If you are caring for an elderly parent or family member, there may come a time when important decisions need to be made involving their finances, property, medical care, living arrangements, or other legal matters. You feel the need to step in because your loved one seems to have difficulty making sound decisions on their own. You wonder, “Can I make decisions on their behalf? When is this allowed? What steps do I need to take?”
This is where a Mental Capacity Assessment, or MCA, becomes relevant. This article explains when an MCA is needed, who can perform it, how to avoid unnecessary time and cost, and the common misunderstandings families often have about the process. We also include practical examples based on our doctors’ experience to help you understand what MCA looks like in real situations. Read on to approach MCA with clarity and confidence.
Table of Contents
1. What Is a Mental Capacity Assessment (MCA)
Under Singapore’s Mental Capacity Act, mental capacity refers to “the ability of a person to make a specific decision at a particular time.”
A Mental Capacity Assessment (MCA) aims to assess such ability. It is a structured medical assessment that answers the question: “Can this person make this specific decision at this particular moment?”
The Act sets out four abilities that must be present to establish if someone has mental capacity:
- Understanding: Can the person understand the information relevant to the decision?
- Retention: Can they remember it long enough to make the decision?
- Weighing: Can they use the information they understand, such as pros and cons, consequences and alternative options, to make the decision?
- Communication: Can they communicate their decision in some way? Speech, writing, gestures, or assistive devices all count.
If a person can do all four, they are considered to have mental capacity for that decision. If they are unable to do any one of these, they may be assessed as lacking capacity for that specific decision.
2. Common Misunderstandings about Mental Capacity
Misunderstanding 1: Repeated bad decisions mean lack of mental capacity
Families often assume that if a loved one keeps making unsafe or unwise choices, they must have lost capacity. In the context of MCA, mental capacity is about the ability to make decisions, not about whether the decision is a “good” or wise one. An individual can make decisions their family strongly disagrees with and still have full capacity, if they understand the situation, consider the options, remember the relevant information, and explain their reasoning.
Dr Alethea Chew, Lead Physician at Ninkatec, shares that families often request an assessment because they are worried about repeated unwise decisions. They may say, “My dad keeps giving money to a friend who never returns it,” or “My mum insists on taking the bus even after falling twice.”
“These concerns are very real, and they can certainly be signs that assessment and support are needed,” explains Dr Chew. “But they don’t automatically mean the person lacks capacity. Sometimes a more helpful first step is to guide the individual toward safer choices, such as speaking with them when they are calmer or more receptive, or involving someone they trust to help explain the risks.”
Misunderstanding 2: Mental capacity applies to all decisions
It is common to assume that a person either has mental capacity or does not, and this applies to all decisions. But capacity can vary depending on the specific decisions the person is making. A person may struggle with a complex financial transaction yet still be able to manage their daily spending effectively. Or they may have difficulty deciding their long-term care plan but can still manage their meals and daily routines, or who they want to be involved in their care.
This is why every MCA starts with identifying the decision being made. The assessor does not seek to judge a person’s overall functioning. They are looking at whether they can understand and decide on a particular issue, at this point in time.
Recognising this helps families support independence where it is still possible. “The goal of an MCA is not to prevent people from making decisions others might disagree with,” advises Dr Chew. “It is to protect their autonomy while also allowing families to step in when the person genuinely struggles to understand or manage an important decision.”
Misunderstanding 3: Mental capacity is fixed
Another common misconception is that mental capacity is permanent and constant. In fact, mental capacity is not always permanent. It can be temporary. A person’s capacity may get better as the underlying condition is treated. It can also get worse as chronic progressive conditions such as Alzheimer’s or other forms of dementia progress.
Oftentimes, mental capacity is also fluctuating. For the same person on the same day, fatigue, medication timing, pain, mood, or even the environment can influence how well they process information. They may be confused in the evening but much clearer in the morning.
This has two important implications on scheduling the assessment and validity of the report.
Firstly, during an MCA, we aim to assess the person when they are at their best level of functioning. If mornings are better, we schedule it then. If medication improves attention, we time the assessment accordingly. The intention is to give the person a fair chance to show what they are truly capable of, rather than capturing them during a temporary low point.
