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

1. 1

   Clarify palliative and hospice care in Germany as well as health insurance coverage if relocating to Turkey

   First, contact the treating medical team or hospital social service (Krankenhaussozialdienst) in Germany to establish seamless symptom and pain management [1][2]:

   • Care in Germany (SAPV, hospice care, and fast-track care level assessment): In cases of complex symptoms, the general practitioner or hospital can prescribe Specialized Outpatient Palliative Care (Spezialisierte Ambulante Palliativversorgung - SAPV under § 37b SGB V), which provides 24-hour home care by a multi-professional palliative team covered by statutory health insurance [1]. Alternatively or additionally, outpatient hospice services and inpatient hospices offer support; nationwide contacts are provided by the umbrella organization Deutscher Hospiz- und PalliativVerband (German Hospice and Palliative Association) at 030 82 00 758-0 or via email at [email protected] [2]. In parallel, submit an initial or upgrade application for a care level (Pflegegrad) to the long-term care insurance fund (Pflegekasse), explicitly noting the palliative situation in writing: under § 18(3) sentence 3 SGB XI (in conjunction with § 18a SGB XI), the Medical Service (Medizinischer Dienst) must complete the assessment within one week if the ill person is receiving outpatient palliative care or is in a hospice [3].
   • If planning continued care or return to Turkey (Form T/A 11 and fitness to fly): If your family member wishes to spend the final stage of life in Turkey, insurance coverage must be clarified prior to departure with the German statutory health insurance fund (gesetzliche Krankenkasse - GKV) and using the guidance sheets of the liaison body Deutsche Verbindungsstelle Krankenversicherung - Ausland (DVKA, German Liaison Office for Health Insurance - Abroad) [4]. For a temporary stay, the health insurance fund issues the entitlement certificate T/A 11 (also referred to as A/T 11) under the German-Turkish Social Security Agreement [4][5]. In Turkey, this form must be submitted to a local branch of the state social security institution (Sosyal Güvenlik Kurumu - SGK) to obtain a YUPASS number for medical treatment at contracted Turkish hospitals [4][5]. Note that this covers only benefits available under Turkish statutory health rules, medical repatriation back to Germany is not included, entitlement to German care allowance (Pflegegeld) generally ceases upon permanent relocation to Turkey, and a medical fitness-to-fly certificate (Fit-to-fly) must be obtained in advance [4][5].
2. 2

   Draft a written advance healthcare directive and treatment plan for Germany and Turkey

   While the ill person has capacity to give informed consent, they should record their medical preferences in writing [6]:

   • Advance directive (Patientenverfügung) under § 1827 BGB: In Germany, a written, personally signed Patientenverfügung bindingly specifies which end-of-life medical interventions (such as mechanical ventilation, artificial nutrition, or cardiopulmonary resuscitation) are consented to or refused [6]. The Bundesministerium der Justiz (Federal Ministry of Justice) provides legally vetted text modules and drafting guides free of charge [6].
   • Emergency palliative sheet and cross-border documentation: Ask the SAPV team or general practitioner to draw up a palliative emergency sheet (Notfallbogen) for emergency medical services [1][6]. If a stay in Turkey is planned, current medical reports, the medication schedule (particularly for strong opioid analgesics), and documented treatment preferences should be carried along with a certified Turkish translation so that Turkish medical teams are informed of the therapeutic goal and designated trusted representatives [5][6].
3. 3

   Execute legally valid powers of attorney separately for Germany and Turkey

   Because a privately signed German power of attorney is not accepted by Turkish banks and authorities, two separate powers of attorney should be executed while the person retains full legal capacity [6][7]:

   • For Germany (Vorsorgevollmacht and Betreuungsverfügung): With a German durable power of attorney (Vorsorgevollmacht, supplemented by an advance care directive for court-appointed guardianship, Betreuungsverfügung), the ill person authorizes one or more trusted individuals to handle healthcare, residence decisions, official administrative matters, and financial affairs [6]. Real estate transactions in Germany require notarization (notarielle Beurkundung) or public certification (öffentliche Beglaubigung); for German bank accounts, a separate bank power of attorney valid beyond death (transmortale Vollmacht) should also be lodged directly with the bank [6]. Register the Vorsorgevollmacht with the Zentrales Vorsorgeregister der Bundesnotarkammer (Central Register of Advance Directives of the Federal Chamber of Notaries) via the toll-free number 0800 3550500 so that guardianship courts (Betreuungsgerichte) and attending physicians can access it immediately in an emergency [8].
   • For Turkey (Düzenleme Şeklinde Vekâletname): For bank accounts, pension matters (SGK), land registry transactions (Tapu), and administrative procedures in Turkey, the representative requires a notarized power of attorney drawn up in formal deed form under Turkish notarial law (Düzenleme Şeklinde Vekâletname) [7]. After completing an online application and booking an appointment, this can be executed in person at the locally competent Türkisches Generalkonsulat (Turkish Consulate General) in Germany (the Consular Call Center for Germany is available 24/7 at +49 30 30 80 70 90, or internationally at +90 312 292 29 29) [7]. Required items include valid identification (T.C. Kimlik Kartı, Mavi Kart, or passport), biometric passport photos, and the personal details of the appointed representative; in cases of serious illness or advanced age, Turkish consulates routinely require a same-day specialist medical certificate confirming full mental capacity (Akıl Sağlığı Raporu) [7].
4. 4

