Cross-Border Terminal Illness & Advance Care Checklist: United States & Colombia

1. 1

   Coordinate Palliative and Hospice Care and Cross-Border Coverage (United States and Colombia)

   Start with the treating medical team in the country where your family member currently receives care to establish symptom management and home or inpatient support:

   • United States: Hospital and outpatient palliative care teams provide pain and symptom management alongside curative treatment, or the person can elect the Medicare Hospice Benefit under Medicare Part A (administered by the Centers for Medicare & Medicaid Services, helpline 1-800-633-4227) once a hospice medical director and the attending physician certify a life expectancy of 6 months or less [1]. Medicare hospice covers home nursing visits, medical equipment, medications for symptom relief, inpatient respite care, and family bereavement support; state-by-state hospice directories and planning guides are also available through CaringInfo (phone 1-800-658-8898, an initiative of the National Hospice and Palliative Care Organization / National Alliance for Care at Home) [2].
   • Colombia: If care takes place in Colombia or a return to Colombia is planned, Ley 1733 de 2014 (Ley Consuelo Devis Saavedra) guarantees the right of patients with terminal, chronic, degenerative, and irreversible illnesses to receive comprehensive inpatient, outpatient, and home-based palliative care (cuidados paliativos) and pain management [6][7]. Services are coordinated and funded through the person's health promotion entity (Entidad Promotora de Salud - EPS) within the Sistema General de Seguridad Social en Salud, under standards issued by the Ministerio de Salud y Protección Social [6][7]. Because US Medicare does not cover healthcare in Colombia and Colombian EPS coverage requires active affiliation, confirm insurance status, opioid medication prescriptions, and medical fit-to-fly clearance before any international relocation.
2. 2

   Execute Written Advance Directives in Both the United States and Colombia

   Medical directives are governed by the law of the jurisdiction where care is delivered, so your family member should execute separate written directives for the United States and Colombia while full decision-making capacity remains:

   • United States: Complete a state-specific Advance Directive (Living Will) stating preferences for life-sustaining treatments (such as cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition or hydration) in accordance with the witnessing or notarization rules of the relevant US state (for example, in Florida, New York, Texas, or California), along with a federal HIPAA release [2][3]. Free federal guides are available from the National Institute on Aging (phone 1-800-222-2225, email [email protected]) [3]. In addition, ask the attending physician or advanced practice clinician to sign actionable Physician Orders for Life-Sustaining Treatment (POLST / MOLST) so emergency medical personnel follow the person's treatment boundaries immediately [2][3].
   • Colombia: Under Ley 1733 de 2014 and Resolución 2665 de 2018 of the Ministerio de Salud y Protección Social, any adult with full mental capacity can sign a written Documento de Voluntad Anticipada (DVA) expressing treatment preferences, refusal of disproportionate interventions, and palliative care wishes [6][7]. Under Resolution 2665 of 2018, a DVA can be formalized through any of three official methods: before the attending physician (médico tratante), in writing before two witnesses (dos testigos), or before a Notary (ante notario), and a copy must be incorporated into the patient's clinical history (historia clínica) [6].
3. 3

   Establish Separate Financial and Healthcare Powers of Attorney in Both Jurisdictions

   Colombian banks, notaries, and land registries do not accept a domestic US state Power of Attorney unless Colombian formalities are met, and US financial institutions require state-compliant mandates. While your family member has full legal capacity, execute separate documents in each country:

   • United States: Execute both a state-specific Durable Power of Attorney for Health Care (Health Care Proxy) and a Durable Financial Power of Attorney complying with state statutory signature, witness, and notary requirements [2][4]. Plain-language fiduciary guidance for financial agents is provided by the Consumer Financial Protection Bureau (phone 1-855-411-2372) [4]. In addition, contact US banks and brokerage firms directly to verify internal POA forms and register Payable-on-Death (POD) or Transfer-on-Death (TOD) beneficiary designations so accounts transfer outside probate.
   • Colombia: For broad property, banking, and legal representation in Colombia, execute a Poder General por escritura pública (General Power of Attorney by public deed) before a Notary in Colombia (Notaría en Colombia) or before a Colombian Consulate in the United States (Consulado de Colombia en el exterior under the Ministerio de Relaciones Exteriores), or execute a targeted Poder Especial with authenticated signature (reconocimiento de firma) [8][9]. Notarial deeds and property registrations in Colombia are supervised by the Superintendencia de Notariado y Registro [9]. If a power of attorney is signed before a US notary public rather than a Colombian consul, it must carry a Hague Apostille and an official Spanish translation.
4. 4

