INITIATIVE TO ADDRESS AGING PRISONERS IN NEW YORK STATE
By: Aiden H. Fel
SUMMARY:
This report highlights various approaches adopted by states such as California, Florida, Louisiana, Nevada, New York, Pennsylvania, Virginia, and Washington to manage their aging inmate populations. Similar initiatives can be found in other states as well.
In California, while the law permits the Department of Corrections and Rehabilitation to collaborate with public or private organizations to create and manage skilled nursing facilities for prisoners, this option has not been utilized yet. Instead, California is constructing a 1,722-bed facility in Stockton to accommodate medically frail inmates, including those suffering from Alzheimer's disease and mental health issues. Additionally, the state has implemented a program where inmates convicted of murder assist fellow prisoners with dementia.
Florida operates four institutions catering to a significant number of elderly inmates, each with different eligibility requirements.
Louisiana's state penitentiary offers a hospice for prisoners nearing the end of their lives, a service also available in at least 75 prisons across 40 states.
Nevada and other states have introduced diverse programs for older prisoners, addressing rehabilitation and age-related illnesses.
New York's Fishkill Correctional Facility houses the Unit for the Cognitively Impaired, primarily serving inmates with dementia.
In Pennsylvania, the Laurel Highlands facility attends to ill and aging prisoners. As a minimum-security institution, it accommodates around 1,400 inmates, with roughly 400 aged 50 and above.
In 2009, Virginia assessed the costs and benefits of outsourcing geriatric offender care to private assisted living or nursing facilities versus state-run operations, finding that the center was more cost-effective than private alternatives in the region.
Washington has established an assisted living unit at the Coyote Ridge correctional facility to cater to the needs of prisoners aged 50 and older. With a capacity of 74 inmates, the unit is situated within the boundaries of a standard prison but remains separate from other units.
INTRODUCTION:
A 2012 study by advocacy group Human Rights Watch revealed that between 1995 and 2010, the number of state and federal prisoners aged 55 or older nearly quadrupled to 124,400, while the overall prison population increased by only 42%. The growth rate for prisoners aged 65 and older has been even faster. Policy shifts such as "truth in sentencing," two and three strikes laws, the elimination of parole for specific violent offenders, and reduced compassionate early release have led to a higher number of elderly prisoners. Furthermore, there has been an increase in aging individuals being convicted of crimes. In 2010, 9,560 people aged 55 and older were sentenced nationwide, which is over double the number in 1995.
There is a growing number of inmates requiring wheelchairs, walkers, canes, portable oxygen, and hearing aids; needing assistance with daily activities such as dressing, using the restroom, or bathing; or suffering from incontinence, memory loss, chronic illnesses, severe illness, or nearing death. The National Institute of Corrections cites arthritis, hypertension, ulcer disease, prostate issues, and myocardial infarction as some of the most prevalent chronic diseases among elderly inmates, with diabetes, hepatitis C, and cancer also being common. Prisoners are more susceptible to dementia than the general population due to the higher prevalence of risk factors such as hypertension, diabetes, smoking, depression, substance abuse, and head injuries resulting from fights and other violent incidents.
The expenses associated with caring for elderly prisoners are substantial and increasing. States spend an average of $70,000 per year to incarcerate someone aged 50 or older, nearly three times the cost of housing a younger prisoner, primarily due to differences in healthcare costs, as stated by the National Institute of Corrections.
Although many states permit compassionate release for geriatric prisoners, a 2010 study by the Vera Institute of Justice, which examined laws concerning the early release of geriatric inmates in 15 states and the District of Columbia, discovered that these provisions are seldom utilized. The Vera Institute study indicates that at least 27 states have a definition for "older prisoner" for compassionate release purposes, with 15 states using 50 years as the cutoff, five states using 55, four states using 60, two states using 65, and one using 70. While Connecticut lacks a specific age, it mandates that eligible prisoners for compassionate parole release must be physically or mentally debilitated due to age or illness, incapable of posing a threat to society, and have served half of their sentence.
Although slightly outdated, a 2008 report by the Illinois General Assembly Legislative Research Unit, comparable to our office, outlines laws in 18 states affecting aging prisoners and describes the facilities and programs available for this population in those states.
INITIATIVES IN OTHER STATES TO SERVE AS MODELS:
California
Contracts with Private Providers:
California Penal Code § 6267 permits the Department of Corrections and Rehabilitation to collaborate with public or private organizations to create and manage skilled nursing facilities for the incarceration and care of inmates who (1) possess limited capabilities to perform daily living activities and (2) require skilled nursing services.
