End of Life Planning Checklist for South Carolina

End-of-life planning in South Carolina involves more documents than most people realize — and several of them interact in ways that create gaps if you complete some but not others. This checklist covers every essential document and step, in the order you should tackle them.

Healthcare Documents

Healthcare Power of Attorney (HCPOA) Names a healthcare agent to make medical decisions during any period of incapacity. Must be signed by two disinterested witnesses. Requires notarization if it includes life-sustaining treatment authority. Use the statutory form under S.C. Code § 62-5-504.

Declaration of a Desire for a Natural Death (Living Will) Direct instructions to physicians about withholding or withdrawing life-sustaining procedures during terminal illness or permanent unconsciousness. Requires two disinterested witnesses plus notarization. Don't forget to initial the feeding tube section — leaving it blank creates ambiguity.

HIPAA Release Authorization Authorizes healthcare providers to share your medical information with your healthcare agent and named family members. Without this, your agent may have decision-making authority but limited access to the medical information they need.

Physician Orders for Scope of Treatment (POST) For patients with serious illness — translates treatment preferences into standing medical orders that follow you across care settings. Must be signed by your physician, APRN, or PA. Register through the My Life My Choices eRegistry for electronic access by emergency responders.

EMS Do Not Resuscitate Order (Form D-3462) If you don't want CPR during a home emergency. Must be signed by your physician. Post it visibly at home and consider an approved DNR bracelet.

Estate Planning Documents

Last Will and Testament Directs how your assets are distributed after death. South Carolina requires exactly two competent witnesses — not three (a common misconception from multi-state templates). Adding a notarized Self-Proving Affidavit allows the will to clear probate without requiring witnesses to testify later.

Financial Power of Attorney Names someone to manage your finances if you're incapacitated. This is separate from the Healthcare Power of Attorney — one handles medical decisions, the other handles money. Without one, your family may need a court-appointed conservatorship to pay your bills during an illness.

Property and Asset Protection

Vehicle Transfer on Death (TOD) Designation Add a beneficiary to your vehicle title to bypass probate. Complete Form TOD-1 and Form 400 through the South Carolina DMV. Costs $15 for the title fee. The title must list co-owners with "or" (not "and") to qualify.

Homestead Exemption Application If you're over 65, permanently disabled, or legally blind and have lived in South Carolina for at least one calendar year, you can exempt the first $50,000 of your home's fair market value from property taxes. File with your County Auditor's office.

Heirs' Property Assessment If your family home has passed through generations without formal probate or deed updates, you may have an heirs' property issue. This prevents you from getting mortgages, home insurance, or FEMA disaster assistance, and any single heir can legally force a partition sale. Resolving this requires an attorney, but identifying the problem is step one.

Medicaid Considerations

Medicaid Estate Recovery Awareness South Carolina uses a "probate-only" definition for estate recovery. If the deceased received Medicaid long-term care after age 55, SCDHHS can claim against probate assets — but not jointly held accounts, trust assets, or TOD vehicles. Recovery only proceeds if the probate estate exceeds $25,000 and Medicaid claims exceed $500. Recovery is deferred while a surviving spouse is alive or if there's a surviving child under 21 or a disabled child of any age.

Qualified Income Trust (Miller Trust) Planning South Carolina is an income-cap state. If monthly income exceeds $2,982, a Miller Trust is required for Medicaid long-term care eligibility. This requires an elder law attorney.

Document Distribution

Completing the documents is half the job. Making them accessible is the other half:

• Give copies of healthcare documents to your healthcare agent, successor agent, and primary care physician
• File copies with your local hospital system's medical records department
• Upload to the South Carolina My Life My Choices eRegistry
• Keep the original will in a fireproof safe or with your attorney
• Carry a wallet card noting that you have an advance directive and where it's stored
• Do not store originals in a safe deposit box — these are often sealed upon incapacity or death

The South Carolina Advance Directive & Living Will Kit includes the complete healthcare document package — HCPOA, Living Will, HIPAA release, witness screening, and document distribution tracking — so the healthcare planning portion of this checklist is handled in one session.

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