Sixty years old, graying and frail, he watches as classification assigns a 280-pound giant to his cell. Within 24 hours, the elderly offender is beaten within an inch of his life losing his sight and some of his hearing.

While an extreme example, this scenario illustrates the vulnerability of older offenders in corrections systems and the need for agencies to have plans to protect and care for them.

"There's no question we have to look at different approaches but corrections administrators are in a bind. From a correctional administrator's standpoint they have a unique and very different challenge that they have to face -- a population that is getting more vulnerable and a population that has increasing medical needs," said Herbert Hoelter, cofounder and chief executive officer of the National Center on Institutions and Alternatives, which has studied the elderly offender problem.

Experts say, and statistics show, that the population of elderly inmates has grown in recent years and will continue to do so as the baby boomer generation ages behind bars. Department of Justice figures from 2003 show that the number of offenders 55 and older has risen 85 percent since 1995 and estimates are that it will continue.

Even though the total percentage of elderly offenders nationally is 4.3 percent, this group represents a much more significant health care cost to agencies and requires special supervision to ensure they are not subjected to cruel and unusual punishment --  the legal bar for many corrections-related lawsuits.

"The elderly run afoul of the ordinary routines due to physical disability and aging itself. It gives them difficulty to deal with the ordinary routines such as being able to stand for long periods of time - and that could get them into trouble," said Cory Weinstein, a private physician who works with inmates in the California Department of Corrections. He also works with the inmate advocacy group California Prison Focus.

Weinstein said he has talked with older offenders who complain of being targets for others who want to take their canteen, special foods and other items.

"I follow a few prisoners around our system that run into that problem over and over again," he said.

To address these issues, many corrections agencies have built prison nursing home facilities with specially trained staff and services for this population. Other agencies have opted for special units or wings for aging offenders in existing facilities in order to provide more specialized care.

"From their [corrections administrators'] perspective that makes sense. There are also some private sector companies that are trying to get states to send them their frail and elderly inmates. [But] from a long-term standpoint and public policy standpoint there has to be a different strategy and, unfortunately, most of those are legislatively driven," said Hoelter.

Prison nursing homes may be an adequate short-term solution, but to address the population increase down the road, states will have to legislate medical parole for older prisoners in order to move them back into the community for their remaining years.

The Virginia legislature, for example, passed a geriatric parole provision three years ago for the state parole board to use to release certain older inmates who would not be a risk to the public.

Many think this type of statute is a good idea.

The NCIA recommends that nonviolent offenders age 65 and older, who have served a significant part of their sentence and pose a low risk to society be placed on structured, supervised release.

"The data on recidivism would support this, aging out supports this and with the sophistication we have in technology to monitor people with GPS, we can know a person's every movement," said Hoelter.

But few states are ready to use a provision like this unless there is a serious medical need for release. Even terminally ill inmates, in many states, are not released until a few months before their expected death.

Nevertheless, some agencies are planning ahead by putting these mechanisms in place and, although medical parole for elderly offenders may not be politically popular now, many believe that it will have to be used if corrections agencies hope to stay afloat financially.

Medical Parole in Two States

Since 1995, the Virginia has operated without a system for parole for offenders who committed their crimes after that date. But, in 2001 legislators passed a statute that allowed for parole for geriatric offenders who are 65 and had 5 years of incarceration or were 60 and had a minimum of 10 years incarceration.

According to Helen Fahey, Chair of Virginia Parole Board, parole decisions for those who committed their crimes prior to 1995 already include consideration of the offender's age and health status. And, of those who are eligible for parole under the geriatric statute, many, she said, have committed serious crimes at an older age and have not yet met the criteria for release.

In recent years, the parole board has only heard between 20 and 25 petitions for parole under the geriatric inmate statute.

"There's a perception there should be lots of people released under this. I looked back to [the petitions] and they were overwhelmingly murderers, rapists and child molesters, [and] people who had committed their crimes when they were older. If they went to trial and were sentenced by jury or judge [they] knew how old they were - absent a change in circumstances like a significant health problems or that the punishment the court or jury handed down has been adequately served - [they would not be released]," said Fahey.