The facility must cater to the inmates' long-term care needs as necessary. Furthermore, it must be designed to:
-
Optimize the inmates' personal security,
-
Enhance the security of the facility, and
-
Guarantee the safety of the external community.
The contractor must acquire a license for operating the skilled nursing facility. The department is responsible for providing security for the facility to ensure the safety of the surrounding community. It must establish an agreement with the contractor regarding placement and review it to determine the contractor's compliance. If the contractor is found to be non-compliant, the department may terminate the agreement.
The department's ombudsman program is responsible for providing ombudsman services to prisoner-residents of contracted skilled nursing facilities. Conversely, the Office of the State Long-Term Care Ombudsman is not required to advocate on behalf of residents of any skilled nursing facilities operated by or under contract to the department, nor investigate their complaints.
To date, it appears that California has not yet entered into contracts for nursing homes under this law.
State Facility:
The California Health Care Facility - Stockton is under construction as an intermediate-level medical and mental health care facility designed to serve inmates in the California state prison system. The state aims to provide healthcare to prisoners more cost-effectively and efficiently by centralizing inmates with the highest medical and mental health care needs in one location.
This 1,722-bed facility will include diagnostic and treatment centers and will accommodate the state's most medically vulnerable prisoners, such as those with Alzheimer's disease and mental illnesses. The facility plans to employ around 1,100 nurses, over 400 psychiatric technicians, more than 140 physicians, mental health providers, and pharmacists, and 130 allied health professionals.
Currently in the design phase, the facility will be encircled by a 13-foot tall lethal electrified fence and feature a 24-hour patrol along with 11 45-foot tall guard towers. The construction cost is estimated to be between $700 and $750 million. In 2007, AB 900 authorized the facility, allocating $7.7 billion to add 53,000 prison and jail beds for inmate treatment, rehabilitation, and reduction of prison overcrowding in compliance with a court order. Additional information about the facility can be found at http://www.chcfstockton.com.
Program for Prisoners with Dementia:
As reported in the February 26, 2012 edition of The New York Times, convicted murderers at the California Men's Colony assist in caring for prisoners suffering from Alzheimer's disease and other forms of dementia. These inmates help others with daily living activities, including showering, shaving, applying deodorant, and changing adult diapers. They also lead exercise classes and organize meetings aimed at enhancing memory and reducing disorientation. Additionally, they accompany inmates to doctor appointments, acting as liaisons. Prisoners participating in this program receive training from the Alzheimer's Association and earn $50 per month.
Virginia
Existing Facility:
In Virginia, the number of inmates aged 50 and older saw a nearly seven-fold increase, from 822 to 5,697, between 1990 and 2010. As of March 2011, 82% of inmates aged 65 and older and 62% of inmates aged 50 to 64 were incarcerated for a violent crime, compared to 57% of younger inmates. Among those aged 65 and older, two-thirds were sentenced when they were 50 or older, and nearly half when they were at least 60.
Most older prisoners in Virginia are housed at the Deerfield Correctional Center, a one-story, handicap-accessible institution catering to inmates' mobility needs. The center is equipped with special healthcare equipment, including additional handicap-accessible vans for transportation.
Since 1998, Deerfield has focused on housing older male inmates and those with special healthcare needs. In 2005, its assisted living unit expanded from 40 to 56 beds. By December 2006, the center had grown from 497 to 1,059 beds to accommodate more geriatric inmates and those requiring assisted living services, necessitating an additional 194 employees. As of 2011, around 16 inmates were wheelchair-dependent, and another 61 required wheelchairs for medium to long-distance trips.
The expansion also included a new 18-bed medical infirmary, providing a skilled nursing level of healthcare. Four of the center's six units feature a nurse's station for easy access to nursing care. Although the infirmary currently meets the Department of Corrections' (DOC) needs, they anticipate further expansion as more Deerfield units and pods are converted to assisted living. This expansion will be incorporated into the DOC's plans for a future statewide correctional medical center, which would include surgery, radiology, medical oncology, dialysis, and physical rehabilitation services.
At Deerfield, the DOC offers geriatric treatment programs such as horticulture, a library with large-print books, assisted living services including dementia and Alzheimer's disease checks, peer tutoring, a computer program for the blind, and a partnership with the Virginia Beach library to assist blind and visually challenged inmates. Additionally, substance abuse, sex offender treatment, educational services, and recreational services are available to geriatric inmates at other prisons throughout the state.
