The Rising Cost of Incarcerating the Elderly

The number of older adults in prison and jail is projected to  grow to a “staggering” 400,000 people by 2030, according to a report released Thursday by the Osborne Association. The aging prison population requires a shift in how the U.S. addresses incarceration, the report says.

At least one-third of the U.S. prison population will be over 50 by 2030, according to a white paper released Thursday by the Osborne Association.

The association, a New York-based advocacy group that works with justice-involved people and their families, cited figures showing that even as states are working to reduce prison populations, the number of older adults in prison and jail is projected to grow by a “staggering 4,400 percent” in the 50-year period between 1980 and 2030—to an estimated 400,000 people.

According to statistics quoted by the researchers, adults over 50 comprised just three percent of the total incarcerated population in 1993, representing 26,300 individuals.

“Justice isn’t served by keeping elderly people locked up as their bodies and minds fail them and they grow infirm and die,” said Elizabeth Gaynes, president and CEO of the Osborne Association, which advocates for improved conditions in prisons and jails, better discharge planning, and expanded compassionate release of the elderly and infirm.

“It’s both inhumane and inefficient.”

reportAccording to the report, entitled “The High Cost of Low Risk: The Crisis of America’s Aging Prison Population,” extreme sentences doled out during the tough- on-crime era, as well as limited mechanisms for compassionate release, have driven what is now a costly and inhumane crisis that the corrections system is unequipped to manage.

The medical costs of caring for a burgeoning elderly population behind bars alone will add to the strains of resource-strapped corrections systems, many experts have said.

According to data analyzed by the American Civil Liberties Union, it costs twice as much to incarcerate someone over 50; in some cases, it may cost up to five times more when medical costs are added.

Between 40 percent and 60 percent of prisoners over 50 have some type of mental illness or cognitive impairment, according to data from the Bureau of Justice Statistics. Some prisons are setting up makeshift hospice wings and opening nursing wards for people with serious cognitive degeneration.

Elsewhere, inmates suffer from such pronounced dementia that they are unable to follow rules, and may not remember why they are incarcerated. For many with cognitive, visual, or hearing loss, a diminished capacity leads to behaviors that are mistaken for disobedience, subjecting them to punishments such as solitary confinement.

See also: Solitary Confinement Policies at ‘Tipping Point’ in U.S., say Reformers

Prisons were never designed to be geriatric care facilities and this surging elder incarceration comes at a high cost,” wrote the authors of the Osborne report.

At the same time, research by the Pew Center on the States shows that incarcerated people over 50 pose little public safety risk, and have the lowest recidivism rate as any other inmate demographic.

The authors argue that addressing this crisis requires what they call a “new paradigm of justice,” involving a shift in how we respond to violence.

The majority of people graying in detention were arrested for violent crimes in their teens, 20s and 30s, according to the report, Yet, it adds, “the low risk of recidivism for older people described earlier holds true for people who are convicted of the most serious acts of violence, particularly homicide-related offenses.”

See also: When Should Older Americans with Alzheimer’s Lose Access to Guns?

The report cites several victims advocates who argue against incarceration as a primary response to violent crime, since it fails to address underlying causes of individual violence in society, including poverty, trauma, isolation and inequity.

“Exposure to violence is especially prevalent amongst those aging behind bars, though decades may have elapsed since such harm was both survived and committed,” a fact that underscores the potential for preventative interventions that address trauma, wrote the authors.

As one example of a more targeted approach to violence, Michigan last year “became the third state in the country to offer a trauma center for victims of crime within a hospital in Flint to promote healing and prevent future crime.”

Health and Accelerated Aging

The report also calls for improved conditions in prisons and jails, including universal guidelines and training for prison staff to help them recognize age-related issues.

Those who are aging in prison have a higher rate of serious medical issues compared to the general population, in addition to health problems correlated with socioeconomic factors. Communicable and chronic diseases such as hepatitis, HIV, tuberculosis, arthritis, hypertension, ulcer disease, prostate problems, respiratory illnesses, cardiovascular disease, strokes, Alzheimer’s, and cancer are far more prevalent in the older prison population compared with the overall prison population.

While there is more bipartisan support for decarceration when it comes to nonviolent offenders, the urgent need for a new approach to violent crimes is underlined by the runaway cost of housing elderly inmates: now an estimated $16 billion-a-year burden on taxpayers, and growing.

Narrow doorways, stairs, and lack of handrails all pose architectural problems for inmates with limited mobility, as do facilities like cafeterias and medical units, which can be spread far apart. The report also notes that older individuals may struggle getting to and from their beds, especially a top bunk; and that geriatric incontinence and other physiological issues that accompany old age “can be extremely difficult to handle with dignity in an environment lacking privacy, leading to harassment and feelings of shame, isolation, and depression.”

Upon release, older adults face greater rates of homelessness, low employment, increased anxiety, fragmented community and family ties, chronic medical conditions, and increased mortality rates, according to the report.

Policy Recommendations

“The issue of aging people in prison can be interpreted through several lenses: an unintended consequence of ‘tough-on-crime’ policies, a human rights crisis, a matter of economic urgency, a public health crisis, an extension of a racialized punishment paradigm, or a reflection of the critical shortcomings of our criminal justice system,” write the authors.

“Any serious and sustainable attempt to resolve this crisis must address the needs of those aging in prison,” in addition to shifting our response to violence away from mass incarceration and long sentences.

