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

1. 1

   Organizing palliative care, hospice care, and cross-border health coverage between Italy and Romania

   The first step is to activate the palliative care team in the country where care is being provided and to verify European health insurance coverage rules if a transfer between Italy and Romania is being considered.

   • Palliative care network and hospices in Italy: Under Law 38/2010 (Legge 38/2010), the general practitioner (medico di medicina generale) or hospital specialist activates the Local Palliative Care Network (Rete Locale di Cure Palliative) of the Local Health Authority (Azienda Sanitaria Locale - ASL, for example ASL Roma 1 or ATS della Città Metropolitana di Milano) for specialized home palliative care (UCP-DOM) or admission to dedicated residential facilities (Hospice), covered in full by the National Health Service (Servizio Sanitario Nazionale - SSN), as set out by the Ministero della Salute (Italian Ministry of Health) [1]. Information on regional networks and specialist centers is also available through the Società Italiana di Cure Palliative (Italian Society of Palliative Care - SICP) [2].
   • Palliative care (îngrijiri paliative) and healthcare coordination in Romania: In Romania, home palliative care (îngrijiri paliative la domiciliu) and inpatient admission to dedicated palliative wards are reimbursed by the public health insurance system through the Casa Națională de Asigurări de Sănătate (National Health Insurance House - CNAS) and the county health insurance houses (Casele Județene de Asigurări de Sănătate, for example in Bucharest or Cluj), based on a specialist medical referral [3]. Accredited non-profit specialist networks also operate across the country, including HOSPICE Casa Speranței and the National Palliative Care Association (Asociația Națională de Îngrijiri Paliative - ANIP) [4]. If you plan to transfer the ill person between Italy and Romania to continue care, verify in advance with the ASL or CNAS the issuance of European forms S1 (for residents insured in the other Member State) or S2 (for planned cross-border medical treatment).
2. 2

   Executing Advance Healthcare Directives and informed consent designations in Italy and Romania

   Written medical directives are governed by the law of the state where care is delivered; it is therefore advisable to formalize them separately in both countries while your family member has full capacity.

   • Advance Healthcare Directives (Disposizioni Anticipate di Trattamento - DAT / Biotestamento) in Italy: Under Law 219/2017 (Legge 219/2017), the ill person can express their wishes regarding diagnostic tests, therapeutic choices, and specific medical treatments (including artificial nutrition and hydration) and appoint a healthcare proxy (fiduciario) to represent them before doctors [5]. DATs are executed by notarial public deed, authenticated private deed, or private document delivered in person to the Civil Status Office (Ufficio di Stato Civile) of the municipality of residence (for example in the Municipality of Milan, Rome, or Turin), which transmits them to the National DAT Database (Banca Dati Nazionale delle DAT) managed by the Ministero della Salute [5][6].
   • Informed consent and representative designation in Romania: In Romania, the Patients' Rights Law (Legea drepturilor pacientului nr. 46/2003, under the purview of the Ministry of Health, Ministerul Sănătății) protects the patient's right to accept or refuse medical treatments and to designate in writing a legal or family representative authorized to receive clinical information and express consent if the patient becomes unable to decide independently [3]. It is advisable to file this written designation directly in the medical record at the Romanian healthcare facility.
3. 3

   Establishing separate financial and healthcare Powers of Attorney in both jurisdictions

   Banks, public offices, and notaries in Italy and Romania require instruments of representation that comply with their respective domestic laws.

   • Notarial power of attorney and Support Administration (Amministrazione di Sostegno) in Italy: While the ill person retains full legal capacity, they can grant a general or special power of attorney (procura generale o speciale) by public deed or authenticated private agreement through a notary belonging to the Consiglio Nazionale del Notariato (National Council of Notaries) to manage bank accounts, real estate, and administrative matters in Italy [7]. If a partial or total limitation of autonomy later arises, family members can apply for Support Administration (Amministrazione di Sostegno) by filing a petition with the Tutelary Judge (Giudice Tutelare) at the court (Tribunale) of the place of residence or domicile.
   • Authentic notarial or consular power of attorney (procură autentică notarială) for Romania: To manage bank accounts, pensions, or real estate located in Romania, an authentic special or general power of attorney (procură autentică notarială) drawn up by a Romanian public notary belonging to the Uniunea Națională a Notarilor Publici din România (National Union of Public Notaries of Romania - UNNPR) is required [8]. If your family member is in Italy and cannot travel to Romania, a power of attorney that is directly valid under Romanian law - without requiring an apostille or translation - can be signed at a Romanian diplomatic or consular mission in Italy (for example in Rome, Milan, Turin, Bologna, or at the Consolato Generale di Romania a Trieste), by booking an appointment on the official consular services portal (eConsulat.ro) [9].
4. 4

   Claiming caregiver leave, work permits, and disability benefits

   Both countries provide employment protections for relatives caring for a seriously ill family member as well as financial support benefits.

