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

1. 1

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

   The first step is to activate the palliative care team in the country of care and verify cross-border reimbursement rules between the Italian National Health Service (Servizio Sanitario Nazionale) and the Swiss health insurer (Krankenkasse / cassa malati).

   • 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 Città di Torino, ATS Insubria, or ASL Roma 1) for specialist home palliative care (UCP-DOM) or inpatient admission to a Hospice, fully covered by the National Health Service in accordance with guidance from the Ministero della Salute (Italian Ministry of Health) [1]. Additional information on regional networks is provided by the Società Italiana di Cure Palliative (Italian Society of Palliative Care - SICP) [2].
   • Spitex palliative care, cantonal networks, and KLV coverage in Switzerland: In Switzerland, home and inpatient palliative care are coordinated through home care nursing services (Spitex-Palliativpflege) and the cantonal networks affiliated with the national association palliative.ch (Schweizerische Gesellschaft für Palliative Medizin, Pflege und Begleitung, such as palliative ti in Ticino or palliative zh+sh in Zurich) [3]. Medical and nursing palliative care benefits are covered under compulsory basic health insurance in accordance with the Healthcare Benefits Ordinance (Krankenpflege-Leistungsverordnung - KLV / OPre). In the event of a transfer or cross-border care between Italy and Switzerland, verify in advance with the ASL or the Swiss health insurer (Krankenkasse) the issuance of Form S1 or prior authorization Form S2 under the bilateral social security coordination agreements.
2. 2

   Executing Advance Healthcare Directives and patient directives in Italy and Switzerland

   To ensure that end-of-life clinical decisions are immediately recognized by physicians in both Italy and Switzerland, it is advisable to execute both documents 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 state their wishes regarding medical treatments (including artificial nutrition and hydration) and appoint a healthcare proxy (fiduciario) to liaise with the medical team [4]. DATs are executed by notarial deed or by 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, Como, or Rome), which transmits them to the National DAT Database (Banca Dati Nazionale delle DAT) at the Ministero della Salute [4][5].
   • Patient directive (Patientenverfügung) in Switzerland: Under Swiss law, patient directives (schriftliche Patientenverfügung / direttive del paziente) are governed by Articles 370 et seq. of the Swiss Civil Code (ZGB / CC) and must be drawn up in writing, dated, and signed by hand by a person who has capacity of judgment, as explained on the official Swiss portal ch.ch [6]. The patient may designate an individual to represent them in medical decisions and use the official templates prepared by the Federazione dei medici svizzeri - FMH (Verbindung der Schweizer Ärztinnen und Ärzte, Swiss Medical Association) or the Swiss Red Cross (Schweizerisches Rotes Kreuz - SRK) [3][7].
3. 3

   Establishing separate financial and healthcare Powers of Attorney in both jurisdictions

   Swiss and Italian banks and public authorities require separate instruments of representation that meet their respective formal rules in order to prevent frozen accounts or administrative paralysis if incapacity occurs.

   • Notarial power of attorney and Support Administration (Amministrazione di Sostegno) in Italy: While the ill person retains legal capacity, they can grant a general or special power of attorney (procura generale o speciale) by public deed or authenticated private instrument before a notary of the Consiglio Nazionale del Notariato (National Council of Notaries) to manage bank accounts, real estate, and tax matters in Italy [8]. If a partial or total loss of autonomy occurs without an adequate power of attorney, family members can petition the Tutelary Judge (Giudice Tutelare) of the competent court (Tribunale) for the appointment of a Support Administrator (Amministratore di Sostegno).
   • Advance care mandate (Vorsorgeauftrag) and bank powers of attorney in Switzerland: In Switzerland, under Articles 360 et seq. ZGB, an advance care mandate (Vorsorgeauftrag / mandato precauzionale) allows a person to appoint a natural or legal person to handle personal care (Personensorge), financial affairs (Vermögenssorge), and legal representation in the event of incapacity of judgment [6][9]. To be valid, it must either be written, dated, and signed entirely by hand by the principal (eigenhändig) or executed as an authentic notarial deed (öffentlich beurkundet); once incapacity occurs, it is validated by the Child and Adult Protection Authority (Kindes- und Erwachsenenschutzbehörde - KESB / APMA) [6][9]. Because many Swiss banks also require their own internal authorization forms, it is advisable to sign dedicated bank powers of attorney (Bankvollmachten) directly with the Swiss financial institutions at the same time.
4. 4

   Claiming caregiver leave, work permits, and disability benefits

   Both Italy and Switzerland provide paid leave for employed family caregivers as well as allowances for continuous care needs.

