|As Outside, So Inside: America’s Aging Prison Population|
|By Robert Winters, JD, Professor, School of Criminal Justice, Kaplan University|
Raise the question of healthcare in the U.S. corrections system, and typically the issue at the forefront is mental health. To be sure, mental health is a significant, expensive, and ongoing challenge for correctional systems at all levels. But a quieter yet steadily growing problem has crested the horizon and creeps inexorably closer. Just as U.S. society as a whole is facing the issue of the aging of the massive Baby Boom generation—with the accompanying implications for the Social Security system, healthcare, and a host of other facets of American life—our prisons contain a steadily growing cohort of elderly inmates, many of whom will likely die incarcerated.
Research by the Pew Charitable Trusts conducted in 2013 examined a broader trend of sharply rising healthcare costs in state and federal prison systems. Across 44 states submitting data to the Bureau of Justice Statistics (BJS), correctional healthcare spending grew to $6.5 billion in 2008 from $4.2 billion in 2001. While the overall correctional population grew 15 percent from 1999 to 2011, states reported that per-inmate healthcare spending grew 32 percent just from 2001 to 2008.
A significant factor in that cost increase is the proportion of offenders aged 55 and older. In 2001 the number stood at 40,200, which was actually a slight decline from the 1999 figure of 43,300. But by 2008 the total was 77,800, an increase of 94 percent. The over-55 population grew even more sharply after 2008, reaching 121,800 in 2011. Just as in the general population, older individuals tend to have more chronic illnesses, and inmates 55 and older incur healthcare costs typically double to triple those of younger offenders. (Some research proposes rates as much as eight times higher.)
Slicing the data somewhat differently presents an even more daunting picture. Calculations likewise based on BJS data show that the population of inmates age 65 and older grew 63 percent from 2007 to 2010 while the overall correctional population increased only 0.7 percent—a rate 94 times greater. Looking at sentencing yields little reason to expect a change in these trends: about 10 percent of state prisoners are serving a life sentence, and among federal inmates, 11 percent of those 51 and older are serving sentences of 30 years or longer.
Simply defining “elderly” in the context of correctional populations is a challenge (and creating standardized criteria would be the first step in addressing the problem). Some researchers and groups, including the National Institute of Corrections, set the lower limit at age 50; others, including the BJS, use 55 instead. States using starting ages that range from 50 to 70, with some states having no official criteria at all. This hodgepodge makes obtaining standardized data on needs and costs across the full range of state and federal agencies next to impossible.
Furthermore, research conducted in 2003 and 2006 suggested that the average inmate is in physiological terms 10 to 15 years older than his or her chronological age. This is the result of a combination of factors, in part the stressful conditions of incarceration but to a great extent living conditions prior to being incarcerated, especially poor healthcare in general and in a majority of inmates a history of substance abuse. (A 2001 study estimated that between 60 and 83 percent of offenders have used illicit drugs at some point, and a 2006 research survey revealed that 56 percent of state inmates and 50 percent of federal inmates reported having used drugs in the month prior to being incarcerated.)
Even in society at large, many experts warn that the U.S. healthcare system is unprepared to deal with a large population of elderly patients. The situation within the correctional system is worse. While geriatrics training for correctional healthcare staff is an obvious requirement, custodial staff members need relevant training as well. Such training needs to focus on understanding age-related conditions (including cognitive deficits such as dementia), how those conditions impact the correctional setting, and how to identify offenders who require immediate assessment by a healthcare professional. In some cases adjustments are fairly simple—understanding, for example, that an inmate who seems noncompliant may actually be suffering from hearing loss or dementia.
Speaking of dementia, the condition is most prevalent among the elderly, and furthermore offenders tend to have a higher frequency of risk factors for dementia such as previous traumatic brain injury, substance abuse, and low educational attainment. Research on the subject in the correctional environment is limited, but estimates range from a frequency of 1 to 30 percent in the prison population—a range that is, granted, so broad as to be almost useless. Clearly further investigation is warranted.
Adapting facilities for elderly inmate populations will be one significant requirement. Such adaptations include showers and latrines that are wheelchair-accessible and appropriate beds. (Climbing to the top bunk is clearly not an option for many of these inmates.) Adaptation also means ensuring less-mobile offenders have appropriate access to dining facilities, pill call, commissary service, education, and other services that may be located an extended distance from housing. Yet concentrating and segregating the elderly from the rest of the population does have its drawbacks, such as the stabilizing effect such offenders tend to have on the population as a whole and the positive effect on morale from friendships and interactions with younger inmates.
Finally, in this age of budget battles it is impossible to ignore the cost factor. More elderly offenders means more and more spending on healthcare. Various agencies have already pursued solutions ranging from privatization to increased reliance on state resources such as university and charity hospitals. The expansion of Medicaid in some states under the Affordable Care Act will extend benefits to virtually all inmates, but the utility of that solution is limited since it is still financed with tax dollars from the same limited pool that funds correctional budgets. The main significant option is to find alternative sentencing measures for elderly offenders such as supervised release. But something will have to be done—the numbers make that clear.
Corrections.com author, Robert Winters, holds a Juris Doctorate degree and is a Professor with Kaplan University. He is also a member of the National Criminal Justice Association and serves as a Western Regional Representative, a member of the National Advisory Board and their National Elections Committee.
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