Cross-Border Terminal Illness & Advance Care Checklist: Germany & Austria

1. 1

   Palliative and Hospice Care and Cross-Border Health Insurance

   • Germany: In the case of an incurable, progressive, and life-limiting illness with complex symptoms, patients are entitled to Specialized Outpatient Palliative Care (Spezialisierte Ambulante Palliativversorgung, SAPV under Sections 37b and 132d SGB V), prescribed by a physician and covered by statutory health insurance [1]. Where palliative or hospice care is needed, a fast-track care level assessment (Pflegegrad-Eilbegutachtung) must be completed within one week (Section 18a SGB XI). Regional SAPV teams, inpatient palliative care wards, and hospices can be located through the German Hospice and Palliative Association (Deutscher Hospiz- und PalliativVerband e.V.) [1].
   • Austria: If care takes place in Austria or a relocation there is planned, graded palliative care relies on mobile palliative teams (supporting care at home or in nursing homes), hospital palliative care units, and inpatient hospices coordinated nationwide through the Austrian umbrella association (Hospiz Österreich) [6]. At the same time, an application for Austrian long-term care allowance (Pflegegeld, structured across seven levels) can be submitted to the competent pension insurance institution, the Pension Insurance Institution (Pensionsversicherungsanstalt) [9]. Before planned follow-up treatment or relocation between Germany and Austria, clarify with the German health insurance fund or the Austrian Health Insurance Fund (Österreichische Gesundheitskasse, ÖGK) whether portable document S1 or S2 is required.
2. 2

   Written Advance Directives in Germany and Austria While Retaining Full Capacity

   Because Austria imposes strict statutory consultation and formal requirements for a legally binding living will, separate advance directives should be executed for both countries while the ill person retains decision-making capacity:

   • Germany: Execute a written, personally signed living will (Patientenverfügung under Section 1827 of the German Civil Code, BGB), supplemented by a palliative emergency sheet (palliativmedizinischer Notfallbogen) for emergency medical services [2]. Official, free text modules and drafting guides are provided by the Federal Ministry of Justice (Bundesministerium der Justiz) [2].
   • Austria: A binding living will (verbindliche Patientenverfügung) under the Austrian Living Wills Act (Patientenverfügungs-Gesetz, PatVG) strictly requires prior comprehensive medical consultation and documentation by a physician, followed by formal execution before a notary, an attorney, or a legally qualified representative of a patient advocacy office (Patientenvertretung) [7]. It is then recorded in the Living Wills Register via the Austrian Chamber of Civil-Law Notaries (Österreichische Notariatskammer) so that hospitals can access it in an emergency [7].
3. 3

   Separate Precautionary, Healthcare, and Banking Powers of Attorney in Both Jurisdictions

   Powers of attorney covering real estate, bank accounts, and healthcare decisions should follow the formal rules of each country to prevent rejection:

   • Germany: Combine a written precautionary power of attorney (Vorsorgevollmacht) with a care directive (Betreuungsverfügung) [2] and register them with the Central Register of Precautionary Deeds of the Federal Chamber of Notaries (Zentrales Vorsorgeregister der Bundesnotarkammer) so that guardianship courts and physicians can immediately verify the authorization in an emergency [3]. If real estate transactions in Germany are included, notarization or public certification is required; in addition, a separate post-mortem bank power of attorney (transmortale Kontovollmacht, valid beyond death) should be lodged with German banks.
   • Austria: An Austrian precautionary power of attorney (Vorsorgevollmacht) must be executed in person before a notary, an attorney, or an adult protection association (Erwachsenenschutzverein) and is registered in the Austrian Central Representation Register (Österreichisches Zentrales Vertretungsverzeichnis, ÖZVV) maintained by the Austrian Chamber of Civil-Law Notaries (Österreichische Notariatskammer) [7]. When the triggering loss of decision-making capacity (Vorsorgefall) occurs, this event is also recorded in the ÖZVV on the basis of a medical certificate so that the representative's authority is legally proven toward banks, authorities, and courts in Austria [7].
4. 4

   Short-Term Care Leave, Family Hospice Leave, and Care Leave Allowance

   Both countries provide statutory leave entitlements and wage-replacement benefits for family caregivers:

