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Social Vulnerability Predictor Of Mortality And Disability

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Question:

Discuss about the Social Vulnerability Predictor of Mortality and Disability.
 
 

Answer:

Introduction

The paper deals with Vulnerable Persons Act in Singapore. This act is the prompt action taken by the Singapore government to prevent the abuse and neglect of older population and others who are susceptible to similar experience. These people are considered “vulnerable persons”.  The Act gives the social work professionals and others to protect the suspected victim with prior permission (Leifer, 2013).  The paper provides the analysis of the Act with regards to the care of seniors or ageing population in Singapore and in terms of the safety issues. It highlights the rationale for implementing this legislation and the strategies of implementation. Based on the analysis, the paper provides insights about the areas that could adversely affect the implementation of the policy. Other countries having similar legislation are discussed to propose the required policy changes. Further, the paper presents the compare and contrast of the Singapore approach with that other countries including Japan, America, Germany, Scandinavian countries. Lastly, the report highlights the scenarios and situations where this system may not accomplish the desired outcome.

The Vulnerable Persons Act was developed for people who are eligible under Mental Capacity Act. The purpose of the Vulnerable Persons Act or Vulnerable Adults Act is to legislate for the adults who are vulnerable to neglect or self harm. The act also provides support for people who have the potential to self harm or are mentally incapable to self care, make ineffective decisions for themselves. The support for these people includes provision of appropriate medical institutions and social work. The Act also supports people who are not mentally incapable but are vulnerable to neglect and lack of care from their families (Leifer, 2013).

The ACT was considered necessary to be implemented because there is a growing number of adult population in Singapore. According to Chang et al. (2017) the “Ministry of Social and Family Development” (MSF) the estimated population of adults who are 65 or above by the year 2030 will be over 900,000 residents. As per the estimated data, a fair number of these people will have no children or remain single. Therefore, they will not be able to care for themselves.  In addition, those who develop Alzheimer or dementia will be more vulnerable to neglect and abuse. According to Pritchard-Jones, (2016) the population of single men and women in Singapore is estimated to be doubled from 34,000 in 2012 to 82,000 in 2030. The report also showed increasing number of people living with disabilities. These people are living longer according to the Ministry and may outlive their parents. Disability and frailty increases the risk of self-neglect, abuse and neglect (Mahesh et al., 2016). These include cases such as not providing food by the family member, physical violence, old mother being abandoned by her son, lack of medical intervention to wheelchair bound dementia patients. The family members of these people prevent care givers and the social workers to interfere and offer protection. It gave rise to critical gap which tends to scupper the efforts of the social service agencies. Consequently, these agencies have no option but to rely on the moral suasion to access vulnerable adult’s homes. It increases the risk of mortality and potential of severe long-term health consequences. Hence, to curb this negative effect it was necessary for the Ministry to implement this ACT (Wei et al., 2017).

 


The necessity of the ACT is to increase the statutory powers of the state to protect its vulnerable adults (Pritchard-Jones, 2016). The ACT allows the government agencies to enter the homes of abuse victims, assess a person’s well being and move them to safe place temporality. Implementation of the ACT gives the workers of the social service a mandate to reach the resident of the suspected vulnerable adult and seek relevant information. These workers are called as protectors. The ACT gives them the right to provide the vulnerable adult with immediate medical facility, and conduct more in-depth assessment of their condition. On behalf of the adults the protectors can make decisions to relocate them to shelter homes. In extreme cases court permission will be granted as vulnerable adults lack the ability to themselves apply to the court for the personal protection orders or PPO (Kohn, 2014).

People strongly supported the vulnerable adult bill (Hui, 2017). According to Sathisan, (2013) there is a strong support for the ACT. People who are contributing to the ACT perceive its necessity in supporting the population with disability and the aged population. The supports of the ACT consider it to be beneficial in complementing the role of family in caring for its vulnerable members. As per the public feedback, the upstream intervention in form of social service is of utmost importance. The contributors were found to agree to the definitions and the guiding principles of the Vulnerable Adult ACT (Ministry of Social and Family Development, 2017). 

