The Corrections Connection recently asked Helen B. McNeal to provide an update on the status of prison hospice programs in corrections. The following is her commentary.

Currently, by our best count, there are 53 end of life care programs in operation in prisons in 26 states with another 13 under development in these same states plus seven other states.  Our goal is to help all 50 states implement prison-based programs for both men and women, and to help jails forge closer working relationships with end of life care providers in their community to meet the needs of terminally ill inmates in the jail setting.
 
As there is a growing acceptance of the reality of the need for different options for incarcerating and caring for elderly inmates, we see a growing interest in palliative and end of life care.  Some of this interest is compassionate but much of it is also very practical.  Just as there is data in the health care sector that indicates palliative and hospice care reduces the cost of care, there is similar data in the prison setting.  In a time when funding is tight, it makes sense to use approaches to reduce cost, improve care and meet the standard of community care.  However, developmentally the programs are "teenagers" in that they are not mature, well-established programs in most instances.  They are subject to disappearing based on a change of warden or loss of program "champion".   We have seen outstanding programs disappear almost overnight as a result of this.
 
Aside the issues of leadership support, the biggest area of resistance that we see in prison considering an end of life care program is to the use of inmate volunteers.  This occurs despite the fact that more than half of those currently in operation use inmate volunteers successfully.  In fact, in some states they are integrating their end of life care program with their long term care program for the elderly and using trained inmate volunteers right from the time that an inmate needs assistance with their activities of daily living.  The result is a much better connection between inmate volunteer and inmate patient hence a greater opportunity for the volunteer to meaningfully support the patient as death approaches.
 
As for the future, I believe as the elderly population incarcerated for violent/serious crimes increases and funding gets even tighter, end of life care programs will continue to grow ... as will the number of different approaches undertaken to implement the programs.  There is not a single model for these programs now and I don't expect that there will be.  But, I do expect that within the next five years we will see programs in existence in at least one prison in almost every state, and more jails building community collaborations to address this need.