For people with dementia, beware of the Baker Act

In 1971, Florida State Representative Maxine Baker, a dedicated mental health advocate from Miami, proposed legislation intended to protect the basic rights and treatment of individuals who were mentally ill. Her efforts resulted in a comprehensive body of law, so called The Baker Act in her honor.

The Baker Act provides that judges, law enforcement officers, physicians, and mental health officials can initiate a process to involuntary institutionalize individuals who 1) appear to be mentally ill, or 2) are likely to cause harm to themselves, harm to others, or are self-neglectful. Once “Baker Acted,” these individuals are taken for evaluation for a minimum of 72 hours at a state-authorized psychiatric center. Alzheimer’s and dementia, which many regard as disability rather than mental illnesses, fits criteria #2 of the Baker Act.

We do not have space here to describe the entire medical and legal processes provided under the Baker Act, but suffice to say that some of its provisions (transport, introduction to an alien environment, forced separation from family, possible placement in a population of people who are seriously mentally ill) can be extremely traumatic for an individual with Alzheimer’s or dementia. The internet is replete with testimony from caregivers about how their loved ones with dementia were harassed, traumatized, and left worse-off by the process.

Due to significant demographic changes over the last 40 years, one can argue that the Baker Act in now being forced to address a problem – dementia — for which it was not primarily intended. The numbers tell the story. In 1995, The St. Petersburg Times reported that in Pinellas County two-thirds of those involuntarily committed under the Baker Act were over the age of 65.

We cannot assume they all had dementia, but undoubtedly many did, and we can be assured that this demographic segment will only grow – numerically and proportionately – in the future. We do know that today, 20 percent of those involuntarily committed under the Baker Act in Citrus County have Alzheimer’s or dementia.

While we have concerns about the Baker Act even when properly applied to individuals with dementia, there is further evidence that in the elder care industry it has been willfully abused. The Florida Supreme Court Commission on Fairness reported in 1997, “Some facilities purposefully use the Baker Act to ‘dump’ residents who are disruptive or require mental health treatment.” I can tell you from my experience; it is not an uncommon practice.

Thanks to modern dementia care philosophy and methodology (e.g. Teepa Snow’s Positive Approach to Care), we now know that much disruptive behavior among dementia sufferers is actually provoked, but insufficiently trained caregivers simply don’t understand what they are doing to trigger such behavior. Most of these moments when a person with dementia is disruptive or even violent can be de-escalated, precluding any need for a reaction as desperate or traumatic as Baker Acting.

We are not condemning the Baker Act, but suggesting that there is dire need for improvement when it is applied to individuals with Alzheimer’s and dementia. This is the same conclusion drawn by the Florida Supreme Court Commission on Fairness.

Many of these concerns don’t require a change in the law, but can be addressed by providing more training based on recently developed understandings of the disease. This training, based on a compassionate and positive approach to care, should be made available or even required for law enforcement officers who are often the front-line decision makers for when Baker Acting is appropriate. They need not be given full caregiver training, but they certainly should benefit from a deeper understanding of the triggers that can cause combative behavior, and how to use that knowledge to de-escalate rather than resort to the Baker Act.

For the care personnel at the psychiatric centers there should be full dementia caregiver training to avoid further trauma, physical harm, and human suffering among individuals with Alzheimer’s or dementia. And such individuals should never be placed in a general population of drug addicts, psychotics, and suicidal patients. Today they are. Just imagine a frightened and confused elder with dementia being thrown into such an environment. For them, it is bedlam, and how can that help, either with assessment or treatment?

The business case for higher training requirements and dementia-segregated communities is obvious. It does not take a lot of imagination to see how fewer transports, less time in Centers, reduced trauma, and avoidance of much of the extensive legal process required by the Baker Act will save a lot of money for the State and its tax payers.
The mental health industry has aggressively fought proposals for modest changes in the Baker Act based on their belief it will be too expensive. I think they are being short-sighted in defending a status quo that will become more and more unacceptable as the percentage of our population with dementia grows.

We need changes in the Baker Act that will 1) better address the specific needs of individuals with Alzheimer’s and dementia, 2) thereby reduce the frequency the law is applied within our elderly population, and 3) provide more specific and appropriate treatment once an individual with dementia is Baker Acted.

In the mean time, what can I say to caregivers in Florida and other states with laws similar to the Baker Act? Beware! Take the time to learn about the whole process and the physical and psychological damage it can cause your loved one with dementia.

For example, the law requires that your loved one will be placed under observation for a minimum of 72 hours, during which you may not see or visit them. But, often the “72 hours” will coincide with a weekend, and you may not be able to see or communicate with them for four or five days. Think about how they will feel and react to this period of isolation in an alien environment.

