Dealing with aging and mentally infirmed prison inmates

As many as 20% of the 14,000 prisoners in Canada’s penitentiaries are over 50 years of age. That comes to 2,800 prisoners, both men and woman who are serving time in our federal prisons. We don’t have to be overly concerned about elderly prisoners in provincial reformatories or jails in Canada over crowding those institutions because the most that they will be incarcerated is two years less a day.

The percentage of elderly prisoners relative to the overall prison population in the United States continues to rise. It has been predicted that by the year 2020, as many as 16% percent of those serving life sentences in the US will be elderly prisoners. Elderly inmates represent the fastest growing segment of federal and state prisons in the US. Mandatory minimum sentences and three strikes sentencing laws established in recent decades are keeping more offenders in prison for longer periods of time. And these inmates are living longer; meaning that prison populations continue to swell. The soaring number of aging inmates is now outpacing the prison growth as a whole. It’s becoming an increasingly common sight in prisons: geriatric inmates spending their waning days behind bars.

Prisons aren’t geared to the needs and vulnerabilities of older people. In the prison environment, there are a number of unique physical tasks that must be performed every day in order to retain independence. They’re not the same tasks that are called for in the community. For example, climbing up into an upper bunk in a cell or climbing stairs in a prison.

There is no national consensus about the age at which an inmate qualifies as “old” or “elderly.” The U.S. Census Bureau defines the general “elderly” population as those 65 and older, but the National Commission on Correctional Health Care uses 55 as its threshold for “elderly” inmates. At least 27 states have a definition for who is an “older prisoner,” according to a recent survey: 15 states used 50 years as the cutoff, five states used 55, four states used 60, two states used 65 and one used age 70. Ohio defines elderly inmates as those aged 50 and older, Minnesota sets the age at 55. Michigan considers those 60 and above as elderly, while in Colorado, this designation is reserved for inmates 65 and older.

Obviously there are prisoners who are older than 65 who are fit for their age and there are also prisoners who are 50 who are not fit for their age. Prison inmates tend to age faster than members of the general population. Research indicates that a prisoner’s physiological age is, on average, seven to 10 years older than their chronological age. Therefore, a 50-year old inmate may likely experience the age-related health problems of a 60-year old on the outside.

Arthritis, hypertension, ulcer disease, prostate problems and myocardial infarction are among the most common chronic diseases among elderly inmates. Diabetes, Hepatitis C and cancer are also common ailments these prisoners suffer from. Like the elderly population outside prison walls, older inmates need special adaptive devices to help overcome physical impairments. For many of the elderly prisoners, walkers, canes, hearing aids, eyeglasses, dentures and geriatric chairs are necessary for them to function well.

Across the United States, various states are beginning to take steps to address the implications of an older prison population. From developing targeted programs and activities for elderly inmates to providing specialized geriatric care, state corrections departments are devoting an increasing amount of attention and resources to the needs of seniors.

At least 16 states provide separate housing facilities for older prisoners; in seven states, these housing units are reserved for elderly inmates with special medical needs or for those otherwise eligible for hospice care. (those who are dying) The Minnesota Correctional Facility at Faribault, a medium security facility for adult males, has a dedicated housing unit for inmates 55 and older with chronic health problems. Licensed practical nurses provide coverage 16 hours a day and around the clock nursing is offered in a clinic area. At Angola State Penitentiary in Louisiana, once known as the bloodiest prison in America, death among inmates is now more often due to natural causes. Facing a fast-growing population of elderly inmates, Angola is one of many prisons across the country that offers hospice care for inmates in the final stages of terminal illnesses.

A few states have even designated prisons for older inmates. Since 1996, Pennsylvania’s State Correctional Institution at Laurel Highlands has been housing only elderly inmates and others who require long-term care or assisted living. Converted from a state mental hospital, the facility is designed to meet the needs of an older population, including long-term care inmates and wheelchair users.
Obviously medical care, handicap facilities, specialized diets and specialized exercise regimens are all easier to provide when elderly inmates are in a single location.

