Vulnerable adults need greater protection - even from 'loved ones'

Social workers are seeing a growing number of cases of vulnerable adults being mistreated by their own loved ones - usually grown-up children who should be caring for them.

Some of these "carers" taunt and torment; others beat, or berate. Yet others cheat their parents of their savings or property proceeds.

The abuse is not limited to the elderly alone. The disabled and the mentally ill with limited cognitive capacity are sometimes not spared either.

Several hundred such cases surface here each year, and the numbers may well be the tip of the iceberg, say social workers.

With their tormentors often their caregivers - and almost always their own flesh and blood - the victims are sometimes too scared to complain. Yet others have already lost the capacity to do so.

However, next year, Singapore will have a new law to better protect them, Social and Family Development Minister Chan Chun Sing said last week during a visit to the Trans Safe Centre, a voluntary welfare agency which specialises in helping victims of elder abuse.

The law - which is yet to be drafted - is likely to give powers to state representatives to intervene in cases where an individual is likely to be harmed. Deputies or guardians will be appointed by the state to act in the best interests of the vulnerable adult if they have no relatives.

Social workers and medical professionals will also be given powers to enter homes where a person is suspected to be a victim of abuse, investigate the matter and remove the person where necessary.

These foot soldiers in the battle against domestic abuse say the planned law will make it much easier for them to protect victims, who often suffer in silence and solitude cloistered at home.

Son made mum beg for money

Indeed, one of the biggest gaps in the system to protect abused adults has to do with access. Social workers from agencies dealing with family violence such as Trans Safe, Project Start and Pave say that if they receive a tip-off that an adult is being abused at home, currently they have no powers to act if the owner of the home refuses them permission to enter.

In one case handled by Trans Safe, a son in his 40s lived off state welfare payments paid to his 83-year-old widowed mother, yet made her beg for money as he pushed her around the streets in a wheelchair.

Not only that, but the son would also ration her food to save money and leave her bed sore wounds undressed. When his siblings, who did not live with them, expressed concern and wanted to remove their mother to a nursing home, he threatened suicide.

Finally, after much cajoling, he has agreed that she go to a nursing home.

Then there are cases where families abandon older folk at home, with minimal care, just waiting for them to die. In one such case, after pleas and requests that lasted four hours, social workers at Trans Safe were allowed access to an emaciated elderly man clad only in adult diapers, who was found lying on black garbage bags.

He was delirious from a lack of food and water. He was removed to hospital, recovered, but died subsequently.

Homecare doctors and social workers emphasise that these are just the cases where they are lucky enough to make a breakthrough and enter a home.

There could be many others, where victims may be dying the same way they lived their last years - suffering slowly in silence.

Even as the new law will address these issues, existing protection measures could also be strengthened.

Under current laws, vulnerable adults - including wives and parents - who are at risk of abuse by family members can apply for a Personal Protection Order (PPO), a court-sanctioned document requiring the abuse to stop.

This PPO regime has largely worked well with victims of spousal abuse. Abusers can be fined or jailed for breaching the order.

But there are several limitations of the PPO when it comes to vulnerable groups such as the abused elderly.

Studies by Trans Safe have shown that in slightly over half the cases of elder abuse, the perpetrator is an adult son. Daughters make up another fifth of abusers. Nearly eight in 10 victims, meanwhile, are women, mostly mothers.

Social workers say that an angry wife will be far more willing to take out a PPO against an abusive husband. Parents, especially mothers, on the other hand, find it hard to act against their own flesh and blood.

Besides, victims are required to apply for PPOs themselves. Frail, illiterate older folk or those who are mentally challenged may need time to understand the process.

Even when they do, if the order is contested, the process could drag for six months or more. The new law could consider ways to speed up the PPO processes.

Giving state-appointed welfare officers the powers to remove victims at risk of further abuse to temporary shelters is another possibility the new law must look into. This could be done while the social workers identify alternative living arrangements, such as with another relative.

This is especially important since the Trans Safe study showed that in nearly three-quarters of elder abuse cases, the victim shares a flat with the abuser.

The Children and Young Persons Act gives state officers the right to assess and remove a child who is being abused or faces a threat to his life and well-being. Similar provisions could be enacted to protect vulnerable adults, too.

Need to protect against financial abuse, too

ANOTHER issue the new law should consider is whether to appoint guardians to assist even those individuals who have not lost their mental capacity altogether, but are in danger of doing so.

This is already done in countries like Japan where guardianship is calibrated according to three distinct degrees of cognitive loss.

The proposed law should also look at strengthening protection against financial abuse.

Currently, this is outside the ambit of domestic abuse laws which protect victims from physical, sexual and psychological abuse.

Countries like Australia and the United States have teams specialising in identifying and taking action in cases of financial abuse. While Singapore has adult protection teams - comprising social workers, doctors, lawyers and police officers - who offer advice on how to deal with abuse cases, these should be expanded to include professionals from the banking, insurance and housing sectors who can provide advice on tackling financial abuse cases.

It is also worth exploring whether some, if not all, adult abuse cases should be referred to a tribunal to be dealt with in a faster, more cost-effective way, compared to the usual court process. Australia, for instance, has a tribunal to consider financial abuse cases.

Announcing the new law, Mr Chan pointed out that by 2030, there will be nearly 900,000 Singaporeans aged 65 and above. 

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With shrinking families, many may not have close relatives and need state-appointed guardians to protect their interests should they be abused or sink into cognitive oblivion.

But in many ways, the silver surge is already here. There are nearly 405,000 people aged 65 and above today, up from only 250,000 a decade ago.

Among those most at risk of abuse are those with dementia and serious psychiatric illnesses. Singapore has an estimated 28,000 dementia patients, with many more diagnosed each year.

Some are slowly but surely losing the ability to remember, to reason and to make decisions for themselves. Yet others have already lost this forever.

There are at least another 25,000 patients with serious mental illnesses in Singapore, whose powers of cognition and decision-making, too, may be diminishing day by day.

Earlier this year, social workers at Project Start, an agency which deals with family violence cases, spoke to a worried man who said his sister was refusing to allow him and other siblings to visit their ailing mother, who lived with her. He feared she was being abused.

Checks revealed she had been missing medical appointments. Other siblings and her friends said they, too, had been denied access. Neighbours said they had not seen the older woman in months.

Social workers have tried visiting the home multiple times with local grassroots leaders and even with police.

Each time, the daughter refused them entry, saying her mother was fine and that she was well within her rights to disallow them from entering.

The social workers say they just do not know whether the old woman is all right. They may not know the woman's fate till the law is passed next year.

One can only hope that by then it is not too late for her.

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radhab@sph.com.sg

This article was first published on Nov 6, 2014.
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