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

1. 1

   Palliative care, hospice care, and cross-border health coverage between the Netherlands and Spain

   Organizing care starts with the medical team where your family member is currently staying, combined with verifying health insurance coverage in case a care relocation between the Netherlands and Spain is considered.

   • Palliative care and long-term care assessments in the Netherlands: The general practitioner (huisarts) or medical specialist coordinates medical care and arranges community nursing (wijkverpleging, reimbursed under the Healthcare Insurance Act, Zorgverzekeringswet). A national overview of palliative care at home, in a homelike hospice (bijna-thuishuis), or in a clinical hospice is available through the government portal Overpalliatievezorg.nl (operated by the Ministry of Health, Welfare and Sport and Palliaweb / PZNL) [1]. If your ill relative permanently requires 24-hour intensive care or close supervision, you or the care provider can apply for a Long-Term Care Act (Wet langdurige zorg - Wlz) assessment from the Centrum Indicatiestelling Zorg (Care Needs Assessment Centre, reachable by phone at 088 789 10 00), which also applies specific procedures for claiming long-term care from or abroad [2].
   • Palliative care and cross-border coverage in Spain: In Spain, palliative care within the public healthcare system (Sistema Nacional de Salud) is delivered through hospital palliative care units (unidades de cuidados paliativos) and specialized home care support teams (equipos de soporte de atención domiciliaria - ESAD), activated by the primary care physician at the local health center (centro de salud, for example via the Servicio Madrileño de Salud in Madrid or CatSalut in Catalonia). A national directory of specialized teams is published by the Sociedad Española de Cuidados Paliativos (Spanish Society for Palliative Care - SECPAL) [3]. Before planning cross-border care or relocating in the final stage of life between the Netherlands and Spain, check in advance with the health insurer (or the CAK for treaty beneficiaries) whether an S1 or S2 form is required and under what conditions medical transport is reimbursed.
2. 2

   Executing valid written Advance Directives in the Netherlands and Spain

   A medical advance directive drafted in one country is not automatically visible in emergency healthcare records in the other country. Execute separate written directives in both jurisdictions while your family member has full mental capacity.

   • Written advance directive in the Netherlands: In the Netherlands, the ill person records treatment wishes and limits - such as a refusal of treatment (behandelverbod), a do-not-resuscitate order (niet-reanimeerverklaring), or the appointment of a healthcare proxy - in writing with a date and signature in accordance with the guidelines of the Dutch central government (Rijksoverheid) [4]. Discuss this document promptly with the general practitioner and treating specialist so that it is entered directly into both the GP medical file and the hospital record [1][4].
   • Living Will (Testamento Vital) and registration in Spain: In Spain, Law 41/2002 (Ley 41/2002) governs the Advance Directive document (Documento de Instrucciones Previas, also known as Voluntades Anticipadas or Testamento Vital). In this document, your family member sets out medical treatment preferences, limits on life-sustaining interventions, and a healthcare representative (representante). To ensure that doctors across Spain can access the directive in the electronic patient record, register it with the regional registry of the autonomous community (Registro Autonómico, for example in Madrid, Andalusia, or Valencia), which is connected to the national Registro Nacional de Instrucciones Previas (National Registry of Advance Directives - RNIP) of the Spanish Ministry of Health (Ministerio de Sanidad) [5].
3. 3

   Establishing separate financial and healthcare Powers of Attorney in both jurisdictions

   Financial institutions and public authorities in the Netherlands and Spain generally require a notarial power of attorney that satisfies their respective domestic formal rules.

   • Living will (levenstestament) and notarial power of attorney in the Netherlands: Through a Dutch civil-law notary, your family member can execute a levenstestament (living will / continuing power of attorney) or notarial power of attorney covering both financial affairs (bank accounts, real estate, taxes) and healthcare representation. The notary registers the deed in the Central Register of Living Wills (Centraal Levenstestamentenregister - CLTR), maintained via the Koninklijke Notariële Beroepsorganisatie (Royal Dutch Association of Civil-Law Notaries, information line 0900 346 93 93) [6].
   • Preventive Power of Attorney (Poder Preventivo) in Spain: To manage bank accounts, property, and administrative matters in Spain, your family member should have a Spanish notary draw up a public deed of Preventive Power of Attorney (escritura pública de Poder Preventivo, or a general power of attorney containing an express clause that it remains valid upon supervening incapacity, cláusula de subsistencia por incapacidad) through the Consejo General del Notariado (General Council of Notaries) [7]. Doing so prevents the need to initiate lengthy court proceedings for judicial support measures (medidas judiciales de apoyo) if capacity is lost [7].
4. 4

   Claiming caregiver leave, informal care support, and dependency benefits

   Both the Netherlands and Spain provide statutory leave entitlements for employees caring for a seriously ill relative, alongside home care support schemes.