   • Law 104/1992 (Legge 104/1992), extraordinary leave, and attendance allowance in Italy: By activating the fast-track procedure for recognition of civil invalidity with attendance allowance (indennità di accompagnamento) and severe disability status (handicap in situazione di gravità under Law 104/1992, Art. 3(3)), employees in Italy are entitled to 3 days of paid monthly leave [10] and up to 2 years 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].
   • Caregiver leave and helplessness allowance (Hilflosenentschädigung) in Switzerland: In Switzerland, the Code of Obligations (Obligationenrecht - Art. 329g OR / CO) entitles employees to paid leave to care for family members with health problems (up to 3 days per event and up to 10 days per year, in addition to up to 14 weeks of care leave for parents of severely ill children financed through the EO/APG loss-of-earnings scheme), as confirmed by the Ufficio federale delle assicurazioni sociali (Federal Social Insurance Office - UFAS / BSV) [12]. For an insured person who regularly requires assistance with everyday activities, a helplessness allowance (Hilflosenentschädigung / assegno per grandi invalidi) under AHV/IV (AVS/AI) can be claimed through the competent compensation fund or IV/AI office, alongside cantonal relief services for family caregivers [13].
5. 5

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

   Because Italy applies EU Regulation No 650/2012 and Switzerland applies the Federal Act on Private International Law (IPRG / LDIP), aligning wills with notarial guidance is essential to avoid conflicts of jurisdiction between the two countries.

   • Succession planning and post-death formalities in Italy: Through a notary of the Consiglio Nazionale del Notariato, your family member can review their testamentary dispositions, and heirs can subsequently search the General Register of Wills (Registro Generale dei Testamenti) [8]. Following death, the Istituto Nazionale della Previdenza Sociale handles applications for survivor pensions (pensione ai superstiti, either reversibilità or indiretta) [14], while heirs must file the inheritance declaration (dichiarazione di successione) with the Agenzia delle Entrate (Italian Revenue Agency) within 12 months of the date of death [15].
   • Succession planning and post-death formalities in Switzerland: In Switzerland, the AHV compensation fund (Ausgleichskasse der AHV), coordinated by the Centro d'informazione AVS/AI (AHV/IV Information Center), pays 1st-pillar survivor pensions (Hinterlassenenrenten: widow's, widower's, and orphan's pensions) [13], while the occupational pension fund (Pensionskasse / 2nd pillar) disburses occupational survivor benefits under its scheme rules. To access bank accounts and transfer assets in Switzerland, heirs apply for a certificate of inheritance (Erbenbescheinigung / certificat d'héritier / certificato ereditario) from the competent cantonal authority (Erbschaftsamt, Bezirksgericht, or Pretura, for example in Zurich, Bern, or Lugano); if the estate is over-indebted, renunciation of the inheritance (Ausschlagung) must be declared within the strict statutory deadline of 3 months from learning of the death under the Swiss Civil Code, as explained on ch.ch [16]. Finally, it is advisable to document wishes regarding local burial or international repatriation of remains or ashes in writing.

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]
   Advance care planning and patient directives (Patientenverfügung) in palliative care — palliative.ch (Schweizerische Gesellschaft für Palliative Medizin, Pflege und Begleitung)
4. [4]
   Advance Healthcare Directives (DAT) - Information and links — Ministero della Salute
5. [5]
   National Database of Advance Healthcare Directives (Banca Dati Nazionale delle DAT) — Ministero della Salute
6. [6]
   Patient directive (Patientenverfügung) and advance care mandate (Vorsorgeauftrag) in Switzerland — ch.ch (Offizielles Portal der Schweizer Behörden)
7. [7]
   FMH Patient Directive (Patientenverfügung): templates and explanatory notes — Verbindung der Schweizer Ärztinnen und Ärzte (FMH)
8. [8]
   Notarial services and deed search (Power of Attorney and General Register of Wills) — Consiglio Nazionale del Notariato
9. [9]
   Incapacity of judgment, patient directive, and advance care mandate (Art. 360 et seq. ZGB) — Verbindung der Schweizer Ärztinnen und Ärzte (FMH)
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]
    Leave for parents and care for relatives (OR / EO) — Bundesamt für Sozialversicherungen (BSV / UFAS)
13. [13]
    AHV/IV benefits and survivor pensions (Hinterlassenenrenten) — Informationsstelle AHV/IV
14. [14]
    Indirect and reversionary survivor pension (Pensione ai superstiti) — Istituto Nazionale della Previdenza Sociale (INPS)
15. [15]
    Declaration of succession (Dichiarazione di successione): information and filing deadlines — Agenzia delle Entrate
16. [16]
    Renouncing an inheritance and certificate of inheritance (3-month deadline under the Swiss Civil Code) — ch.ch (Offizielles Portal der Schweizer Behörden)