Aging prison population challenges correctional health systems
The prison population is growing at a record pace—over 7 percent annually—but for the first time, it’s graying even faster. The Department of Justice estimates that by the end of next year the U.S. prison population will exceed 2 million. And like society at large, prisoners are getting older, sicker, and more costly to care for.“We are seeing more and more elderly prisoners, and it’s going to extend out for the foreseeable future,” said Rebecca Craig, MPA, RN, past president of the American Correctional Health Services Association. “We are going to see entire prisons getting licensed as acute care settings.”Still, many experts say U.S. prisons aren’t ready to handle large numbers of elderly prisoners. “There is a crisis in the making. The national prison population is graying at an unprecedented rate, and the prison system is simply not prepared to deal with gerontological disease and geriatric care,” said Jonathan Turley, a law professor at The George Washington University in Washington, D.C., and the founder of Project for Older Prisoners (POPS), an advocacy group for elderly inmates. “The geriatric prison population has very specialized needs that most facilities are very poorly suited to handle. The result is that most gerontological problems go untreated until they are chronic.”Many problemsElderly inmates pose a variety of problems for correctional facilities, not the least of which is the inflated cost of health care. The Texas Criminal Justice Policy Council found that the cost of medical care for the general prison population in 1997 was $5.23 per offender. For elderly inmates, the figure was $14.50, nearly three times as much.That’s not all. Because age-related health problems usually occur earlier in life for prisoners, inmates are considered “elderly” at age 55, which is 10 years before they would receive that distinction outside prison.“This is a population in general that comes in with a very high level of need, and it only increases as they get older,” said Allen Sapp, assistant director of Texas Correctional Managed Health Care, which handles health care for the state’s 150,000 prisoners at 110 prisons.Texas is one of seven states that have established separate facilities for elderly prisoners. Seven years ago the state converted part of the W. J. Estelle prison in Huntsville into a 60-bed geriatric center, adjacent to the Estelle Regional Medical Facility Unit, one of the five medical centers in the state where prisoners can receive extended care. The Estelle center is equipped to handle the geriatric population and includes a skilled nursing facility.But the state is not presently prepared to deal with an expected population explosion of older inmates, Sapp said. Elderly prisoners already account for three times as many new admissions as younger prisoners. Overall, the number of elderly offenders increased by more than 86 percent from 1994 to 1998, more than twice the 35.4 percent growth rate of the rest of the prison population.But the most significant increase will be the present population of inmates condemned to grow old behind bars: There are nearly 60,000 prisoners between 36 and 54 years of age, serving an average sentence of almost 24 years.Complex needsTreating any prisoner is a complex undertaking. Security is the primary concern and can complicate treatment. In Texas, the entire prison population is served by either the University of Texas Medical Branch at Galveston or the Texas Tech University Health Sciences Center at on-site clinics, infirmaries, and convalescent hospitals and medical centers.But for elderly prisoners, age-related problems are compounded by facilities that are poorly equipped to deal with gerontological illnesses, especially illnesses that have been compounded by years of neglect.“You’re going to see the same disease entities, but the difference is that the older prisoners have had no or limited exposure to the healthcare system,” said Jan Osten, RN, chief nurse for the Federal Bureau of Prisons. “Our staff will be trained to deal with the increase in the number of older prisoners, but balancing care and custody is necessary when you work in a prison. We tell every nurse we hire that they are also a correctional officer.”Some say the extra training may not be enough. “Medical personnel are already pushed to the limit in most facilities, and it makes it very difficult to deal with the daily needs of older prisoners,” Turley said.