   • Caregiver leave and municipal support in the Netherlands: Under the Work and Care Act (Wet arbeid en zorg), employees in the Netherlands can request short-term care leave (kortdurend zorgverlof, up to twice their weekly working hours per 12 months at a minimum of 70% pay) and long-term care leave (langdurend zorgverlof, up to six times their weekly working hours per 12 months, statutorily unpaid unless a collective labor agreement stipulates otherwise) from their employer, as explained by the Dutch government (Rijksoverheid) [8][9]. For practical assistance, respite care, and home adaptations, contact the Social Support Act desk (Wmo-loket) of the municipality of residence (such as the municipality of Amsterdam, Rotterdam, or Utrecht) and the national association for informal caregivers (MantelzorgNL).
   • Fast-track dependency assessment and employment leave in Spain: If your family member resides in Spain, an assessment under the Dependency Act (Ley 39/2006, coordinated nationally by IMSERSO) can be requested through the social services of the autonomous community to obtain home care services or financial allowances [10]. Employees working under a Spanish employment contract are entitled under the Workers' Statute (Estatuto de los Trabajadores) to paid leave for the serious illness or hospitalization of a close relative, as well as a reduction in working hours (reducción de jornada) or unpaid family care leave (excedencia por cuidado de familiar).
5. 5

   Aligning wills, bank access, funeral wishes, and estate administration

   Coordinating estate documents and succession rules between the Netherlands and Spain during the illness prevents frozen bank accounts and duplicate probate procedures after death.

   • Estate preparation and settlement in the Netherlands: Consult a notary belonging to the Koninklijke Notariële Beroepsorganisatie to verify whether the will aligns with the EU Succession Regulation (Regulation (EU) No 650/2012) and whether an express choice-of-law clause is advisable; after death, the notary can issue a Dutch certificate of inheritance (verklaring van erfrecht) or a European Certificate of Succession and check the Central Register of Wills (Centraal Testamentenregister - CTR) [6]. The Sociale Verzekeringsbank (Social Insurance Bank - SVB) administers the state pension (AOW) and survivor benefits under the Surviving Dependants Act (Algemene nabestaandenwet - Anw) [11]. Heirs can accept an estate unconditionally, renounce it, or accept it under benefit of inventory (beneficiair aanvaarden) by filing a declaration with the district court under the procedures of the Dutch Judiciary (de Rechtspraak) [12]. The Belastingdienst (Dutch Tax and Customs Administration) handles inheritance tax returns (erfbelasting) and the final income tax return (F-biljet), supported by the Bereavement Tax Helpline (BelastingTelefoon voor nabestaanden at 0800 235 83 54) [13].
   • Estate preparation and settlement in Spain: In Spain, once 15 working days (15 días hábiles) have elapsed after death, heirs can request a certificate from the Central Registry of Last Wills (Certificado de Actos de Última Voluntad) using Modelo 790 from the Ministerio de Justicia (Ministry of Justice) [14]. The Instituto Nacional de la Seguridad Social (National Institute of Social Security - INSS) processes applications for the funeral expenses grant (auxilio por defunción) and survivor pensions (pensión de viudedad / orfandad) [15]. Keep in mind that the Spanish inheritance tax return (Impuesto sobre Sucesiones y Donaciones) must be filed within 6 months of the date of death (with the option to request a 6-month extension within the first 5 months). In addition, document any preferences for local burial versus international repatriation and review life or funeral insurance policies in writing ahead of time.

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Recording wishes in the palliative phase (Wensen vastleggen in de palliatieve fase) — Overpalliatievezorg.nl (Ministerie van VWS)
2. [2]
   Applying for long-term care (Wlz) from abroad — Centrum Indicatiestelling Zorg (CIZ)
3. [3]
   Directory of Palliative Care Resources in Spain (Directorio de Recursos de Cuidados Paliativos en España) — Sociedad Española de Cuidados Paliativos (SECPAL)
4. [4]
   How do I draw up an advance directive (wilsverklaring)? — Rijksoverheid
5. [5]
   National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) — Ministerio de Sanidad
6. [6]
   Arranging a living will (levenstestament) and power of attorney with a notary — Koninklijke Notariële Beroepsorganisatie (Notaris.nl)
7. [7]
   Notaries and personal and patrimonial protection (Preventive Power of Attorney / Poder Preventivo) — Consejo General del Notariado
8. [8]
   Caregiver leave (zorgverlof) for relatives — Rijksoverheid
9. [9]
   How do I apply for care leave (zorgverlof)? — Rijksoverheid
10. [10]
    Managing bodies of the autonomous communities and territorial offices of IMSERSO (SAAD) — IMSERSO
11. [11]
    What is the Anw survivor benefit (nabestaandenuitkering Anw)? — Sociale Verzekeringsbank (SVB)
12. [12]
    Procedure for accepting or renouncing an inheritance — De Rechtspraak
13. [13]
    Inheritance tax (erfbelasting) and surviving relatives — Belastingdienst
14. [14]
    Certificate of Last Wills (Certificado de Actos de Última Voluntad) — Ministerio de Justicia
15. [15]
    Death and survivor benefits: Funeral grant (auxilio por defunción) and pensions — Seguridad Social (INSS)