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

1. 1

   Palliative and Hospice Care and Cross-Border Health Insurance (Germany and Italy)

   • Germany: In the case of an incurable, progressive illness with complex symptoms, the ill person is entitled to Specialized Outpatient Palliative Care (Spezialisierte Ambulante Palliativversorgung, SAPV under Section 37b SGB V), prescribed by a physician and covered by statutory health insurance [1]. Regional outpatient hospice services, palliative care wards, and inpatient hospices can be found through the German Hospice and Palliative Association (Deutscher Hospiz- und PalliativVerband) [1]. In addition, in palliative or hospice situations, a shortened one-week deadline applies for the fast-track care level assessment (Pflegegrad-Eilbegutachtung) by the Medical Service following application (Section 18a SGB XI) [1].
   • Italy: If care is to take place in Italy or a relocation is planned, Law No. 38/2010 guarantees access to the National Palliative Care and Pain Therapy Network (Rete Nazionale delle Cure Palliative e Terapia del Dolore) within the National Health Service (Servizio Sanitario Nazionale) [6]. Through the local health authority (Azienda Sanitaria Locale, ASL) and the general practitioner, home palliative care teams (Unità di Cure Palliative Domiciliari, UCP-DOM) or inpatient hospices are coordinated, with supplementary guidance available from the Italian Society of Palliative Care (Società Italiana di Cure Palliative, SICP) [6]. Before any cross-border transfer, clarify in advance with the competent health insurance fund whether cost coverage is secured via the European Health Insurance Card (EHIC), portable document S1 (transfer of residence), or portable document S2 (planned medical treatment).
2. 2

   Written Advance Directives While Retaining Full Decision-Making Capacity (Patientenverfügung and DAT)

   While the ill person retains full legal and decision-making capacity, medical treatment wishes should be documented in writing for both countries:

   • Germany: A written living will (Patientenverfügung under Section 1827 BGB) bindingly specifies which medical measures are consented to or refused in specific treatment scenarios [2]. For this purpose, the official text modules and drafting guides of the Federal Ministry of Justice (Bundesministerium der Justiz) can be used and supplemented with a palliative emergency sheet (palliativmedizinischer Notfallbogen) for emergency medical services [2].
   • Italy: Under Law No. 219/2017, adults with legal capacity can execute Advance Treatment Directives (Disposizioni Anticipate di Trattamento, DAT, also known as Biotestamento) and appoint a healthcare proxy (fiduciario) therein [6]. The DAT are lodged in person with the civil status office of the municipality of residence (Ufficio di Stato Civile del Comune), before an Italian notary, or abroad at the competent Italian consulate, and are transmitted to the National DAT Database maintained by the Ministry of Health (Ministero della Salute) [6].
3. 3

   Separate Precautionary and Financial Powers of Attorney in Both Jurisdictions

   So that authorized representatives can act without delay toward physicians, banks, and public authorities, separate instruments should be executed in Germany and Italy while full legal capacity remains:

   • Germany: A precautionary power of attorney (Vorsorgevollmacht), supplemented by a care directive (Betreuungsverfügung), appoints a trusted person for healthcare and financial matters to avoid court-appointed guardianship [2][3]. The deed should be registered with the Central Register of Precautionary Deeds of the Federal Chamber of Notaries (Zentrales Vorsorgeregister der Bundesnotarkammer) so that guardianship courts and treating physicians have immediate access to the notice in an emergency [3]. For real estate or corporate transactions, notarization is required; for bank accounts, a post-mortem bank power of attorney (transmortale Bankvollmacht, explicitly valid beyond death) should also be lodged directly with the credit institution.
   • Italy: For asset, banking, and real estate matters in Italy, Italian banks and public bodies regularly require a notarized special or general power of attorney (procura speciale or procura generale), which can be executed through an Italian notary (Consiglio Nazionale del Notariato) or an Italian consular mission. If decision-making capacity becomes impaired without an adequate power of attorney in place, the guardianship judge (Giudice Tutelare at the Tribunale) appoints a legal support administrator under the Amministrazione di Sostegno procedure.
4. 4

