The information contained in this post is specific to all foreigners and expats living in Nicaragua. It was the easiest way for me to disseminate this important information. After writing an article for the Nicaragua Dispatch, Does Death Become You as an Expat? I organized a meeting in Granada with representatives of Vivian Pellas Hospital, the U.S. Embassy representative, lawyers from Nicaragua, and other U.S. Embassy wardens.
My hope is that this valuable information can be disseminated throughout Nicaragua. Each region of Nicaragua will have specific needs about issues of death and palliative care. Please disseminate this information to your region.
I. Procedures for death of an expat or foreigner in Nicaragua
Bryan M. Giblin, U.S. Embassy in Managua, Nicaragua discussed the procedures for death of a U.S. citizen in Nicaragua. This information pertains to other foreign deaths, too. Following are the steps the U.S. Embassy takes when there is a death of a U.S. citizen in Nicaragua.
A. Verify the person is a U.S. citizen
When a U.S. citizen dies abroad, the Bureau of Consular Affairs must locate and inform the next-of-kin. Sometimes discovering the next-of-kin is difficult. If the U.S. citizen’s name is known, the Bureau’s Office of Passport Services will search for his or her passport application.
1.) Nicaraguan law requires disposition of remains (either cremation or burial) within 24 hours, unless the remains are to be shipped outside the country or embalmed. Therefore, time is of essence in a death of a foreigner.
2.) If you are a U.S. citizen, you can expedite the information process by registering with the Smart Traveler Enrollment Program.
3.) If you are an expat from another country, contact your Embassy to see if you can enroll in a similar program for identification purposes. Foreign Embassies and Consulates in Nicaragua.
B. Provide information to grieving family members on how to make arrangements for local burial or return of the remains to the United States.
The disposition of remains is affected by local laws, customs, and facilities, which are often vastly different from those in your home country.
1.) Although an autopsy is not required by law if cause of death is natural, over 90% of U.S. deceased citizens in Nicaragua are autopsied. The main reason is that it buys time for the grieving families to decide procedures for transport or local burial. Remember the 24 hour Nicaraguan law for disposition of remains.
2.) The Bureau of Consular Affairs relays the family’s instructions and necessary private funds to cover the costs involved to the embassy or consulate. The Department of State has NO funds to assist in the return of remains or ashes of U.S. citizens who die abroad.
3.) Options for making decisions
1. The cost for preparation and burial in Managua, Nicaragua is approximately $2,000.
2. Should grieving families decide to have remains returned to the United States for burial, the costs are substantially greater due to the high cost of air freight and embalming. The cost for preparation of remains returned to the U.S. is approximately $4,500 plus tax. The cost for air freight shipment is dependent on where the body is shipped. Expect to pay approximately $10,000 for shipment of remains.
3. The total cost for preparation, cremation and air shipment of ashes to the United States is approximately $1,750. Airlines permit carrying ashes in checked luggage at no additional cost.
There are four funeral homes in Nicaragua (two of them have English speakers) that will assist in the legal paperwork and act as a liaison among the various governmental agencies. Contact the U.S. Embassy for information on these funeral homes.
C. The Nicaraguan Death Certificate and Consular Report of Death
The consular “Report of Death of an American Citizen Abroad” is a report that provides the essential facts about the death of a U.S. citizen, disposition of remains, and custody of the personal effects of a deceased citizen. This form is usually used in legal proceedings in lieu of the foreign death certificate. The Report of Death is based on the foreign death certificate, and cannot be completed until the Nicaraguan death certificate has been registered and issued by the Civil Registry or the municipality where the death took place.
In order to register the death of a U.S. citizen in Nicaragua, you or your legal agent (embassy or funeral home, for example) will need to do the following:
1. Register the Death Certificate issued by the Ministry of Health with the Civil Registry (City Hall).
2. Submit the following documents to the Consular Section of the U.S. Embassy: Copy of Death Certificate issued by the Ministry of Health, the original Registered Death Certificate issued by Civil Registry, deceased U.S. citizen’s passport, deceased U.S. citizen’s Naturalization or Citizenship Certificate, if dual national, and Social Security card.
3. The Consular section will issue six original official reports of death for family members and will send copies to the Department of State, the Social Security Administrations and Veterans Administration, if applicable.
