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

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].
   • Spain: If care takes place in Spain or a relocation there is planned, the public National Health System (Sistema Nacional de Salud) provides inpatient palliative care units (unidades de cuidados paliativos) and home palliative support teams (equipos de soporte de atención domiciliaria, ESAD) for care at home or in hospital [6]. A nationwide directory of resources is maintained by the Spanish Society for Palliative Care (Sociedad Española de Cuidados Paliativos) [6]. Before planned follow-up treatment or a move between Germany and Spain, clarify with the German statutory health insurance fund whether portable document S1 (change of residence) or S2 (planned medical treatment) is required, and whether a fit-to-fly medical certificate is needed prior to transport.
2. 2

   Written Advance Directives in Germany and Spain While Retaining Full Capacity

   Because formal requirements and registries for living wills are governed by national law, separate documents should be executed for both countries while the ill person retains mental 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].
   • Spain: Execute a Spanish advance directive (Documento de Instrucciones Previas or Voluntades Anticipadas / Testamento Vital under Law 41/2002) before a notary, before designated regional health administration officials, or before the legally required witnesses [7]. Register the document in the corresponding regional autonomous registry (Registro Autonómico), which is electronically linked to the National Registry of Advance Directives (Registro Nacional de Instrucciones Previas, RNIP) maintained by the Ministry of Health (Ministerio de Sanidad), ensuring that treating physicians across Spain can access it [7].
3. 3

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

   Powers of attorney covering real estate, bank accounts, and public authorities should follow the formal rules of each country to prevent rejection or lengthy court guardianship proceedings:

   • 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 hospitals 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 directly with German banks.
   • Spain: For banking, asset management, real estate, and healthcare decisions in Spain, banks and registries regularly require a public notarial deed (escritura pública de Poder Preventivo, or a general power of attorney with a clause continuing its validity in the event of incapacity under Spanish civil law reforms) [8]. This deed is executed before a Spanish notary organized under the General Council of Notaries (Consejo General del Notariado), which arranges registration in the Civil Registry, or alternatively before a Spanish consulate abroad [8].
4. 4

   Short-Term Care Leave, Family Caregiver Leave, and Support Benefits

   Both countries provide statutory leave entitlements and financial support 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].
   • Spain: In cases of severe care dependency, an urgent dependency assessment (valoración urgente de dependencia) can be requested through the regional social services of the Autonomous Community under the Dependency Act (Law 39/2006 / IMSERSO) [6]. In addition, the Spanish Workers' Statute (Estatuto de los Trabajadores) grants paid statutory leave days in the event of serious illness or hospitalization of close relatives, as well as the right to reduced working hours or unpaid family care leave (excedencia por cuidado de familiar).
5. 5

   Aligning Wills, Survivor Benefits, and Estate Administration

   Organizing estate documents early simplifies subsequent administration between German and Spanish 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 testamentary dispositions in official custody 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].
   • Spain: Following a death, the funeral grant (auxilio por defunción) as well as widow's and orphan's pensions (pensiones de viudedad y orfandad) are claimed from the National Institute of Social Security (Instituto Nacional de la Seguridad Social) [9]. For estate settlement, after at least 15 working days following the death, obtain the Certificate of Last Wills from the General Registry of Last Wills (Registro General de Actos de Última Voluntad) using Form Modelo 790 before executing the notarial acceptance of inheritance before a notary via the General Council of Notaries (Consejo General del Notariado) [8]; furthermore, the Spanish inheritance tax return (Impuesto sobre Sucesiones y Donaciones) must generally be filed within six months from the date of death (with the option to request an extension within the first five months).

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]
   Directory of Palliative Care Resources in Spain — Sociedad Española de Cuidados Paliativos (SECPAL)
7. [7]
   National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) — Ministerio de Sanidad
8. [8]
   Preventive Power of Attorney and Wills Before a Notary — Consejo General del Notariado
9. [9]
   Death and Survivor Benefits: Widowhood, Orphanhood, and Funeral Grant — Instituto Nacional de la Seguridad Social (Seguridad Social)