Don’t Wait Until Dementia: Why Singaporeans Should Think About ACP and LPA Earlier

When we talk about Lasting Power of Attorney (LPA) or Advance Care Planning (ACP), it is easy to think of them as things we need to deal with when we are older.

Perhaps when our parents begin to show signs of cognitive decline. Or when someone receives a serious diagnosis. Or simply at some vague point in the future when conversations about incapacity, end-of-life care and death feel more relevant.

I used to think of an LPA largely in those terms too. But I am currently in the process of making my own, at 42.

I have already decided that I want one. The only reason I have not completed the certification yet is rather mundane: I know that I can get my LPA certification done for free through an arrangement with my insurance company, and I am waiting about a month for an appointment. If that option were not available, I would simply pay for it.

It is hardly an exciting piece of life admin. But perhaps that is exactly how we need to start thinking about planning for incapacity — not as something ominous that we do because we expect the worst, but as ordinary preparation for something we hope never happens.

That is particularly relevant as we mark World Alzheimer’s Day on 21 September. Dementia is one reason someone may eventually lose the ability to make decisions independently, but it is far from the only one.

Singapore’s Ministry of Health estimates that around 74,000 people here were living with dementia in 2023, a figure projected to rise to 152,000 by 2030. Singapore’s ageing population makes these conversations increasingly pressing, but loss of mental capacity can also happen much earlier because of an accident or serious illness.

ACP and LPA are not the same thing

The terms are sometimes mentioned together, but they serve different purposes.

“LPA is a legal document that lets you appoint one or two individuals (Donee) to make decisions for you by law in Singapore under the Mental Capacity Act,” explains Mr Sammy Leong, Case Manager and Certified Advance Care Planning Facilitator at SATA CommHealth.

Those decisions can concern your personal welfare as well as your property and financial affairs, and the LPA comes into effect when you lose the mental capacity to make those decisions yourself.

An Advance Care Plan, on the other hand, is not a legal document. It records your values and preferences concerning your future healthcare and personal care, helping your loved ones and healthcare team understand what you would want if you became unable to communicate those wishes yourself.

One way of thinking about the difference is this: an LPA determines who can legally make certain decisions for you, while an ACP helps communicate what you would want when it comes to your care.

Neither is a substitute for a will. A will deals with what happens to your assets after you die; an LPA concerns decisions made while you are alive but have lost mental capacity.

“But I’m still young”

That is apparently one of the responses Sammy hears frequently.

Others include: “I don’t have property”, “I have done a will”, “my family can manage for me” and simply, “not that important now, can wait till later”. When it comes to ACP, he encounters similar assumptions: “I’m still healthy” and “my children know what to do”.

The problem is that planning for loss of mental capacity only works while you still have the capacity to make those decisions.

Sammy stresses that ACP and LPA should not be seen solely as matters for elderly people. Unexpected accidents and serious illnesses can affect younger adults too.

What happens if you lose mental capacity without an LPA?

This is where the assumption that “my family can handle everything” can become problematic.

Being your spouse, child or parent does not automatically give someone the legal authority that an LPA donee has.

“If someone loses mental capacity without an LPA, then someone needs to apply to the Court to be a Court Appointed Deputy,” Sammy explains, adding that the process can involve “thousands of dollars in legal fees” depending on what is required.

More importantly, the family is dealing with that legal process after something has already happened.

An LPA allows you to make the choice beforehand: who do you trust to make decisions for you if you cannot?

Your family may not know what you want as well as you think

ACP deals with a different problem.

Suppose you became seriously ill and could no longer communicate. Would you prioritise independence for as long as possible, or would you be comfortable relying heavily on someone else for your daily care?

If you were approaching the end of your life, would privacy and being left alone matter greatly to you, or would you want loved ones constantly around you?

These are among the scenarios Sammy uses to encourage people to think about their preferences. His point is simple: what you think you would want may be quite different from what your loved ones assume you would want.

Without an ACP, families may find themselves making decisions about matters such as life-sustaining treatment, tube feeding and where someone should receive care without knowing what that person would have preferred. Sammy says this uncertainty can contribute to guilt and disputes between family members.

Choosing a donee is about more than choosing the person you love most

Making an LPA also raises a deceptively difficult question: who should you appoint?

The obvious answer might be your spouse, eldest child or closest family member. But closeness alone does not necessarily make someone the best person to handle your affairs.

Sammy suggests asking four practical questions:

• How well does this person manage their own affairs, particularly their finances?
• How well do they understand your wishes concerning healthcare and financial matters?
• Can they handle the responsibility of making potentially difficult decisions for you?
• Do you trust them to make decisions in your best interests?

How do you even start this conversation?

Forms may actually be the easier part.

Sammy suggests approaching it indirectly. A news story, television programme or the experience of someone you know can provide a natural opening. From there, you might ask: “What would you want if that person were you?”

The conversation does not necessarily need to begin with death. You could ask your parents where they would prefer to be cared for if they became seriously ill, talk to your spouse about who should manage the household finances if one of you became incapacitated, or discuss what quality of life means to each of you.

Making an LPA may cost less than you think

Cost can also be a reason to delay — and this is where my own experience comes in.

As of 2026, Singapore citizens using LPA Form 1 do not pay an application fee to the Office of the Public Guardian. There is, however, normally a professional fee for the Certificate Issuer who witnesses and certifies the LPA. The Government does not prescribe a fixed certification fee; what you pay varies according to the Certificate Issuer and complexity of the case.

That is the fee I am currently waiting to avoid through the free certification option available to me.

Whether waiting makes sense will depend on your circumstances. Saving some money is attractive; indefinitely delaying something important because you are waiting for the cheapest possible option is another matter entirely.

These decisions aren’t set in stone

Another potential hesitation is the fear that you are making decisions now that your future self might regret. Fortunately, planning ahead does not mean you can never change your mind.

Sammy recommends reviewing an ACP every few years and particularly when your health changes. An ACP facilitator or healthcare team can help update it. Likewise, an LPA can be revoked while you still have mental capacity.

Your relationships can change. Your health can change. Your priorities can change. Planning ahead is not about predicting all of those things correctly. It is about making sure there is a plan that reflects what you want now, and revisiting it when necessary.

Don’t wait for dementia to make the conversation relevant

World Alzheimer’s Day understandably focuses attention on dementia. But perhaps one of the most useful things younger Singaporeans can take from it is that planning for loss of mental capacity should happen before cognitive decline makes it urgent.

An LPA gives someone you trust the legal authority to act for you if you lose mental capacity. An ACP helps the people caring for you understand what matters to you.

Neither requires you to believe something bad is about to happen.

Sammy puts it rather neatly: “Prepare your umbrella before it rains.”

I am still waiting for my own LPA certification appointment. Hopefully, I will never need anyone to use the document once it is registered.

But that is rather the point.

Mr Sammy Leong is a Case Manager and Certified Advance Care Planning Facilitator at SATA CommHealth.

Images: Envato