Do America’s Sick, Aging Inmates Deserve the Right to Die at Home?

Terminally ill Vermont  inmate Bobby Hutt made it home to die, thanks to the fierce advocacy of his sisters. But although nearly all states allow “compassionate release,” it’s often underused.

Two photo albums encompass Bobby Hutt’s 48 years of life.

Black-and-white photos show him as a baby petting a dog, and as a moppy-haired boy playing basketball. The pages lead to an adult Bobby in a blue jumpsuit standing in a prison yard with two other inmates.

Hutt, who died from cancer four years ago shortly after he was granted medical release from prison, spent 30 years struggling with drug addiction, which repeatedly got him in trouble with the law.

His sister Melissa Dumont fought tears as she looked at the photos. Those she prefers are an image of Bobby captured between his prison sentences, wearing a backward baseball.

“That was Bobby, he always wore his hat like that,” Dumont said.

A unrecognizable Bobby stares back from the following page: a skeletal man in a hospital bed. His eyes barely open, he manages a weak smile for the family members who came to say goodbye.


Bobby Hutt’s sisters Janice Hull (left) and Lisa Dumont. It took more than a year of efforts to obtain his release from an Arizona prison on compassionate grounds. Photo by Elizabeth Murray/Free Press

Those final moments would have been impossible without the fierce advocacy of Bobby’s sisters, who lobbied to bring him back to Vermont from an out-of-state prison and then to get him home.

Dumont and Janice Hutt made hundreds of phone calls to navigate a complex and often unclear process while they say their brother wasted away. They can’t imagine what would have happened if they hadn’t been fighting for him.

“He would have died in Arizona,” Hutt said.

Vermont is one of 49 states to pass compassionate release legislation, which is a special dispensation for inmates suffering from terminal or serious illnesses to die outside prison.

The need for such laws is likely to grow, as the nation’s aging prison population is at risk of chronic and terminal diseases that corrections officials and inmate advocates say are more appropriately treated outside prison.

Typically, in Vermont, the population of inmates who are 55 and older has increased in the past five years, even as the total number of inmates has dropped.

Mary Price, general counsel for Families Against Mandatory Minimums and a national expert on compassionate release, says the U.S. as whole underuses compassionate release.  She gives Vermont’s laws — officially termed medical furlough and medical parole — a B-minus or C-plus.

Thanks to Bobby’s sisters, he died holding his mother’s hand.

But not all inmates get the chance to end their days close to loved ones.

Vermont offers an example.  While prison officials are supposed to initiate consideration of medical release when an inmate presents severe health issues, those providing inmate health care have sometimes failed to recognize terminal illnesses.

That was likely the case for Roger Brown of Windham County who was among about 270 Vermont inmates sent to SCI-Camp Hill in Pennsylvania in June 2017. He died there in October.

“[From] everything we’ve seen both from Roger and the witnesses, it appears to be obvious that he was ignored,” said James Valente, the lawyer for Brown’s estate.

Valente said he is still collecting evidence, but no information has yet been released publicly that suggests otherwise.

Brown developed cancer while incarcerated, but it’s unclear whether he knew about it.

Brown’s diary chronicles months of illness, for which he was treated with ibuprofen, and was told his chronic pain was not a medical emergency. Weeks before he died, he could barely move from his bed.

“We were continually rebuffed and refused medical attention,” wrote his cellmate Clifton Matthews, 67, who took over the log of Brown’s deterioration when he could no longer write.

“[He was] told repeatedly it was all in his head, even at the point he could no longer stand or sit up.”

Sending people out of state creates an extra layer of issues when trying to identify who might qualify for medical furlough or medical parole, said Vermont Defender General

Matt Valerio, of Vermont’s Prisoner’s Rights Office, said trying to get information from SCI-Camp Hill was “a nightmare,” since the prison contract stipulated that grievances must first go through the Pennsylvania administration.

Valerio said he was unaware of the severity of Brown’s condition since his office never received any complaints or grievances.