However, there are some safety related concerns expressed by the public. Some contributors believe that the state should involve in wider range of cases in addition to neglect, self-neglect and abuse. Some supporters are cautious that the state powers should not be left unchecked (Hui, 2017). These concerns have been considered valid by the ministry. In response to these concerns, the state offers the right to the vulnerable adults with mental capacity to give their consent for relocation (Yuen & Soh, 2016).  Further, it is ensured that only the protectors and the director of social welfare under the MSF and other senior officers of the Adult Protective Service have the right to exercise the power of intervening the vulnerable adults and removing them to safe placements. In addition, several contributors also raised the concerns related to state taking the role of the family members and excluding them, from decision making. In response to this concern the state ensured that the ACT will encourage strong familial support wherever deemed appropriate as a part of protection given to the vulnerable adults. According to the ACT, if the initiatives to engage the vulnerable adults and their family members turn unsuccessful, then the state will execute the statutory powers. This exercise of powers is the outcome of the urgent and deep need to provide safety to the vulnerable adult. These concerns thus strengthened the ACT so that it cannot be misused (Leifer, 2013).

Some of the contributors believe that the act of neglecting and abusing the vulnerable adults by the family members should be declared a criminal offence (Wei et al., 2017). The drawback or potential negative outcomes of it may include withdrawal of help seeking behaviour by the vulnerable people. It may create fear of implicating the family members. Therefore, in response to the concern the MSF has enhanced penalties for offences committed by the family members against the vulnerable adults. It is ensured that the offences are relevant as under the “Penal code and Protection from Harassment Act” committed against vulnerable adults (Hui, 2017). Overall, these actions represent the country’s strong disapproval of such behaviour conducted by the family members.

There are several strategies to implement such ACT for public protection. The MSF is responsible for implementing, reviewing the policy and procedures. In Singapore, the MSF has initially released the draft or bill of the proposed ACT to collect the public feedback (Kohn, 2014).  After the public has raised concerns related to ACT such as holders of statutory power, rights of decision making of family members and others the draft or bill was modified prior to its implementation. The two major issues in the launch of the ACT include terminology and the contextual applicability. It includes defining a “vulnerable adult”. Under the ACT the MSF includes both adults with and without mental impairment who are unable to care for themselves and are experiencing neglect and any other vulnerability (Taylor et al., 2014). The second issue dealt was the effectiveness of the ACT. It includes making the boundaries of the ACT narrow enough such that it ensures identifying the adult considered to be vulnerable. On the other hand, it is ensured that the ACT reaches those who are on the margins of the targeted class of individuals (Hui, 2017). The implementation of the ACT includes the challenge of social stigma. It may arise from mischaracterisation of individuals effected from the ACT. The other challenge includes need of legislation to encompass broad range of factual matrices to make the ACT a safety net (Johns, 2014).

 


The government has established national offices to safeguard the vulnerable persons. The establishment of dedicated staff for developing comprehensive implementation follows it (Keen et al., 2016). The offices are responsible for data collection, generating annual report on abuse of vulnerable people, establish best practice to promote welfare, assess risk and implement a plan intervention, and support the accountability. They are recruited after clearly delivering instructions on their roles and responsibilities (Choon, 2010). Further, the ministry establishes inter-sectoral committee for safeguarding vulnerable persons. These committees are independently chaired and have the rights to promote the culture of protecting vulnerable adults. They may also develop new policies. In future, the inter-agencies at national level will be established to make collaborative arrangements (Lymbery, 2010).

Areas, which affect the effective implementation of the policy intent

The system of protecting the vulnerable adults in Singapore and other countries such as Japan, Germany, and America are more or less similar. There are no significant differences found except few factors. For instance, the criteria of informed consent (which is to be taken by the protectors from the victim) applied in Singapore is also applied in Germany and Europe (Wallace et al., 2015). Unlike in Singapore, the guardianship in Japan is calibrated as per 3 different degrees of cognitive impairment (Schafer & Koltai, 2014). In countries like United States and Australia, there are specialised teams established to undertake action in case of financial abuse. Similar system should be incorporated in the ACT of Singapore. In Singapore, the protection team is comprised of lawyers, doctors, social workers, and police offers. The role of this team is to deal with neglect and abuse related case. Basu, (2017) recommended that Singapore policy should be amended. It should integrate the system of dealing with the financial abuse cases. Singapore should recruit people from the insurance, banking, and housing sector. Australia offers tribunal services for solving abuse cases faster than the usual court process. Unlike in Singapore and Italy, the provision of advanced decision such as assisted death is covered by Germany (CNUE – Vulnerable Persons, 2017).

