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Caring for the Elderly Behind Bars
By Michelle Gaseau, Managing Editor
Published: 11/19/2001

One of the biggest health care problems facing corrections does not revolve around a specific disease at all, but rather a population. Elderly inmates and their multiple health complications typically cost corrections agencies tens of thousands of dollars each year and the number of inmates who fall into this category are increasing.

According to a recent report of the GRACE (Guiding Responsive Action in Corrections at End-of-Life) Project by the Volunteers of America, not only is the number of inmate reaching age 50 or more increasing, but fewer inmates now die behind bars. This equation means corrections agencies must become creative in how they manage this older and sicklier population.

The answer many agencies have chosen includes inmate hospice, institutions designated specifically for elderly inmates or special elderly inmate units. The idea of compassionate release, however, has only been embraced by a few states even though many believe it is a viable option.

'It is difficult to find someone who says it is a bad idea to move people into the community. The problem is there isn't a will among the groups that are strong enough to do it. There's a reluctance to say 'I'm going to be the one who opens that gate and lets someone out.' At the same time, they say it is a reasonable idea,' said Barry Holman, Director of Public Policy for the National Center on Institutions and Alternatives. 

Advocating Release

In a survey conducted by the NCIA in 1997, the organization found that the federal Bureau of Prisons spent over $409 million each year housing elderly offenders. NCIA also estimated that the cost of housing elderly inmates averaged $69,000 a year. The report said elderly inmates spend twice as much time in medical facilities and have three times the health care costs of younger inmates. So how could agencies save that money?

NCIA advocated structured supervised release for prisoners who meet certain criteria including: being 55 years old or older, have committed a nonviolent offense, have served a substantial part of their sentence (one-third or more) and are deemed not to be a significant risk to the community.

'Most of [the states] weren't doing anything [for elderly inmates] at the time. There were only six states that defined what elderly meant [in prison],' said Holman.

Since then, however, agencies have made several changes including written definitions of who falls into the elderly inmate category, creating hospice for prisoners and building facilities to house only elderly inmates. Several state agencies, such as the Pennsylvania Department of Corrections, have embraced the idea of what many call prison nursing homes. But while these strategies centralize inmates with similar needs, they do not necessarily save DOCs money.

Hospice is another strategy that has gained attention as a humane way for elderly and terminally ill inmates to spend their remaining time behind bars. But Holman said even this option has its downside.

'I think it is the right thing by a lot of prisoners [but] when we start to institutionalize it and it becomes the option of choice, it lets people in prison feel good about what they are doing and it can become the justification for leaving people there,' he said. 'A large proportion could be dealt with in community corrections.'

Holman said legislative people he has talked to say structured release is not up to them and corrections experts say their job is to house inmates not make decisions about their release. 

'They are more bricks and mortar and not looking at individuals to see if they need to be in prison,' Holman said.

Besides NCIA, programs such as Project for Older Prisoners (POPS), which began in Louisiana, work toward early release for elderly inmates by proving case-by-case to parole boards that certain elderly inmates pose little if any threat to the community and should be eligible for parole or alternative housing. Yet the majority of elderly inmates remain in prison.

If inmates are going to stay behind bars, then strategies have to be executed to manage the elderly inmate population properly and potentially provide an improved quality of life.

A Place of Their Own

The Ohio Department of Rehabilitation and Correction houses many older inmates at the Hocking Correctional Facility where 398 of 407 inmates are 50 years old or older. At HCF, medical costs for these inmates are double from the average $6.79 per inmate per day to $14.75.

The idea for the facility is to house these similar offenders together for more consistent care as well as for protection from younger inmates. Staff are also specially trained to work with this population and have a higher sensitivity to their needs and difficulties.

According to Larry Jones, of the Human Services and Religious Services office of the Ohio DRC, sensitivity training helps staff to understand some of the issues older offenders face.

'[In the training] staff tape their fingers together to try to feed [themselves] or count out pills. We do this department-wide. It isn't mandatory, but those people who serve that population get involved,' said Jones, who helps coordinate older offender programming for the DRC.