   Fast-Track Disability Benefits and Statutory Leave for Family Caregivers

   • Germany: Working relatives may take up to 10 working days off work in an acute care situation and apply to the ill person's long-term care insurance fund (Pflegekasse) for care support allowance (Pflegeunterstützungsgeld) as a wage-replacement benefit [4]. For accompaniment during the final phase of life (at home or in a hospice), the Caregiver Leave Act (Pflegezeitgesetz) provides an entitlement to full or partial release from work for up to 3 months (in companies with 16 or more employees), supported by an interest-free loan [4]. Free advice is provided by the family ministry's information portal (Wege zur Pflege) and the Care Helpline (Pflegetelefon) at 030 20 17 91 31 [4].
   • Italy: Through the National Institute for Social Security (Istituto Nazionale della Previdenza Sociale, INPS), an expedited assessment of severe disability (handicap in situazione di gravità under Law 104/1992) as well as attendance allowance (indennità di accompagnamento) can be requested in cases of severe oncological or life-limiting illness [7]. Once severe disability is recognized under Article 3(3) of Law 104/1992, employees insured in Italy are entitled to 3 paid leave days per month as well as up to 2 years of paid extraordinary caregiver leave (congedo straordinario) [7].
5. 5

   Aligning Wills, Survivor Pensions, and Estate Administration

   Under the EU Succession Regulation (Regulation (EU) No 650/2012), succession as a whole is governed in principle by the law of the state in which the deceased had their last habitual residence, unless an explicit choice of law in favor of the law of nationality (Italian law for Italian nationals) has been made in a testamentary disposition.

   • Germany: Following a death, an application for the advance payment covering the three-month pension transition period (Sterbevierteljahr) for surviving spouses or registered partners should be submitted to the Renten Service der Deutschen Post within 30 days; the formal application for a survivor pension (Witwen-, Witwer- oder Waisenrente) is filed with the German Statutory Pension Insurance (Deutsche Rentenversicherung) [5]. In addition, notify the statutory health insurance fund and, where required, apply to the probate court (Nachlassgericht at the Amtsgericht) for a German certificate of inheritance (Erbschein) or a European Certificate of Succession.
   • Italy: Survivor pensions (pensione di reversibilità for pensioners or pensione indiretta for insured workers) are claimed from the National Institute for Social Security (Istituto Nazionale della Previdenza Sociale, INPS) [7]. Where estate assets or real estate exist in Italy, heirs must generally file the electronic inheritance declaration (dichiarazione di successione) with the Italian Revenue Agency (Agenzia delle Entrate) within 12 months from the date of death (an exemption applies only if the estate passes to a spouse or direct-line relatives, does not exceed EUR 100,000, and includes no real estate) [8]. Testamentary dispositions in Italy can be verified through the General Register of Wills (Registro Generale dei Testamenti).

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Specialized Outpatient Palliative Care (SAPV) and Hospice Support — Deutscher Hospiz- und PalliativVerband (DHPV)
2. [2]
   Living Will (Patientenverfügung) and Precautionary Power of Attorney (Vorsorgevollmacht) — Bundesministerium der Justiz (BMJ)
3. [3]
   Central Register of Precautionary Deeds (Zentrales Vorsorgeregister - ZVR) — Bundesnotarkammer
4. [4]
   Short-Term Work Absence, Care Support Allowance, and Caregiver Leave — Bundesministerium für Familie, Senioren, Frauen und Jugend (Wege zur Pflege)
5. [5]
   Survivor Pensions and Three-Month Pension Transition Period (Sterbevierteljahr) — Deutsche Rentenversicherung
6. [6]
   Advance Treatment Directives (DAT) and Palliative Care in Italy — Ministero della Salute
7. [7]
   Law 104 Caregiver Leave, Extraordinary Leave (Congedo Straordinario), and Survivor Pensions — Istituto Nazionale della Previdenza Sociale (INPS)
8. [8]
   Declaration of Succession (Dichiarazione di successione) — Agenzia delle Entrate