Do not take the Baker Act lightly or as a convenient “tool” for dealing with disruptive behavior. My advice is to use it only as a last resort under circumstances where you or your loved one are under imminent threat of physical harm. And when you use it, do not expect your loved one to return home “better.”

Until next time remember: “We all deserve the best”

Send your comments and stories to deb@coping.today

© Debbie Selsavage, 2016


Comments

For people with dementia, beware of the Baker Act — 11 Comments

  1. Debbie, thanks for the info. My Alzheimer’s husband was Baker acted from a nursing home on Sat 9/17/16. As his wife of 50 years I called, was asked where he was, (how do I know), then told without a security code as far they were concerned, he wasn’t there! Can you tell where do I get this security code? Since it was a Saturday and evaluation won’t start until Monday AM, then I can’t see him until Wednesday?? Help. Pat Henderson

  2. My Mother was Baker Acted (she’s 85 by the way) after we put her in Brookdale Asststed Living in Tavares FL, after only 1/12 days in the facility. She was not assessed before she move in because the administrator was “on vacation” or “not available” at the time so it just didn’t get done. But they sure took her money along with her mind. I cannot find the type or any type of an Attorney that will help me. The police officer (I have her name, she agreed to help, like anyone will) she thought it was unnecessary and the facility just did not want to “deal” with her. My sister and I do not have the money or means to hire anyone, it took not only all her money but left her severely clinically depressed, scared to sleep at night and her mental status continuesto decline rapidly.

    This facility, along with the one she is in now needs to be held accountable for her rapid decline. If anyone has the know how to sue these people for what they did to her I would greatly appreciate it. She was a great Mom and does deserve the benefit of being her cared for properly. I’m sure we are not the only ones to have had this happen to them. I see them (the elderly) being abused by minimum wage employees abusing them both verbally & being manhandled by them or drugged by the Caretakers, P.A.’s, nurses, med techs & administrators who think we don’t know or hear how they treat them.

    They outlawed the hospitals that treated the mentally handicapped years ago, now their attention is focused on the older people who are just dropped there to be forgotten and suffer and walk around and around in a square with no way out to even breath fresh air. Many sit in a chair sleeping they wake them 4 times. Breakfast, lunch, dinner & to get ready for bed. If they do get up to walk they run after them yelling at them to get their walkers because they are so over medicated that they could fall over with one puff of air from the air conditioner that is set at a constant 67 degrees! Where are the regulations for these places? Nice on the outside but most of the residents live in fear. My Mother being one! HELP

    MY PLEAS FOR HELP FOR HER WILL GO ON DEAF EARS!

