The population of older adults in U.S. increased by 280% from 1999 to 2016.
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The U.S. corrections system faces a health care crisis as the population ages rapidly, offering a troubling glimpse into the challenges facing the nation as a whole. By 2050, the U.S. population of older adults is projected to increase from 58 million in 2022 to 82 million in 2050—a trend already evident in prisons. Between 1999 and 2016, the population of incarcerated adults ages 55 and older increased by 280%, while the number of younger adults increased by only 3%. Since then, the number of older residents continues to grow. The ACLU estimates that seniors will make up 1/3 of the total prison population by 2030.
As the demographics of the carceral system, and the country, change, institutions will be forced to adapt to meet the unique needs of their aging populations. While some prisons have taken steps to provide hospice and palliative care to a limited number of residents, many facilities are not equipped to care for a high volume of older adults, a report from the Office of the Inspector General confirms. Compassionate release and medical parole are an option for the select few who qualify, but these programs are often underutilized and difficult to navigate. In response to these challenges, some non-profit organizations have stepped up to fill the gaps in care for incarcerated people, while state and federal governments work to create long-term change. The Humane Prison Hospice Project created a unique model that could mediate the growing care crisis in prisons over coming decades. Humane trains residents to serve as hospice and palliative caregivers and grief companions to their aging and dying peers. This cost-effective and humanitarian approach benefits caregivers, care recipients, medical staff, and the facilities that implement it, and could serve as a scalable model for addressing the needs of aging adults in the broader community.
Dangers of Aging in Prisons
Prisons can be generally unhealthy places for people of all ages due to several environmental and systemic factors, but older adults are particularly vulnerable to poor mental and physical health outcomes. Incarcerated individuals over the age of 50 are more likely to be diagnosed with dementia and other mental health conditions than their non-incarcerated peers. Older residents also experience chronic conditions at higher rates than younger residents, and many are diagnosed with comorbid physical and mental health conditions. Incarcerated people with chronic conditions are not always granted medical exemption from mandated labor and can be required to work in hazardous environments without accommodations.
Caring for Incarcerated Individuals: Challenges & Solutions
Incarcerated individuals in the U.S. have a right to adequate healthcare, upheld by the Constitution, but older residents require more extensive, and more expensive, care than their younger counterparts. The U.S. Government Accountability Office reports that the Federal Bureau of Prisons spent over $9 billion on health care between 2009 and 2016, citing the aging inmate population as one of the key factors that contributed to these costs. In Texas, costs to incarcerate older adults increased by over $250 million between 2012 and 2019.
These funds go toward providing medical care to elderly and sick residents, which requires increased staffing, and making facilities more accessible for those with limited mobility. The California Medical Facility in Vacaville, VA, opened the first prison hospice unit in 1993. The hospice was originally built to care for incarcerated people dying of AIDS, but in recent years, the unit has transitioned to serve the needs of the facility’s aging population. The state penitentiary in Oak Park Heights, Minnesota recently expanded its transitional care unit to meet the needs of its aging population. The unit offers 24-hour nursing care and a clinic where patients can receive dialysis, among other medical treatments. Other state departments of corrections have established “prison nursing homes” at certain facilities. However, these existing units are not able to house all the incarcerated individuals who need extensive care— the CMF hospice has only 17 beds. Despite increases in spending on healthcare, the majority of prisons in the United States do not offer hospice programs; of the more than 1,566 state prisons across the country, 75 offer hospice care.
The hospice at California Medical Facility was the first of it’s kind, originally created in the … [+]
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A Humane Approach to Prison Health Care
Peer caregiving can transform the way aging and dying residents receive care in prisons across the United States, while lowering costs for facilities and providing a range of benefits to residents and staff. During the pandemic, the team at the Humane Prison Hospice Project developed a new curriculum in collaboration with Dr. Michele DiTomas and her colleagues at California Correctional Health Care Services, to bring their peer caregiving model to the California Medical Facility and the Central California Women’s facility. As part of this new program, volunteers must complete a 15-module course on hospice and palliative care, with a focus on the lived experiences of a prison population. Peer caregivers then work alongside other medical staff as part of a multidisciplinary team to address the health care needs of an aging population and occupy the space between residents and staff to advocate for the needs of care recipients. The program builds upon established communities within prisons, which allows individuals to receive care from people that they trust.
Laura Musselman, Director of Communications at Humane, emphasizes the presence of caring communities within many prisons nationwide. These communities have formed to support each other, serving as the foundation for Humane’s approach.
The peer caregiving model not only eases the strain on overworked medical staff but also fosters a nurturing environment within the prison community. Acts of compassion, no matter how small, contribute to a culture of empathy and respect. The ultimate goal of this program is to positively influence attitudes, behaviors, and health outcomes throughout the institution.
Humane has successfully implemented hospice and palliative care programs in five California prisons, training 118 peer caregivers. Their efforts are now focused on expanding this model to other states. Each facility is unique, requiring a tailored approach that involves input from community members and local organizations.
To establish a peer caregiving program in your area, Humane recommends three initial steps: researching available programs and resources, building relationships with local prison communities, and collaborating with relevant organizations to create a comprehensive care program.
Addressing the healthcare needs of older adults in prisons and post-release is an ongoing challenge. Community care models offer a human-centered solution that can bridge gaps in palliative and hospice care for incarcerated individuals and their non-incarcerated counterparts.
For more information and to get involved, visit humaneprisonhospiceproject.org.
The Well Beings Blog is committed to promoting health and well-being, reducing stigma, and changing public discourse. The Well Beings campaign, launched by WETA in 2020, continues to raise awareness through various initiatives, including the documentary series “Ken Burns Presents Hiding in Plain Sight: Youth Mental Illness.” The campaign also includes upcoming projects like the documentary film “Caregiving,” executive produced by Bradley Cooper and Lea Pictures.
For more information and support, visit wellbeings.org. Remember, you are not alone. If you or someone you know is in crisis, please reach out for help by calling, texting, or chatting with a crisis counselor at 988. Veterans can contact the Veterans Crisis Line by dialing 988 and pressing 1, visiting VeteransCrisisLine.net for online chat support, or texting 838255.
