In 1971, Maxine Baker was a state representative from Miami. She had a heart for mental health issues and this concern led her to sponsor a bill in the Legislature. The bill soon became a Florida statute, aptly named, “The Baker Act.” (Baker Acting has become a slang word used across the U.S.) The purpose of this law is to allow for involuntary examination ordered by law enforcement officials, judges, physicians, of at–risk-individuals suspected of having possible mental illness (as defined in “The Baker Act”). There must be a strong concern that these individuals may harm themselves or others.
Having spoken to hundreds of families in crisis, I have a deep concern regarding when it is or is not an appropriate time to “Baker Act” family members struggling with dementia. After all, it is a 72 hour mandatory commitment for a psychiatric evaluation. This may result in strong resentment and anger that can last a lifetime.
Unfortunately, I have seen Baker Acting used as practically a babysitting tool. This is abuse of both the individual and the system.
When I started working on the Alzheimer’s/Dementia Hospital Wristband Program, I sat down and directly addressed this problem with hospital administrations. Often, I would just get a quizzical look and nothing further would be done about it. But, after concluding the first six month pilot program at Bayfront Health Brooksville Hospital, we called a meeting and the first thing the chief of nursing said was, “My goodness! We have had dementia patients coming out of care facilities, being Baker Acted, when the only real problem was that they were suffering from a urinary tract infection. They simply needed to be on the correct antibiotics.”
During the required 72 hour period, which according to Department of Children and Families actually averages 4.5 days, the person ordered is not allowed any family contact and is many times physically and/or medically restrained. Now, imagine yourself going through that and suffering from dementia at the same time.
Considering the many questions about doing such a radical thing, as caregivers, we should only use Baker Acting as a last resort when it comes to dementia.
Unfortunately, the general public and even many first responders do not usually understand the difference between “cognitive impairment” and a mental illness. Again, Baker Acting can only be initiated by law enforcement officers, physicians or circuit courts. There has been a 50 percent increase in these orders in the past 10 years in Florida. The state has a budget as of 2013 of $77.5 million for these specific beds.
I have been doing quite a bit of first responder training on dementia care and I have run into the same conversation during every class I teach. For example, I just taught a couple of classes to the Hillsborough County Sheriff’s Department, they stated that when they get a call out to a home where there’s a situation with dementia involved, they really don’t have a choice, the dementia person ends up getting Baker Acted. Many times the caregiver has hardly slept and their exhaustion is actually the instigator of the situation. I truly feel for the officers. They explained that if they leave both parties at the scene and another call comes in from the same residence, they could be looking at their own suspension or even worse.
Let’s look for another option. I believe that instead of Baker Acting there should be a 48 hour respite available in, let’s say, a skilled dementia care facility. This would serve to defuse the situation, instead of it escalating.
There are after effects that nobody sees except the family. I can’t tell you how many times the courts step in to tell the family, “Obviously you can’t handle your loved one.” The next thing you know a legal guardian is appointed and the family’s rights are removed. It doesn’t matter if you have power of attorney or not. Your loved one could be placed in a facility 100 miles away and there is nothing you can do about it.
We have to find other options. I will soon be putting a team together to start talking to our state officials about this. We must initiate the conversation now.
For a decade, Gary Joseph LeBlanc was the primary caregiver of his father, after his father was diagnosed with Alzheimer’s disease. He can be reached at firstname.lastname@example.org. His newly released book “Managing Alzheimer’s and Dementia Behaviors,” and his other books “While I Still Can” and an expanded edition of “Staying Afloat in a Sea of Forgetfulness,” can be found at www.commonsensecaregiving.com.