Texas End of Life Planning Checklist: Every Document You Need

End-of-life planning in Texas touches three systems that don't talk to each other: the healthcare system (advance directives), the court system (probate and estate), and the financial system (beneficiary designations, property titles). Miss one, and your family hits a wall — even if the other two are perfectly organized.

This checklist covers every document a Texas resident needs, in the order you should complete them.

Part 1: Healthcare Documents

These documents control what happens to you medically when you can't speak for yourself.

Directive to Physicians and Family or Surrogates (Living Will) States your preferences for life-sustaining treatment when you have a terminal or irreversible condition. Requires two qualified witnesses or a notary. Valid indefinitely until revoked.

Medical Power of Attorney (MPOA) Names a healthcare agent to make all medical decisions when you lack capacity — not just end-of-life situations. Covers surgery consent, facility selection, medication decisions, rehabilitation, and more. Requires the same witness/notary formalities as the living will.

Declaration for Mental Health Treatment (DMHT) Provides instructions for psychoactive medications, convulsive therapy, and emergency psychiatric care. Unique among Texas directives: it expires after three years unless you're incapacitated at the expiration date.

Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order Instructs EMS and first responders to withhold CPR, defibrillation, and ventilation outside a hospital setting. Must be signed by both you and your attending physician. Texas does not recognize POLST forms — the OOH-DNR is the state's equivalent for out-of-hospital settings.

OOH-DNR Identification Device A state-approved yellow bracelet or metal necklace that EMS is trained to recognize. Without the physical form or device present, emergency responders will perform full resuscitation regardless of your wishes. Order from state-approved manufacturers after your physician signs the OOH-DNR.

Part 2: Estate and Property Documents

These documents control what happens to your assets after death and who manages the process.

Last Will and Testament Names your executor, distributes property, and can designate guardians for minor children. Texas requires the will to be in writing, signed by you, and witnessed by two credible witnesses (or entirely in your own handwriting for a holographic will — no witnesses needed, but higher risk of challenge).

Statutory Durable Power of Attorney (SDPOA) Names an agent to handle financial matters — banking, real estate, taxes, insurance — if you become incapacitated. This is the financial counterpart to the MPOA. Without it, your family may need a guardianship proceeding just to pay your bills.

Community Property Survivorship Agreement For married couples: converts community property to right-of-survivorship ownership, so it passes directly to the surviving spouse without probate. Must be in writing, signed by both spouses, and can cover specific assets or all community property.

Transfer on Death Deed (TODD) or Lady Bird Deed Passes real property (typically your homestead) directly to a named beneficiary at death, bypassing probate entirely. Critical for MERP protection — Medicaid Estate Recovery can only pursue assets that pass through the probate estate.

Part 3: Beneficiary Designations

These pass outside your will and override whatever your will says — a fact that catches many families off guard.

Life insurance policies: Verify beneficiary designations are current. A policy naming a deceased spouse or ex-spouse creates administrative delays.

Retirement accounts (401(k), IRA, TSP): These pass by beneficiary designation, not by your will. Under federal law (ERISA), a 401(k) must go to your spouse unless they sign a written waiver.

Bank and brokerage accounts: Add payable-on-death (POD) or transfer-on-death (TOD) designations to avoid probate on financial accounts.

Texas vehicle titles: Senate Bill 2064 (effective September 1, 2025) simplified vehicle title transfers, exempting inherited and right-of-survivorship vehicle transfers from state sales tax and eliminating the $10 gift tax filing requirement.

Part 4: Medicaid and MERP Protection

If you or your spouse may need Medicaid long-term care after age 55, these steps protect your homestead from estate recovery.

Understand the MERP exemptions: Texas MERP will not file a claim if a surviving spouse is living, a surviving child under 21 is living, a surviving disabled child of any age is living, an unmarried adult child lived in the homestead for at least one year before death, or the estate is valued at $10,000 or less.

Title the homestead outside probate: A TODD, Lady Bird Deed, or revocable living trust keeps the homestead out of the probate estate, which is the only thing MERP can reach. This single step can protect the family's largest asset.

File for hardship waiver if needed: If a MERP claim is filed, heirs can request an undue hardship waiver (Form 5006 or 5006-S) within 60 days of the Notice of Intent. Up to $100,000 of homestead value can be exempt if the heir's income is below 300% of the federal poverty guidelines.

Part 5: Funeral and Body Disposition

Designation of Agent for Disposition of Remains Names the person who controls funeral and burial decisions. Without this form, Texas law gives priority to the surviving spouse, then adult children (by majority agreement), then parents. Family disagreements over burial vs. cremation have forced families into court.

Pre-need funeral arrangement Not a legal document but a practical one. Locks in pricing and prevents the family from making expensive emotional decisions under pressure. Texas funeral homes must honor pre-need contracts.

Organ and tissue donation Register with the Glenda Dawson Donate Life Texas Registry. Once you register at age 18 or older, the decision is legally binding and cannot be overridden by family members after your death.

The Execution Order

If you're starting from scratch, complete the documents in this priority:

1. MPOA + Directive to Physicians — these protect you during any medical crisis
2. SDPOA — prevents financial paralysis if you're incapacitated
3. Will — controls asset distribution and executor appointment
4. TODD or Lady Bird Deed — protects the homestead from probate and MERP
5. Beneficiary designation audit — verify all accounts name the right people
6. OOH-DNR — if appropriate for your medical situation
7. Funeral pre-planning — when you're ready

The Texas Advance Directive & Living Will Kit covers the first group — all four Texas healthcare directive forms with execution instructions, witness validation, and a hospital intake coversheet for getting your documents on file with your medical providers.

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