Helping your parents to age with dignity

Talking about “tough topics” can be a challenge, – even in the most normal of circumstances. Remember telling them about the time you wanted to scuba dive when you were advised to only tell them AFTER you bungeed jumped? What about when you decided to move out before you were married? Or why their grandkids may prefer a croissant over kaya toast?

As difficult as it may seem, some conversations are a must. And that includes the one where they need to hear some painful truths about getting older, and why they need to make a Lasting Power of Attorney (LPA) and Advanced Medical Directive (AMD) to ensure they are taken care of.

Some hard truths about getting older in Singapore.

One in 10 people above the age of 60 may already have dementia. Elderly pedestrians account for over 60% of all pedestrian fatalities in Singapore. If your parents are above 65, this age group accounts for half of those diagnosed with cancer. Around 65% of this group will pass away from cancer, according to the National Registry of Diseases Office.

Financially, without the right plan in place, caring for dementia or Alzheimer's can be extremely expensive. In 2015, around S$2.8 billion was spent on caregiving for dementia patients, and that number is expected to double by 2030.

As we get older, these risks get more real with every passing year. Our role as children, stepchildren, or grandchildren, is to look after them as best we can.

Facing your fears: Talking to your parents

For a lot of us, this is the hardest part: getting our parents to admit they need help. The Pioneer Generation and Merdeka Generation have seen it all – and they are hardy, tough and resilient. Which only makes a tough conversation even tougher. Here are some tips:

• Recognize the enormity of the task. As children, we need to first acknowledge that this talk will be extremely difficult and may not go as planned. If you have a parent-child relationship that has had its ups-and-downs, recognise their anger or defensiveness, and perhaps revisit the topic after everyone has calmed down.
  
  
• Think about who should have that conversation and plan it from start to end. You know who among your siblings can manage the conversation better. But offer your support even if you have been rebuffed a few times.
  
  One possible conversation starters: appeal to their knowledge and experience with something like: "I've been thinking about my own long-term care plans lately and I was wondering if you had any planning tips for me?"
  
  

To apply, your parents would need to first decide if they want an LPA or AMD, or perhaps even both. They should decide who they want to appoint, and the amount of authority they want to give their appointee(s). The Office of the Public Guardian site has a list of accredited issuers here.

Key elements of the plan: LPA and AMD

Under Singapore law, being a child or a relative doesn't automatically give us the right to decide what to do if our parents become mentally incapacitated such as being diagnosed with a mental illness like dementia which prevents them from communicating their own intentions.

• A Lasting Power of Attorney (LPA) allows our parents to appoint someone (the donee) to make decisions about these issues: bank accounts, property and tax matters, long-term care, among others.
  
  Unlike a Will, the LPA doesn't wait until the person passes away to come into effect. At a time of increasing incidences of dementia and mental illness, having this power of attorney could prevent families from being locked out of accounts or assets unnecessarily.
  
  Note that the LPA can only be used when the person loses their mental capacity. If they regain their mental capacity, remember to inform the relevant agencies to deactivate the use of the LPA. The donee then no longer has power to make decisions on behalf.
  
  
• An Advanced Medical Directive (AMD) allows our parents to let doctors know if they have decided against life-sustaining treatment when they are in a terminally ill or unconscious state.
  
  

How can my parents apply for an LPA?

The LPA is a legal instrument, and it can help your parents appoint someone they trust to make the decisions, if they can no longer tell the doctors, judge, bank officer or HDB officer what they intend to do with their assets or about their own medical condition. An LPA must be registered by the Office of the Public Guardian (OPG) in order for it to be valid.

Your mom and dad can appoint more than a single person to do that, but when it comes to decision-making, these appointees need to stick to the specific areas they have been tasked with, with zero interference into the other appointee's scope. If they didn’t specify what their roles are, Singapore law assumes they are to act in concert on mon and dad’s behalf.

Remember: there is no automatic "right" for families to manage their loved one's affairs, even if you believe you have their best interests at heart. Without an LPA, some families may get caught up in unnecessary and lengthy court proceedings for even the simplest things we take for granted daily.

Note: If your parents regain their mental capacity, the LPA is no longer enforceable. This is slightly different from a Trust, which essentially comes into effect once it has been signed.

How does an LPA work?

A Singapore-originating LPA only works in Singapore. If you parents are overseas, or intending to move there, it is best to have an LPA in those countries.

In Singapore, there are two options:

These forms are available from the Office of the Public Guardian, Singapore.

Once mom and dad have decided, they will need to visit a Certificate Issuer who will vouch that they have the mental capacity to make an LPA and were not forced or bluffed into doing so. The Certificate Issuers will also submit the LPA Form for you* to the Office of the Public Guardian (OPG).

To avoid any potential conflicts of interest, the Certificate Issuer cannot be a family member, your donee, or seen to benefit in any way. Refer to the Ministry of Social and Family Development’s guidelines for details of who qualifies – and who doesn’t.

If your Certificate Issuer is a medical practitioner, expect to pay between S$24-80; most charge S$50. This rate is based on the top 10 most-visited accredited medical practitioners. If you’re getting a lawyer or psychiatrist to submit the LPA for you, expect the rates to be quite different.

*Fee for form submission to OPG: Waived till 31 March 2021.

How can my parents apply for an AMD?

Cancer. Stroke. Road accidents. These unwanted illnesses or situations can alter our physical state in an instant.

An Advanced Medical Directive, or AMD, is a legal document that lets doctors know when a patient has decided against life-sustaining treatment in a terminally ill or unconscious state.

The AMD helps remove any burden on a family member, or members, in making a decision that can create an immense amount of guilt and hurt. A decision on behalf of a terminally ill member of the family has wide-ranging consequences – including one that could tear the entire family apart emotionally or create unwanted financial burdens from life-preserving treatment or surgery.

It also helps alleviate what could be costly medical bills. The AMD also makes their dying wishes clear to all family members and medical staff if pushed into life or death decision.

Getting an AMD

In Singapore, an AMD document can be obtained from medical clinics, polyclinics or hospitals. Alternatively, it can be downloaded from this link.

Once your parents have decided on having an AMD, a licensed doctor in Singapore will have to determine three things:

• That they haven’t been forced into making the AMD
  
  
• That they have the mental capacity to make this decision
  
  
• That they understand what you have done
  
  

Then it needs to be registered with the Registrar of Advanced Medical Directives. Once completed, an acknowledgement of their medical wishes will be sent back to complete the AMD.

There is no better time than now for this conversation. With each passing year, the chances of getting cancer or heart disease goes up and their state of mind to clearly consider an LPA or AMD goes down.