How do prisons cope with very old prisoners who are serving life sentences? What happens to the ones who are infirm and can no longer care for themselves? What about prisoners who develop dementia - are there Alzheimer’s wards inside prisons?
Well, fellow Doper Qadgop the Mercotan is a physician in a prison hospital somewhere in … Wisconsin, I believe? So at least some, and I think a majority of, prisons have on-site medical centers and physicians with prescriptive authority and, presumably, an on-site pharmacy as well.
Beyond that, I don’t know. Are end-stage Alzheimer’s patients typically paroled into nursing homes instead of being kept in prison? It seems rather pointless to lock up a person who can’t even remember his own name nine times out of ten.
My WAG would be that few people ever suffer from Alzheimer’s or die of old age in prison. They would likely be paroled at the point where they no longer present a danger to the public, and/or where they would prove a burden to the prison system because of, say, Alzheimer’s.
Look at Alvin Karpis. Part of the Ma Barker gang, Karpis was captured and sentenced to life in 1936. From the Wikipedia link:
Karpis spent 25 years in Alcatraz (longest serving inmate, apparently), but being born in 1907, he would have been about 29 when he was sentenced to life, and about 62 when he was paroled. So, no rotting away in jail for this lifer; he only served 33 years of a life sentence behind bars.
Although Karpis is just one example, I’m sure there are many others where parole for a lifer becomes possible in old age.
We cope as best we can.
There is exactly one prison infirmary (think skilled nursing facility) in my state to serve the needs of 23,000 inmates. That infirmary has less than 70 beds. And needs to be used by more than just the old folks. Quadriplegics need it (damn computer crime! It puts a new population in prison that used to have trouble breaking the law). Post-op patients need a bed for a week or two at times. And now we’ve got hundreds of inmates in their 70’s.
Last month, a new inmate was sent to prison, just in time to celebrate his 89th birthday.
With our state’s “Truth in Sentencing” laws, these guys will not get paroled sooner than their fixed maximum discharge date, no matter how good they behave, and no matter that they’re no longer a risk to the community. Instead, we’ll spend tens of thousands of dollars to provide nursing home care in a secure environment. It’s not cheap, we need more beds, and we need a prison designed for geriatric patients.
Judges and politicians in my state don’t want to be seen as being soft on crime, so few people get released to outside nursing homes just because they’re so demented they don’t know who they are anymore.
Inmates who can basically take care of themselves without the need for 24 hour nursing live in the general population as best they can.
We’re trying to develop inmate health aides and personal care assistants to help some of the older and disabled patients stay in the general population. Many just need a little help dressing themselves and reminders of when to take their pills and where to shower. But the regulations on inmate workers and HIPAA laws are making it difficult to get this implemented.
It’s a looming mess and it is going to get worse. At least in my state. And I just returned from the National Correctional Health Care conference, and it sounds like most of my colleagues in other states are facing similar dilemmas.
Slightly off topic, in Minnesota the State Hospital system holds mentally ill & chemically dependent people. There are now enough elderly people in the system that the state has one facility that functions as a nursing home for these patients. It’s much like a similar civilian nursing home, except that many of the patients are mentally ill, and some are very violent. Security is a major concern, but otherwise it’s a typical nursing home.
My state has only one of the facilities like **Qadop **and t-bonham@scc.netdescribed. It houses about 350 elderly inmates.
It’s constantly on the chopping block because it costs so much to operate. It has the same budget as a prison many times its size. (Many of the costs of running a prison are fixed-- utilities, staff pay, etc.-- which aren’t dependant on population). Whenever budget cuts are discussed, that’s always the one which gets mentioned first. Thus far, it’s survived, but its future is tenuous at best.
Also to add, hubby just told me a couple of interesting things.
There is something called a “compassionate release”. This is a release, sought from the judge, Governor or parole board that releases a prisoner prior to the end of the sentence based upon some exigent circumstances. With indefinite sentences, it is much easier, as the parole board has complete discretion. But, since “truth in setencing” came out, it takes a whole lot more.
With over 40K prisoners, and 1,000’s over the age of 50 in the state, hubby knows of only 1 compassionate release of a “truth in sentencing” inmate in his entire career. There may be more parole ones, but those would be hard to identify because they would just do it and it would not be that big of a deal.
