Vulnerable Adults: How Caregivers Can Protect & Care For Them
When an individual requires assistance to carry out daily activities, the job of looking after such an individual (known as the care recipient) falls to a caregiver.
Caregiving involves the managing of needs of the care recipient by family members and/or with the help of caregiving services.
Caregiving can be provided to a range of individuals, from infants and children to the elderly. The care recipient may suffer from an illness, a special needs condition, or may just be unable to look after themselves due to their age.
This guide will take you through what you need to know as a caregiver looking after a vulnerable adult.
In this article, vulnerable adults refer to persons aged 18 or older who are unable to protect themselves from abuse or neglect due to mental or physical infirmity, disability or incapacity.
Becoming a Caregiver
When a loved one needs support for everyday tasks on a daily basis, a family member will usually assume the role of a primary caregiver. This is the person who lives with the vulnerable adult and provides their day-to-day care.
Do I need to be formally appointed to act as a caregiver?
For the most part, there is no need for a family member to be formally appointed to act as a caregiver.
However, if the vulnerable adult has lost their mental capacity (and are thus unable to make their own decisions), you would need to have been appointed as their donee under a Lasting Power of Attorney (LPA) by that individual (i.e. the donor).
The LPA empowers a donee to make decisions related to property and finance as well as personal welfare on behalf of the donor.
If the individual has not made an LPA prior to losing their mental capacity, you will require a court order to appoint you as a deputy to make such decisions on their behalf.
The Role of a Caregiver
If you decide to take up the responsibility of being a caregiver, you will have to consider the following needs of your care recipient:
- Physical needs: Attending to his/her daily activities including bathing and feeding.
- Health needs: Ensuring his/her attendance at doctors’ appointments and consumption of medication.
- Emotional needs: Providing mental support, encouragement and company.
- Spiritual needs: Helping him/her to continue his/her religious practices and beliefs.
- Financial and legal needs: Managing his/her assets and financial responsibilities and planning for his/her future.
Enlisting the Help of Caregiving Services
It is important for caregivers to be conscious of their own needs and limitations.
According to a 2012 Survey on Informal Caregiving commissioned by the then-Ministry of Community Development, Youth and Sports, caregivers spend an average of 38 hours a week providing care for their care recipients.
As a result, caregivers are susceptible to high levels of stress and exhaustion.
Enlisting the help of caregiving services can help ease the strain of caregiving and prevent burnout. These services may supplement the care you’re already providing, by allowing you to take some time off for yourself when necessary.
If the needs of the care recipient exceed what you can reasonably provide at home, you may opt for a service that replaces you as the primary caregiver.
There is a range of caregiving options to choose from to suit your needs:
- Home Care: Care services administered at the home of homebound care recipients. These include home medical and nursing services and eldersitter programmes that provide cognitive and mental stimulation for elders. The employment of Foreign Domestic Workers (FDWs) to provide full-time care is also a popular option.
- Day Care: Care centres that care recipients can go to during daytime. Such centres include Day Rehabilitation Centres which provide occupational therapy for elders who suffer from medical conditions, and Social Day Cares which provide recreational activities, personal care and exercise for frail elders.
- Stay–In Care: Care facilities that provide residential care are an option for care recipients whose families are unable to commit to caring for them or who have medical conditions that make it more economical and practical for them to be in residential care. Stay-in care can be short-term, (e.g. in a community hospital after being discharged from an acute hospital), or long-term (e.g. in a nursing home).
To get a better idea of the options available to you, it may be useful to speak to a Medical Social Worker (MSW) who can advise on suitable caregiving services after conducting risk and financial assessments on your circumstances.
Support for Caregivers
Another way to ensure the best possible care for your loved ones is to take advantage of the support available. Support is predominantly in the form of educational resources, training courses and services as well as possible grants and respite care services to aid caregivers.
Educational resources and caregiving courses
An important aspect of being a good caregiver is being adequately informed of caregiving techniques.
The Agency for Integrated Care (AIC) has created guides providing caregiving tips. Topics include supporting seniors that have dementia and moving persons (e.g. from wheelchair to bed).
Singapore SilverPages provides caregiving training courses held at training facilities or at the care recipient’s home. These courses range in length and subject and are conducted by teams of nurses, physiotherapists, and occupational therapists.
