I took my parents for advance care planning in Singapore, here’s why

My parents are aged 67 and 64 respectively. From their point of view, they think that they are old. From what national statistics suggest, there’s still 2 decades of lifespan left in each of them. How much of their remaining lifespan will be in the form of healthspan is anyone’s guess given how unpredictable life is. Since this segment is uncertain, I broached the topic of Advance Care Planning (‘ACP’) to them so that our family can make care decisions ahead of time.

Mum was receptive as she feels that I always have her best interests at heart while Dad reacted the exact opposite. The ACP process is fuss-free and straightforward but as one can imagine, getting seniors to take that first step is the hardest battle being fought here. In the end, both managed to complete their advance care plans with a certified ACP facilitator. Here are the benefits of ACP and a step-by-step guide on how to complete a ACP too.

What Is Advance Care Planning?

According to Agency of Integrated Care (‘AIC’), Advance Care Planning is a national programme that aims to empower Singaporeans to choose how they would like to be cared for. An ACP communicates to your loved ones and healthcare team about your values and how these values shape your healthcare preferences. This becomes especially critical if one becomes incapable of making decisions or speaking for oneself.

ACP is not to be confused with Advance Medical Directive (‘AMD’) or Lasting Power of Attorney (‘LPA’). LPA is the legal appointment of another person (Donee) to make decisions and act on his/her behalf if the donor loses mental capacity. In an LPA, the Donee is given legal right to make decisions on personal welfare on behalf of the donor. Unless the donor’s care preferences have been clearly communicated prior to the loss of mental capacity, the donor would be second guessing at best. For instance, where would the donor like to live (own home, assisted living facility, nursing home, hospice), how to be cared for (by domestic helper, nurses, children), what type of medical treatment to receive (life-sustaining or comfort care) etc when he or she is mentally incapacitated.

Frequently asked questions on ACP is complied on AIC’s website as shown in Diagram 1. Head over there if you have any questions.

Since my parents have already completed and registered their LPA at Office of the Public Guardian Online in 2023, I encouraged them to complete their ACP so that their values and preferences on their future care needs are made known to all their children. I see the LPA and ACP as complementary.

Benefits of Advance Care Planning

1) Share your values and care preferences with a Nominated Healthcare Spokesperson 

The most important benefit of an ACP is that the person is able to share his/her values and care preferences with a Nominated Healthcare Spokesperson. The spokesperson will represent the person when he or she no longer have the capacity to decide or communicate his/her wishes. Imagine this spokesperson speaking to a doctor, a medical social worker etc. In my mum’s case, my brother and I are her nominated healthcare spokespersons.

Various scenarios are covered to determine the person’s attitudes and values on their care preferences. Below are some examples that I noted down during my own experiences accompanying my parents:

• How they would like to be cared for when they are very ill
• What’s their perspectives on palliative care?
• What type of funeral arrangement would they prefer?

These values and preferences are noted down and eventually submitted as shown in Diagram 2.

2) Mitigate emotional stress of your loved ones

As I have demonstrated, the permutations are many given the multitude of choices under each scenario. Asking the donee to second-guess is already a stressful event on its own. Unfortunately, this stress is magnified many times over when a loved one suddenly lapses into a serious medical condition. If an ACP have been done, the nominated healthcare spokesperson can confidently make decisions that he or she knows are decisions that the loved one would have made herself. Seen from another angle, this is tantamount to fulfilling your loved ones’ wishes for them.

Growing up in an Asian society rooted in Confucian teachings, filial piety and “face” are traits of high importance. The final aspect of the care journey is the sending off of your loved ones in a funeral. Therefore, getting this aspect right is very important to some families since funeral is a highly visible event. An ACP covers this taboo topic and is capable of fleshing out the inner wishes from the person. For instance, I never knew that my mother prefers a longer funeral (so that her family from Malaysia can make the way down to visit) and for her ashes to be scattered into the sea.

3) ACP is reversible and not cast in stone

Finally, because an Advance Care Planning is reversible, there is never an excuse of it still being done “too early”. Care preferences may change along the way as we age and experience various milestones. Therefore, do an ACP early and revise it along the way if your care preferences have evolved.

In addition, as ACP touches on emotionally heavy topics, it is not necessary to finish it in one seating. Take the time or go out for a breather for better clarity of thought.

Step by Step Guide on the Advance Care Planning Process

a) Make an appointment with an ACP facilitator 

An ACP can only be done with an ACP facilitator who is a professional employed by healthcare/social care organisations. You may look for an ACP facilitator from this directory.

For my parents, 2 factors were very important in their choice of ACP facilitator- location and Chinese-speaking. In the end, Fei Yue ticked the boxes as it was near my parents’ home and the assigned counsellor can speak Mandarin.

b) Mentally prepare your parents (Optional)

You may want to look up AIC’s website for its list of resources or provide them with hard copy brochures to mentally prepare your parents. At this juncture, your parent can also think about their preferred spokespersons.

This step is entirely optional but it may be helpful in expediting the actual process.

c) Attend the session

I requested for an in-person session as I felt that my parents might not adapt well to online sessions. I brought them to the active ageing centre and sat with them thoughout the sessions. The session with my mum was around 1.5 hours long as she enjoyed chatting with the facilitator. The session for my dad was half as short as I could tell that he couldn’t wait to finish and leave the room. LOL

d) Nominated Health Spokespersons’ signatures

Once the notes are transcribed, the spokespersons have to sign the document. Since my brother is one of the spokespersons who did not attend the session, my mum brought the document home for him to sign.

Once the signed document is returned to the facilitator, he/she will complete the last step of filing it onto the government portal.

ACP Fees

Some centres may charge a nominal fee for ACP. Depending on whether the person is a member of the Pioneer or Merdeka generation or the colour of the CHAS card their household carry, fees may be further subsidised by the centre. My parents missed out on these benefits as they only received their Singapore citizenship after these schemes were introduced. Even then, I only paid $40 per person which I find to be very reasonable.

Conclusion

As I sat through both my parents’ individual ACP sessions, I came away with insights that go far beyond their care preferences. I was surprised to learn that they share a common principle that guided their decision-making process. At the root of it all was their preference not to trouble their children as much as possible since they each have their own families to manage. I was very touched and even shed a tear when I heard this repeated on multiple occasions to the facilitator.

I recognise that one’s future care needs and preferences are not the easiest thing to talk about with your loved ones. Having completed the ACP process with my parents, I felt that it was all worth it in the end. To the older readers of this blog, I encourage you not to be afraid to talk about your own care preferences and wishes.

This article is published on 17 April 2024.

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