SINGAPORE — When social workers found 85-year-old Mr Wong (not his real name), he had not bathed for months. He had a maggot-infested wound on his foot and required urgent hospitalisation.

The diabetic, who lived alone, refused to be admitted to a hospital or nursing home.

It was only after the authorities managed to locate his step-daughter, and with much collective persuasion — including repeated assurances that his leg would not be amputated — that Mr Wong agreed to receive medical care in his home.

In another case, 29-year-old Sam (not his real name), who suffers from attention deficit hyperactivity disorder, autism and has an intellectual disability, was found with wounds inflicted by his father, who tried to control his son’s behaviour by hitting him. The authorities realised that Sam’s father, who was under great stress because of Sam’s behaviour, had harboured thoughts of killing his son and himself. Sam was eventually placed at a facility better equipped to care for him.

These cases, cited by Social and Family Development Minister Desmond Lee, are among the “vulnerable adults” that new laws passed on Friday (May 18) seek to protect by allowing the Government to act early to prevent further harm.

Currently, the authorities can only assist in cases that are first referred to and managed by social and community groups.

The Vulnerable Adults Act was first mooted in 2014 and will take effect by the end of this year. It allows the state to promptly intervene in cases where the adult is suffering or at a risk of abuse, neglect, or self-neglect, and is assessed to be incapable of protecting himself.

Twelve Members of Parliament (MP) took part in the debate on Friday and raised various concerns including the need to balance state intervention and individual autonomy. They questioned why the proposed law was silent on financial abuse, as well as the delay in tabling it.

Ms Denise Phua (Jalan Besar) and Workers’ Party chairman Sylvia Lim, who is an MP for Aljunied group representation constituency, sought clarifications on when and how the Ministry of Social and Family Development (MSF) would decide to intervene, with Ms Lim cautioning against the risk of “governmental over-reach”.

Nominated MP Chia Yong Yong, on the other hand, felt the balance “must be struck in favour of protecting the vulnerable”.

The new Act is meant as a “law of last resort” and does not seek to diminish the role of the family and community, said Mr Lee. The MSF is working with its partners to develop a mental capacity assessment form which sets out certain requirements in determining if a vulnerable adult lacks mental capacity, he said.

While the Act allows officers appointed by the Government to enter private premises, assess the vulnerable adults and remove them where necessary, this provision will be invoked only after their safety and well-being are deemed to have been compromised, or are at risk, said Mr Lee.

In cases where family members do not have the financial means or appropriate skills to provide adequate care, the Government will work with other agencies to provide financial assistance and enhance caregiving skills.

“State intervention through the exercise of statutory power will be applied judiciously and only when absolutely necessary. This is because personal care arrangements are largely matters for individuals and families to decide,” said Mr Lee.

While a vulnerable adult’s right to self-determination should be respected, there may be “exceptional situations” where intervention is necessary even when the vulnerable adult has mental capacity — such as when he or she is refusing external help under duress.

If there are reasonable grounds to believe that a vulnerable adult is under influence to withhold consent, or is doing so because of coercion, the state can apply to the courts for an order to allow for intervention.

The MSF’s Adult Protective Service, set up in 2015, handled an average of 110 cases annually involving vulnerable adults between May 2015 and end-2017. Of the total of about 285 cases handled in that period, about 50 are due to self-neglect.

In other cases involving family violence and caregiver abuse, circumstances are often “not black and white”, said Mr Lee.

“Caregivers who abuse vulnerable adults may themselves be victims of difficult circumstances and be under tremendous stress. They are sometimes unable to control their emotions, which may cause them to hurt vulnerable adults or other family members,” he said.

Marine Parade MP Seah Kian Peng suggested a mandatory reporting scheme, which requires all stakeholders involved in caring for vulnerable adults to report to the relevant authorities if there are reasonable grounds to believe that a vulnerable adult has been neglected or abused.

The MSF considered but decided against such a scheme because it was found to have led to over-reporting in other jurisdictions, said Mr Lee.

Instead, the Act protects whistleblowers from civil and criminal liability as long as they had acted with reasonable care and in good faith. They will also not be regarded to have breached any professional etiquette or ethics.

While almost half of the MPs who spoke up wanted the new law to cover financial abuse, Mr Lee said there are existing ways to help vulnerable adults who are being financially exploited by their caregivers.

For instance, if the alleged abuser is a donee appointed under the Lasting Power of Attorney scheme, or a court-appointed deputy, the authorities can seek an order to suspend or revoke his powers to make decisions on behalf of the vulnerable adult. The authorities will continue to study the “complex issue” of financial exploitation among family members, he said.

On the delay in tabling the Bill, Mr Lee noted that the authorities did not want to rush into the legislation as it involves “intrusive statutory intervention” in the family and personal realms.

The legal framework will only succeed in enhancing protection for vulnerable adults if everyone keeps an eye out for the most vulnerable members of society, he stressed.

Citing the tragic case of Ms Annie Ee, a 26-year-old intellectually disabled waitress who was abused to death by her flatmates in 2013, the minister said: “None of the intervention powers in the (Act) will be meaningful unless those who meet and interact with vulnerable individuals, like Ms Ee, step forward and raise the alarm bells for community agencies and the authorities to intervene.”

Govt looking into ‘universal’ adoption of Lasting Power of Attorney

SINGAPORE – In future, all Singaporeans may need to legally appoint someone to make decisions on their behalf should they become mentally incapacitated.

The Office of the Public Guardian is looking into “universal” adoption of the Lasting Power of Attorney (LPA) here, and an inter-agency workgroup has been formed, said Minister for Social and Family Development Desmond Lee in Parliament on Friday (May 18).

Since the tool was introduced in 2010 when the Mental Capacity Act took effect, the authorities have encouraged the public to make an LPA. Efforts have seen limited success, and it was previously reported that about 33,360 people had made an LPA as of August last year.

Mr Lee was responding on Friday to Nee Soon Member of Parliament Henry Kwek’s call for a stronger push for LPA adoption as the population ages and the number of individuals who lose mental capacity increase.

Mr Kwek suggested either making it mandatory or amending the Mental Capacity Act to include a default LPA. He also wanted the cost of making an LPA to be reduced.

The LPA allows people aged 21 and above to appoint a “donee” – who may be a family member or a paid professional – to act on their behalf, including on financial matters, when they become mentally incapacitated.

The LPA was thrust into the spotlight in 2014 when former China tour guide Yang Yin was accused of manipulating wealthy widow Chung Khin Chun for control of her assets, estimated at S$40 million.

She had appointed him her donee in 2012, and was later diagnosed with dementia. Mdm Chung’s niece Hedy Mok exposed Yang’s deeds, was appointed by the court to be her aunt’s deputy to make certain decisions on her behalf, and the LPA has since been revoked.