End-of-life documents every hospice family needs

When someone enters hospice care, the window for completing certain legal and medical documents may be shorter than families expect. Some of these documents can only be signed by someone with full decision-making capacity, and that capacity can diminish quickly. Knowing which end-of-life documents a hospice family needs, and which ones to prioritize right now, is one of the most practical things this guide can offer.

The documents that matter most in hospice

Not every estate planning document is equally urgent when someone is in hospice. These are the ones that need to be in place, or confirmed as in place, quickly.

Advance directive (healthcare directive)

An advance directive is a legal document that records a person's wishes about medical treatment if they become unable to communicate those wishes. It typically includes two parts: a living will, which specifies which medical interventions the person does or does not want, and a healthcare proxy designation, which names someone to make medical decisions on their behalf.

If your family member does not have an advance directive, the hospice social worker can help complete one during the enrollment period. Most states have a standard form. It requires witnesses, and in some states notarization. The hospice team handles this regularly.

If your family member does have one, confirm it is accessible to the hospice team and that the designated healthcare proxy knows their role and where the document is.

POLST or MOLST (Physician Orders for Life-Sustaining Treatment)

Unlike the advance directive, which is a personal statement of wishes, a POLST (or its state equivalent, sometimes called a MOLST) is a physician's order. It specifies, in medical terms, which life-sustaining interventions a patient does or does not want, such as CPR, mechanical ventilation, and artificial nutrition.

The critical difference: a POLST is legally actionable by emergency responders. If paramedics arrive at a home where a hospice patient has died and there is no POLST, they may be legally required to attempt resuscitation. A signed POLST prevents this.

Ask your hospice physician about completing a POLST at enrollment if one does not already exist.

Durable power of attorney for healthcare (healthcare proxy)

This document designates a specific person to make medical decisions if the patient cannot. It is often included within an advance directive, but it can also be a standalone document.

The person named as healthcare proxy carries significant responsibility and needs to know they have been designated, understand the patient's wishes, and have a copy of the document.

If the patient currently has decision-making capacity, this document can still be signed. If they do not, it is too late to create a new one through normal channels, and a family may need to pursue healthcare guardianship through a court, which is a much more difficult process.

Do Not Resuscitate (DNR) order

A DNR is a physician's order that instructs healthcare providers not to perform CPR if the patient's heart stops or they stop breathing. For patients in hospice who have chosen comfort-focused care, a DNR is almost always appropriate.

The DNR may be part of the POLST or a standalone order. Confirm with your hospice team that it is in place and that emergency contacts know about it.

Documents that are important but less urgent

These documents matter, but a family can typically navigate the immediate hospice period without them if they do not yet exist. That said, the weeks of hospice enrollment are often a practical window to complete them.

Will or living trust

A will specifies how assets are distributed after death. A living trust achieves similar goals but avoids probate. If your family member does not have either document, encourage them to consult an estate attorney while they still have capacity. The hospice social worker may be able to help with a referral.

Durable power of attorney for finances

This document gives someone the legal authority to manage financial affairs if the patient can no longer do so. It is separate from the healthcare proxy. It allows a designated person to access accounts, pay bills, and manage assets without going through a court. If the patient has not yet designated someone and still has capacity, this is worth completing.

Life insurance policies and beneficiary information

Locate all life insurance policies and confirm that the beneficiary designations are current. Outdated beneficiary designations are one of the most common sources of estate complications.

Funeral and burial preferences

Has your family member recorded their preferences for burial or cremation? Do they have a pre-arranged funeral? Is there a funeral home they have a relationship with? These preferences, even if written informally, reduce the burden on family members in the immediate aftermath of death.

What to do if documents don't exist

If key documents do not exist and your family member still has decision-making capacity, the hospice social worker is your first point of contact. They work with these situations regularly and can:

• Help complete an advance directive and POLST during the hospice enrollment
• Refer to a local estate attorney for a will or power of attorney
• Coordinate with the hospice physician on any orders that need to be signed

If your family member no longer has decision-making capacity and key documents do not exist, the situation is more complicated. A family may need to pursue legal guardianship or conservatorship to have legal authority over healthcare or financial decisions. An estate attorney can advise on your state's options.

Where to store and share these documents

A document that exists but cannot be found when needed is only slightly better than no document at all.

Store originals in a secure location at home or in a document vault. Give copies to:

• The hospice team
• The designated healthcare proxy
• Any family members who may need to make decisions
• The primary care physician

Post a copy of the DNR and POLST somewhere visible in the home, such as on the refrigerator door. Emergency responders are trained to look there.

The end-of-life documents checklist provides a comprehensive list of what to gather and where to store it.

Frequently asked questions

Can an advance directive be changed once hospice starts?

Yes, as long as the person has decision-making capacity. The document can be updated, and a new version supersedes the old one. The hospice team and any healthcare providers involved should receive updated copies.

What if family members disagree about the patient's wishes?

If there is no advance directive, family disagreements about care decisions can become genuinely complicated. The hospice social worker can facilitate a family meeting. If conflict is severe, the hospice ethics consultant or a legal mediator may be involved. The best protection is documentation of the patient's own stated wishes.

Is a handwritten advance directive valid?

This varies significantly by state. Some states accept holographic (entirely handwritten) documents; most require specific forms with witnesses. The hospice social worker knows your state's requirements.

What happens to these documents after the person dies?

The medical documents (advance directive, POLST, DNR) are no longer operative after death. The financial and legal documents (will, trust, power of attorney) become relevant for estate administration. The executor of the estate typically takes over from the healthcare proxy at the point of death.

What Passings can help with

Passings includes a free document vault for securely storing and sharing important end-of-life documents. You can store advance directives, insurance policies, and financial records in one place, and designate which family members can access them and when. Start a free plan at Passings. Whenever you're ready, we'll be here.

Related resources

• End-of-life documents checklist
• What is an advance directive
• How to prepare when a parent enters hospice care
• Estate planning checklist

Passings is not a law firm and does not provide legal or medical advice. This article is for general informational purposes. Legal document requirements vary by state. For advice specific to your situation, consult a licensed attorney or healthcare professional.

Disclaimer — For informational purposes only

This article is compiled from publicly available resources and is provided solely for general informational purposes. It does not constitute and should not be relied upon as legal, financial, tax, insurance, medical, psychological, or other professional advice. Passings is a planning and organizational platform, not a licensed advisory service, and no attorney-client, financial advisor-client, or other professional relationship is created by reading this content.

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