In support of a solution, the Osborne Association makes a number of specific policy recommendations, grouped into five clusters:

  • Improve conditions inside of prisons and jails for those aging within them,
    including strengthening staff capacity to recognize and address aging issues, and
    adopting policies and practices that are age-considerate;
  • Improve discharge planning and reentry preparation for older people within
    correctional facilities;
  • Expand specific release mechanisms for older people;
  • Improve the reentry experience of older returning citizens by increasing
    community supports and receptivity, including addressing their housing, medical/
    health, mental health, post-incarceration, financial, family, and employment needs;
  • Shift our response to violence by expanding the range of services offered to
    victims and survivors of crime, and by reducing excessively long sentences for all crimes
    of conviction, including for violent crimes, that drive the crisis of aging in prison.

These recommendations and the full report can be explored in more detail here.

This summary was prepared by TCR Deputy Editor Victoria Mckenzie. Readers’ comments are welcome.


Feds OK Nursing Home for Infirm, Elderly Parolees

A landmark decision last month to certify a private Connecticut facility is called a “huge deal” by advocates of better care for the nation’s growing population of aging prisoners.

A one-of-its-kind nursing home whose patients include extremely frail inmates paroled from the Connecticut Department of Correction has won certification from the federal Centers for Medicare & Medicaid Services—a move that will ease the strain on that state’s correctional health care coffers.

Correctional health experts say the December 2016 federal certification of the 60 West nursing facility in Rocky Hill, about 10 miles from Hartford, is  a “huge deal” because it’s a potential treatment model for the growing number of American prisoners who are aging and infirm.

It is the first certification ever granted to a nursing home housing former inmates paroled largely because they’re physically and/or mentally debilitated.

“This gives people somewhere to go so they don’t have to die in a [prison] infirmary,” said Judith Dowd, health and human services director for Connecticut’s Office of Policy Management

The state contracted a private company, iCare Management, to run 60 West; federal rules  forbid prison administrators from actually operating nursing homes.

Being certified means an estimated $5 million a year in federal Medicare and Medicaid funds—those dollars, in part, will match state allocations—could pour into the Connecticut’s correctional health care budget, predicted Dowd, who said the nursing home’s expenses amount to roughly $10 million annually.

A ‘Model’ for Other States

Calling it a “victory” with national implications, Dowd said, “Now, other states will have a model.”

Prison officials in several states, she added, have already asked how they can copy 60 West, but she would not disclose the names.

Several of the nation’s top correctional health experts told The Crime Report that prisons are not medically equipped to care for the most chronically, critically and paralyzingly ill patientsand that the higher costs of geriatric care will strain corrections budgets in the years to come.

The landmark certification is “particularly exciting,” said Steven Rosenberg, president of Community Oriented Correctional Health Services, an Oakland, California-based consultancy for prisons and jails nationwide.

“It speaks to the kind of federal-state partnerships we’re likely to see in the future. The federal government is starting to see that Medicaid [and Medicare are] underused tools that let states use their own discretion about who belongs behind bars and who is better off getting treatment in the community.”

Whatever patients’ physical or mental incapacities, other nursing homes often—and unfairly, experts said—have been reluctant to admit those with criminal convictions.

“Those inmates that are in for life are aging. One of the real problems that prisons, and even jails, are facing is what do we do when people are that debilitated and they don’t fit the correctional model?” said Donna Strugar-Fritsch, a correctional health care strategist and principal with Lansing, Michigan-based Health Management Associates.

Calling the certification a “huge deal,” Dowd added, that aging, frail prisoners “cannot follow rules because they don’t understand rules, and cannot dress themselves. What do we do about people who can’t feed themselves? That’s not prison work.”

Initially, the Centers for Medicare & Medicaid Services had denied Connecticut’s certification application for 60 West.

“What do we do about people who can’t feed themselves? That’s not prison work.”

The facility opened in 2013 amid protests from residents of the bedroom community where it’s situated who worried that the nursing home inmates were a safety threat.  State officials who spent the last two years or so resolving issues related to the certification, called the concerns unfounded.

(60 West, for example, contains a secured unit for dementia patients who might wander off.)

Those treated at the 95-bed facility have included both old and young residents with terminal and chronic physical illness—as well as those with psychiatric disorders who had previously been housed and treated at other state and municipal facilities.

Next Steps

Tempering praise for the federal certification were warnings that Medicare and Medicaid officials have much to work out regarding their funding of correctional health.

For one, Strugar-Fritsch pointed out, federal rules do not allow Medicare or Medicaid funding for nursing homes that are locked and guarded in the same way as prisons. That’s why 60 West only takes parolees.

And there also remains unresolved the question of how to address wheelchair-bound and bed-ridden inmates who may never be paroled, Strugar-Fritsch added.

Connecticut’s Dowd said the state  pressed its case for the federal certification  because of the fiscal impact of caring for acutely ill individuals who are confined behind the walls of prisons that are wholly unequipped to provide such care.

But she also added that Connecticut officials believed they were following the U.S. Supreme’s Court 1999  Olmstead v L.C.  ruling that treatment for  individuals with disabilities should  be administered  in appropriate community settings instead of institutions.

(That Supreme Court decision centered on persons with mental illness, a group that increasingly and disproportionately ends up in jails and prisons.)

“It’s been a long process. People were patient because they knew it was the right thing to do,” Dowd said.

Katti Gray

Katti Gray

Editor’s Note: For an earlier story on current research spotlighting the problems of America’s aging prisons, see Katti Gray’s Nov 7, 2016 article in TCR.

Katti Gray,  a contributing editor of The Crime Report,  covers criminal justice, health and education. She welcomes your comments.