Typically, he said, when the office hears an inmate is in that condition, the agency’s staff begins to communicate with the inmate’s family and the Vermont Department of Corrections about options for release.

More than 200 out-of-state inmates from Vermont have since moved to a prison in Mississippi.

 RELATED: Why Vermont inmates eligible for medical release often remain behind bars

‘You Felt Like You Had to Beg’

Bobby began noticing pain while was serving 10 to 15 years in an out-of-state prison for three counts of assault and robbery with a weapon.

He put in multiple sick slips to be seen by a doctor and get an X-ray, his sisters say.

“Everybody always accused him of med-seeking,” Hutt said.

“You’re a drug addict, you’re med-seeking.”

Dumont said she continued to insist, in almost monthly conversations with her brother, that he keep asking for an X-ray.

“It got so bad that he would end up crawling on the floor because he couldn’t stand,” she said.

Bobby’s femur snapped underneath him while he was putting on his pants in November 2013 after months of receiving ibuprofen for pain management, but not much further treatment. That’s when Dumont and Hutt say they began their yearlong fight to secure their brother’s return to Vermont and his eventual release.

In Vermont, the decision about who is eligible for medical release is made by prison staff and officials. There is no formal process for families to advocate for the medically necessitated release of their loved ones. Inmates can request consideration for release through sick slips, but are given no other options to advocate on their own behalf.

The sisters made hundreds of phone calls trying to find someone who could help. Some people hung up on them.

They sent emails. A number went unanswered.

“You felt like you had to beg,” Dumont said.

Lisa Menard, commissioner of the Vermont Department of Corrections. Photo by Glenn Russell/Free Press

When first asked whether the Department of Corrections made information on medical release available to inmates’ families, Commissioner Lisa Menard said all policies were accessible on the agency’s website.

A review of “Friends and Families of a Person Incarcerated in a Vermont Correctional Facility,” which is posted on the department’s website and was last updated in 2017, failed to list any explanation of medical release options.

The other uploaded document, a “Health Services Handbook,” which was last updated in 2007, briefly defines the three types of medical furlough.

The section concludes: “If you have questions about your loved one’s health there are several steps to take.” But, rather than outlining actions that can be taken or listing departments to contact, the Q&A that follows repeatedly instructs concerned family members to consult the inmate.

In a follow-up conversation, Menard said she was unaware that the resources referenced in her previous conversation with the Free Press were so out-of-date and confusing.

“That’s a good catch,” Menard said. “I truly thought that there was more information in those, and that is unfortunate. We will make those more accessible.”

Menard said the handbooks were due for an update and she would like to bring inmates’ families into the process.

“We want family members involved in these cases, we really truly do; and certainly we need to make some more effort to make sure it’s easy and clear to find out how to do that,” Menard said.

Bobby’s sisters say they eventually made contact with Vermont’s out-of-state unit supervisor, who kept them in the loop. That connection gave them a leg up in trying to navigate the process.

Two months after receiving an advanced cancer diagnosis, Bobby was brought back to Southern State Correctional Facility in Springfield, Vermont. When his family went to visit, the healthy, athletic man they remembered had all but disappeared. Bobby could barely walk.

For their mother, seeing his condition was devastating.

“This damn near killed her,” Janice Hutt said. “I think she lost nearly 60 pounds.”

After that, the sisters say Bobby Hutt didn’t want them to visit as much. It was too painful physically, and he didn’t want them to see him so sick.

The family continued to work with the Vermont Corrections Department to coordinate an approved residence and medical coverage if he was released from prison. Dumont converted her living room into a bedroom where Bobby’s hospital bed was placed, and, in August, Bobby was finally released on medical furlough.

Two months later, Bobby was dead. But, home.

“For all that we went through, he died where he wanted to die,” Dumont said.

 This is a condensed and slightly edited version of a story by Elizabeth Murray, a staff writer with the Burlington Free Press, as part of her 2018 John Jay Rural Justice Reporting Fellowship. The full version and sidebars are available here. A video interview with Hutt’s sister can be accessed here. Follow Murray on Twitter at @LizMurrayBF.


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.