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Opening Speech by Minister Desmond Lee at the Second Reading of the Vulnerable Adults Bill

1.      Mr Speaker, I beg to move, that the Bill be now read a Second time.

2.       With your permission, Mr Speaker, may I ask the Clerks to distribute an A4 copy of an infographic on the Vulnerable Adults Bill. This Bill seeks to protect individuals, 18 years and older, who cannot protect themselves from abuse, neglect or self-neglect, because of a mental or physical infirmity, disability or incapacity.

Introduction

3.       In the course of our work as MPs, we would have come across households seeking help and assistance, as they juggle the many roles expected of a family:

  • breadwinner,
  • caregiver to elderly parents,
  • and parents to young or teenage children.

4.       It gets harder when elderly parents lose mental capacity because of dementia, or become bedridden because of illness. Double the challenge if they have children with disability or special needs to provide for.

5.       Through various schemes and programmes, we want to better enable our families as they carry out their caregiving role as the first line of care and protection for their vulnerable members.

6.       Indeed, one of the key priorities for MSF and MOH, both now and in the years ahead, is to enhance support for the elderly and people with disability and special needs, and to better enable their family members and loved ones to carry out their roles as caregivers.

7.       From time to time, we hear about sad cases where elderly persons or persons with disability or special needs are abused or neglected. Currently, we have in place a network of community and social service agencies which support families through social intervention, such as counselling, case management and case monitoring. Take the case of "Madam Chua" (not her real name).

8.       Madam Chua is a 68 year-old lady with early-stage dementia. When neighbours spotted Madam Chua wandering the neighbourhood with bruises on her arms and around her left eye, they alerted the Family Service Centre (FSC). The FSC found out that Madam Chua's daughter would beat her mother every time Madam Chua soiled herself or left the stove on. When social workers contacted the daughter, she expressed remorse for using force against her mother. We found out that the daughter's anger stemmed from her frustration and stress. Not only was she coping badly with her mother's failing health, she also needed to care for her own son who has special needs. The daughter agreed to participate in counselling and assistance programmes to help her manage Madam Chua's failing mental and physical health. To provide the daughter with caregiver respite, the FSC also persuaded another of Madam Chua's daughters to step in to care for Madam Chua on weekdays. Assistance was also given to help her care for her son, who had special needs. Since the FSC's involvement, there have not been further incidents of violence.

9.       Cases such as this remind us of the complexity of family relationships, and the crucial role that family and community intervention plays in helping vulnerable individuals.

10.       But Singapore's population is rapidly ageing.

  • Today, more than 450,000 Singaporeans are 65 and above.
  • By 2030, 1 in 4 Singaporeans will be aged 65 and above; that is more than 900,000 elderly individuals.
  • The number of residents living alone is also projected to increase to more than 80,000 in 2030.

11.       Our changing demographics impact our household structures. And this can complicate family dynamics. In our midst are vulnerable Singaporeans who may not be able to care for themselves, as they have physical or mental infirmities or disabilities. Some of these vulnerable individuals may not be able to depend on their families to provide adequate care for them; others may not even have family members or friends to rely on.

12.       While our adult protection framework has functioned well, there are instances where family and community interventions may not be effective. Since MSF's Adult Protective Service (APS) was established in 2015, the number of referrals to MSF has increased. On average, MSF has handled about 110 cases annually involving vulnerable adults aged 18 years and above, though not all of these cases eventually required our intervention. Our experience, validated by feedback from our stakeholders, indicates that family matters are never clear cut, never black and white.

13.       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. One of the cases where MSF had to intervene involves "Sam" (not his real name), a 29-year-old young man with Attention Deficit Hyperactivity Disorder (ADHD), autism and an intellectual disability. Sam is an only child and lived with his elderly parents. However, his parents were not able to understand his condition and hence care for Sam. Sam's father would hit him to try and control his behaviour. This resulted in severe cuts and bruises on Sam, all of which required medical attention. However, Sam's behaviour also caused his father a lot of stress. When MSF spoke with Sam's family members, they mentioned that Sam's father had entertained thoughts of killing his son, and ending his own life. Sam's father refused assistance and therapy for himself and Sam, insisting that Sam be medicated to control his behaviour. Given the high risk of Sam being hurt again, Sam was placed at a facility that was equipped to address his care needs.

