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

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].
   • Poland: If care takes place in Poland or a relocation there is planned, home hospice care (hospicjum domowe) and inpatient palliative medicine wards (oddział medycyny paliatywnej) are funded on the basis of a medical referral (skierowanie with an ICD-10 diagnosis code) by the National Health Fund (Narodowy Fundusz Zdrowia, with its 24-hour patient helpline Telefoniczna Informacja Pacjenta at 800 190 590) [6]. Additional guidance on patient rights is provided by the Patient Rights Ombudsman (Rzecznik Praw Pacjenta) [7]. Before planned follow-up treatment or relocation between Germany and Poland, clarify with the health insurance fund whether portable document S1 or S2 is required and what conditions apply for medically supervised patient transport.
2. 2

   Written Advance Directives and Medical Authorizations While Retaining Full Capacity

   Because living wills and medical information rights are governed differently under national laws, separate declarations should be prepared for both countries while the ill person has 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].
   • Poland: Lodge a written patient declaration (pisemne oświadczenie pacjenta) together with an explicit authorization enabling a trusted person to access medical records and receive information on the patient's health status (upoważnienie osoby bliskiej do informacji o stanie zdrowia i dokumentacji medycznej) under the Polish Act on Patient Rights and the Patient Rights Ombudsman (Rzecznik Praw Pacjenta) [7]. This authorization should be recorded both in the treating clinic's medical files and digitally via the official Online Patient Account (Internetowe Konto Pacjenta, IKP) [7].
3. 3

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

   Powers of attorney covering real estate, bank accounts, and public authorities should follow the local formal requirements of each country to avoid rejection in cross-border legal matters:

   • 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 set up with German banks.
   • Poland: For real estate transactions, succession matters, and broad property dispositions in Poland, a power of attorney in the form of a notarial deed (pełnomocnictwo w formie aktu notarialnego) is required, executed before a Polish notary (organized under the Polish National Council of Notaries, Krajowa Rada Notarialna) or before a Polish consulate [8]. For Polish bank accounts, lodge both a dedicated bank power of attorney (pełnomocnictwo do rachunków bankowych) and a statutory bank account disposition upon death in favor of close relatives (dyspozycja wkładem na wypadek śmierci under the Polish Banking Law) directly with the respective bank.
4. 4

   Short-Term Care Leave, Caregiver Leave, and Support Benefits for Relatives

   Both countries grant statutory leave rights and financial benefits for family caregivers and seriously ill individuals:

   • 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].
   • Poland: Employees insured in Poland can apply through the Social Insurance Institution (Zakład Ubezpieczeń Społecznych) for a care allowance (zasiłek opiekuńczy) for up to 14 days per calendar year to personally care for an ill family member [9]. In addition, the Polish Labor Code (Kodeks pracy) provides up to 5 days of caregiver leave (urlop opiekuńczy) per calendar year, and adults with severe support needs can apply to the Social Insurance Institution (Zakład Ubezpieczeń Społecznych) for the state support benefit (świadczenie wspierające) [9].
5. 5

   Aligning Wills, Survivor Benefits, and Estate Administration

   Early coordination of estate planning prevents later conflicts between German and Polish authorities:

   • 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].
   • Poland: Following a death, the funeral grant (zasiłek pogrzebowy, which must be claimed within 12 months of the date of death) and survivor pension (renta rodzinna) are claimed from the Polish Social Insurance Institution (Zakład Ubezpieczeń Społecznych) or the Agricultural Social Insurance Fund (KRUS) [9]. Proof of inheritance for assets in Poland is obtained either through a notarial deed of certification of inheritance (Akt Poświadczenia Dziedziczenia, drawn up with all heirs present before a notary and registered in the Inheritance Register Rejestr Spadkowy maintained by the Krajowa Rada Notarialna) or through a court order confirming acquisition of inheritance (sądowe stwierdzenie nabycia spadku) [8]. Observe the six-month deadline for declaring acceptance or renunciation of the inheritance and the six-month tax reporting deadline (Form SD-Z2 filed with the tax office, Urząd Skarbowy) to secure full inheritance tax exemption for close family members.

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]
   Home Hospice and Palliative Care (Patient Telephone Information) — Narodowy Fundusz Zdrowia (NFZ)
7. [7]
   Authorizing a Close Person for Medical Records and the Online Patient Account (IKP) — Pacjent.gov.pl / Rzecznik Praw Pacjenta
8. [8]
   Notarial Registers: Inheritance Register and Deed of Certification of Inheritance — Krajowa Rada Notarialna
9. [9]
   Apply for a Funeral Grant and Social Insurance Benefits from ZUS — Portal Gov.pl / Zakład Ubezpieczeń Społecznych (ZUS)