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How Can We Meet the Challenges of an Aging Prison Population?
By John Rees
Published: 09/15/2022

Older inmate American prisoners 55 and older grew by an astounding 300 percent between 1999 and 2017 and by 2030 will account for a third of all U.S. prisoners. The number of people incarcerated for over 20 years is also rapidly increasing. This rapid aging of America’s prison population begs two obvious questions: 1) Can we really expect those who entered prison in their twenties—who essentially grew up in prison and have known nothing else—to succeed in a world that’s changed so much in their absence, especially if family and friends are no longer around to support them? And 2) Are our prisons really ready to serve as skilled nursing facilities and assisted living homes for seniors experiencing Alzheimer’s, dementia, and other age-related ailments?

Data and common sense answer both questions in the negative. No, aging prisoners are not prepared to succeed outside. Formerly incarcerated individuals are almost ten times more likely to become homeless than the general population with former inmates over 45 leading the nation in homelessness, suicide, and drug overdose.

Aging In Prison Is Different

Neither are our prisons prepared to serve as skilled nursing facilities and assisted living homes. If anything, prison accelerates the mental, physical, and social effects that come with aging. Studies show that people serving long sentences tend to have the same psychological age and health concerns as people on the outside who are ten to 15 years older. Prisoners typically suffer from an earlier onset of age-related health issues, including decreased mobility, impaired ability to care for oneself, poor eyesight and hearing, and medical conditions like cancer, heart disease, diabetes, and arthritis. According to a report by the National Association of Area Agencies on Aging, 73 percent of those incarcerated over the age of 50 have a chronic medical condition with older offenders experiencing an average of three chronic illnesses during their incarceration.

Other Costs

Individuals serving a long-term sentence also suffer trauma caused by their social isolation, leading to a distrust of others and anxiety felt in public places. Many suffer from loneliness and a sense of disconnection from a world that’s gone through unimaginable changes while they’ve been incarcerated. Their social isolation can worsen as they live through the death of family members and the estrangement of friends and acquaintances. Their grown children may also choose to separate themselves as a result of feeling abandoned.

How Did We Get Here?

It all began in the 1970s with the “Three Strike Rule” and mandatory minimum sentencing that accompanied America’s “War On Drugs.” But many of those receiving long prison sentences decades ago no longer pose the threat they once did. Older individuals, especially those who have spent long periods of time incarcerated, are far less likely to reoffend.

Stranger in a Strange World

So is early release the solution? Under certain conditions, yes. Unfortunately, a pervasive lack of affordable housing and specialized facilities to accommodate their needs can make re-entry problematic. In many parts of the country, the only residential option is a halfway house, a transitional living facility or a homeless shelter, none of which provide the specialized assistance that’s needed. In such environments, seniors who appear vulnerable can in fact become targets for abuse and manipulation. And though government-assisted programs may be available to help, navigating them can be overwhelming for those unfamiliar with new technology.

A Better Way

I was fortunate to serve as Kentucky’s Commissioner of Corrections under a governor, Dr. Ernie Fletcher, who was willing to think “outside the box.” The Recovery Kentucky program we developed provided a remarkably effective alternative to incarceration for individuals coming from prisons, jails and community supervision. The peer-driven, social model of care provided by the Recovery Kentucky program proved effective at easing the transition anxieties common to those who feel alone, isolated, and distrustful.

Taxpayer Savings

The Recovery Kentucky program was also amazingly cost-effective with per diem costs of housing an individual in a Recovery Kentucky facility running less than half the per diem costs of incarceration. Individuals may also qualify for federal assistance, such as Medicaid, to treat chronic medical conditions, Alzheimer’s, or dementia—costs that are not federally supported for those who are incarcerated. Prisons with convalescent care units for inmates must absorb all medical costs, including specialized staffing, supervised hospitalizations, and transportation for off-site medical appointments.

Here To Serve

There’s clearly an urgent need for safe, supportive re-entry housing. It won’t eliminate our older population of people in prisons or guarantee that no one will ever re-offend. But seniors in prison who present no current threat to public safety should be considered for release to transitional housing for one simple reason: it’s more effective, costs less, and dramatically reduces the burden otherwise born by our jails and prisons.

John Rees is the Fletcher Group’s SME (Subject Matter Expert) regarding criminal justice and treatment and recovery options. His experience is vast. As Kentucky’s Commissioner of Corrections he worked with recovery centers to provide alternatives to incarceration for offenders from prison, jails, and community supervision. Rees has served as a Warden, Facility Administrator or Consultant in numerous states, including Oklahoma, Texas, Louisiana, Kentucky, Tennessee, and New Mexico. At the Corrections Corporation of America, he served as Vice President of Business Development, overseeing governmental affairs on both the state and federal level. John has published several articles related to the criminal justice system including Establishing Partnerships Between Correctional Agencies and University Researchers to Enhance Substance Abuse Treatment Initiatives and is the author of the book, My Life: John D. Rees's Four-Decade Career in Corrections. In 2013 John was inducted into the Hall of Fame at Florida State University’s School of Criminology. His expertise, experience, and networking skills play a key role in the Fletcher Group’s ability to offer alternative paths to those with drug-related crimes so that they can find the treatment they so desperately need.


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