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

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].
   • Switzerland: If care takes place in Switzerland or a relocation there is planned, outpatient palliative care is delivered through specialized Spitex palliative services and cantonal palliative networks coordinated through the Swiss Association for Palliative Medicine, Care and Support (Schweizerische Gesellschaft für Palliative Medizin, Pflege und Begleitung, palliative.ch) [6]. Physician-prescribed nursing care at home or in a nursing home under mandatory Swiss health insurance is governed by the Healthcare Benefits Ordinance (Krankenpflege-Leistungsverordnung, KLV). Before a planned relocation between Germany and Switzerland, clarify with the German statutory health insurance fund or the Swiss health insurer whether portable document S1 or S2 is required.
2. 2

   Written Advance Directives in Germany and Switzerland While Retaining Full Capacity of Judgment

   Because formal rules and standard templates differ between the two countries, separate advance directives should be prepared for both jurisdictions while the ill person retains full mental capacity and capacity of judgment (Urteilsfähigkeit):

   • 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].
   • Switzerland: Prepare a written, hand-dated, and personally signed advance directive (Patientenverfügung under Articles 370 et seq. of the Swiss Civil Code, ZGB) specifying consented medical measures and designating a healthcare representative for medical decisions [7]. Recognized templates (both short and comprehensive versions, including an emergency wallet card) are provided by the Swiss Medical Association (Verbindung der Schweizer Ärztinnen und Ärzte FMH) and the Swiss Red Cross (SRK) [7].
3. 3

   Separate Precautionary Powers of Attorney, Advance Care Mandates, and Bank Authorizations

   Powers of attorney covering real estate, bank accounts, and representation during incapacity are subject to different statutory validity rules in Germany and Switzerland:

   • 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 directly with German banks.
   • Switzerland: In Switzerland, an advance care mandate (Vorsorgeauftrag under Articles 360 et seq. ZGB) governs personal care, asset management, and legal representation in the event of permanent incapacity of judgment [8]. It must either be written, dated, and signed entirely by hand from start to finish (holographic form) or be publicly notarized (öffentlich beurkundet) [8]. When incapacity of judgment occurs, the competent Child and Adult Protection Authority (Kindes- und Erwachsenenschutzbehörde, KESB) examines and validates the mandate and issues an official certificate of representation to the appointed representative; in addition, separate bank powers of attorney should be lodged directly with Swiss banks, as explained on the official Swiss authorities portal (ch.ch) [8].
4. 4

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

   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].
   • Switzerland: Under the Swiss Code of Obligations (Article 329g OR), employees are entitled to paid short-term caregiver leave (bezahlter Betreuungsurlaub) to care for a family member or partner with a health impairment (up to three days per event and up to ten days per year). Furthermore, in cases of long-term need for assistance with everyday tasks, an income-independent helplessness allowance (Hilflosenentschädigung) under the Old-Age and Survivors' Insurance (AHV) or Invalidity Insurance (IV) can be claimed through the cantonal compensation office based on guidance from the AHV/IV Information Center (Informationsstelle AHV/IV), alongside cantonal relief services [9].
5. 5

   Aligning Wills, Survivor Pensions, and Estate Administration

   Because Switzerland is not a party to the EU Succession Regulation, international jurisdiction, choice of law, and estate settlement should be coordinated early between both legal systems:

   • Germany: 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].
   • Switzerland: Following a death, first-pillar survivor pensions (widow's, widower's, and orphan's pensions under the AHV) must be claimed from the competent compensation office (Ausgleichskasse) in accordance with the official information sheets of the AHV/IV Information Center (Informationsstelle AHV/IV), alongside second-pillar occupational pension survivor benefits (Pensionskasse / 2nd pillar) [9]. To access estate assets in Switzerland, the competent cantonal authority (Erbschaftsamt, district court, or notary at the last domicile) issues the certificate of inheritance (Erbenbescheinigung); pay strict attention to the three-month statutory deadline for renouncing an inheritance under the Swiss Civil Code (ZGB), as detailed on the official Swiss portal (ch.ch) [8].

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]
   Palliative Care and Regional Networks in Switzerland — Schweizerische Gesellschaft für Palliative Medizin, Pflege und Begleitung (palliative.ch)
7. [7]
   FMH Living Will (Patientenverfügung under Art. 370 et seq. ZGB) — Verbindung der Schweizer Ärztinnen und Ärzte (FMH)
8. [8]
   Advance Care Mandate (Vorsorgeauftrag), Inheritance, and Renouncing an Inheritance — Schweizer Behördenportal (ch.ch)
9. [9]
   AHV Survivor Pensions (Widow's, Widower's, and Orphan's Pensions) and Helplessness Allowance — Informationsstelle AHV/IV