And, until next year, offenders who have served at least 10 years of their sentence (who are not already covered under parole) aren't eligible to apply for consideration.

"For those who are eligible, although they can petition, if we are reviewing them annually and considering their age, it's unlikely they will be released under a geriatric provision," Fahey said.

The parole board is not inclined to release any geriatric inmates any time soon, unless they can show their risk to the public has diminished significantly.

"If I looked at a case and saw a judge who sentenced an offender who was 64 and gave them 30 years, [then] they didn't think that they should be released in five years and we do give weight to that. [However] some people come down with certain illnesses which change the circumstances and would change their risk to the community," Fahey said.

However, Fahey said as offenders move beyond the 1995 date when regular parole ended, she predicts more worthy petitions for release will arrive before the board.

Medical parole exists in Maryland where offenders can request release based on health care circumstances, although, according to Maryland Department of Public Safety spokesman Mark Fernarelli, it is rarely used.

In a typical case, the state's Commissioner of Correction will receive recommendations from medical staff about inmates who should be considered for medical parole. The commissioner forwards these requests onto the Maryland Parole Commission.

While the number of requests is low, around 20 requests a year since 2001, the chances of being approved are fair. In 2001 there were 19 requests and 10 were granted and this year there have been 22 requests, seven have been approved and five are pending.

One recent change to this process, according to Fernarelli, is the creation of a special group called the Palliative Care Committee, which recently celebrated its first anniversary.  The focus of this group is on making seriously ill or dying inmates comfortable---and helping them gain medical parole, if possible.

While the full effect of this committee is yet unknown changes such as this are on the horizon in corrections agencies as they look toward the future.

But until costs for caring for the elderly become too great for agencies to support -- and it becomes absolutely necessary -- state legislatures won't take the political risk to release these offenders in any great number. So, until then, state DOCs have come up with special programs geared toward this group while they remain behind bars.

Managing Aging Offenders Behind Bars

Beyond the geriatric parole provisions in Virginia, corrections officials there also began planning for the expected rise in offenders over age 50 who would need some type of medical assistance.

"All you have to do is look at the baby boomer population. There's a huge tidal wave over the next 25 years of people growing old and needing medical attention. That's running a dual track," said Fred Schilling, Director of Health Care for the Virginia Department of Corrections.

Compound that expectation with the increased biological age of offenders (who typically have lived a life without proper medical care) and corrections agencies will see much higher percentages of the "elderly and infirm."

Knowing this, Virginia DOC has prepared for the increase by serving aging and sick offenders in several specialized units that provide care to the geriatric population.

The system has several large infirmaries in which inmates can receive skilled nursing care equivalent to nursing home care. In addition, the DOC has assisted living units available, which provides a level of care "just below skilled".

The DOC defines assisted living as the need for assistance with one or two activities of daily living. Skilled care is for these with the need for assistance with three or more such activities, which include walking, bathing, ambulating, dressing and toiletry.

Schilling explained that several years ago the DOC set in place the ability for offenders to be medically classified to those units that matched their need. In addition, the DOC began housing like offenders in one of its facilities, Deerfield Correctional Center, which has a 30-bed assisted living unit and 10-bed skilled care unit.

With the growth of this population in mind, the DOC built Deerfield with the ability to expand as the numbers of geriatric offenders did.

The DOC has also kept care in the forefront.

It staffs Deerfield and other such units with nurses and specially trains its custody staff on how to work with the aged and those with physical and cognitive limitations.

"Instead of an officer walking up to an inmate and saying stand up and get up immediately, they know they can't jump up immediately. Or someone with moderate Alzheimer's can be confused [but] they are not purposefully being disobedient," Schilling said.

In the state's other facilities, medical staff keep an eye out for aging lifers in the general population and refer them on to other units when health problems arise for them.

In Maryland, it is the Division of Corrections' Social Work Department that keeps track of aging offenders and their needs.

According to Dot Strawsburg, Director of Social Work, a database of older offenders is maintained and watched closely to ensure that inmates receive regular physical and mental exams.