Across the country, corrections professionals, academics and policymakers are considering whether some older inmates should be released through medical and early release programs. A number of states have compassionate release programs in place for terminally ill inmates, but some experts claim that these programs are rarely used, due to bureaucratic and other obstacles.

I can see an obstacle that would prevent elderly infirmed prisoners being released back into the community. I am referring to prisoners who are serving life sentences for murder, terrorism or other serious violent crimes. I cannot in all honesty see the sense of releasing these kinds of prisoners back into the community no matter how ill they are.

But surely, those who are sentenced in the United States under the three-strikes-law are eligible to being released back into the community if they are elderly and infirm unless of course, their latest crime was one of extreme violence.

You may well ask, what about Bernie Madoff who is serving 150 years in prison for defrauding billions of dollars from so many unsuspecting victims? He is an elderly prisoner and if he becomes infirm, should he be released in passionate grounds? I think not. He wasn’t sent to prison for the protection of society because it would be highly unlikely that anyone would ever trust this scammer again. He was sent to prison for two reasons. The first as punishment and if anyone is ever deserving of punishment, it is this man. The second reason is that his imprisonment for such a long period of time is intended to act as a deterrent. Unless he is dying or requires immediate hospitalization, he should remain in the prison infirmary if he is ill.

Elderly inmates who are infirm and not the kind of prisoners I have just mentioned and who are considered low-risk for re-offending, should be released under a medical reprieve and undergo a supervised release program.

I am not necessarily speaking about prisoners who have just been incarcerated. Unless they are dying or require immediate hospitalization, they should serve a period of incarceration. After all, they were sent to prison for punishment. In Canada, prisoners are eligible to apply for an early release after they have served one sixth of their sentence while incarcerated. Generally, they have to serve two-thirds of their sentences before they are automatically released but in cases where the prisoner is permanently infirm and requires hospitalization, he can be released earlier.

Although the prisons may reduce costs through early release of elderly infirm prisoners, the cost to taxpayers doesn’t necessarily go away. The medical care and hospital costs outside the prison will still be a burden for the taxpayers.

Many elderly prisoners suffer from some form of mental illness. Up to 50% of over 60s charged with a crime may suffer from a mental illness. Alcoholism is one of the most common illnesses, but it depends on the crime. Sex offenders who had a mental disorder were more likely to suffer from dementia, depression or personality disorder. Shoplifters tended to suffer from depression, as do the very small proportion of elderly homicides with mental illness. It has been estimated that nationwide, 16% of inmates suffer from some form of mental illness in the United States.

Of the older mentally ill inmates in the Utah State Prison, 57% had a primary diagnosis of depression, 25% schizophrenia, and 18% bipolar disorder. Schizophrenia spectrum disorders were seen in 3% of the older population, exceeding the incidence in seniors in the community. The rate of atypical anti-psychotic medication use in older mentally ill inmates was 33% versus 23% for younger inmates. The majority of older mentally ill inmates required sheltered or specialized mental health housing.

Age-related changes and conditions specific to confinement will no doubt influence the mental health of aging inmates. The fear of dying in prison and of falling victim to pain and disability are heightened. Further, limited physical strength and the lessened ability to defend oneself against younger, predatory inmates is a worry for many. The death of relatives, friends, and other older inmate companions may create a sense of increasing interpersonal isolation.

Apprehension about becoming helpless and the loss of independence may arise from the declining health and premature aging that many older inmates experience. Finally, there is the fear of release from prison: how to locate housing and support oneself financially, how to secure medical care, and how to reintegrate into a fast-paced society that has been moving forward as the inmate’s life has stood still. All these factors will increase the inability of the aging prisoner to mentally function properly.

It is obscene to house aged and mentally infirmed prisoners with younger prisoners since the latter are prone to bullying the older prisoners and those suffering from mental illnesses. There is a responsibility placed upon our correctional services to protect the aged and the mentally infirmed prisoners but unfortunately, our governments in Canada, both federal and provincial are found wanting with respect to the treatment and care of the aged and mentally infirmed prisoners.