Secondly, MCA report does not have a fixed validity period. There is no official expiry date, but because a person’s ability can change over time, you may be requested for a more recent assessment, especially for major financial or legal matters. The goal is to ensure the person’s capacity is evaluated as close as possible to the time a decision is made.
Misunderstanding 4: A dementia diagnosis can substitute an MCA
It is true that dementia is associated with changes in memory and thinking, and over time a person may gradually lose the ability to make certain decisions. However, “it does not automatically mean a person is incapable of making important decisions,” notes Dr Alethea Chew. “We regularly see patients with early or moderate dementia who can still understand their finances and express their preferences and choices clearly.”
For this reason, banks, lawyers, and institutions in Singapore do not accept a dementia report as a substitute for an MCA. The two documents serve different purposes. A dementia diagnosis guides medical treatment and long-term management. An MCA answers the practical question of whether the person can understand, retain, weigh, and communicate a specific decision at that moment in time.
3. When You Need an MCA, and When You Don’t
As a rule of thumb, MCA is necessary when someone else needs to act on behalf of the individual, especially for financial or legal matters. The third party involved in executing the financial or legal matters requires an MCA to ensure the legitimacy of the requested action.
This means you likely need an MCA when:
- A Lasting Power of Attorney (LPA) needs to be activated, and the Donee needs to make decisions specified in the LPA.
- A bank, insurer, or financial institution sees signs that the elderly person/individual has unusual behaviour indicating they may lack mental capacity.
- A decision involves property, large sums of money, contracts, or legal documents, and there is reasonable concern that the person cannot appreciate the consequences of their decision.
- You are considering a court deputyship application
When MCA is usually not required
- The person can still explain their decisions clearly to the staff at the bank, insurance company they are transacting with
- The matter is small or routine
- No institution is asking for formal proof
For seniors and families who wish to have an LPA done, please note that process already involves a step where a certificate issuer verifies the LPA. As such, a separate MCA is not required. Here’s how you can get it done conveniently online in 4 steps.
Now, let’s look at a few real-life examples to illustrate further when you need or do not need an MCA.
Example 1: A senior has dementia. Does the family need an MCA to withdraw money from their bank account?
Banks generally do not ask for MCA if:
- The senior comes in personally as the account holder
- They can communicate and answer questions about the transaction
- The amount is small or routine
Banks usually request for a memo to state the patient’s mental capacity if:
- A family member accompanies the senior and speaks over them during the transaction
- The transaction involves an unusually large amount
- The senior appears confused, distressed or unsure about what they are doing
- Someone presents an LPA and asks to act as Donee
It is important to note that an LPA does not automatically allow the Donee to act. The Donee may only handle banking matters when a doctor has formally assessed and documented that the Donor lacks mental capacity for financial decisions at that time. Without this medical assessment, the LPA has not taken effect.
As family members, you can rest assured that front-line staff at banks in Singapore are trained to follow guidelines and watch for red flags such as confusion, unusual banking activity, repeated failed transactions or difficulty recalling PINs. These safeguards aim to protect the seniors from financial loss and exploitation.
Example 2: A senior insists on living alone after a fall. Does the family need an MCA to decide on care arrangements?
MCA is not required if the senior can:
- Describe the fall and explain the current situation
- Understand the risks of living alone and the alternatives
- Discuss the pros and cons of different care options
- Communicate their preference in a stable, consistent manner
Even if the family disagrees, the decision still belongs to the senior if they can understand and reason through the situation.
However, MCA is required when the senior:
- Denies the fall or other incidents despite clear evidence
- Becomes confused or overwhelmed when care options are explained
- Gives conflicting or inconsistent answers
- Faces escalating safety concerns related to mobility, balance or home hazards
If the family has already tried explaining the risks and supporting the senior to make a safer choice, and still believes they need to take over this decision for the senior’s welfare, an MCA is the required next step.
If MCA shows lack of capacity and an LPA is in place, the Donee can now legally make care and welfare decisions on the senior’s behalf, such as arranging home care, hiring a live-in helper, or moving the senior to safer living arrangements. If there is no LPA, the family may need to apply for deputyship to obtain the legal authority to make care decisions and sign the necessary documents. Deputyship can be applied online or via a law firm.