One training course, called Try Another Way, has staff use blindfolds, bulky gloves and other props to help them understand the limitations some elderly inmates face daily.

Jones said that the DRC also pays attention to quality of life issues for elderly inmates and helps them prepare for their future, either outside or inside.

'With [elderly inmate] programming we are looking at wellness programs and nutrition and recreation. With the overall programming [we focus on] the front end, so the back end doesn't become so heavy. If you can get them to stop smoking [for example] then maybe at age 50 they won't have breathing problems,' said Jones. 

A program called Don't Forget is targeted to older inmates to provide techniques for improving memory, a grandparenting program teaches them how to become active with their family from behind bars and other programs teach the inmates about what health issues they can expect as they age.

At the Ohio Reformatory for Women, an assisted living program is available for older female inmates or those with major health issues. Jones said the physical set up of the facility is a one-floor dorm with its own commissary, food service and recreation area to make movement easier.

Jones said case managers also work to place elderly inmates in the appropriate setting if they will be released.

'We've started to look at things a little further down the road. Some might go into nursing homes; it depends on the kinds of support they have on the outside,' said Jones.

According to Holman, in England, prison officials are using a different model for elderly inmates that may have some further benefits to the general population. 

The model for older inmates in England is to house them in a general population facility but in a unit that is accessible only to the elderly population, he said. This avoids the feeling some older inmates have of being sent to a 'pine box motel' where some believe they may die behind bars.

'They don't want to segregate the older inmates because they serve a calming function. And [the inmates] don't want to be sent somewhere where they think they are gong to die,' he said. 'It [doesn't] have the [negative] psychological effect on the older prisoners. They feel safe, but not cordoned off.'

But regardless of what type of institution elderly inmates are housed in, it is important to ensure they are healthy while they are there.

Staying Well

Montana corrections officials are having success with a new wellness program for inmates over 40. The program came to the DOC through a study conducted by John Amtmann of a partnership between Montana Tech and the University of Montana and the Montana State Prison.

The partnership involved interns from the school working with older inmates in a program called Exercise Over 40. The program included flexibility, strength training and cardiac aerobic training with a group of older inmates and their progress was followed over 14 weeks.

According to Sally Johnson, Health and Treatment Administrator for the Montana DOC, the study applied measurements and comparisons of body composition, muscular endurance, resting heart rate, strength and a group of measurements such as infirmary visits per month, body weight, push ups, sit ups, reach and resting heartbeat.

Johnson said inmates improved in a number of areas. Blood pressure had decreased, all lost weight and there was an improvement in body composition in comparison to the control group where inmates lost muscle and gained fat. 'There was a significant decrease in heart rate, a statistically significant increase in sit ups and push ups, then the skin fold test, which showed body composition improved,' she said.

'If one unhealthy person with hypertension gets their weight under control, it is something we are real proud of. We hope most of these people will be able to be out of prison but whether they are in or out, they will cost us less money in terms of medical bills,' said Johnson.

Johnson said the inmates also saw the benefits of the program. She said the inmates reported feeling better physically and spiritually. One inmate, who couldn't tie his shoes before the program, could afterwards and several reported that they no longer felt they had to take medication for various medical and mental problems after the program. 

Johnson said the inmates also felt they received another benefit from the program. Many felt it gave them better access to weights and exercise equipment that they would not otherwise have received. ' The inmates think they got something really special. It gives the over 40-group access to the gym on a regular basis. The younger inmates tend to bull dog. Now they have an isolated time they can go and apply a healthy regime,' said Johnson.

With the entire program costing less than $25,000 per year, Johnson said it is well worthwhile to help reduce the costs of keeping elderly inmates healthy.

'It helps them behind bars because they are positively oriented toward something. They can see that they have been successful at something and their behavior is better,' she said.


For more information about the NCIA study, visit the website at http://www.ncianet.org/ncia/home.html

For information on POPS run from George Washington Law School go to: http://www.law.gwu.edu/acad/clinics.asp

The GRACE Project: http://www.graceprojects.org/


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