14.       In cases like this, the Government must take a proactive approach and intervene early, as any delays may lead to further harm, or worse.

Intent underlying the Vulnerable Adults Bill

15.       I am therefore putting the Vulnerable Adults Bill before this House, to seek your support to strengthen the existing adult protection framework. The Bill will allow the Government social services to intervene, assist and protect vulnerable adults when social work-based family and community interventions are inadequate. It will complement other existing laws that protect vulnerable individuals, such as the Women's Charter and the Mental Capacity Act.

16.       We hope to achieve two objectives. First, we want to ensure that we have the ability to move quickly to protect and support vulnerable adults as well as their caregivers, when the need arises; and Second, we want the protection for vulnerable adults to be effective.

17.       In drawing up the Bill, we consulted our community partners and public agencies. Together, we reviewed cases where vulnerable adults were abused, neglected or self-neglected, and discussed how best to calibrate the powers that the Bill should give. This was an important exercise that we did not want to rush, as we should not be excessively intruding into the sanctity of the home and eroding the autonomy and responsibility of the family. During our consultations, we received strong support for the Bill. I met our community partners earlier this year when the draft Bill was finalised. I was encouraged by their continued strong support. I would like to thank all stakeholders who provided valuable insight. We have studied these views carefully, and incorporated them into the Bill where appropriate.

18.       Before I go into the main provisions of the Bill, I would like to assure Members that the Bill does not and must not replace the social work that supports vulnerable adults and their caregivers. Social work intervention is, and remains, the main form of external intervention in such cases. This Bill, if passed by Members, should be a law of last resort; 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 on. This Bill does not seek to supplant or diminish the role of the family and community.

Key Provisions in the VA Bill

19.       Mr Speaker, let me now bring the House through the main features of the Bill, which fall broadly into four categories:

  • Scope of the Bill, and guiding principles underlying intervention;
  • MSF's ability to intervene and protect vulnerable adults;
  • Court orders that will enhance the protection and support for vulnerable adults and their caregivers; and
  • Community involvement in protecting vulnerable adults.

Scope of the Bill and guiding principles underlying all intervention

20.       First, the Bill protects vulnerable adults and explicitly sets out the guiding principles underlying State intervention.

21.       Clause 2 defines a vulnerable adult as an individual, aged 18 years or older, who because of mental or physical infirmity, disability or incapacity, is incapable of protecting himself or herself from abuse, neglect or self-neglect. For individuals above the age of 16 but below 18, we are looking to amend the Children and Young Persons Act to extend statutory protection under the Child Protective Service.

22.       Since its formation in 2015, MSF's APS has seen a range of vulnerable adult cases involving abuse and neglect.

  • "Abuse", under the VA Bill, refers to physical, emotional or psychological abuse. "Abuse" also includes any conduct or behaviour which causes an individual to fear for his safety or well-being, or unreasonably deprives, or threatens to unreasonably deprive, him of his liberty of movement or wellbeing. Hence, an individual who excessively controls another individual's day-to-day life and social relationships, and as a result causes the individual to suffer adverse emotional health effects, may be regarded as having abused that individual. A vulnerable adult may also require protection if she or he has been neglected.
  • "Neglect" refers to the lack of provision of essential care to an individual, to the extent of causing or being reasonably likely to cause injury or pain. Not providing food, clothing, medical aid, lodging, supervision and other necessities of life are examples of neglect.
  • A vulnerable adult may also neglect himself. "Self-neglect" refers to the failure of an individual to perform essential tasks of daily living, such as eating, drinking and seeking medical aid. Vulnerable adults may, as a result of self-neglect, live in grossly unsanitary or hazardous conditions; suffer from malnutrition or dehydration; or suffer from untreated physical or mental illness or injury.