In this one case, the single inmate was costing around 1,000,000 a month in medical expenses. He was over 40 and was sentenced on a non-violent offense. He had only 6 months to go and they got the governor to release him (mostly to save money). By the time the paperwork went through, he had already cost over 6 million dollars.
The fact is, as the prison population continues to age, and Life Without Parole is used more often (over 300 in my state), this will become a much larger issue. When hubby was in charge of the medical/mental health operations, he sought a “compassionate release” for a particular offender. Once again, budget was the primary issue.
He was receiving a non-formulary drug to treat an advanced form of cancer. Since the drug was rarely used, and not in production by any firm save one, it cost over 3K a dose, 3 times a day. Thus, it was costing him 300k a month for one prisoner. In addition, the prisoner needed frequent trips to the ER, or hospital for some treatments, and this costs a lot (transportation, extra security, etc…) In all, this one inmate was costing a lot of money. If you extrapolated his costs annually, he would represent almost 10% of the prisons budget to house 2,850 inmates. He was 65+ years old and was serving 5 consecutive sentences of life for rape and murder. He had been in prison for 30+ years.
However, his first parole eligibility date was still not until 2030+. They did all the paperwork, but as you can imagine, the political realities of sex offenders resulted in a denial. The inmate has still not passed on, he is not receiving the same treatment, but now requires dialysis and other life sustaining measures. He has been moved to a secure long-term chronic care facility. The average cost per inmate (non-medical) is about 100k a year. In addition, the inmates secondary expenses run in the thousands a month.
This is just two inmates.
There are 100’s of inmates on dialysis, when years ago there were just dozens.
There are dozens of alzheimer’s patients, when years ago there were none.
There are hepatitis and AIDS rates as high as 30%.
There are over 1,000 inmates on his prison’s chronic care caseload (heart disease, diabetes, etc…) that require more intensive treatment.
There are 100’s of inmates undergoing chemotherapy treatments, when there used to be only a handful.
To make matters worse, a recent class action lawsuit resulted in a settlement that is expected to raise healthcare costs by a factor of 20-30% a year. Currently, the budget for the dept is 1.8 billion. 8.2% of that is medical care (budget) alone. that is around 150 million. Each year, they must move millions from other line items to cover health care cost run-overs.
The simple fact is, the get tough approach on crime resulted in longer sentences (many times for the crimes that most people feel are heinous and play on the fears of the public- sex/murder/kidnap. But, the are a lot of non-violent offenders with huge setnences). The legislature is even talking about using civil committment to deal with sex offenders, that will result in the average cost of “incarcerating” sex offenders, who otherwise would have been released, at an annual cost of about 100k an inmate.
Regardless of any indivdual stance on this issue, the straightforward reality is impossible to avoid. The taxpayers will have to get their checkbooks out and pay for this.
The only question one has to ask themselves is, how much money are you willing to spend to minimze the potential risk to the community of aging offenders? Regrettably, whenever an emotional issue comes up, most people cry “think of the children” and stipulate no cost is too great to bear in order to protect a single child. However, these same people are typically the ones who don’t want to raise taxes and then wonder why there are budgetary shortfalls.
I am reminded of a story my husband once told me about how he was briefing “freshmen” legislatures. He was explaining the medical budget and one of them asked in an excited and incredulous tone “You mean we PAY for inmate health care, I have constituents who cannot afford health care”. My husbands reply, “Yes sir, we do.” The legislator asked why. My husband simple said soemthing to the effect of, “Well, you know the pesky Constitution gets in the way alot”.
But on the other hand, a special medical facillity probaly wouldn’t cost more then those State Hoispitals for the mentally ill and mentally retarded that were popular back in the day.
Where are the inmates supposed to find medical care after they have been granted an early release? Something bothers me about the idea of locking up someone for life, and then chucking them out the door when they become a financial burden.
Another country and another situation, but somewhat related.
In Spain, a “life sentence” used to mean exactly that, but one of the first laws passed post-Franco turned “life” into “40 years”. This led to releases of people who had never, ever, expected to leave. One of them went to a judge’s house and asked him to let him back into the prison: he didn’t have any family and the outside world was completely alien. He’d been a gardener in the jail in Seville for the last 20 years.
They couldn’t let him back in as such, so what they did was place him in an old folks’ home and allow him to go to the jail every day, to work on “his” gardens. The guards would pick him up on their way to work and bring him back at night.
