Social workers who need a court order to assess the well-being of vulnerable adults despite uncooperative family members have had the process of doing so clarified, with the development of guidelines in the past few months.
Other powers granted by an Act to help vulnerable adults that came into force last month include a protection order to restrain abusers from inflicting further harm, and prohibiting them from entering such an adult's residence.
The Vulnerable Adults Act (VAA), passed in Parliament last May, provides an additional avenue for social workers to turn to when other attempts at engaging the family of the adult - typically an elderly person - have failed.
In response to media queries, the Ministry of Social and Family Development (MSF) said recently that there have not yet been instances where the Act had to be invoked as it was brought into force only on Dec 19.
In the meantime, MSF has worked with medical professionals, social service agencies, the police and the courts to develop standard operation procedures and assessment guides, including a final round of briefings with community agencies in October last year.
MSF officers have also received specialised training on case assessments and interventions, including the protocols that should be adhered to if the VAA powers are invoked, said the ministry.
A vulnerable adult is an individual aged 18 or older who, because of a physical or mental infirmity, disability or incapacity, cannot protect himself from harm.
MSF said more than half of the vulnerable adults it has encountered are above 60 years old, with most of them being women.
There are a range of orders that could be applied for by MSF's adult protection officers or by approved welfare officers, depending on what is needed in each case, and the process is similar to applying for a child protection order, said senior social worker Kristine Lam, manager of Care Corner Project StART, one of Singapore's three family-violence specialist centres.
MSF said most vulnerable-adult cases are managed by such community agencies or MSF's social service offices, which provide support such as financial assistance and counselling.
"Such help is aimed at stabilising the family environment and restoring the relations between the vulnerable adult and caregiver," it added.
In addition, hospitals such as Ng Teng Fong General Hospital also help to identify and assess risks faced by vulnerable adults, and recommend interventions.
More than half of the vulnerable adults whom the Ministry of Social and Family Development (MSF) has encountered are above this age, with most of them being women.
Number of cases a year involving vulnerable adults which MSF has handled under the Adult Protective Service, which was set up in 2015, before the Vulnerable Adults Act was introduced.
Ms Long Chey May, who is a master medical social worker at the hospital, said the vulnerable adults who show up at the emergency department or specialist outpatient clinics usually present themselves with physical signs and symptoms such as poor hygiene and unkempt appearance which "warrant attention and assessment".
If family and community intervention efforts are ineffective, MSF can step in and apply for court orders under the VAA if the vulnerable adult has experienced, is experiencing, or is at risk of experiencing abuse, neglect and self-neglect, and if such orders are necessary for his protection and safety, said MSF.
Certain orders under the VAA could be applied for by approved welfare officers, including from community agencies, or by a vulnerable adult's appointed deputy to the family court.
These orders include prohibiting a person from communicating with or visiting a vulnerable adult, and granting the vulnerable adult the right of exclusive occupation of specific premises.
Other orders, such as a placement order to relocate the vulnerable adult to a temporary shelter, must be applied for by MSF's adult protection officers. These powers were not available before the VAA was passed.
A family court judge can call for family members to make representations to allow the judge to decide whether a court order should be given. These decisions can be appealed.
Case of 'mistreated mum' shows hurdles faced by social workers
An elderly woman is suspected to have been mistreated by her daughter, who occasionally does not allow social workers to speak with her mother.
The daughter, who is in her 50s, had admitted to making her mother sleep on the floor, not allowing her to leave the flat or speak with anyone, not changing her diapers regularly and overdosing her on sleeping pills, among other acts, said senior social worker Kristine Lam.
It took three weeks for social workers to gain access to the mother, who is in her 80s, but that process could be shortened with powers granted under the new Vulnerable Adults Act (VAA), said Ms Lam, who is manager of Care Corner Project StART.
The Act came into force last month but has not been invoked thus far, said the Ministry of Social and Family Development.
"The daughter knows that whatever she did was wrong, but she continued to do so," said Ms Lam. "If we were unable to convince the daughter, we would likely have to continue to wait till the elderly woman gets to leave the flat, which may be weeks or months later. With VAA, we would be able to get entry earlier, minimising the risk to the mother's welfare."
This case highlighted the complexity of the issues faced by vulnerable adults, she said, as doctors who assessed the mother were unable to give social workers the green light to put her in a shelter as she did not give consent even though she knew she was being abused.
Social workers, together with her neighbours and befrienders, have been scheduled to visit the flat weekly. Her doctors have also been told to keep an eye out for the medication dispensed to her to reduce the chances of overdosing.
"Invoking the VAA should be a last resort because it is ultimately quite intrusive," said Ms Lam. "However, there will be situations where family members will, for whatever reason, continue to use violence on the vulnerable person and refuse to work with community agencies."
Lim Min Zhang
Before the VAA was introduced, MSF had established the Adult Protective Service to protect vulnerable adults in 2015. It has handled about 110 cases a year involving vulnerable adults since then.
In many of these cases, it is the caregivers, including family members, that are the perpetrators, said MSF.
Ms Cherylene Aw, centre director of Trans Safe Centre, said the number of cases seen at the Adult Protective Service is "certainly the tip of the iceberg".
About 15 per cent of those helped by the centre in Bedok - which provides help to victims of abuse, people who abuse their families, and affected family members - are vulnerable adults.
On how the VAA is beneficial, Ms Lam cited a recent case of an elderly woman who is suspected to have been mistreated by her daughter. It took her team three weeks to gain entry to assess the mother as the daughter did not allow them to visit the elderly woman at first. With the VAA, they could intervene earlier in such instances.
Ms Aw said that for the majority of the cases Trans Safe Centre handles, there is no need to invoke the Act. "However, for cases in which we are really stuck - for example, the family cannot be engaged - the Act provides an additional avenue for us to take action," she said.
This is especially for cases where the family member using violence - usually a son or daughter - also has vulnerabilities such as chronic mental illness, intellectual disability and financial hardship, she added, emphasising that each vulnerable adult's needs and challenges are different.
MSF said that, as far as possible, it will try to place vulnerable adults with other family members who can take care of them, and avoid placing them in care institutions.
Added Ms Aw: "It's a delicate balancing act, to take into account the vulnerable adult's right to self-determination and dignity while looking out for his best interest.
"Even if their mental capacity has been lost, their past wishes, values and feelings should be considered."