23.       Since 2015, APS has seen close to 50 cases of self-neglect. Many do not have families to care for them. Take Mr Wong (not his real name) for example. Mr Wong is an 85-year-old elderly man who lives alone. He has diabetes and has developed diabetic-related wounds on his feet. When community workers found him, he had not bathed for months. He did not keep his medical appointments despite running out of medication, and was not able to take care of the wounds on his feet. As a result, maggots had infested the wound and he required urgent hospitalisation. Despite repeated engagements by the community, Mr Wong refused to be admitted to a hospital or nursing home. MSF persisted, and found his step-daughter. Together, they persuaded him to accept medical care in his home, after getting assurances that his leg would not be amputated. APS also managed to get help for Mr Wong to manage his swollen legs and to monitor his condition.

24.     As of today, nursing staff from a social service agency visit Mr Wong weekly to clean his wound. This has reduced the stench of rotting flesh from his right leg. Three meals are delivered daily to him. Each week, staff from our Senior Activity Centre visit him. They also arrange for a doctor to see him whenever necessary. Mr Wong's step-daughter plays her part, dividing up her time between work, her own family, and looking after Mr Wong. We are supporting her with caregiver support, to help her cope. Cases like Mr Wong highlight the need for adult protection legislation that will provide Government social services with powers to better support these vulnerable adults.

25.       When drafting the proposed definitions, we wanted to ensure that the Bill complements, but does not supplant, existing laws and support networks. Certain scenarios are therefore not covered. For example, an individual who is physically abused by a family member, but who is capable of protecting himself - in other words, he does not meet the vulnerability threshold under the Bill - may instead apply for a personal protection order, or PPO, under the Women's Charter. Individuals with suspected mental illness, who are not vulnerable adults, may also be assisted under the Mental Health Care and Treatment Act, if their behaviour places them at risk of harm.

26.       Next, clause 4 of the Bill sets out the five key principles that guide how we will carry out the duties or exercise the powers under the Bill. The powers of the Bill are intrusive, and hence must be exercised within limits and with the right intent. We have therefore embedded these key principles in the Bill, to balance the need to protect a vulnerable adult with his right to autonomy and self-determination.

27.       What are these principles?

28.       First, when we exercise the powers or perform the duties under the Bill, it must be to protect vulnerable adults from abuse, neglect and self-neglect. The Bill is not intended to solve community disputes, nor remove persons from their homes just because they may be perceived by their family members or neighbours to be a nuisance. We will intervene if we assess that doing so is the only way to protect the vulnerable adult.

29.       Second, we recognise that a vulnerable adult with mental capacity is generally best placed to decide how he or she wishes to live, and whether or not to accept any assistance. The Bill does not seek to override an individual's freedom of choice nor coerce individuals to behave in a certain manner. MSF will seek an individual's consent before intervening. Having said this, there may be circumstances where we should intervene, even though the vulnerable adult has mental capacity and refuses to accept protection. Such intervention will only take place in extreme cases involving the safety and protection of the vulnerable adult.

30.       Third, we must consider the previously-expressed views, wishes, feelings, values and beliefs of a vulnerable adult who lacks mental capacity, where reasonably ascertainable. MSF will, as far as possible, respect an individual's choices and beliefs when we intervene.

31.       Fourth, we must intervene and assist in a manner that is less restrictive of the vulnerable adult's rights and freedom of action. In order to do this, MSF will work closely with the vulnerable adult and involve his family and caregivers, where possible.

32.       Finally, the welfare and best interest of the vulnerable adult must be the first and paramount consideration.

MSF's ability to intervene and protect vulnerable adults

33.       The next category of provisions sets out the State's powers. Cases such as Mr Wong, which I referred to earlier, illustrate why it is crucial for MSF to have powers to enter private premises, assess, and if necessary, remove a vulnerable adult. The Bill will only be effective if it allows us to intervene quickly to prevent further harm to the vulnerable adult.

34.       Part 2, Division 1 of the Bill empowers MSF to enter private premises, to assess a person whom we suspect to be a vulnerable adult, if we have reason to believe that the individual has suffered from, is suffering or, is at risk of abuse, neglect or self-neglect.

