As dementia progresses, persons with this condition will have increasing difficulty with judgment and problem solving. They might be less able to make financial and healthcare decisions, and the people surrounding them need to give them more support to make these decisions. This loss of decision-making ability is a common experience in persons living with dementia, and it is also known as a loss of mental capacity.
Persons living with dementia do not always lose mental capacity upon the onset of dementia, but may gradually lose mental capacity as their condition progresses into the moderate and severe stages of the condition.
If you or your loved one has dementia, it is advisable for you or your loved one to make a Lasting Power of Attorney (LPA) to ensure decisions are always made in the best interests of the person living with dementia. If your loved one’s condition has progressed and they no longer have the mental capacity to make an LPA, you may also apply to be their deputy.
Read on to find out more about mental capacity, the LPA, and options for professional doneeship and deputyship.
What Is Mental Capacity?
Mental capacity is a person’s ability to make a decision at a particular time for a specific task or matter because of an impairment or disturbance in the functioning of the mind or the brain.
Why do I need to know what mental capacity is?
Since dementia affects a person’s mental processes over time, including their reasoning and decision-making abilities, it is important for caregivers to understand what mental capacity is and how it works. Such an understanding will help protect their loved ones’ rights and interests.
What key principles should those caring for persons living with dementia abide by when considering their loved ones' decision-making abilities?
Before an assessment of mental capacity, the person is assumed to be capable of making his/her own decisions. We cannot treat someone as not having mental capacity just because he/she has made an unwise decision, or without first doing what can be practically done to support them in making a decision. When making a decision for someone without mental capacity, actions taken should be in the person’s best interests and with as much respect for the person’s rights and freedom of action as possible.
Who can make decisions about my loved one's mental capacity?
On a day-to-day basis, caregivers can and need to make judgments about whether their loved ones are able to do different tasks on that day, such as to go out of the house alone, and make the decisions involved.
When are formal assessments of a person’s mental capacity done?
- A professional who is involved with the person’s assets, such as an accountant or lawyer, or the Donee of a Lasting Power of Attorney (LPA) may seek a formal assessment when they have doubts about the person’s capacity over a decision.
- Formal assessments are done when the decision the person has to make is an important one, or when the person requesting the assessment anticipates a dispute over the decision. Examples of such decisions may include transferring ownership of assets, giving gifts, making a will, entering into a contract, and to start or to be subjected to legal proceedings.
Who can make formal assessments?
- A registered medical practitioner who has been specially trained or specialists in mental health, such as psychiatrists, can conduct formal assessments of mental capacity.
How do I know whether my loved one has the mental capacity necessary to decide on the matter at hand?
It is important to presume that your loved one can make decisions when provided with support before assessing their mental capacity. Your loved one’s decision-making ability may vary from matter to matter, and from time to time.
You can use the following questions to guide your judgement on whether your loved one has the mental capacity to decide on a matter at hand:
Can your loved one understand the information about this matter?
Can your loved one remember the information at the time of making this decision?
Can your loved one weigh the pros and cons between choices in this decision?
Can your loved one communicate this decision to you or other parties?
If the answer to any of these questions is “No”, your loved one might not have the mental capacity for this decision. Hence, someone may need to act on their behalf for important decisions.
Example: When considering whether your loved one should go out alone to withdraw money from an ATM, ask these questions: during the process, will they be able to (1) recall why they are withdrawing the money, and (2) decide how much is a reasonable amount to withdraw?
The LPA: A legal document that allows one to look after another person's affairs when mental capacity is lost
The Lasting Power of Attorney (LPA) is a legal document that allows a person (a donor) to appoint one or more persons as donee(s) who can represent them should they lose mental capacity. The donor must be at least 21 years of age and must be assessed to have the mental capacity to voluntarily make this appointment.
Why Should You Make an LPA? (English Version)
Source: Special Needs Trust Company
This video introduces the purpose of the Lasting Power of Attorney and why it is important to make one while you have mental capacity.
How is an LPA created?
A person who is appointed by a donor to act on this donor’s behalf upon the donor’s loss of mental capacity is known as a donee. Donees must be at least 21 years of age, and someone whom the donor trusts to make decisions on his/her behalf in their best interests.
It is necessary for a certified issuer to sign the LPA as a witness and to certify that the donor is aware of the implications of making an LPA. A certificate issuer can be a psychiatrist, a practising lawyer, or an accredited medical practitioner.
There are two types of LPA Forms:
Form 1: This is a standard version that individuals use to grant general powers with basic restrictions to their donee(s).
Form 2: This is for those who have non-standard requirements and wish to grant customised powers to their donee(s). It is typically chosen by those who have larger and more complicated assets.
If you are interested in making an LPA, or feel that an LPA is important for yourself or someone you know, please visit the Office of the Public Guardian (OPG). To find out more about the process or apply for an LPA, you can use the OPG’s online system (OPGO).
For more information, you may also call 1800-226-6222, or email [email protected].
Deputyship: If an LPA Has Not Been Made When a Person Loses Mental Capacity
If an LPA has not been made and a person has lost mental capacity to make a LPA, an individual or trust company who wants to be responsible for managing the affairs of this person living with dementia has to apply for deputyship. A potential deputy has to apply to the court to seek a court order to be a deputy for the person who has lost mental capacity. The Court will then decide whether to appoint this person as a deputy of this person.
Read more about deputies.
Professional Duties
The donee of an LPA does not necessarily have to be a caregiver or related to the donor. The Professional Deputies and Donees (PDD) scheme allows for individuals who currently have mental capacity to make an LPA by appointing a professional donee. This scheme came into effect in September 2018.
Professional deputies and donees:
- are paid for their services;
- must not be related the person they are appointed to act for;
- must submit annual reports to the Office of the Public Guardian to explain the decisions and expenses they made on the person’s behalf; and
- must be an eligible professional from a professional group specified by the Mental Capacity Act (lawyers, doctors, accountants, allied health professionals, nurses, and social workers).
For more information on the Professional Deputies and Donees scheme, visit the Office of the Public Guardian. A list of registered professional deputies and donees can also be found here.
Additional Resources
Channel 8 News Video:《有法说清楚》持久授权书究竟有多重要？
My Legacy
This is a Singapore government website which contains information on end-of-life planning. Find out more about making a LPA. This page is also available in Mandarin (中文), Malay (Melayu), and Tamil (தமிழ்).
Ask the Experts – Planning Ahead: Finances & Legal
This video by AIC addresses some financial and legal concerns such as how to address frozen assets and how the LPA works.
Making your Lasting Power of Attorney (LPA) using the Office of Public Guardian Online system (OPGO)
Source: Ministry of Family and Social Development
This video details the process of making, certifying and submitting and LPA on the OPGO step-by-step.
Ask the Experts – Planning Ahead: Finances & Legal
Source: Agency for Integrated Care
In the second episode of our 6-part series “All About Dementia – Ask the Experts”, Mr Yue-En Chong answer questions related to finances and legal planning. Whether you are a caregiver, a person living with dementia (PLWD), or know a caregiver or PLWD, we hope that you can find some inspiration and helpful tips.