End of Life Planning Checklist for Tennessee

End-of-life planning in Tennessee involves more than filling out a form. The state's specific rules around advance directives, clinical orders, probate venues, and Medicaid estate recovery create a series of decisions that work together — miss one, and the others may not function as intended.

This checklist covers the major planning steps in the order most families need them.

Healthcare Documents

Execute your Advance Directive for Health Care. Tennessee's unified form combines your living will and healthcare agent appointment into one document. You need either a notary or two qualified witnesses. At least one witness must be unrelated to you and have no claim to your estate. Neither witness can be your healthcare agent.

Discuss a POST form with your physician. If you have a serious illness, are in a nursing facility, or your doctor would not be surprised if you passed within the next year, ask about completing a Physician Orders for Scope of Treatment (POST) form. Unlike your advance directive, a POST gives direct medical orders that EMTs can follow during emergencies.

Consider a standalone DNR order. If you specifically want to refuse CPR but otherwise want full medical treatment, a Universal DNR order covers that narrow scenario. A POST form includes a DNR option and addresses broader treatment decisions — most people need one or the other, not both.

Register your directive. Tennessee allows you to register your advance directive through the Department of Safety Driver's Services emergency contact portal. This makes your wishes accessible even if you're brought to an unfamiliar hospital.

Financial and Estate Protection

Understand Tennessee's tax advantage. The state has no income tax, estate tax, or inheritance tax. This simplifies estate planning significantly compared to states with estate taxes, but federal estate tax still applies to very large estates (the 2026 exemption is $13.99 million per individual).

Review probate avoidance strategies. Tennessee's probate-only Medicaid recovery rule means TennCare can only pursue assets that pass through probate court. Assets that bypass probate — joint tenancy with right of survivorship, payable-on-death accounts, transfer-on-death deeds, and assets held in trust — are completely insulated from estate recovery claims.

Know the homestead exemption limits. Tennessee protects $35,000 in home equity for single homeowners and $52,500 for married couples from unsecured creditors. If your equity exceeds these amounts and you face liability exposure, consider a Tennessee Investment Services Trust (TIST) for additional protection.

Plan around TennCare estate recovery. If you or a spouse may need Medicaid-funded long-term care, understand the five-year lookback period for asset transfers. Transferring property to family members within five years of applying for TennCare CHOICES benefits triggers a penalty period of ineligibility. An elder law attorney can structure trusts or life estates that protect assets without violating lookback rules.

Estate Administration Preparation

Identify your probate court venue. Tennessee's probate system is county-by-county. Depending on your county, jurisdiction may fall under a dedicated Probate Court (Davidson and Shelby counties), a Chancery Court, a Circuit Court, or a County Court. Your family needs to know which court handles your county before they need it.

Determine whether the small estate process applies. If your probate assets total $50,000 or less and you own no real property, your estate may qualify for the simplified Limited Letters process under the Small Estate Probate Act. This avoids the full four-month creditor notice period and reduces costs, though filing fees range from $133 to $334.50 depending on the county.

Prepare for TennCare estate recovery clearance. Even if TennCare has no valid claim, the personal representative must submit a Request for Release to the Division of TennCare before distributing estate assets. This clearance step can delay distribution if not submitted promptly after letters are issued.

Document Distribution

Ensure copies are in the right hands. Your advance directive, POST form (if applicable), and DNR order should be distributed to:

• Your healthcare agent and alternate
• Your primary care physician
• Any hospital or facility where you regularly receive care
• Close family members who might be present during an emergency
• Your estate planning attorney, if you have one

Keep originals accessible. Do not store your advance directive or POST form in a safe deposit box. These documents need to be produced during emergencies — locked storage defeats the purpose. The refrigerator door, bedside, or a clearly labeled folder near the front entrance are standard placements for home-based documents.

The Tennessee Advance Directive & Living Will Kit provides a complete planning system that covers every step on this checklist — from executing your advance directive with a witness verification protocol to understanding how your healthcare documents connect to your estate plan.

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