   Use statutory caregiver leave and care support allowance in Germany

   Employed family caregivers in Germany can claim statutory leave and wage-replacement benefits, on which the Pflegetelefon des Bundesministeriums für Familie, Senioren, Frauen und Jugend (Care Helpline of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth) provides advice at 030 20 17 91 31 or by email at [email protected] [9]:

   • Short-term inability to work (Kurzzeitige Arbeitsverhinderung, up to 10 working days): To organize care in an acute care situation, employees may take up to 10 working days off work and apply to the ill person's Pflegekasse for Care Support Allowance (Pflegeunterstützungsgeld) as a wage-replacement benefit [9].
   • End-of-life care leave (Pflegezeit in der letzten Lebensphase) and Family Care Leave (Familienpflegezeit): Under the German Care Leave Act (Pflegezeitgesetz), employees (in businesses with 16 or more employees) are entitled to full or partial leave of up to three months to accompany a close relative during the final phase of life - even if care is provided in an inpatient hospice [9]. For home care, employees may also claim up to 6 months of Pflegezeit or up to 24 months of Familienpflegezeit (in businesses with 26 or more employees), supplemented by the option of an interest-free loan from the Federal Office of Family Affairs and Civil Society Functions (Bundesamt für Familie und zivilgesellschaftliche Aufgaben) [9].
5. 5

   Organize cross-border succession, bank accounts, and funeral wishes between Germany and Turkey

   Put asset and estate documents in order early, as special conflict-of-laws rules apply between Germany and Turkey [10][11]:

   • Account for the split estate (Nachlassspaltung) regarding real property: Under the bilateral German-Turkish Agreement on Succession of 1929 (Annex to Article 20 of the Consular Treaty), which remains in force, as well as Turkish private international law (MÖHUK Art. 20), immovable property is mandatorily governed by the law of the state in which the real estate is situated (lex rei sitae), as explained by the Deutsche Vertretungen in der Türkei (German Missions in Turkey) [10]. Real estate in Turkey is therefore always inherited under Turkish succession law regardless of nationality (including Turkish compulsory share rules and a Turkish certificate of inheritance, Veraset İlamı), whereas movable assets (such as bank accounts) are governed by nationality or a choice of law under the EU Succession Regulation [10]. Because certain German forms of wills (such as a joint Berliner Testament) can create legal complications in Turkey, seeking notarial advice in Germany is advisable, along with official custody of the will and registration in the Zentrales Testamentsregister der Bundesnotarkammer (Central Register of Wills of the Federal Chamber of Notaries) at 0800 3550700 [10][11].
   • Funeral wishes and repatriation burial funds (Cenaze Fonu): Discuss with your family member whether burial in Germany or repatriation to Turkey is preferred, and check whether they hold membership in a mutual funeral assistance fund (Cenaze Fonu, for example through DITIB or IGMG) or funeral expense insurance (Sterbegeldversicherung), which coordinates official formalities and international transport in the event of death [7][10].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Hospice and Palliative Care in Germany (SAPV under § 37b SGB V) — Bundesministerium für Gesundheit (BMG)
2. [2]
   German Hospice and Palliative Association (Deutscher Hospiz- und PalliativVerband e.V. - DHPV) - Contact and Guidance — Deutscher Hospiz- und PalliativVerband e.V.
3. [3]
   German Social Code Book XI (SGB XI) § 18a - Assessment Deadlines for Palliative and Hospice Care — Bundesministerium der Justiz / Gesetze im Internet
4. [4]
   Information Sheet on Holidays and Stays in Turkey - Health Insurance Coverage (Form T/A 11 and SGK) — GKV-Spitzenverband / Deutsche Verbindungsstelle Krankenversicherung - Ausland (DVKA)
5. [5]
   Turkey: Travel and Safety Advice - Medical Care and Social Security Agreement — Auswärtiges Amt
6. [6]
   Durable Power of Attorney (Vorsorgevollmacht), Care Directive, and Advance Directive (Patientenverfügung) - Forms and Text Modules — Bundesministerium der Justiz (BMJ)
7. [7]
   Consular Notarial Services (Vekâletname) and Consular Call Center — Ministerium für Auswärtige Angelegenheiten der Republik Türkei (konsolosluk.gov.tr)
8. [8]
   Central Register of Advance Directives (Zentrales Vorsorgeregister - ZVR) of the Federal Chamber of Notaries — Bundesnotarkammer / Serviceportal Bund
9. [9]
   Ways to Care (Wege zur Pflege) - Care Support Allowance, Care Leave, and Family Care Leave — Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ)
10. [10]
    Succession Law and Bilateral Succession Agreement in German-Turkish Relations — Deutsche Vertretungen in der Türkei (Auswärtiges Amt)
11. [11]
    Central Register of Wills (Zentrales Testamentsregister - ZTR) of the Federal Chamber of Notaries — Bundesnotarkammer / Serviceportal Bund