A 2011 presentation by the DOC highlighted specific re-entry challenges for geriatric prisoners leaving the correctional system, such as a declining number of assisted living facility beds, an insufficient number of Medicaid nursing home beds, and a lack of specialized housing for violent and sex offenders.
Privatization Study:
In 2008, Virginia's appropriations act mandated that the Department of Corrections and the Virginia Parole Board examine the costs and benefits of contracting privately operated assisted living or nursing facilities for geriatric offenders, as opposed to state-operated facilities. The study revealed that the overall cost of private facilities was more than double that of housing prisoners at Deerfield. Although Medicare and Medicaid would significantly lower the state's expenses, the cost estimate for private facilities did not account for security costs associated with housing prisoners. The fiscal year 2010 per capita expense at Deerfield was $29,600, while most other medium-security dormitories averaged $18,000.
The study also highlighted the challenges of contracting privately operated assisted living or nursing facilities for lower-risk geriatric offenders. Public facilities for geriatrics in the community are limited, and many for-profit facilities have long waiting lists, with several refusing to accept offenders.
Florida
According to the Department of Correction policy, a physician evaluates and diagnoses all inmates with limited abilities to perform daily living activities. These prisoners receive a service plan tailored to their medical and mental health requirements and are accommodated according to their custody level and medical status. Inmates with specialized needs, such as those who are blind, deaf, or require a walker or wheelchair, are assigned to designated institutions for appropriate custody and care.
A 2011 annual DOC report indicated that as of June 30, 2011, there were 17,492 elderly inmates in prison, accounting for 17.1% of the total population. Units that accommodate large numbers of elderly prisoners include:
-
Central Florida Reception Center's south unit, designated specifically for elderly and palliative care inmates;
-
Zephyrhills Correctional Institution, which has two dorms designed for elderly inmates and those with complex medical needs;
-
River Junction Work Camp, a work camp for minimum or medium security elderly inmates in good health and able to work; and
-
South Florida Reception Center's F-Dorm, with 84 beds designated for palliative and long-term care, providing step-down care for inmates discharged from hospitals but not yet ready for an infirmary level of care at an institution.
Eligibility criteria for these facilities differ. The Central Florida Reception Center unit accommodates male inmates aged 50 and above with no recent violent disciplinary reports. The Zephyrhills Correctional Institution houses male inmates aged 59 and above and serves as a corrections mental health institution. To qualify for the work camp, inmates must be at least 50 years old, have no escape history, be eligible for parole within 10 years, and have no history of violent, sexual, or homicide offenses. The South Florida Reception Center dorm houses male inmates aged 59 and above with no serious escape or recent violent disciplinary reports.
Louisiana
Louisiana State Penitentiary (Angola) houses a significant number of aging men serving lengthy sentences, with approximately 85% of the nearly 5,100 inmates anticipated to pass away within the facility. In collaboration with University Hospital Community Hospice in New Orleans, the prison established a program that adheres to national standards for community hospice programs. Both prison staff and inmate volunteers offer supportive care within the prison infirmary at no extra cost. The community hospice contributed consultation, training, and services free of charge.
Inmates with severe illnesses are transferred to hospice care when doctors estimate they have around six months left to live. These patients receive additional privileges and a hospice team composed of fellow inmates. Each patient is assigned six hospice volunteers who regularly visit and attend to their needs. More information about prison hospice programs, including Angola's, can be found at http://npha.org.
Nevada
In response to the growing population of aging prisoners, in conjunction with lengthier sentences and increased life expectancy, the Department of Corrections (DOC) broadened its programs for older inmates. Typically, these initiatives admit individuals aged 50 and above, depending on the program's criteria and objectives. These objectives include:
-
Rehabilitation,
-
Enhancing cognitive behavior, physical agility, emotional health, and nutrition,
-
Assisting with community re-entry,
-
Managing prescriptions,
-
Fostering social interaction, and
-
Addressing age-related diseases.
Considering the growth of the aging inmate population, staff at the Northern Nevada Correctional Center developed the Senior Structured Living Program (SSLP) to serve aging offenders. Seniors can participate in various therapies, recreational activities, and cognitive skill-maintaining programs. One objective of the program is to decrease criminal behavior and enhance participants' sense of societal responsibility, as many have been removed from the community for extended periods.