4. If your plans are to die and be buried in Nicaragua, an MD certifies the death, then an appointed friend or family member goes to the local public health center where a provisional death certificate is issued. Then, with the provisional death certificate, the deceased can be buried in the local cemetery.
D. Personal Estates of Deceased U.S. Citizens
A U.S. consular officer has statutory responsibility of the personal estate of an American who dies abroad if the deceased has no legal representative in the country where the death occurred. This is why a Nicaraguan will is extremely important!
The consular officer takes possession of personal effects such as: convertible assets, jewelry, apparel, personal documents and papers. Then, he/she prepares an inventory and carries out instructions from members of the deceased family about the effects. In Washington, the Bureau of Consular Affairs gives the next-of-kin guidance on procedures to follow in preparing Letters of Testimony, Letters of Administration, and Affidavits of Next-of-Kin as acceptable evidence of legal claim of an estate. Without a will, this process can take months and possibly years. MAKE A WILL to avoid these problems.
II. Laws of Nicaragua Concerning Death of a Foreigner
Alexandra and her husband Pablo are Nicaraguan lawyers from Managua. They both speak English and discussed the laws in Nicaragua concerning death of a foreigner. They also assist with the immigration process and help foreigners get residency in Nicaragua. Their contact information is: email: beteta email@example.com phone numbers: (505) 2277-0034, (505) 8663-5883 Address: Registro Mercantil 75 vrs al este A -92-B Managua, Nicaragua, A.C.
A. Nicaraguan Death Laws
1. Nicaraguan law requires disposition of remains ( either cremation or burial) within 24 hours unless the remains are to be shipped outside the country or embalmed.
2. An autopsy is required by law only in the case of foul play or suspicious circumstances surrounding a death. Remains are not sent for autopsy if it is a clear case of natural cause. Autopsy services are available in Managua and Matagalpa. However, remember that 90% of U.S. citizens’ remains are sent for an autopsy because it buys time for the family to choose the best option for their loved one.
3. Local police in Nicaragua have no legal responsibility for a foreigner’s death of natural causes in Nicaragua.
4. Local burial by law can only be in a certified cemetery in Nicaragua. You are not permitted by law to bury your loved one on your property. However, there are no laws about spreading ashes.
5. Embalming is not common, nor required by law in Nicaragua.
6. If a foreigner dies in his or her rental home in Nicaragua, it is illegal for a landlord to lock the house and take possession of the contents of the deceased until the rent is paid. We had that happen to a close friend of ours that died in Granada.
B. Wills and Advanced Medical Directives in Nicaragua
1. There are two types of Nicaraguan wills, the Closed Will and the Open Will.
The Closed Will is not commonly used in Nicaragua. For a Closed Will, you write it yourself, give it to a notary before 5 witnesses, who keeps it until the person dies. With the Open Will, you go before Notary Public, explain what you have and who you want to leave it to, take 3 witnesses, notary signs it and provides a copy and notary keeps original. You must let a few people know that it exists by giving copies to your local friends or relatives. Expats can do this, including leaving property that is registered in their name to whomever they choose. All lawyers in Nicaragua are notaries, as well.
2. Advanced Medical Directives or a Living Will
There is no legal regulation of an advanced directive format: Vivian Pellas doctors will respect it, but we’re not sure about other hospitals. Vivian Pellas patients receive a card with all their information and this could be included.
Without an advanced directive, it is required that doctors do everything to preserve life because it’s a Christian country and so enshrined in the law. A Living will/advanced directive should be separate from a property will and it can’t include anything against the law.
3. With an Open Will, probate can take at least 2 months. First, the heir has to register the property in their name, then register the will in their name.
4. If you die without a Nicaraguan will, the family has to start a legal process so the judge can declare them the new owners—can take 12-18 months. If there is no evidence of an heir, the property goes to the local municipality where the death occurred.
So, the moral of these laws is to MAKE A WILL for Nicaragua if you are an expat in Nicaragua.
III. Palliative Care in Nicaragua
Two representatives of Hospital Metropolitano Vivian Pellas attended the meeting in Granada to discuss how palliative care at Vivian Pellas Hospital operates. Carolina Castro and their Chief Medical Officer kindly and thoroughly explained the services available for pain management and palliative care.
Palliative care is an approach that improves the quality of life for a person diagnosed with a terminal or life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.
