Terminal Illness & End-of-Life Administration in Germany: 5-Step Official Checklist

1. 1

   Coordinate palliative and hospice care and apply for a fast-track care level (*Pflegegrad*)

   As a first step, discuss palliative medical support with the treating general practitioner, specialist practice, or hospital social service (Krankenhaussozialdienst), and initiate long-term care insurance benefits in parallel [1][2]:

   • Specialized Outpatient Palliative Care (SAPV) and hospice support: In cases of complex pain or disease symptoms, the physician prescribes Specialized Outpatient Palliative Care (Spezialisierte Ambulante Palliativversorgung - SAPV under § 37b SGB V), through which a multi-professional palliative team with 24-hour on-call availability provides care at home or in a residential care facility [1]. In addition, outpatient hospice services (ambulante Hospizdienste) provide psychosocial support for the ill person and their relatives; if home care is no longer sufficient, the health insurance fund covers the cost of an inpatient hospice (stationäres Hospiz) upon medical certification [1]. Regional addresses of SAPV teams, palliative wards, and hospices are provided by the national umbrella organization Deutscher Hospiz- und PalliativVerband (German Hospice and Palliative Association) at 030 82 00 758-0 or by email at [email protected] [2].
   • Expedited care level (Pflegegrad) assessment within one week (§ 18(3) sentence 3 and § 18a SGB XI): Submit an initial or upgrade application for a Pflegegrad immediately to the competent long-term care insurance fund (Pflegekasse, affiliated with the statutory health insurance fund for GKV members, or via private compulsory long-term care insurance and Compass Private Pflegeberatung for privately insured individuals) [1][3]. Explicitly state in writing on the application that outpatient palliative care is in place or that admission to a hospice is occurring: under § 18(3) sentence 3 SGB XI in conjunction with § 18a SGB XI, the Medical Service (Medizinischer Dienst) must then complete the assessment no later than one week after receipt of the application so that care allowance (Pflegegeld), care-in-kind benefits (Pflegesachleistungen), and care aids are available without delay [3].
2. 2

   Draft a written advance healthcare directive (§ 1827 BGB) and emergency care plan

   While the ill person has capacity to give informed consent, they should document their medical wishes in a legally binding manner [4][5]:

   • Advance directive (Patientenverfügung) under § 1827 BGB: In a written, personally signed Patientenverfügung, your family member specifies whether they consent to or prohibit specific medical measures (such as mechanical ventilation, artificial nutrition, dialysis, or cardiopulmonary resuscitation) in defined end-of-life clinical scenarios [4]. Because general statements are often insufficient, the Bundesministerium der Justiz (Federal Ministry of Justice) provides legally vetted text modules and comprehensive drafting guides free of charge [4].
   • Palliative emergency sheet and advance care planning (§ 132g SGB V): Together with the treating medical team or SAPV service, draw up a concise palliative emergency sheet (often called a Notfallbogen or Palliativ-Krisenbogen) and place it in a clearly visible spot in the home for emergency medical services to prevent unwanted emergency hospital admissions [1][5]. If the ill person lives in a residential care facility or an integration assistance facility, they are also entitled to structured Healthcare Planning for the Final Phase of Life (Gesundheitliche Versorgungsplanung für die letzte Lebensphase) under § 132g SGB V, funded by the health insurance fund [5].
3. 3

   Establish a durable power of attorney, care directive, and bank powers of attorney

   Without an express power of attorney, neither children nor other close relatives in Germany are automatically entitled to make legally binding financial or administrative decisions (the statutory emergency spousal representation right under § 1358 BGB applies only to spouses for healthcare matters and is strictly limited to a maximum of six months) [4][6]:

   • Durable power of attorney (Vorsorgevollmacht) and care directive (Betreuungsverfügung): Using the official template issued by the Bundesministerium der Justiz, the ill person can authorize one or more trusted representatives for healthcare, residence decisions, administrative matters, housing, and financial affairs, as well as make a subsidiary care directive (Betreuungsverfügung) [4]. If the power of attorney is also intended to authorize the sale or encumbrance of real estate or the taking out of loans, it must be notarized (notariell beurkundet) or publicly certified (öffentlich beglaubigt) by a notary [4][7].
   • Registration in the Central Register of Advance Directives (ZVR): Register the Vorsorgevollmacht (along with notice of an existing Patientenverfügung) with the Zentrales Vorsorgeregister der Bundesnotarkammer (Central Register of Advance Directives of the Federal Chamber of Notaries) via the toll-free number 0800 3550500, allowing guardianship courts and attending physicians to verify 24/7 who is authorized to act in an emergency [6].
   • Transmortal bank and account power of attorney (transmortale Kontovollmacht): Because financial institutions often subject privately signed durable powers of attorney to lengthy review in day-to-day banking, your family member should also sign the bank's own account power of attorney valid beyond death (transmortale Kontovollmacht) directly at their banks and savings banks (Sparkassen) so that ongoing bills and subsequent funeral expenses can be paid seamlessly [4].
4. 4