In UK the Data Protection Act prevents the representatives of the adults and the officials from accessing personal information of the client. It delays the assistive purpose. These issues are resolved in Singapore, Germany and Italy by offering the legal power of attorney to the concerned representative (The Vulnerable in Italy, 2017).  The same has been implemented in other states such as Finland, Denmark, Belgium, and Netherlands (CNUE – Vulnerable Persons, 2017). In most of the Nordic countries it was found that the local authorities are more responsible than the government for care of elderly and the disabled people. In countries like Iceland and Norway, the national government plays a special role. The government share of financing is higher in Finland when compared to Denmark and Sweden where majority of the expenditure is financed by the local authorities (Social Protection in the Nordic Countries. (2017).

 

Scenarios, situations whereby the system may not achieve the desired outcome

In every country, there are situations and scenarios that prevents the system from achieving the desired outcome, which are discussed in this sections.

It is difficult to successfully implement the ACT in areas with high level of illegal practices. There are cases of legal loopholes, which people can exploit to gain the assets of the vulnerable people. Therefore, it is recommended that every country must provide the evidence of power of attorney or capacity as a representative. It is difficult to complete and resolve the legal matters with the vulnerable client who is single. It gives rise to problem of guardianship (Basu, 2017). Sometimes it is difficult to identify the legal status of the vulnerable adult if the cognitive impairment is between mild to moderate. Further, areas with low socioeconomic status, there is a concern for affordability of services. Therefore, there is a need of legislations to monitor the professional doneeship as well as deputyship sector and develop non-profit options. The list of the professionals working as protectors must be informed to public via websites. It will give a source of information to the banks to perform verifications. Additional concerns are that the procedural rules and enforcement of measures vary from country to country. Further limitation includes difficulty to provide powers to the representative of the vulnerable adult who are in abroad (Hui, 2017).

 Other areas of concerns include malpractice. For instance, the professionals or staff members of voluntary service organisation can register themselves as professional deputies. It may lead to chaos related to charging fees. On the other hand, the vulnerable adults and family members lack security and confidence that they are dealing with the bonafide protectors. If the deputies or protectors turn to be deceptive then there is a chance of breach of confidentiality of client’s information. This kind of practices has high chance of occurrence in rural and remote areas.  It demands the need of accessibility of information by the financial institutions on the status of deputies and if they currently hold powers related to the ACT (Tai, 2017). If these situations persist, the desired outcome that is the safeguard of the vulnerable adults may not be achieved.

There were several cases in Singapore were half the cases of elder abuse was found to have adult son as perpetrator. Another fifth of the abusers were found to comprise of daughters.  Since, majority of the victims are dependent mothers or wife, it is more likely to apply for PPO. For instance, an angry wife will show high willingness to take out PPO against her husband. On the other hand it is difficult for mothers to take action against their own blood. In these, scenario  the purpose of the ACT may be defeated. Since the ACT demands the victim to apply for PPO himself or herself, it limits the illiterate and frail people of the society. They need additional time to understand the process (Basu, 2017).

 

Conclusion

In conclusion, Vulnerable Persons ACT is effective in protecting the rights of the vulnerable adults living with mental disability or those who need support to have safe life.  However, the purpose of the ACT would be defeated if the above discussed challenges remains unaddressed. Every country must try hard to equally share the financial expenditure of the vulnerable adults. There should be equal share of responsibilities by the government and the local authorities. There is no significant difference found between the Singapore and other countries in terms of the implementation of the policy related to safeguard of vulnerable adults. The matter of concern is the legal issues and possibility of malpractice against which effective measures should be taken.

 

References

Basu, R. (2017). Vulnerable adults need greater protection - even from 'loved ones'. The Straits Times. Retrieved 24 April 2017, from https://www.straitstimes.com/opinion/vulnerable-adults-need-greater-protection-even-from-loved-ones

Chang, S., Ong, H. L., Abdin, E., Vaingankar, J. A., Jeyagurunathan, A., Shafie, S., ... & Chong, S. A. (2017). Head circumference, leg length and its association with dementia among older adult population in Singapore. International Journal of Geriatric Psychiatry.