Topics covered in training typically include basic care such as bathing, while more specialised courses include courses related to clinical skills such as tube feeding and catheter care.
Caregiving grants and respite care services
You may also be eligible for grants to relieve the financial burden of caregiving. These include grants for attending caregiving courses, employing an FDW, and purchasing assistive devices such as wheelchairs and walking aids.
For example, by the end of 2019, a $200 monthly Home Caregiving Grant will be rolled out to replace the current $120 FDW grant. This Home Caregiving Grant can be used to offset caregiving costs (including the cost of hiring a FDW) such as transportation to medical appointments and home or community-based services.
Note that each grant has their own eligibility criteria. For example, the Caregivers Training Grant, which provides course subsidies to caregivers, is only available to caregivers of persons who are:
- A Singapore citizen or Permanent Resident; and
- Aged 65 years old and above (care recipients below 65 years old may qualify if they have a disability that has been certified by a Singapore-registered doctor)
Plans are also in the works for selected nursing homes to offer night respite services. These services engage care recipients with behavioural or sleep issues in cognitive exercises, so as to help their caregivers to get more sleep at night after working or caring in the day.
Caregivers of vulnerable adults with disabilities and special needs may also approach organisations such as SG Enable and Special Needs Trust Company (SNTC) for specialised caregiver support.
SG Enable is an agency dedicated to providing resources, grants, and support to disabled persons and their caregivers. One of its aims is to build a network of support for caregivers so they can share their experiences and advice with one another.
On the other hand, SNTC is a non-profit trust company that provides trust services for persons with special needs. It primarily aims to provide long-term financial help for the caregivers of persons with special needs through the implementation of unique care plans for each care recipient.
For example, caregivers can set up a trust fund for their care recipients to ensure that the care recipients can continue to fund their daily needs after the caregiver is no longer around.
Are caregivers entitled to caregiving leave?
As a caregiver, you are not entitled to any government-paid leave to take care of family members (aside from childcare leave).
However, you may wish to check with your employer if they have implemented any eldercare leave or familycare leave policies.
In general, eldercare leave policies allow you to take leave to accompany your parents or parents-in-law to medical appointments, or to look after them when they fall sick, while familycare leave could be taken for your siblings or older children.
Disputes Among Caregivers
Caregiving is often a family affair, with multiple caregivers looking after one care recipient. This could potentially lead to tension between caregivers where finances are a concern and there may be conflicting interests on what may be the best caregiving decisions for the vulnerable adult in question.
For example, disagreements may arise about how to pay for the medical bills, suspicions that a family member is taking advantage of the care recipient, or whether the care recipient should undergo certain treatments.
The best way to avoid disputes in the first place is to hold regular meetings among the caregivers.
These meetings should be used to discuss financial issues and to allocate caregiving roles. For example, one of them could be the primary caregiver while the other is placed in charge of transporting the vulnerable adult to, for instance, hospitals.
Keep in mind that everybody has their own way of contributing. Distribute the caregiving responsibilities accordingly and try to reach a consensus that everybody can agree on.
If necessary, a written agreement can be drawn up, or a calendar or weekly schedule distributed to ensure everyone is aware of their responsibilities.
However, disagreements between caregivers may still arise despite the arrangements made above.
Clashing personalities and family dynamics make conflict almost inevitable. This can interfere with the well-being of the vulnerable adult where rash decisions are made due to overwhelming emotions, without considering the interests of the vulnerable adult.
In such situations, it may be beneficial to seek the help of an impartial mediator to ease tensions and reach a compromise.
Protection of Vulnerable Adults
Unfortunately, the situation may arise where a vulnerable adult has been subject to abuse or neglect by a caregiver or co-caregiver. Because of their susceptibility to abuse or neglect, vulnerable adults are accorded special protection under the Vulnerable Adults Act (VAA).
Obtaining a protective court order(s)
If the court is satisfied that a vulnerable adult has been subjected to, or is at risk of, abuse or neglect, it can make a protective order for the protection and safety of the vulnerable adult.
Where the vulnerable adult lacks mental capacity, the protective order can be applied for by a donee or deputy, a family member who is at least 21 years old, or approved welfare officer.