I don’t know about your average thief or murderer, but if you’re a major Nazi war criminal serving a life sentence, you’ve got a 2/3 chance of getting released early once you get too old or sick. Of the three Nuremburg trial defendants handed a life sentence, two of them (Raeder and Funk) were released less than ten years into their sentence for reasons of ill health.
I’m shocked. 70 beds for 23000 inmates? We have eighty beds in my facility alone and only 1600 inmates. Granted we are a medical facility.
People should realize in most states it’s not like every inmate is dumped together. We try to seperate the hard-core from those just doing time. An elderly inmate who’s no longer a security risk will end up in a minimum security prison. And we have special units for inmates who are senile or have Alzheimer’s (or are just retarded).
But don’t underestimate the old timers. Some of them are surprisingly scrappy. We have one 80 year old prisoner who was arrested at the age of 71 (he was a major drug dealer). When the police showed up to arrest him he pulled out a gun and tried to shoot his way out.
Perhaps there is the case of Ernest Saunders to consider.
Can you imagine the outcry if any of the Enron people were to successfully try this?
Maybe it’s the Canadian in me, but I agree this seems rather horrendious.
At the same time, I’m not sure I can justify spending $3000 on medication for one prisoner. I would really wonder if an alternative therapy wasn’t available - of course, I’m not a Dr. and it’s possible that this inmate needed that particular drug; however, had I been the administrator of the prison, I might have been asking doctors about some less expensive alternative therapies.
But - for the guy who’s care was costing $1,000,000 a month - who was going to pay for his treatment when he got out? The state, I assume?
He did. There were actually a lot of meetings about the inmate in question, not only with the doctors who work in the prison, but other doctors and experts who might be able to suggest some alternatives.
Considering the security issues and the man’s medical conditions, there really was no alternative.
Great summary, Lissa. I can echo nearly all of that, tho we’re fortunate in that our HIV rate is only about 1%. But diabetes is an epidemic, and we’re literally diagnosing new cases weekly as the inmates are admitted. They’ve had symptoms of diabetes for months to years prior to coming in, but ignored it.
We too don’t get many guys out via “Compassionate Release”. To be eligible, one has to expect to die in less than 6 months. Even then, if it’s a sex offender, forget it. The judge will not spring for that. Heck, I lost two patients to advanced cancer recently, both of them were to be released within weeks of the date they died, both were multiple DUI convictions without bodily harm to anyone, and in each case, neither made “Compassionate Release”. It cost our system tens of thousands of dollars for caring for them in the last few weeks of their lives.
Those elderly who do get out are almost always eligible for medicare, and our social workers generally work on getting that set up for them before they leave. They go out with two weeks worth of meds (one month of psychiatric meds tho) but then they have to get it themselves.
We get a lot of liver failure patients too, due to years of alcohol and drug abuse. Their only shot is to get a liver transplant, and frankly most of them get the transplant, then die slowly in the hospital over the next 6 months, costing millions of dollars. I’ve seen very few successful liver transplants in our system. Our population just has such bad health to begin with that any sane transplant doc should be extra leery of operating on them.
Our politicians visit our prison and ask me why the hell we’re giving these criminals any medical care at all! Of course I reply “the law says we have to”. When they talk about changing the law, I inform them that they’ll probably have to amend the constitution first. At present, I believe that inmates are the only class of people in the US who have health care paid for by the government as a guaranteed constitutional right. The VA, which serves our vets, is not constitutionally guaranteed care.
And as our older guys get to be less of a threat, they migrate from max to medium to minimum. Some never mellow out enough to reduce their security status tho.
I could go on for hours, as I’m sure lissa and her husband could too.
Oh, do please go on, Qadgop! That goes for Lissa and hubby, too. I’m sure I’m speaking for everyone who’s posted to this thread when I say we want to hear more.
Which part of the constitution states, or is interpreted as stating, that state or federal governments must provide health care to prisoners? (Not that I doubt you; I’m just curious and want to read more about this.)
8th Amendment, made applicable to the states by the 14th Amendment.
It’s considered to be cruel and usual punishment to imprison someone without providing necessary health care.
Here’s what the U.S. Supreme Court had to say in Estelle v. Gamble, 429 U.S. 97 (1976), after a brief discussion of 8th Amendment law:
Note: the reference to “1983” is to a statute that provides a remedy for violations of Constitutional rights.
Oh, and here’s a link to the full text of the case:
http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=429&invol=97