Strawsburg said older, infirm offenders many times are housed in special units where they are closer to medical units and can receive any additional care they require. If they cannot be cared for adequately in these units, then they would be referred for medical parole.

A relatively new mechanism for monitoring geriatric offenders' needs is the agency's Palliative Care Committee, which was formed in 2003.

The idea behind the formation of the committee, according to Jennifer Sears, Director of the Palliative Care Committee for the Baltimore region, was to work together inter-departmentally to share information and expedite the process for medical parole (sentenced inmates) and compassionate release (pre-trial detainees). 

Another goal for the committee was to identify inmates who could not be released on medical parole or compassionate release, but who were terminally ill.

"Usually, the reason the inmate could not be released had to do with the sentence and/or the severity of the offense.  In such cases we hope to provide the inmate an opportunity to spend as much time as possible with his family and to ease his final days in whatever way we could," said Sears. 

With this in mind, the committee has designated a Palliative Care room in one of the department's infirmaries and has worked with the warden there to permit more liberal visiting hours and to allow family members to bring in favorite foods or similar comforts for terminally ill inmates.

When older inmates are not terminal and end up finishing their sentence behind bars, the agency's social work department works with those offenders closely to make sure they have planned for their release and have supports in the community.

"Because we keep a database on them, we are aware of when they are coming up for release. Often when we are doing their physical we talk about [release planning]," Strawsburg said.

During those discussions, the team discusses financial arrangements, family support and how to re-enroll in health care benefits.

Over the past 10 years the Correctional Services Canada has also changed certain requirements for the older inmates it confines and strengthened some of its ties in the community to help these offenders transition back into the community.

According to Julie Keravel, Director of Institutional Reintegration Operations, CSC tries to meet the physical and mental needs of the older offenders who are being housed in its correctional facilities.  In some cases, she said, facilities have been altered so that they accessible for those inmates who are in wheelchairs and special bars have been added in some showers for offenders who require extra support.

Also, Keravel said, older offenders with limited physical abilities are not required to do heavy lifting or difficult manual labor as part of their work assignments.

"We are trying to use their skills and their strengths in other ways, like maybe in the library or assisting some of the administrative departments or doing more hobby-crafts," she said.

Keravel noted that as offenders age and their risk level decreases, CSC may transition them back into the community by sending them to a community facility.

"It benefits the offender in that they are in the community and closer to their family and maybe to some of the services that we have to contract out to get," Keravel said.

At that point, CSC depends heavily on community-based services to meet the needs of older offenders, she added.

"We look for resources in the community that are already established and specialized," Keravel said.  "We are not trying to duplicate that."

She said CSC teams up with local outreach organizations like the John Howard Society and the St. Leonard's Society of Canada to provide services to these offenders.  Church groups also send volunteers to help older offenders adjust to life in community.

"We have great volunteers that will offer services and time," Keravel said.

According to Keravel, linking older offenders with those services and the companionship of volunteers are both vital to their successful transition back into the community.

"That is the key to success - when they have a good, strong, community network of support that really takes care of their emotional needs," she said.

While Canada focuses on transitioning offenders out of the incarcerated setting, the standard is not yet set in U.S. politics and corrections for how to handle the aging offender population. But many believe that changes will be coming.

According to Hoelter, even the U.S. Sentencing Commission has begun to look into the development of guidelines for elderly inmates and it has created a task force to consider the issue.

But it may be the sheer cost of caring for these offenders when they become sicker that ultimately turns the tide.

"One of my charges [as a physician] is to protect my patients, and identify prisoners who are at risk and vulnerable," said Weinstein. "They are not threats to society, it is vicious to keep them in, their children want them out to die in their home or community, there is no penological purpose, [and] it costs the taxpayers an incredible quantity of money."

Resources:

NCIA study on elderly offenders -
http://66.165.94.98/stories/eldst.pdf

NCIA - http://66.165.94.98/

Information on Canada's Elderly Offenders - 
http://www.csc-scc.gc.ca/text/pblct/duoweb/229/mandat_e.shtml