Nevada End-of-Life Planning Checklist: Every Document and Step You Need

End-of-life planning in Nevada involves more moving parts than most states. Between the advance directive, POLST coordination, the Lockbox registry, aggressive Medicaid estate recovery rules, and community property implications, skipping even one step can leave your family exposed to costs and delays you intended to prevent.

This checklist covers every document and action item in the order you should complete them.

Step 1: Execute Your Advance Health-Care Directive

The NRS 162A.855 advance directive is the foundation. It names your healthcare agent (and alternates), specifies your treatment preferences for life-sustaining treatment, artificial nutrition, and comfort care, and can include burial or cremation instructions.

Execute it by either having your signature notarized or signing before two qualified adult witnesses. If you live in a care facility, obtain a competency certification from a physician, APRN, psychologist, or clinical social worker and attach it to the document.

Step 2: Complete the Dementia Addendum (If Applicable)

If you are over 55 or have a family history of cognitive decline, execute the NRS 162A.870 dementia addendum at the same time. This addresses feeding tube decisions and comfort-only care preferences specifically for progressive dementia. It must be signed while you have full cognitive capacity — waiting for a diagnosis may mean waiting too long.

Step 3: Register with the Nevada Lockbox

Submit your completed directive and the Advance Directive Registration Agreement to the Secretary of State's Lockbox Division. Processing takes 7 to 14 business days and costs nothing. You will receive a wallet card with your registration number and password that gives any Nevada hospital 24/7 access to your documents.

Do not skip this step. A signed directive in a safety deposit box is inaccessible during an emergency.

Step 4: Discuss POLST Timing with Your Physician

If you have a terminal diagnosis or are very frail, ask your doctor about executing a Provider Order for Life-Sustaining Treatment (POLST). The POLST converts your advance directive wishes into clinical orders that paramedics and EMTs must follow. Without a POLST or Out-of-Hospital DNR, emergency responders are legally required to attempt full resuscitation regardless of what your advance directive says.

Healthy adults doing routine planning do not need a POLST yet — but knowing when to request one is part of the plan.

Step 5: Review Your Estate Documents for Medicaid Exposure

Nevada's Medicaid Estate Recovery program operates under an expanded "undivided estate" definition (NRS 422.054). This means the state can recover long-term care costs from assets that pass outside of probate, including:

• Revocable living trusts
• Joint tenancies with rights of survivorship
• Life estates
• Annuities
• Deeds Upon Death (transfer-on-death deeds)

If you are over 55 and may eventually need Medicaid-funded long-term care, review how your assets are titled. A revocable living trust — which many Nevadans use for privacy and probate avoidance — does not protect your home from Medicaid recovery after death.

Know the federal mandatory protections: recovery is deferred during the lifetime of a surviving spouse, or if there is a surviving child under 21 or a child of any age who is blind or permanently disabled. The caregiver child exemption (two years of in-home care that delayed institutionalization) and the sibling equity exemption (one year of co-residency) can block recovery against the home.

Step 6: Understand Community Property Implications

Nevada is a community property state with no state income, estate, or inheritance tax. If you die without a will, your surviving spouse automatically retains their half of community property and inherits your half. But your separate property (acquired before marriage, or by gift or inheritance) follows different rules:

• One child + spouse: Split 50/50
• Multiple children + spouse: Spouse gets one-third, children split two-thirds
• No children + spouse: Spouse gets half, remainder goes to parents or siblings

If you own real estate in Nevada but live out of state, any Nevada real property triggers mandatory local probate jurisdiction. Nonresidents cannot use the simplified small estate affidavit to transfer real property — court proceedings are required regardless of the estate's total value.

Step 7: Brief Your Agent and Distribute Documents

Give your healthcare agent:

• A copy of your advance directive and any addenda
• Your Lockbox registration number and password
• A list of your physicians, medications, and insurance information
• Contact information for your alternate agents

Also provide copies to your primary care physician, any specialists you see regularly, and close family members who should know your wishes even if they are not your designated agent.

Step 8: Set a Review Schedule

Nevada advance directives remain active indefinitely unless they contain an expiration date. But life changes — marriages, divorces, moves, new diagnoses — should trigger a review. Set a reminder to revisit your documents every two to three years, or immediately after any major life event.

The Nevada Advance Directive & Living Will Kit covers steps 1 through 3 and step 7 with ready-to-use forms, the Lockbox registration walkthrough, and an agent briefing template — everything needed to complete the healthcare planning portion of this checklist.

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