If the vulnerable adult still has mental capacity, their consent is required for the application. Alternatively, the vulnerable adult themselves can make the application.
The Director of Social Welfare or a public officer appointed as a protector can also apply for the protective order, regardless of the mental capacity or consent of the vulnerable adult, if required.
To make an application, head down to the Family Protection Centre at the Family Justice Courts with these supporting documents:
If the person making the application is a family member:
- Documents proving relationship with the vulnerable adult
- Medical reports proving the vulnerable adult’s physical or mental infirmity or disability or incapacity
- (If the vulnerable adult does not lack mental capacity) Consent Form (Form 64F) signed by the vulnerable adult to consent to the application
- (If the vulnerable adult lacks mental capacity) Mental Capacity Assessment (Form 64A) signed by a registered medical practitioner to verify that the vulnerable adult lacks mental capacity
If the person making the application is a donee/deputy:
- LPA or court order under the Mental Capacity Act for the appointment of a deputy
- Medical report(s) proving the vulnerable adult’s physical or mental incapacity
- Mental Capacity Assessment (Form 64A) signed by a registered medical practitioner
If the person making the application is the vulnerable adult:
- Medical reports proving physical or mental infirmity or disability
Types of protective orders the court can make
The types of protective orders the court can make include orders:
- Restraining the abuser from abusing the vulnerable adult;
- Committing the vulnerable person to someone else’s care for up to 6 months;
- Granting the vulnerable adult exclusive position of their place of residence such that the abuser is excluded;
- Prohibiting the abuser from entering a frequented place or area near the residence of the vulnerable adult; or
- Prohibiting the abuser from visiting or communicating with the vulnerable adult.
The court may also make an expedited order where it is satisfied that the vulnerable adult is experiencing or is in imminent danger of abuse or neglect. These are temporary orders issued while the hearing for the main application is pending.
Where the above interventions have failed (e.g. the abuser does not comply with any protective orders made against him/her), the authorities may enter the vulnerable adult’s premises, assess his/her condition and remove him/her to safety, as a last resort.
Should the vulnerable adult refuse assistance, the Ministry of Social and Family Development (MSF) may apply for a relevant protective order(s) from the court to ensure the vulnerable adult’s protection and safety nevertheless.
MSF officers are also empowered to inspect premises and search for evidence of any offences committed under the VAA.
Penalties for abusive caregivers
Abusers of vulnerable adults may also face criminal sanctions in accordance with the harm inflicted.
Depending on the charge levied on the accused, abusive caregivers may face imprisonment, a fine, and/or caning.
The court also has the discretion to levy enhanced penalties up to one and a half times the maximum punishment on abusive caregivers of vulnerable adults.
Commencing civil litigation
The family of the vulnerable adult may be able to commence civil proceedings against the abusive caregiver(s) or the care facility (e.g., nursing home) to pursue monetary compensation.
In a nursing home abuse case, the court may find the nursing home to be negligent in their duties and supervision of their staff members, resulting in the abuse to the vulnerable adult. It can also find that the nursing home is vicariously liable.
To prove negligence, several elements must be present. It will probably be found that the nursing home owes the victim a duty of care to ensure his/her safety. In addition, the nursing home may have also breached this duty, by falling below the reasonable standards of careful and responsible supervision of their staff members.
Civil proceedings, if successful, can provide monetary compensation for the loss suffered by the victim. This can even include compensation for the mental suffering suffered by the victim.
Removal of Vulnerable Adults
Self-neglect is another issue that may arise where a vulnerable adult is concerned. This occurs when the vulnerable adult intentionally fails to take care of his/her essential physical needs.
For example, not eating and becoming malnourished as a result, or refusing to seek medical care thus aggravating a physical injury.
The law provides for the removal of a vulnerable adult from the place they reside, even if he/she does not wish to be removed. This could occur where the vulnerable adult does not lack mental capacity but does not consent to the removal, for example.
The removal may even be made without the consent of the vulnerable adult’s donee or deputy.
The vulnerable adult will be removed to either a temporary care location or to the care of a person who is fit to do so. In a situation where someone is obstructing the removal of the vulnerable adult, such force as is necessary and appropriate may be used.
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