35.       In severe cases, the vulnerable adult may no longer be safe within his place of residence. Under clauses 10 and 11, MSF may remove vulnerable adults from their residence and commit them to gazetted care facilities, or to the care of a fit person. This allows swift assistance to be rendered to the vulnerable adult, while other care arrangements are worked out. MSF must apply for a Court order within 14 working days after the removal, unless the vulnerable adult is earlier permitted to return to his residence. This requirement was included because we recognise that placement can significantly impact the vulnerable adult's way of life. I wish to assure members that committals to these care facilities will only be done as a last resort, for an appropriate duration, until the vulnerable adult can be safely reunited with his family. To ensure the vulnerable adult's well-being and safeguard the vulnerable adult's health, MSF may require him to be treated by a registered medical practitioner or registered dentist before or during his stay in these care facilities. Once committed to a care facility, the vulnerable adults must be protected from further harm. Clause 19 requires the care facilities to undertake security measures to ensure the safety and protection of the vulnerable adults residing within their premises. Clause 20 empowers MSF to establish a Review Board to ensure that proper care plans are in place for the vulnerable adult. The Review Board will also advise MSF on whether a vulnerable adult can be discharged when the period of committal ends.

36.       By and large, the Bill is premised on the vulnerable adult's autonomy to make his own decisions. That said, our experience working with vulnerable adults is that there are exceptional circumstances where we may have to intervene to ensure a vulnerable adult's safety, despite his refusal to consent to intervention. This includes instances where the vulnerable adult refuses to consent to assistance because he is under duress or undue influence. Clauses 7 and 10 will therefore allow MSF to apply for a Court order to assess and commit a vulnerable adult to a care facility, where a vulnerable adult with mental capacity refuses assistance.

37.       Let me explain our considerations for this:

38.       First, during our consultations, some stakeholders highlighted actual cases where they were unable to help a vulnerable adult, because the vulnerable adult refused to accept their assistance. Some of these adults were abused or neglected until the day they died.

39.       Second, we looked at other countries which have longer experience with vulnerable adult legislation. Some of these jurisdictions have laws that allow a vulnerable adult's stated wishes to be overridden. For example, Scotland's Adult Support and Protection Act permits the State to intervene despite a vulnerable adult's refusal to consent, if there is evidence that the adult is unduly pressurised, and there are no other reasonable steps that can be taken to prevent further harm to the adult.

40.       Similarly, in British Columbia, Canada, the State can intervene, without the vulnerable adult's agreement, to remove an adult, provide them with emergency health care and take any other emergency measures necessary to protect the adult, if the adult is suffering from abuse or neglect. The State can do this if it is of the view that it is necessary to act without delay, in order to:

  • Preserve the life of the adult;
  • Prevent serious physical or mental harm to the adult; or
  • Protect the adult's property from significant damage or lost.

41.       Like the adult protection laws in these countries, our Bill will similarly allow MSF to intervene despite a vulnerable adult's wishes, if it is necessary to protect them and ensure their safety. But, as a safeguard, we will get a Court order to do so.

42.       Ensuring the vulnerable adult's welfare and best interests is paramount. However, we must also hold abusers accountable for their actions if they are culpable. Clauses 26 to 29 empower MSF to investigate offences under the Bill.

43.       To deter people from harming vulnerable adults, clauses 40 and 41 make related amendments to the Penal Code and Protection of Harassment Act, respectively, to enhance the maximum penalties of specific offences by up to one and a half times, if these acts are committed against a vulnerable adult. This aligns with the enhanced penalties for Penal Code offences against domestic workers, who are also a vulnerable group. Clause 42 also amends the Women's Charter to enhance the penalties for breaches of Women's Charter protection orders to maintain parity with the Bill. These enhancements received strong support during our consultations on the Bill.

Court orders that will enhance the protection and support for vulnerable adults and their caregivers

44.       I now move to the orders that the Court may make to protect vulnerable adults and support their caregivers.

45.       Clause 14 empowers the Family Justice Courts to make intervention orders to protect vulnerable adults from further harm. The need to apply for a Court order serves as a safeguard against excessive statutory intervention. When considering whether to make orders and what orders to make, the Court must have regard to the same five guiding principles in the Bill that I had articulated earlier, but it may also take into account any other relevant matters it deems fit.