Example 3: A 85-year old senior wants to make significant changes to their will. Do they need an MCA?
MCA is not required if the senior can:
- Explain in simple terms what a will is
- Describe who they want to give their assets to and why
- Show consistent wishes throughout the conversation
- Understand that a will takes effect after death
- Communicate their instructions clearly and freely
Neither advanced age nor the extent of the requested change in the will always requires a clear MCA. Lawyers are equipped to assess if a person has the capacity to make decisions through direct conversation. However, if they have reasons to doubt a senior is of sound mind and free will when making the decision, they will request for an MCA.
MCA is required when the senior:
- Cannot explain the purpose or effect of a will
- Gives contradictory or confused answers about beneficiaries or assets
- Cannot hold information long enough to reason through the decision
- Has fluctuating clarity
- Appears influenced or coached by others
4. What Happens During an MCA Appointment
In Singapore, an MCA must be conducted by a registered medical practitioner trained in the Mental Capacity Act, or by a recognised mental-health specialist such as a psychiatrist or geriatrician. Not every doctor performs MCA, so families usually seek someone familiar with capacity assessments and experienced in preparing reports for banks, lawyers, or care decisions.
While every doctor may have their own communication style, the core process is generally similar. From start to finish, the assessment typically takes 30 to 60 minutes.
Step 1: Caregiver briefing
The appointment often begins with input from the caregiver or family. They may be asked about recent concerns, changes in behaviour, patterns of confusion, and when the senior is usually clearest. The assessor will also ask an important question: what specific decision is being evaluated?
Step 2: Private conversation with the patient
A private, respectful conversation with the senior is essential. This allows the doctor to understand the person’s own perspective without interference or pressure. The intention is to explore reasoning and understanding, not to “test” or “trap” the individual.
Step 3: Structured assessment of understanding, reasoning, and communication
Questions are tailored to the type of decision.
- For a property-related decision, this may involve discussing ownership, the purpose of the sale, alternatives and consequences.
- For a banking decision, the discussion may cover source of funds, intended use and transaction limits.
- For care decisions, the conversation may explore risks, options and the person’s reasoning.
The assessment focuses on the four abilities defined in the Mental Capacity Act: understanding, retention, weighing and communication.
Step 4: Documenting the conclusion
A proper MCA report must be clear, factual, and well-supported. More than a medical opinion, it is also a legal document that may be used by banks, lawyers, hospitals or even the courts to understand your loved one’s decision-making ability.
When selecting a mental capacity assessor for your loved one, it helps to choose an assessor who is not only clinically competent but also experienced in preparing MCA reports. This gives families confidence that the assessment has been carried out thoughtfully and that the documentation will serve its purpose smoothly when institutions or service providers need to rely on it.
5. Choosing the Right Doctor for MCA
Every caregiver wants to keep their loved one safe. The challenge is doing so without taking away their dignity or sense of control. When the decisions involve money, property or medical care, the stakes feel even higher. Understanding what an MCA is helps families find the right balance between supporting independence and stepping in when safety or clarity becomes a concern.
A good MCA depends not only on medical skill but also on the doctor’s ability to listen patiently, speak with compassion and treat every senior with respect. Families should look for someone who is trained in capacity assessment, experienced with the Mental Capacity Act and comfortable guiding both the patient and the family through each step. Do note that the doctor must not relate to the person being assessed to maintain impartiality.
At Ninkatec, all mental capacity assessments are carried out by doctors who are formally trained in the Mental Capacity Act and who understand the sensitivities involved. Assessments can be done in our clinic, or at home when a senior has mobility limitations or feels more comfortable in familiar surroundings. Our doctors take time to ensure the process is calm, respectful and centred on the best interests of your loved one.
Whether you need an MCA, LPA, in the comfort of your home or in our clinic, or simply have questions about what is appropriate for your situation, we are here to support you. All enquiries are handled promptly and with strict confidentiality.
This article provides general information and is not a substitute for legal advice. For legal matters such as LPA, deputyship or will-making, please consult a qualified professional.
