SINGAPORE – Nursing homes are turning to professionals to act on behalf of their mentally incapacitated patients who do not have loved ones to take charge of their affairs – in a bid to get the bills paid.
Ms Esther Tan, general manager of Special Needs Trust Company (SNTC), said it has 60 trust accounts set up by professional deputies for nursing home patients in the past five years.
This means that at least 60 such patients in the past five years had professional deputies, such as lawyers and social workers who are not related to them, liquidate their assets to pay their nursing home and other bills.
The SNTC is the only non-profit organisation set up to provide trust services for persons with disabilities. It is supported by the Ministry of Social and Family Development (MSF).
Ms Tan expects the number of such cases to rise, given the growing awareness by the public and those in the social service sector about the Professional Deputies and Donees scheme.
Under the scheme launched by the MSF’s Office of Public Guardian in 2018, a person who is mentally sound can hire a professional donee to make decisions on his behalf should he lose mental capacity, for example, through dementia.
The appointment is formalised through a legal document called the Lasting Power of Attorney (LPA).
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If an LPA is not done before the person loses his mental capacity, the courts can appoint a professional deputy to make decisions on his behalf. A professional donee can also act as a professional deputy.
Kwong Wai Shiu Hospital (KWSH), a charity that runs two nursing homes among other centres, has found professional deputies for four patients, who are all single, since it started doing so in 2023.
Its medical social worker Jasmine Sng said one of these patients is a woman in her 70s who suffers from dementia and has no next of kin. She has been staying in KWSH for two or three years.
While Ms Sng cannot remember how much the woman has chalked up in bills, she has a three-room flat and money in the bank.
The professional deputy sold her flat, consolidated her assets and started a trust account for her at the SNTC. The latter manages the money and pays KWSH the patient’s bills.
Nursing home fees at the KWSH range from $550 a month to over $1,000, depending on care needs and subsidies, which is means-tested, Ms Sng said.
Ms Stephanie Wan, KWSH’s assistant director of its resident care office, said: “It’s also fair for us as we are caring for them, and we are a charity home dependent on donations.
“It’s fair to everybody, as it is also about accountability for one’s personal needs.”
The Straits Times contacted five nursing homes that are known to have approached professional deputies for the task, but only KWSH agreed to be interviewed.
SNTC’s Ms Tan said most nursing homes here have sought help in getting a professional deputy to act on behalf of their patients who do not have family or friends to act as their deputy.
The professional deputy would manage the patient’s assets, such as by selling his flat if he has one and consolidating his funds in his CPF and bank accounts, to start a trust account with the SNTC.
SNTC’s case managers will develop a care plan to estimate the amount of money needed for the patient’s long-term care needs, and disburse the funds to pay, say, the nursing home and medical bills.
Ms Tan said: “If these nursing home residents have assets that can be unlocked by having the professional deputy act on their behalf, these residents can use their own funds instead of tapping MediFund to service the nursing home fee.”
MediFund is the Government’s safety net for Singaporeans who face financial difficulties with healthcare bills, even after getting government subsidies as well as tapping their MediSave and insurance.
However, these professional deputies have to apply and be appointed by the courts to perform the role of the patient’s professional deputy.
Many nursing home patients they have acted for have at least a small Housing Board flat and some savings to fund their care needs, said the professional deputies interviewed.
Most of them are single while some have children.
Lawyer Low Seow Ling, managing director of Emre Legal LLC, said some of these seniors are estranged from their children.
She was the professional deputy for a woman in her 80s who suffers from a mental illness and stays in a nursing home.
Ms Low said: “Her family did not want to be involved as relationships are also strained.”
The woman had less than $200,000 in CPF savings and in her bank account, which Ms Low used to start a trust account with the SNTC. The latter administers her funds to pay her nursing home and other bills.
Professional deputies said sometimes the patient’s children are not interested or involved in their parent’s care, but they object to someone else acting on their parent’s behalf.
The children could be afraid that there would be no or little inheritance left for them, if the parent’s assets are sold to pay for care in a nursing home.
Lawyer Lim Shu Fen, a partner at JS Law Partners LLP, said the professional deputy has to get consent from “relevant persons” in the patient’s life, such as family members, in the application to the courts to act as the patient’s professional deputy.
In cases where there is a dispute as to who is to be the deputy due to differing views among family members, the courts will have to decide on the matter, she noted.
Ms Julia Lee, group head of Touch Professional Deputies and Donees at Touch Community Services, said professional deputies have to submit annual reports to the Office of the Public Guardian to account for all the decisions and transactions they have made for the patient.
She added: “This is so that the use of the money is transparent and accountable.”