Carolina explained that Vivian Pellas Hospital is a “no pain hospital” with a pain clinic available for everyone in need.
A. Pain medications in Nicaragua and treatment
1. Nicaragua passed a law in 2012 that provides pain treatment with morphine, however the administration of morphine is strictly enforced in Nicaragua.
a. In order for morphine to be given in an IV, the person must be an inpatient in Vivian Pellas hospital, and morphine must be administered by one of their highly trained and certified doctors.
b. Morphine in pill form can be administered in a patient’s home with a trained doctor on staff at Vivian Pellas administering the morphine pill.
2. Pain medicines are strictly controlled in Nicaragua and can only be prescribed by certain doctors.
3. Vivian Pellas hospital receives a variety of highly controlled pain medicines, and other hospitals in Nicaragua often go to Vivian Pellas to purchase these medicines that are not available in their hospitals.
4. Pain management and palliative care is centered around the patient’s needs at Vivian Pellas Hospital. They can provide care in the home with their trained doctors and nurses, but keep in mind that if a patient needs a morphine IV, then the patient must receive it in the hospital under a trained and certified doctor at Vivian Pellas.
5.Vivian Pellas Hospital staff and doctors are open to attending conferences and meeting with other trained personnel who have started hospice without borders programs and have the experience and knowledge to help them improve their hospice services.
One very interesting program that Vivian Pellas is in the process of starting is a residential long-term skilled nursing facility for foreigners with Alzheimer’s and other age related illnesses. It is based on a U.S. model and planned in cooperation with a U.S. based company. This is exciting news for many foreign retirees who live in Nicaragua. Expect more news on this development, soon.
The Red de Apoyo de Cuidados Paliativos de Nicaragua
A member of the Network Support Hospice of Nicaragua, Dr. Claudia Evans Baltodano, attended the meeting to explain the hospice services available through the cooperation of Rotary International and the faculty of Medicine of the University Americana (UAM).
1. The World Health Organization (WHO) pointed out in 2008 that 80% of the world population does not have access to treatment of moderate to severe pain, and every year tens of millions of people around the world–including four million patients with cancer and 0.8 million people with HIV / AIDS at the end of their life suffer from untreated pain.
2. Recently, the importance of palliative care worldwide has appeared in the Action Plan of the WHO Global Noncommunicable Diseases 2013-2020, in which the integration of efficient programs within the national health plans is promoted in all countries.
3. Their mission statement:
Create and promote a culture of palliative care at the national level by establishing a network involving public services and private health, non-governmental organizations, that will raise the quality of life for people with cancer and other chronic diseases that endanger their lives and carry a significant burden of pain and suffering.
This program is in its infancy, but I feel that it is an important step in the right direction for Nicaraguans who suffer with terminal illnesses. For more information ( in Spanish only) contact: email: firstname.lastname@example.org Telephone: Claro (505) 8608-3984 Moviestar (505) 7885-3664.
A BIG thank you to all the people involved in this informational meeting. It was a successful beginning to understanding what is available and what we can do to help in Nicaragua.
Now, that you have the information on everything you need to know about death of a foreigner in Nicaragua, please disseminate this information to all the regions of Nicaragua.
Expats in each region will have specific needs. For example, on Ometepe Island, currently our most pressing need was to learn about the process and procedures of a foreigner’s death. However, maybe Granada, with a larger population of expats will have a need for the establishment of a palliative care center.
Once your region has the information available, you may want to hold smaller meetings to discuss this information among your regional expats, network with Vivian Pellas Hospital, or explore the procedures for each foreign embassy or consulate in Nicaragua. I only included the information from the U.S. Embassy on procedures for deaths of U.S. citizens because I am involved with the embassy when there is a U.S. citizen death on Ometepe Island.
According to Bryan Giblin, he is involved with a U.S. citizen death in Nicaragua approximately once a week. I was amazed at that statistic.
How can you be a responsible expat living in Nicaragua?
1. Register with your home embassy so all information is available to them in time of an emergency or death.
2. Make a Nicaraguan will and distribute copies to your friends and family.
3. Network with your regional expats to discuss concerns and issues for your area.
4. Know the laws of Nicaragua pertaining to death issues.
5. If your area of expertise is a hospice nurse, or medical doctor, explore the programs available and volunteer your services.