The program is open to prisoners aged 60 or older who have not committed disciplinary offenses for at least a year. Participants earn work time and meritorious credit for active involvement. While in the program, they cannot hold outside jobs or attend full-time educational programs. Inmates temporarily assigned to the institution for various reasons or in transit are ineligible for the SSLP. Participants must also engage in daily and weekly therapy activities, group therapy programs targeting their offense history, and complete daily life skill assignments.
The DOC plans to increase the program's capacity and extend it to other DOC facilities in southern Nevada. This expansion will enable the department to process prisoners on waiting lists and integrate them into the program.
Pennsylvania
In 1980, Pennsylvania's prison system held only 370 inmates aged 50 and older, as per the Department of Corrections' statistics. By 2010, this figure had risen to 8,462.
The state correctional institution at Laurel Highlands caters to sick and elderly inmates. This minimum-security facility accommodates nearly 1,400 inmates, with around 400 of them being over the age of 50, according to the Department of Corrections. The remaining inmates are either younger individuals requiring special medical treatment or healthy prisoners working in food service, maintenance, and janitorial services.
Laurel Highlands houses two skilled care units, accommodating about 100 inmates, many of whom are transferred from other prisons. A referral process and waiting list are in place for inmates seeking transfer to Laurel Highlands. Additionally, the facility offers a four-bed hospice that provides specialized nutrition, chaplain visits, and other services. The prison medical staff consists of 26 registered nurses, 42 licensed practical nurses, 30 certified nursing assistants—all state employees—and four contracted physicians.
The prison offers specialized programs to address the needs of geriatric and seriously ill inmates, including long-term medical care, life skills programs, recreational activities tailored to older or infirm inmates, substance abuse programs, psychological assessment and treatment, and religious services.
As reported in the November 21, 2011 edition of LancasterOnline, the average annual cost for housing, feeding, and caring for a state prison inmate in late 2011 was $32,986, including $4,737 for healthcare, according to Department of Corrections spokeswoman Susan Bensinger. The annual per-inmate cost at Laurel Highlands was $45,993—almost 30% higher—including an average healthcare cost of $14,003. A 2004 legislative task force study found that the average annual cost per inmate receiving long-term care at Laurel Highlands was $63,500, compared to $62,000 per patient in a publicly-funded nursing home in the same county (the latter figure does not include security costs that would be incurred if the nursing home housed prisoners).
Washington
In 2011, Washington had 2,495 inmates aged 50 or older, which the state considers elderly. To cater to this population's needs, an assisted living unit was established at the Coyote Ridge Correctional Facility. The unit, with a capacity of 74 inmates, is located within the regular prison's perimeter but is separate from other units. Two nurses are assigned to the unit 24 hours a day, seven days a week.
To be eligible for the unit, an inmate must have a disability and be considered a minimum security risk. The average age in the assisted living unit was 59, a figure slightly influenced by three inmates in their 30s with disabilities. The majority of inmates in the assisted living unit were convicted of murder or sex crimes, though some were serving time for assault, drug, or property crimes.
New York
New York's Unit for the Cognitively Impaired, situated in the Fishkill Correctional Facility, mainly caters to prisoners with dementia. A February 26, 2012, article in The New York Times reported that the unit had cared for 84 inmates between its opening in 2006 and early 2012. The unit's annual cost per bed is approximately $93,000, compared to $41,000 for the general prison population. Fishkill also functions as the regional medical hub for the state prison system, with the unit occupying the third floor of the prison's four-story medical center. This setup allows the unit to provide a maximum-security environment within a medium-security prison, enabling it to accommodate inmates of any security classification from any facility across the state system.
In 2014, an expansion at the Walsh Medical Unit in Rome, New York added 38 skilled nursing facility beds.
KEY WEBSITES CITED IN THIS REPORT
-
McCarthy, Kevin Edward, and Carrie Rose. . Connecticut General Assembly, Office of Legislative Research, 2013. – General model for the current initiative.
-
2012 Human Rights Watch study
-
http://www.hrw.org/sites/default/files/reports/usprisons0112webwcover_0.pdf
-
2010 Vera Institute of Justice study
http://www.vera.org/sites/default/files/resources/downloads/Its-1about-time-aging-prisoners-increasing-costs-and-geriatric-release.pdf -
2008 Illinois General Assembly Legislative Research Unit report
http://www.ilga.gov/commission/lru/april2008firstrdg.pdf -
Virginia privatization study
http://sfc.virginia.gov/pdf/Public%20Safety/September%2024%20mt
g/Final%20Geriatric%20Report%20for%20Item%20387-B%20incl.%20Ex.pdf