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

1. 1

   Coordinate specialist palliative care, hospice services, and cross-border coverage

   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 can provide 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) once a hospice physician and the attending physician certify a life expectancy of 6 months or less [1]. Medicare hospice covers home nursing visits, medical equipment, medications for pain and symptom relief, inpatient respite care, and family bereavement support; state-by-state hospice directories and advance care guides are also available through CaringInfo (an initiative of the National Hospice and Palliative Care Organization) [1].
   • United Kingdom: In the UK, the National Health Service coordinates community palliative nursing, GP home visits, and referrals to hospice care (alongside charitable providers such as Hospice UK and Marie Curie) [4][5]. If the person is in the UK and experiencing rapidly deteriorating needs, ask a clinician to submit a Fast Track Pathway Assessment for NHS Continuing Healthcare so a fully funded care package can be arranged urgently without means testing [5]. Because Medicare does not generally cover healthcare outside the United States and NHS eligibility is based on ordinary residence in the UK, any planned relocation for end-of-life care requires advance verification of health coverage, private medical transport insurance, and direct clinical handover.
2. 2

   Execute written Advance Directives in both the United States and the United Kingdom

   Medical directives are governed by the law of the jurisdiction where care is delivered, so a person with ties to both countries should execute written directives in each jurisdiction while full mental capacity remains [1][4]:

   • United States: Execute a state-specific Advance Directive (Living Will) stating preferences for life-sustaining treatments (such as mechanical ventilation, cardiopulmonary resuscitation, and artificial nutrition or hydration) in accordance with the witnessing or notarization rules of the relevant US state [1]. For a person with an advanced illness, ask the attending physician or advanced practice clinician to complete actionable Physician Orders for Life-Sustaining Treatment (POLST, or MOLST in certain states), which translate treatment boundaries into standing medical orders recognized by emergency medical personnel.
   • United Kingdom: In England and Wales (under the Mental Capacity Act 2005), prepare a written Advance Decision to Refuse Treatment (ADRT / Living Will) [4]. To validly refuse life-sustaining treatment in England and Wales, the ADRT must be in writing, signed, witnessed, and contain an explicit statement that the refusal applies even if life is at risk; clinicians can also record a ReSPECT emergency care summary plan in the medical record [4].
3. 3

   Establish separate financial and healthcare Powers of Attorney in both jurisdictions

   Financial institutions and healthcare providers in the United Kingdom rarely accept a US state Power of Attorney directly, and US banks normally require state-compliant mandates. While your family member has full legal capacity, execute separate documents in each country [3][6]:

   • United States: Execute both a state-specific Durable Power of Attorney for Health Care (Health Care Proxy / Medical POA) and a Durable Financial Power of Attorney complying with state statutory signature, witness, and notary requirements. In addition, ask US banks and brokerage firms to register Payable-on-Death (POD) or Transfer-on-Death (TOD) beneficiary designations on accounts so funds remain accessible after death without waiting for court probate.
   • United Kingdom: Complete and register two separate Lasting Powers of Attorney with the Office of the Public Guardian in England and Wales: a Lasting Power of Attorney for Health and Welfare and a Lasting Power of Attorney for Property and Financial Affairs (or a Continuing and Welfare Power of Attorney with the Office of the Public Guardian in Scotland) [6]. Registration with the Office of the Public Guardian takes roughly 8 to 10 weeks and is required before the attorney can act [6].
4. 4

   Claim fast-track terminal illness benefits and statutory caregiver leave

   Both jurisdictions provide fast-track disability pathways and statutory caregiver protections:

   • United States: Apply to the Social Security Administration (phone 1-800-772-1213) for expedited disability processing under the Compassionate Allowances (CAL) and Terminal Illness (TERI) programs, which fast-track Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims for qualifying life-limiting diagnoses [2]. Eligible employees caring for an immediate family member with a serious health condition can request up to 12 workweeks of unpaid, job-protected leave under the federal Family and Medical Leave Act administered by the U.S. Department of Labor, alongside paid family leave programs available in several US states [3].
   • United Kingdom: Where a clinician judges that the person may have 12 months or less to live, benefit claims can be expedited under the Special Rules for End of Life administered by the Department for Work and Pensions [7]. Ask the GP, consultant, or specialist nurse to complete an SR1 medical form to fast-track Personal Independence Payment (PIP), Attendance Allowance, or Universal Credit without a face-to-face assessment; UK caregivers may also claim Carer's Allowance and statutory Carer's Leave [7].
5. 5

   Align cross-border wills, beneficiary designations, tax filings, and funeral wishes

   While capacity is intact, coordinate wills covering US and UK assets with cross-border legal professionals so that one will does not accidentally revoke the other, review pension and life-insurance beneficiary designations on both sides of the Atlantic, and gather civil certificates, Social Security and National Insurance numbers, property deeds, and account records [2][8]. Record clear wishes regarding burial, cremation, or international repatriation of remains or ashes.

   Following a death, US administration involves notifying the Social Security Administration (at 1-800-772-1213 in the US or via the Federal Benefits Unit at the US Embassy in London), contacting the Department of Veterans Affairs (if the person served in the US military), filing the final federal income tax return (IRS Form 1040) with the Internal Revenue Service, and opening estate administration with the local state Probate Court where required [2]. In the United Kingdom, registering the death unlocks the Tell Us Once service to notify the Department for Work and Pensions (including the DWP Bereavement Service and International Pension Centre) and HM Revenue & Customs (HMRC), while the executor applies to HM Courts & Tribunals Service for a Grant of Probate in England and Wales (or Confirmation in Scotland) [8].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Medicare Hospice Benefits and Coverage (Medicare Part A) — Centers for Medicare & Medicaid Services (Medicare.gov)
2. [2]
   Compassionate Allowances and Expedited Disability Claims — Social Security Administration (SSA)
3. [3]
   Family and Medical Leave Act (FMLA) Caregiver Leave — U.S. Department of Labor (DOL)
4. [4]
   Advance Decision to Refuse Treatment (Living Will) - End of Life Care — National Health Service (NHS)
5. [5]
   Places You Can Have Care and NHS Continuing Healthcare — National Health Service (NHS)
6. [6]
   Make, Register or End a Lasting Power of Attorney — GOV.UK / Office of the Public Guardian
7. [7]
   The 'Special Rules': How the Benefit System Supports People Nearing the End of Life — GOV.UK / Department for Work and Pensions
8. [8]
   Applying for Probate in England and Wales — GOV.UK / HM Courts & Tribunals Service