   • Law 104/1992 (Legge 104/1992), extraordinary leave, and attendance allowance in Italy: By requesting an urgent assessment (fast-tracked within 15 days for oncology patients) for civil invalidity with attendance allowance (indennità di accompagnamento) and severe disability status (handicap in situazione di gravità under Law 104/1992, Art. 3(3)), employed family caregivers in Italy can claim 3 days of paid monthly leave [10] and up to 2 years in total of paid extraordinary caregiver leave (congedo straordinario retribuito) through the Istituto Nazionale della Previdenza Sociale (National Social Security Institute - INPS, toll-free number 803 164 from landlines or 06 164 164 from mobile phones) [11].
   • Medical leave for caring for an oncology patient in Romania: In Romania, workers insured under the public system are entitled to paid medical leave and an allowance for caring for and accompanying an adult oncology patient (concediu și indemnizație pentru îngrijirea pacientului cu afecțiuni oncologice) for up to 45 calendar days per year, paid through the Casa Națională de Asigurări de Sănătate [3]. In addition, the Romanian Labor Code (Codul muncii) grants employees 5 working days per year of caregiver leave (concediul de îngrijitor) to assist a relative with serious medical problems.
5. 5

   Aligning wills, bank accounts, funeral wishes, and succession procedures

   Coordinating testamentary dispositions and civil status records in advance between Italy and Romania simplifies social security, banking, and tax formalities following a death.

   • Succession planning and post-death formalities in Italy: With the assistance of a notary from the Consiglio Nazionale del Notariato, your family member can draft or review a will in accordance with EU Regulation No 650/2012 (which allows a Romanian citizen residing in Italy to choose Romanian national law or retain the law of habitual residence) and heirs can later search the General Register of Wills (Registro Generale dei Testamenti) [7]. After death, the Istituto Nazionale della Previdenza Sociale processes survivor pension claims (pensione ai superstiti, either reversibilità or indiretta) [12], while the inheritance tax return (dichiarazione di successione) must be submitted electronically to the Agenzia delle Entrate (Italian Revenue Agency) within 12 months of the opening of the succession [13].
   • Succession planning and post-death formalities in Romania: In Romania, the Casa Națională de Pensii Publice (National House of Public Pensions - CNPP, via its territorial pension offices, Case Teritoriale de Pensii) pays the statutory funeral grant (ajutorul de deces) - which by law is disbursed within 3 working days of submitting a complete application with the death certificate and proof of funeral expenses - as well as the survivor pension (pensia de urmaș) [14]. The notarial succession procedure (procedura succesorală notarială) takes place before a Romanian public notary in the district of the deceased's last domicile or where the main assets are located [8][15]; if the succession is completed within 2 years of the date of death, heirs are exempt from the 1% inheritance tax on the value of the estate (which applies after 2 years and is payable to the National Agency for Fiscal Administration, Agenția Națională de Administrare Fiscală - ANAF) [16]. Finally, it is advisable to leave written instructions regarding preferences between local burial and international repatriation of remains or ashes.

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Palliative care and Hospices in Italy (Law 38/2010) — Ministero della Salute
2. [2]
   Implementation of Law 38/2010 on palliative care and pain therapy — Società Italiana di Cure Palliative (SICP)
3. [3]
   Insured Person's Guide: Palliative care and medical leave for caring for an oncology patient — Casa Națională de Asigurări de Sănătate (CNAS)
4. [4]
   Palliative care services in Romania (Servicii de îngrijire paliativă în România) — HOSPICE Casa Speranței
5. [5]
   Advance Healthcare Directives (DAT) - Information and links — Ministero della Salute
6. [6]
   National Database of Advance Healthcare Directives (Banca Dati Nazionale delle DAT) — Ministero della Salute
7. [7]
   Notarial services and deed search (Power of Attorney and General Register of Wills) — Consiglio Nazionale del Notariato
8. [8]
   Notarial procedures and successions in Romania — Uniunea Națională a Notarilor Publici din România (UNNPR)
9. [9]
   Notarial deeds: Authentication of powers of attorney and declarations at the consulate (eConsulat.ro) — Ministerul Afacerilor Externe - Consulatul General al României la Trieste
10. [10]
    Allowance for paid leave taken by workers to care for severely disabled family members (Law 104/1992) — Istituto Nazionale della Previdenza Sociale (INPS)
11. [11]
    Allowance for extraordinary leave to care for family members with severe disabilities — Istituto Nazionale della Previdenza Sociale (INPS)
12. [12]
    Indirect and reversionary survivor pension (Pensione ai superstiti) — Istituto Nazionale della Previdenza Sociale (INPS)
13. [13]
    Declaration of succession (Dichiarazione di successione): information and filing deadlines — Agenzia delle Entrate
14. [14]
    Funeral grant (Ajutorul de deces): conditions and payment deadlines — Casa Națională de Pensii Publice (CNPP)
15. [15]
    Useful guide: Notarial succession procedure and required documents — Uniunea Națională a Notarilor Publici din România (UNNPR)
16. [16]
    Tax on income from the transfer of real estate from personal patrimonio (successions) — Agenția Națională de Administrare Fiscală (ANAF)