   Use statutory caregiver leave and care support allowance for relatives

   Employed family members are entitled to leave from work and financial support under the Care Leave Act (Pflegezeitgesetz) and Family Care Leave Act (Familienpflegezeitgesetz). 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 on these entitlements at 030 20 17 91 31 or by email at [email protected] [8]:

   • Short-term inability to work and Care Support Allowance (up to 10 working days): To organize or ensure appropriate care in an acute care situation, employees may stay away from work for up to 10 working days and apply to the ill person's Pflegekasse (or private long-term care insurer) for Care Support Allowance (Pflegeunterstützungsgeld) as a wage-replacement benefit [8].
   • Accompaniment during the final phase of life (up to 3 months) and Care Leave (Pflegezeit): Employees in businesses with 16 or more employees can take full or partial leave from work for up to three months to accompany a close relative during the final phase of life [8]. This special leave requires only a medical certificate confirming limited life expectancy, and the entitlement also applies when care takes place in an inpatient hospice or on a palliative care ward [8]. For home care, up to 6 months of Pflegezeit or up to 24 months of partial release under Familienpflegezeit (in businesses with 26 or more employees) is available, supplemented by an interest-free loan from the Federal Office of Family Affairs and Civil Society Functions (Bundesamt für Familie und zivilgesellschaftliche Aufgaben) [8].
5. 5

   Organize wills, insurance beneficiaries, and funeral wishes

   While full testamentary and legal capacity remains in place, key asset and succession documents should be reviewed and organized [7][9]:

   • Will and official custody: In Germany, a will (Testament) can either be written, dated, and signed entirely by hand (eigenhändiges Testament) or notarized before a notary (öffentliches Testament); a notarized will normally replaces the need for a fee-based certificate of inheritance (Erbschein) later on [7][9]. Both notarized wills and handwritten wills placed in special official custody (besondere amtliche Verwahrung) at the local probate court (Amtsgericht / Nachlassgericht) are recorded in the Zentrales Testamentsregister der Bundesnotarkammer (Central Register of Wills of the Federal Chamber of Notaries, toll-free hotline 0800 3550700), ensuring the last will is automatically located upon death [9].
   • Insurance policies, contracts, and document folder: Review the named beneficiaries (Bezugsrecht) on life insurance, funeral expense insurance (Sterbegeldversicherung), and private pension policies, as benefits with a named beneficiary are paid out directly outside the estate. Assemble a clear advance planning folder containing the identity card, birth and marriage certificates (or family register, Familienstammbuch), pension insurance number, insurance policies, an overview of bank and digital accounts, and written funeral wishes (e.g., burial vs. cremation, grave type, and any pre-need funeral contract, Bestattungsvorsorgevertrag) [4][9].

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 Directory — Deutscher Hospiz- und PalliativVerband e.V.
3. [3]
   German Social Code Book XI (SGB XI) § 18a - Assessment Procedure and 1-Week Deadline for Palliative Care — Bundesministerium der Justiz / Gesetze im Internet
4. [4]
   Durable Power of Attorney (Vorsorgevollmacht), Care Directive, and Advance Directive (Patientenverfügung) - Forms and Text Modules — Bundesministerium der Justiz (BMJ)
5. [5]
   German Social Code Book V (SGB V) § 132g - Healthcare Planning for the Final Phase of Life — Bundesministerium der Justiz / Gesetze im Internet
6. [6]
   Central Register of Advance Directives (Zentrales Vorsorgeregister - ZVR) of the Federal Chamber of Notaries — Bundesnotarkammer / Serviceportal Bund
7. [7]
   Federal Chamber of Notaries and Central Registers of Advance Directives and Wills — Justizportal des Bundes und der Länder (justiz.de)
8. [8]
   Ways to Care (Wege zur Pflege) - Care Support Allowance, Care Leave, and Family Care Leave — Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ)
9. [9]
   Central Register of Wills (Zentrales Testamentsregister - ZTR) of the Federal Chamber of Notaries — Bundesnotarkammer / Serviceportal Bund