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  4. I had no other choice but to put my mom in a long term nursing home.she had 2 tia’s and some very short term memory loss and was in and out of the hospital with a fall and while there found out she had a uti she eventually received a carotid stent. And antibiotics for uti..i was her live in aid for meny years while i kept a job untill i had to take time off work to care for her after all this happened. I had to go back to work because i had depleted all my savings. Everything im reading from the post in here are totally true in outmr case as well..staff was exstreemly short handed and it was fround upon that i was up there to visit her every day after work. They basically didnt like it.and told me i needed a life and i needed to desensitize and almost disconnect..the first day we got there i walked around the place having to put it all together myself.very unprofessional. Not all the nurses cold but alot were.first off after my mother finished her antibiotics i asked the administrator if they did a follow up on her uti and she said they dont do follow ups.thst if she tested all her residents more than half would have a uti..i couldn’t believe what I was hearing. I would have pulled my mom out of there that day but it was one of those situations to where we had to stay there because we had applied for Medicaid and you have the waiting process and if you leave you have to start the whole process over again somewhere else so she was basically being held hostage by the system people say well you should have prepared for this but I don’t care if we had several hundred thousand dollars did nursing homes charge $7,000 a month for private pay so it would have dwindled those funds down anyways there is no preparing for it unless your a billionaire. The people that were in there that were in a private room or receiving the same pore care did the other people were receiving. My mom fell 3 times in this place and she was there a few months prior in the rehab section wich is outsourced. She had developed a chest cold and i had them put her on mucinex. Well when we came back to this facility months later for long term care they just admitted her and rolled over her meds from last time including the mucinex.once i found out she was on it i asked them to discontinue and i asked them 3 different times to stop..after 3 weeks i found out she was still being given the mucinex and i demanded them to stop.well they finally did and 48 hours later i was called to come to the facility at midnight with them telling me she was having a panic attack well when i got there my mom couldn’t breathe and i could hear she had developed fluid over load and was dieing.one nurse said.oh she was doing this the other day.i told them to call 911 now.they took her to hospital and put her diuretics to purge all the fluid. And i was told she had a mini hart attack..i do think the mucinex had kept her so dry that this was all a result from 3 weeks of being on it. Thry also knew my mom was a smoker and needed a patch and never got one. So she became exstreemly aggravated and disruptive and did i mention she has dry macular as well so she get very liw eye sight.but the staff did not have the patience to give my mother a little extra help with eating and they hardly ever gave her a bath and she was starving half the timr. They would spill food all over her at feeding time..at first i wasnt aloud to help her at all and when i was visiting and she had to use the bathroom id have to ask someone for help and if there wasn’t any id have to sit there and watch my poor mother peen in her chair.i was also told we were to keep 130$ out of her ssi checks for her personal needs. Well the financial ladygave me a bill that was for the full amount of ehat her monthly income was and when i asked about it she said you have to pay us the hole amount untill they found out after insurance kicked in or changed and if it was the same amount that they would pay us back the difference..i told her its been tge same amount direct deposit ssi income for the last 3 months she said ill talk to you about it in a few weeks then she went on vacation. I kept the 130$ in her account and shure enough i was right..im glad i did because they would have took forever to pay us those funds back.at some point a so called aid made a accusation that she heard me verbally abusing my mother which was a lie because i was one of the only family members of all the residents that was always visiting after work and was told by meny staff that i was such a good son. They called the cops on me and had me trespassd.this was all to get me out of the picture..so then my mother is with out me and started being disruptive and they tried to give her a injection and it didnt help so they baker acted her. And now shes in a behavioural facility.we did get accepted and got the Medicaid and at that point we needed to get her out of there asap and my mom did it herself not even knowing it.now shes in a hospital that can give her the proper psychiatric medication which is working I had to tell them to give her the nicotine patch and when they did they said they noticed an immediate different in her mood..my mother has diagnosed PTSD and needed anxiety medication that they kept trying to cut her off from.the administrator said the government was making them cut back on all meds like that..well my mom needs it. It helps her blood pressure and without it it shot up to 200. So now my mom is at the behavioral hospital wating and going through test and waiting for new placement.and i can only see her for one hour day..i dont have any brothers or sisters and me and Mom are all each other has so this whole situation has been devastating in a nightmare to say the least..the head staff members can have all the m meetings they want and break out all the bells and whistles but they’re not around at 3 in the morning..the work ethic and compaction is terrible fron staff..they should go work at target for the same money and get far away from the health care business..i told one nurse my mom had to pee and he said she peed earlier..and just sat there on his phone. I was very courteous polit and always said than you and alot of the residents loved me snd so did some staff..it was the supervisor and director of nursing and the administrator that took a personal dislike to me..but once agsin thers to much for me to list here but the things i see you guys posting is absolutely correct

    • Hello Jay, I am sorry that you have had to experience what you have. Somethings have not changed much in the caring for people living with dementia in a very long time. I wish it would be different but health care industry is not very knowledgeable about this disease, they do not provide proper training for the care team and do not see that changing anytime soon. I hate to have caregivers use the excuse that the team is under paid and overworked, this community has promised you that they can care for your loved one, hold them accountable to do that. Unfortunately they do not like that and you/caregiver gets looked at as a pest. The medications are another issue all their own and needs to be really thought about before we start them on those medication, this should not be taken lightly. I thank you for your comment, if there is anything that I can do for you please do not hesitate to contact me at my email deb@coping.today. If you are local and would like to attend one of our workshops please let me know, if you would like to have a local church or organization host a workshop we can make that happen also. Good luck. Thank you again.

  5. I work at a Baker Act receiving facility and we just received a 75-year-old client under a Baker Act from a HOSPICE FACILITY. The police should be ashamed to have written this one…the gentleman is already dying of lung cancer, takes around-the-clock morphine, and is in early stages of dementia. He is adjusting to his impending mortality to the best of his ability. If he needs to express his frustration or even his readiness to accept his mortality, he should be able to do so without being plucked from his living space and denied the medication he is scheduled to receive. We did our best to get him home quickly, but this was absolutely ludicrous.

    • Nurse,
      You are exactly correct this should never of happened. There are so many in the health industry that do not or do not want to understand a person living with dementia. This is absolutely the wrong place for anyone with dementia, it changes them forever and they will never be the same after their time in a baker act facility. I hope some day in the near future in our area we can hope for another alternative to baker acting a person with dementia. Thank you for you input and I will keep doing what I can to educate the caregivers to understand behaviors and to make changes so that they do not have to call 911.

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