   Claim Fast-Track Terminal Illness Benefits, Disability Support, and Caregiver Leave

   Both jurisdictions provide disability pathways and workplace protections for family caregivers:

   • United States: Apply to the Social Security Administration (phone 1-800-772-1213) for fast-track disability processing under the Compassionate Allowances (CAL) and Terminal Illness (TERI) programs, which expedite Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims for life-limiting diagnoses [5]. Eligible employees caring for an immediate family member with a serious health condition can take up to 12 workweeks of unpaid, job-protected leave under the federal Family and Medical Leave Act (FMLA) administered by the U.S. Department of Labor (phone 1-866-487-9243), alongside state Paid Family Leave programs where applicable [10].
   • Colombia: Under Colombian labor law, employees may request paid workplace leave for serious domestic calamity (licencia por calamidad doméstica) when a close family member suffers a grave health crisis, while medical incapacity benefits are processed through the person's EPS [6]. If the illness results in a certified loss of working capacity of 50% or more (pérdida de capacidad laboral), the insured person can apply for a disability pension (pensión de invalidez) through the public pension administrator Colpensiones (or their private pension fund, AFP) [11].
5. 5

   Align Cross-Border Wills, Pension Claims, Tax Filings, and Estate Administration

   Coordinate wills covering US and Colombian assets with cross-border legal professionals so that one will does not accidentally revoke the other, taking into account Colombian forced-heirship rules (asignaciones forzosas / legítimas rigurosas). Gather civil certificates, Social Security numbers, Colombian citizenship ID cards (cédula de ciudadanía), property deeds, and written funeral or international repatriation wishes:

   • United States: Following a death, notify the Social Security Administration (at 1-800-772-1213 in the US, or via the Federal Benefits Unit at the U.S. Embassy in Bogotá) regarding survivor benefits and the lump-sum death payment [5], contact the Department of Veterans Affairs (VA) if the person served in the US armed forces, file the final federal income tax return (IRS Form 1040) with the Internal Revenue Service (IRS), and initiate estate administration with the local state Probate Court for assets not held in a trust or POD/TOD designation.
   • Colombia: Apply to Colpensiones (or the relevant private pension fund) for the statutory funeral grant (auxilio funerario, paid to the person who covered funeral expenses, equivalent to between 5 and 10 monthly legal minimum wages - SMLMV) and the survivor pension (pensión de sobrevivientes) for eligible family beneficiaries [11]. To transfer Colombian bank accounts and real estate, heirs may complete a notarial succession procedure (trámite de sucesión ante notaría, when all heirs are in agreement, before a Colombian notary overseen by the Superintendencia de Notariado y Registro and the Unión Colegiada del Notariado Colombiano) or a judicial succession (sucesión ante juzgado) [9].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Hospice Care Coverage (Medicare Part A) — Medicare.gov (Centers for Medicare & Medicaid Services)
2. [2]
   Advance Directives and State-Specific Living Will Forms — CaringInfo (National Hospice and Palliative Care Organization)
3. [3]
   Advance Care Planning: Advance Directives for Health Care — National Institute on Aging (NIH)
4. [4]
   Managing Someone Else's Money: Help for Agents Under a Power of Attorney — Consumer Financial Protection Bureau (CFPB)
5. [5]
   Compassionate Allowances and Expedited Disability Claims — Social Security Administration (SSA)
6. [6]
   Documento de Voluntad Anticipada (DVA - Resolución 2665 de 2018 y Ley 1733 de 2014) — Ministerio de Salud y Protección Social de Colombia
7. [7]
   Reglamentación de la Ley 1733 de 2014 sobre Cuidados Paliativos y Voluntad Anticipada — Ministerio de Salud y Protección Social de Colombia
8. [8]
   Reconocimiento de firma en documento privado y trámites notariales en Consulados de Colombia — Ministerio de Relaciones Exteriores de Colombia (Cancillería)
9. [9]
   Concepto sobre otorgamiento de poderes por escritura pública y actuaciones notariales — Superintendencia de Notariado y Registro
10. [10]
    Family and Medical Leave Act (FMLA) Caregiver Leave — U.S. Department of Labor (DOL)
11. [11]
    Trámites de prestaciones económicas: Pensión de invalidez, pensión de sobrevivientes y auxilio funerario — Administradora Colombiana de Pensiones (Colpensiones)