Choon, C. N. (2010). Social protection in Singapore: Targeted welfare and asset-based social security. Social Protection in East Asia-Current State and Challenges, 90.

CNUE – Vulnerable Persons. (2017). The-vulnerable.eu. Retrieved 24 April 2017, from https://www.the-vulnerable.eu/Answers.aspx?c=de&q=2

Hui, G. (2017). Considering Constructing Vulnerabilities in the Vulnerable Adults Act. The Singapore Law Review. Retrieved 24 April 2017, from https://www.singaporelawreview.com/juris-illuminaeentries/2015/5tpxkmjy4kut8ur4pponn76kyvu46x

HUI, K. (2017). 'Strong support' for Vulnerable Adults Bill. The Straits Times. Retrieved 24 April 2017, from https://www.straitstimes.com/singapore/strong-support-for-vulnerable-adults-bill

Johns, R. (2014). Using the law in social work. Learning Matters.

Keen, S., Parker, J., Brown, K., & Galpin, D. (Eds.). (2016). Newly-qualified social workers: A practice guide to the assessed and supported year in employment. Learning Matters.

Kohn, N. A. (2014). Vulnerability theory and the role of government.

Leifer, M. (2013). Singapore's foreign policy: coping with vulnerability (Vol. 10). Routledge.

Lymbery, M. (2010). A new vision for adult social care? Continuities and change in the care of older people. Critical Social Policy, 30(1), 5-26.

Mahesh, M., Abdin, E., Vaingankar, J. A., Picco, L., Jeyagurunathan, A., Shafie, S. B., ... & Subramaniam, M. (2016). Disability in Singapore's Elderly Population. Annals of the Academy of Medicine, Singapore, 45(7), 284.

Ministry of Social and Family Development | Strong Support for New Vulnerable Adults Bill in Complementing Role of Family and Community. (2017). Msf.gov.sg. Retrieved 24 April 2017, from https://www.msf.gov.sg/media-room/Pages/Strong-Support-for-New-Vulnerable-Adults-Bill-in-Complementing-Role-of-Family-and-Community.aspx

Pritchard-Jones, L. (2016). The good, the bad, and the ‘vulnerable older adult’. Journal of Social Welfare and Family Law, 38(1), 51-72.

Sathisan, V. (2013). Singapore's ratification of the UN convention on the rights of persons with disabilities. JE Asia & Int'l L., 6, 600.

Schafer, M. H., & Koltai, J. (2014). Does embeddedness protect? Personal network density and vulnerability to mistreatment among older American adults. The Journals of Gerontology Series B: Psychlogical Sciences and Social Sciences, gbu071.

Social Protection in the Nordic Countries. (2017). https://norden.diva-portal.org. Retrieved 24 April 2017, from https://norden.diva-portal.org/smash/get/diva2:882555/FULLTEXT01.pdf

TAI, J. (2017). Vulnerable Adults Act to include protection for self-neglect cases. The Straits Times. Retrieved 24 April 2017, from https://www.straitstimes.com/singapore/vulnerable-adults-act-to-include-protection-for-self-neglect-cases

Taylor, B. J., Killick, C., O’Brien, M., Begley, E., & Carter-Anand, J. (2014). Older people’s conceptualization of elder abuse and neglect. Journal of elder abuse & neglect, 26(3), 223-243.

The Vulnerable in Italy. (2017). The-vulnerable.eu. Retrieved 24 April 2017, from https://www.the-vulnerable.eu/Answers.aspx?c=it&q=2

Wallace, L. M., Theou, O., Pena, F., Rockwood, K., & Andrew, M. K. (2015). Social vulnerability as a predictor of mortality and disability: cross-country differences in the survey of health, aging, and retirement in Europe (SHARE). Aging clinical and experimental research, 27(3), 365-372.

Wei, K. C., Lee, C., Mahendran, R., & Lim, C. G. (2017). Improving mental health care for people with an intellectual disability in Singapore: bridging the health-social care divide.

Yuen, B., & Soh, E. (2016). Housing for Older People in Singapore: An Annotated Bibliography.

Yuen, B., & Soh, E. (2017). State of Elderly Housing in Singapore. In Housing for Older People in Singapore: An Annotated Bibliography (pp. 1-41). Springer International Publishing.

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