Nursing homes can potentially be dangerous places for the elderly, considering a wide array of residents’ backgrounds—including convicted criminals—and a recently journal article suggests this may be a growing issue considering an “exponential rise” in the number of older prisoners that’s creating new and costly challenges to the nation’s criminal justice system, state economies, and the communities to which older former prisoners return.
In a letter to the editor of the Bradenton Herald, a Florida newspaper, a retired licensed practical nurse writes:
“Where do you think elderly convicts, sexual predators and drug addicts go? They are mixed in with the frail, elderly handicapped, mentally and physically. And yes, abuse does happen. The state usually investigates and they, the convicts, etc., are moved to—you guessed it, another nursing home!”
Another news piece from an Alabama ABC affiliate mentions a state push to pass a bill notifying nursing home and other senior care facility residents when anyone with a sexual abuse history is admitted, citing a 93-year-old woman who had been abused by a fellow resident who happened to be a repeat sex offender with a criminal record. Only two states—Virginia and Oklahoma—have passed similar laws, the article says.
From that perspective, current nursing home residents can be placed in dangerous positions if they’re living alongside other people who may have violent or otherwise criminal backgrounds. But an article published in the June edition of the American Journal of Public Health says there’s actually an even bigger problem at hand: how the nation will care for a growing population of old, sick prisoners.
During a 2011 roundtable meeting at John Jay College of Criminal Justice in New York City, a group of national experts in correctional health care, academic medicine, nursing, and civil rights proposed a policy agenda meant to address several priority areas for the nation’s elderly prisoners.
For prisoners that aren’t transferred to nursing homes, prisons themselves will need to become more accommodating to an aging population, they said.
More than 95% of prisoners are eventually released to the community, the article’s authors point out, and by that time, many have chronic medical conditions and either rely on expensive emergency services, or are hospitalized upon release, often at enormous expense to the healthcare system.
Rather than releasing them in such poor condition, the authors call for earlier identification of and attention to age-related disabilities, along with prison programs that improve health and cognitive skills.
“One of the greatest challenges for the criminal justice system is how to adapt prison facilities designed for younger persons to accommodate an aging population,” they write in the article. “One solution is specialized facilities, often referred to as geriatric units. Such specialized facilities, which are intended for use only by frail older adults or disabled younger adults, differ by prison but might include, for example, handrails, accessible ramps and showers, and no bunk beds. Such geriatric units require a large up-front investment, yet proponents argue that centralizing aging populations enhances prisoner safety and make providing care easier and less costly.”
On the other hand, some argue that older prisoners should be removed from a traditional prison and placed in a separate facility that’s similar to the long-term care facility model.
“Aggregating older prisoners into living quarters with greater access to assistance, supervision, and health care could help to target services and medical care programs to prisoners at highest risk of adverse health outcomes,” they write. “This could decrease cost by streamlining staff, improving chronic disease management, and decreasing hospitalizations.”
This model has some drawbacks, though, the authors note, as older prisoners may not want to leave the general prison population and be segregated by age, and prisons would have to be governed by prisoner preference.
Ultimately, they say, more prisons will need to develop plans for a continuum of care, from community independent living to assisted living facilities to skilled nursing care. And considering how much it costs to provide 24-hour-care and the limited number of units available in which to administer such care, the article continues, it will be important to develop a long-term care model of prison.
“As the criminal justice system works to decrease its burgeoning population, it is important that national and state policymakers work with corrections and community organizations to understand the number of older inmates who are dual eligible (Medicare and Medicaid eligible), the impact on county and state services and budgets, and how gaps in the continuum of care can be addressed,” the article concludes.
Access Aging in Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care here.
Written by Alyssa Gerace