |
| 12% | Siblings |
| 15% | All others (nieces, nephews, friends, unmarried partners) |
Key strategies:
- Maximize spousal transfers -- all property passing to a surviving spouse is taxed at 0%
- Life insurance payable to a named beneficiary is generally exempt (72 P.S. Section 9111(h)). Name individuals, not the estate
- 1-year lookback -- gifts made within one year of death are pulled back into the taxable estate
- Trusts do not avoid inheritance tax -- a revocable trust avoids probate but not inheritance tax
- Agricultural exemption -- working farmland may qualify if it generates $2,000+ in gross annual income (72 P.S. Section 9111(s))
For complete details, see estate and inheritance tax in Pennsylvania.
Part 5: Digital Accounts
Create a secure inventory of all digital accounts -- email, social media, cloud storage, financial platforms, subscriptions, and cryptocurrency -- and store it separately from your will (which becomes public record). Use a password manager and share the master credentials with your agent through a secure method.
Part 6: Funeral and Disposition Preferences
Document your preferences in writing: burial vs. cremation vs. green burial, specific funeral home or cemetery preferences, religious or cultural customs, and organ/tissue donation (register at donatelife.net).
Disposition authority: Pennsylvania law gives the surviving spouse sole authority over disposition (20 Pa.C.S. Section 305). If you want a different arrangement, document it clearly and discuss with your family.
For pricing details, see the Pennsylvania funeral cost guide and funeral and burial laws in Pennsylvania.
Part 7: Pennsylvania-Specific Considerations
No State Estate Tax
Pennsylvania does not have a separate state estate tax (unlike New York and Illinois). The federal estate tax applies to estates exceeding $15,000,000 (as of P.L. 119-21, OBBBA, signed July 4, 2025), with a top rate of 40%.
Step-Up in Basis
Under IRC Section 1014, inherited assets receive a step-up in basis to fair market value at the date of death. In equitable distribution states like Pennsylvania, only the deceased's share of jointly held property gets the step-up.
Gift Tax
The federal gift tax exclusion for 2026 is $19,000 per recipient per year. Pennsylvania does not have a separate state gift tax, but remember the 1-year lookback for inheritance tax purposes.
Medicaid and Estate Recovery
Pennsylvania's Medicaid Estate Recovery Program can recover Medicaid costs from a deceased recipient's estate. A 5-year lookback period penalizes asset transfers made to qualify for Medicaid. Assets passing outside probate (POD, TOD, life insurance) may still be subject to recovery in Pennsylvania.
Safe Deposit Box Access
Pennsylvania's safe deposit box rules (61 Pa. Code Chapter 93) make it difficult to retrieve documents after death. Do NOT store the original will in a safe deposit box.
Complete Planning Checklist
Healthcare: Advance Health Care Directive with living will + healthcare POA (2 witnesses, 20 Pa.C.S. Ch. 54) / POLST if appropriate (physician-signed) / Out-of-hospital DNR if desired (Sections 5481-5488) / Mental health directive if needed (Ch. 58)
Financial/Legal: Financial POA (2 witnesses + notarization, 20 Pa.C.S. Ch. 56) / Will with self-proving affidavit (Section 3132.1) / Trust if needed / File POA copies with bank and brokerage
Beneficiary Designations: POD on bank accounts (Ch. 63) / TOD on securities (Ch. 64) / Retirement and life insurance beneficiaries / Review after any major life event
Inheritance Tax: Maximize spousal transfers (0%) / Name individuals on life insurance (not estate) / Account for 1-year lookback on gifts / Review rates for each beneficiary category
Funeral: Document preferences / Register as organ donor / Tell family where documents are
Document Organization: Store originals accessibly (not in safe deposit box) / Distribute copies to agents, executor, physician / Create master document list
Frequently Asked Questions
Do I need a lawyer to create these documents?
No. Pennsylvania provides example forms for the advance directive (Section 5471) and financial POA (Section 5602). You can complete them yourself for straightforward situations. An attorney is recommended for inheritance tax planning, especially for estates passing to non-spousal beneficiaries.
How often should I update my documents?
After any major life event: marriage, divorce, birth, death of a named agent or beneficiary, significant asset changes, or a move. At minimum, review everything every 3-5 years.
Does a trust avoid the Pennsylvania inheritance tax?
No. A revocable trust avoids probate but does not avoid the inheritance tax. Assets in a revocable trust are taxed at the same rates as assets passing through probate.
Where should I store these documents?
Originals in a fireproof safe or with your attorney. Do NOT use a safe deposit box for the original will -- Pennsylvania's access rules make retrieval difficult after death.
What to Do Next
Kaira organizes every step for your state -- deadlines, forms, and next actions -- so nothing gets missed. See how it works.
Related guides:
- How Probate Works in Pennsylvania
- Estate and Inheritance Tax in Pennsylvania
- Pennsylvania Funeral Cost Guide
- How to Close Bank Accounts After Death in Pennsylvania
Disclaimer: This article provides general legal information about end-of-life planning in Pennsylvania. It is not legal advice. Laws and tax rules change. Consult a licensed attorney and financial advisor for guidance specific to your situation.
Sources: 20 Pa.C.S. Chapters 54, 56, 58 (PEF Code); 72 P.S. Sections 9111, 9116 (Inheritance Tax); Act 169 of 2006; Act 103 of 2016; Act 194 of 2004; IRC Section 1014; P.L. 119-21 (OBBBA).