   • Germany: In an acute care situation, employees may take up to 10 working days off work and claim care support allowance (Pflegeunterstützungsgeld) as a wage-replacement benefit from the ill person's long-term care insurance fund (Pflegekasse) [4]. For accompaniment during the final phase of life, the Caregiver Leave Act (Pflegezeitgesetz) provides a full or partial release from work for up to three months [4]. Free advisory support is available through the Care Helpline (Pflegetelefon) of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend, reachable at 030 20 17 91 31 or by email at [email protected]) [4].
   • Austria: Employees in Austria have a legal entitlement to Family Hospice Leave (Familienhospizkarenz under Section 14a AVRAG) to accompany a dying close relative, allowing a reduction of working hours, a change in work schedule, or full release from work initially for up to three months, extendable up to six months per case [8]. For financial security during Family Hospice Leave or care leave (Pflegekarenz), caregivers can apply for the income-dependent Care Leave Allowance (Pflegekarenzgeld) through the competent federal authority, the Ministry of Social Affairs Service (Sozialministeriumservice) [8].
5. 5

   Aligning Wills, Survivor Benefits, and Probate Proceedings

   Coordinating estate planning early prevents friction between German probate courts and Austrian court commissioners:

   • Germany: Under the EU Succession Regulation (Regulation (EU) No 650/2012), verify which national succession law applies in the absence of a choice of law, and deposit wills with the probate court (Nachlassgericht at the Amtsgericht) and the Central Register of Wills (Zentrales Testamentsregister). In the event of death, notify the statutory health insurance fund and apply for survivor pensions (Witwen-/Witwerrente or Waisenrente) with the German Statutory Pension Insurance (Deutsche Rentenversicherung) [5]. If the deceased was already receiving a German pension, the surviving spouse can apply within 30 days of death to the Renten Service der Deutschen Post for the advance payment covering the three-month transition period (Sterbevierteljahr, paid at the full insured pension rate) [5].
   • Austria: Following a death, widow's, widower's, and orphan's pensions are claimed from the Austrian Pension Insurance Institution (Pensionsversicherungsanstalt) [9], and any healthcare benefit matters are coordinated with the Austrian Health Insurance Fund (Österreichische Gesundheitskasse, ÖGK). Unlike in Germany, once a death is registered in Austria, court probate proceedings (Verlassenschaftsverfahren) are initiated automatically ex officio and conducted by the locally competent notary acting as court commissioner (Gerichtskommissär) on behalf of the district court (Bezirksgericht), organized under the Austrian Chamber of Civil-Law Notaries (Österreichische Notariatskammer), from the initial death record (Todesfallaufnahme) through to the formal vesting of the estate (Einantwortung) [7].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Specialized Outpatient Palliative Care (SAPV) and Hospice Support — Deutscher Hospiz- und PalliativVerband e.V. (DHPV)
2. [2]
   Living Will (Patientenverfügung), Precautionary Power of Attorney, and Care Directive — Bundesministerium der Justiz (BMJ)
3. [3]
   Central Register of Precautionary Deeds of the Federal Chamber of Notaries (Zentrales Vorsorgeregister) — Bundesnotarkammer / Bund.de
4. [4]
   Ways to Care (Wege zur Pflege): Caregiver Leave, Care Support Allowance, and Care Helpline — Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ)
5. [5]
   Survivor Pensions: Widow's Pension, Orphan's Pension, and Three-Month Transition Period (Sterbevierteljahr) — Deutsche Rentenversicherung (DRV)
6. [6]
   Graded Hospice and Palliative Care in Austria — Dachverband Hospiz Österreich
7. [7]
   Precautionary Power of Attorney, Living Will, and Probate Proceedings in Austria — Österreichische Notariatskammer
8. [8]
   Care Leave Allowance (Pflegekarenzgeld) and Family Hospice Leave (Familienhospizkarenz) — Sozialministeriumservice
9. [9]
   Widow's/Widower's Pension, Orphan's Pension, and Long-Term Care Allowance (Pflegegeld) — Pensionsversicherungsanstalt (PV)