46.       There are three categories of Court orders:

47.       First, core protection orders protect the vulnerable adult from any third party who may cause him to suffer from abuse or neglect. It includes restraining orders, exclusive occupation orders and orders prohibiting a person from visiting or communicating with the vulnerable adult.

48.       Second, alternative placement and supervision orders ensure that the vulnerable adult is relocated to a safe environment. The Court may order a vulnerable adult to be committed to a care facility for a specified period of time; or order that the vulnerable adult be placed under the supervision of an appointed person. This appointed person may include a protector or an approved welfare officer.

49.       Third, the Court can also make other protection and intervention orders including orders to make the vulnerable adult's residence a safe living environment; and an order requiring the vulnerable adult or any other person to attend counselling or any such programmes as directed by the Court. This includes the power to order a vulnerable adult or any other person, including a caregiver who may have caused the abuse or neglect, to go for counselling or training, and get additional support.

50.       Some vulnerable adults may face difficulties applying for such Court orders on their own. Hence, clause 12 allows approved welfare officers to apply for core protection orders.

51.       More importantly, clause 12 preserves the role of the family, as it also empowers family members, including a vulnerable adult's donee or deputy, to apply for protection orders. By "donee", I refer to a person who has been appointed by the vulnerable adult under a Lasting Power of Attorney or LPA to make decisions and act on his behalf for his personal welfare, property and financial affairs in the event he loses mental capacity. And a "deputy" is a person appointed by the Court to make such decisions on the vulnerable adult's behalf, if the vulnerable adult no longer has mental capacity to decide for himself and did not make a LPA previously.

52.       Our aim is to help every vulnerable adult return to the love and care of his or her family, eventually. I would like to come back and talk about "Sam", the 29 year-old individual whose father had hit him in order to control his behaviour. The Bill, if Members support it, will allow Sam to be placed in a care facility, where he will receive the support necessary for him to manage his condition and recover from physical abuse. Having Sam temporarily away from his home may also provide respite for Sam's parents. MSF can continue to engage Sam's father and ask that he attend therapy and counselling sessions to help him better understand and care for Sam. If the father refuses, we can apply for a Court order requiring him to go for counselling or other such programmes that the Court deems necessary.

53. The Bill allows us to calibrate the level of intervention necessary for each case, through a combination of statutory orders as well as social work interventions. This complements our existing adult protection system which seeks to support both the vulnerable adult as well as their family and caregivers.

Community involvement in protecting vulnerable adults

54.       Finally, I will now explain how the Bill enables our wider community to play a bigger role in preventing family violence and the abuse and neglect of vulnerable adults. Members of this House will recall the sad and tragic case of Ms Annie Ee. Ms Ee was a 26 year-old intellectually disabled waitress who left home because she wanted to work and be independent.

55.       She stayed with people whom she believed were her friends. Unfortunately, she was severely abused by her flatmates, and eventually passed away. This was horrible and tragic.

56.       While the Bill will allow the State to step in to protect individuals like Ms Ee, none of the intervention powers in the Bill 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.

57.       For example, in the case of "Madam Chua", the first example I gave today, her neighbours saw bruises on her arm and around her eye, and promptly sounded the alert. Our FSC was therefore able to enquire about the circumstances and take action. We have therefore included clauses in the Bill to strengthen the roles of both the family and community.

58.       Specifically, clause 23 protects people who report such cases to the relevant authorities. These whistle-blowers will be protected 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. This will protect professionals such as doctors, lawyers and counsellors.

59.       Clause 22 also places restrictions on the publication of information identifying a vulnerable adult. Any information that may lead to the identification of a vulnerable adult cannot be published or broadcasted. This is to safeguard a vulnerable adult's privacy and allow him to recover; this privacy will also allow the vulnerable adult and the family to focus on repairing their relationship.

60.       That said, clause 24 allows the disclosure of confidential information relating to a vulnerable adult to MSF, and by us to any other Government agency, statutory body, police officer or prescribed person or body. This would include MSF's community partners such as the Family Violence Specialist Centres and Family Service Centres, as well as medical and healthcare professionals. This is to ensure that swift action can be taken by different agencies to protect the vulnerable adult, hold perpetrators accountable, and ensure that appropriate assistance is provided to their families.

