Tip Sheets

Caring for an aging prison population presents challenges for all communities

By Liz Seegert

With an increasingly aging prison population, how to care for inmates with chronic illnesses or other infirmities and those at the end of life has become an urgent challenge for federal and state governments, and for inmate and elder rights advocates.

An increasing number of prisoners need wheelchairs, walkers, canes, portable oxygen, and hearing aids. Many are incontinent or forgetful and need assistance to get dressed, go to the bathroom, or bathe, according to the Connecticut Office of Legislative Research. Authorities must balance appropriate care with ballooning health costs, determine who will provide care and pay for it. The situation is squeezing state correctional budgets, health services, safety-net programs and local communities.

Among the inmate population, 50 is considered “old.” Lack of appropriate health care and access to healthy living prior to incarceration, plus the heavy stresses of life behind bars, accelerates the aging process of prisoners so that they are actually physically older than average individuals.

The U.S. prison population experienced a dramatic 282 percent increase in the number of inmates 55 and older from 1995 to 2010, according to researchers at Penn State. Other sources estimate the growth is even larger. Data from American Civil Liberties Union found that in 2012, about 16 percent of the national prison population was age 50 and older. About 13.5 percent of federal prisoners were age 50 and older. In some locations an even higher proportions of prisoners have joined that age group: West Virginia (20 percent), New Hampshire (20 percent), Massachusetts (19 percent), Florida (18 percent), and Texas (18 percent).

The National Institute of Corrections identifies arthritis, hypertension, ulcer disease, prostate problems, and health disease as among the most common chronic diseases for older inmates. Diabetes, hepatitis C, and cancer also are common. Prisoners are also more prone to dementia than the general population because they more often have risk factors, such as hypertension, diabetes, smoking, depression, substance abuse, and head injuries from fights and other violence.

Cost of care escalating

It costs three times as much to care for elderly inmates as it does for younger, healthier ones, according to the National Institute of Corrections. The ACLU estimates that the cost of managing an elderly prisoner was approximately $70,000 annually. That works out to a per diem of $192, compared with the average healthcare cost of $10.96 per inmate per day for all facilities in fiscal 2013-14. In one example, this USA Today story looks at New Jersey’s soaring costs of care for aging inmates.

In Florida, the State Department of Corrections tallied 20,753 elderly inmates in prison on June 30, 2014, or 20.6 percent of the total inmate population. Of those, 94.6 percent were male. Three were age 92. The Florida State Correctional Medical Authority (FSCMA) reported:

“Older inmates have more health problems and generally consume more health care services than younger inmates. Older inmates may also place a greater fiscal strain on correctional systems as they may require additional housing and management needs in a prison setting, secondary to their generalized vulnerability and medical conditions.”

Many will never leave prison because of the length of their sentences. The FSCMA report concluded that older prisoners will continue to increase in numbers and in the overall percentage of prisoners, and “will continue to consume a disproportionate share of an already limited number of resources available for health care and programmatic enhancements within the correctional setting.”

What to do?

Experts in correctional health care, academic medicine, nursing, and civil rights have pinpointed key knowledge gaps and proposed a policy agenda to improve the care of older prisoners.

Participants at a 2011 roundtable at John Jay College of Criminal Justice in New York City identified nine priority areas to be addressed:

  • Definition of the older prisoner.

  • Correctional staff training.

  • Definition of functional impairment in prison.

  • Recognition and assessment of dementia.

  • Recognition of the special needs of older women prisoners.

  • Geriatric housing units, issues for older adults upon release.

  • Medical early release.

  • Prison-based palliative medicine programs.

The group, in an American Journal of Public Health article, called on national and state policymakers to work with corrections and community organizations to understand the number of older inmates who are Medicare and Medicaid dual eligible, the impact on county and state services and budgets, and how gaps in the continuum of care can be addressed.

Aging prisoners also present a challenge for palliative and end-of-life (EOL) care. An analysis of peer-reviewed research articles about EOL or palliative care for prisoners by researchers at Penn State found that while prison hospice care has increased, the systems are inconsistent across the U.S.

“It was surprising to find that family was clearly absent from these studies,” said study co-author Susan Loeb, Ph.D., R.N., an associate professor of nursing and medicine and director of the doctoral nursing program at Penn State. “There was mention of prisoners receiving family visits, but there was no family perspective on end-of-life care in prison.”

EOL care for prisoners is provided by many different people, from fellow inmates to professional healthcare workers, and the care itself ranges from addressing psychosocial and emotional needs to providing health care interventions. Attitudes toward hospice care for prisoners varied among prison staff, with corrections officers expressing the most resistance.

“Hospice coordinators felt that EOL care had a positive impact on the general prison population as well as on dying prisoners because it promoted compassion and presented an alternative to the view of the prison system as entirely punitive – showing it to be more humane and caring, supportive of the dignity of the dying patient, and encouraging trust between prison staff and inmates,” researchers concluded.

How states are coping

In Connecticut, the Department of Correction operates interdisciplinary hospice programs at three correctional institutions that “provide twenty-four hour compassionate, quality end-of-life care to terminally ill inmates” and include families as part of the care team. The state’s office of legislative research reported:

  • California law allows the Department of Corrections and Rehabilitation to contract with public or private entities to establish and operate skilled nursing facilities to incarcerate and care for inmates. Instead, the state built a 1,722-bed prison in Stockton to house medically infirm prisoners, including those with Alzheimer’s disease and mental illnesses. Sacramento TV station KCRA reported the price tag was $839 million. California also has a program where convicted murderers serve as aides to other inmates who have dementia.

  • Florida has four facilities that house large numbers of elderly prisoners, with varying eligibility criteria.

  • Louisiana's state penitentiary has a hospice for prisoners near the end of their life, as do at least 75 prisons in 40 states.

  • Nevada and other states have a wide range of programs for elderly prisoners that address rehabilitation and diseases of the elderly.

  • New York's Unit for the Cognitively Impaired, located in the Fishkill Correctional Facility, primarily serves prisoners with dementia.

  • In Pennsylvania, the Laurel Highlands facility serves sick and elderly inmates. The minimum-security facility houses nearly 1,400 inmates; approximately 400 are over age 50.

  • Most older prisoners in Virginia are housed at the Deerfield Correctional Center. In 2009, Virginia compared the costs and benefits of contracting for privately operated assisted living or nursing facilities for geriatric offenders, compared to the state operating such facilities. It found that the center is less costly than caring for these prisoners at private nursing homes in the same area.

  • Washington state created an assisted-living unit at the Coyote Ridge correctional facility. The unit, which has a capacity of 74 inmates, is inside the fence of a regular prison but segregated from other units

Ideas for journalists

  • If your state is listed above, find out how well these initiatives are working. Are costs coming down? Are prisoners receiving appropriate care?

  • What programs address caring for older, sick, and dying inmates in your state? Does the state contract with private care organizations or do inmates primarily provide care?

  • What happens to those who are released back into the community? Are programs and support services available?

Additional resources

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology and Home Care Technology report. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.