61.       MSF recognises that working with vulnerable adults sometimes requires the making of difficult professional judgments. If we want those who work with vulnerable adults to carry out their duties diligently and professionally, we must provide them peace of mind. Clause 34 therefore protects anyone performing a function or exercising powers under the VA Bill from legal liability, so long they have acted in good faith and with reasonable care. Such protection is extended to any member of the Review Board, any person appointed by the Court, and any person working in the care facilities. However, protection will only be afforded if they act professionally and responsibly.

62.       Mr Speaker, let me now speak in Chinese.

63.       我国人口正在急速老龄化。到了2030年,每四人当中,就有一人年纪在65岁或以上。随着人口结构改变,更多人,包括他们的看护者,都会年华老去。成年人遭受虐待、疏于照顾或是自我糟蹋的现象,将会越来越普遍。

64.       制定 "弱势成人法令" (Vulnerable Adults Bill) ,就是为了保护生活在我们周遭的成年弱势群体。

65.       在新法令下,家属对弱势年长家人的照顾,会获得更多的支持。当看护者没有照顾好这些家人,有关当局有权介入,委任适当的家庭成员负起这个责任。家属也可以申请庭令,阻止任何蓄意加害者接近弱势家人,以便更好地保护他们的安全。

66.       揭发或举报蓄意伤害弱势成人的事件,或挺身而出帮助弱势成人的人士,将无需承担法律的责任。任何出自善意而采取行动的社会人士,也都会受到这项法令的保护,这包括专业人士、家庭成员、左邻右舍或者公众人士等等。

67.       社会及家庭发展部只有在万不得已之下才会干预,保护弱势成人。在家庭无法自行解决,社区介入也无计可施的情况下,社会及家庭发展部人员有权进入弱势成人的住所,评估各方面的状况,再把这位弱势者重新安顿在安全的地方。法律也会加强管制,对任何欺凌弱势成人的罪行,施以严厉的惩罚,以制止弱势者受虐待、或疏于照顾的行为。

68.       议长先生,我们深切了解,看护家中弱势者并不容易,有时候确实会让看护者不胜负荷。

69.       我们要告诉这些看护者的是:你们并不孤独,我们理解你们所面对的压力和挑战。社区伙伴如家庭服务中心会适时提供援助,当你们的后盾。这些社区伙伴会根据个别家庭的需求,在必要时提供辅导和支持,也可以帮助个别家庭联系护联中心 (Agency for Integrated Care) 或残障者自立局 (SG Enable) ,让家中有弱势成人或行动不良者,能从这些机构提供的日间护理或居家服务受惠。看护者也可以善用这些暂托护理服务,给自己一个喘息的空间。

70.       要更好地照顾我们挚爱的家人,就必须先把自己照顾好,千万别让自己不胜负荷而崩溃,以至无心伤害了所爱的亲人。向周遭 需要帮助的人伸出援手的同时,也要懂得在自己需要帮助的时候,尽早求助。

71.       议长先生,让我现在以英语总结发言。

Conclusion

72.       Mr Speaker, sir, the Bill will only be effective if each and every one of us in the community continue to play our part. We must look out for the safety of vulnerable people, and extend warmth and a helping hand to families who care for their vulnerable family members. But the abuse and neglect of vulnerable adults is not a private matter, and must not be tolerated. Everyone - including family members, neighbours, community leaders, employers and healthcare professionals - has a role to play to prevent vulnerable people from being abused, and to stop it if it happens. Let's step forward to break the silence, by reporting suspected cases of abuse, neglect and self-neglect.

73.       Beyond the Bill, MSF will continue to facilitate the community's efforts in reaching out to vulnerable adults. We will reinforce our existing help networks, such as our Social Service Offices' local networks and the Community Network for Seniors programme, to better reach out to vulnerable adults and their caregivers.

74.       Even as MSF operationalises the Bill, we will continue to work with families, professionals and volunteers to strengthen the care networks across the community. Together, we can all do our part to keep an eye out for the most vulnerable members of our society.

75.       Mr Speaker, I beg to move.

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Published On Fri, May 18, 2018
Last Reviewed On Mon, May 21, 2018

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