Aging Behind Bars

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Older offenders are of course more likely to suffer from serious medical conditions, and unlikely to receive the care they require. Old people in any institutional setting may find that their health complaints are not taken seriously, due to some combination of dismissive attitudes and cost-cutting. In prison, such factors apply in the extreme. When I spoke with health care providers working in one Southern prison, they described how a diabetic man’s illness was misdiagnosed by the prison, resulting in months of excruciating pain and the amputation of toes and part of one foot. Back in prison, the man asked for prosthetic shoes so he could get around by walking; his request was denied. Another man complained of an earache for months. He was given drops, but the pain persisted. Eventually he was sent to a local hospital emergency room, where doctors discovered the earache was in fact brain cancer, which might have been treated if discovered back when he first complained. Now he is terminal.

Brie Williams of the University of California Medical School at San Francisco and Rita Abraldes, an independent researcher, recently completed a study that was published as a chapter in the book Growing Older: Challenges of Prison and Reentry for the Aging Population. They found that the cost for each geriatric inmate came to $70,000 a year. In addition to the chronic diseases that increase with age, these offenders have have problems such as paraplegia because of gunshot wounds, and advanced liver disease, renal disease, hepatitis and HIV from drug and alcohol abuse. Living under prison conditions, they are more likely to get pneumonia and flu.

Many older offenders suffer from serious mental illness–some of it lifelong, and some of it produced by their incarceration. One study revealed depression among male prisoners was 50 percent higher than for those living outside. All in all, 54 percent of older prisoners met standards for psychiatric disorders. Williams and Abraldes write, “In one report from a maximum-security hospital, 75 percent of elderly prisoners were admitted between age 20 and 30 and the majority were schizophrenic.” At Angola, the warden reported that 2,000 of over 5,000 inmates were on psychotropic drugs. Many mentally ill prisoners are simply warehoused and fed drugs to keep them under control. Even worse, some are labeled “discipline” problems, and end up in solitary confinement.

Jonathan Turley, a George Washington University law professor and founder of the Project for Older Prisoners, has written extensively about alternatives for aging offenders: for lower risk prisoners, various forms of supervised release, including electronic bracelet monitoring; and for higher risk prisoners, geriatric units, where the cost of better care could be more than balanced by reducing the number of corrections officers. “Although a geriatric prisoner may still be a risk for a given category of crime,” Turley writes, “he is unlikely to toss his walker over a razor-wire fence or outrun perimeter guards.”

In 2008, the federal government finally launced the Elderly Offender Home Detention Pilot Program, under which old prisoners can be released into a kind of supervised house arrest. As outlined by Families Against Mandatory Mimimums, eligibility guidelines are strict: Offenders must be over 65, and must have served at least 10 years and 75 percent of their sentences; no lifers and no perpetrators of “crimes of violence,” including sex crimes and firearms violations. Total number expected to participate: 80 to 100 nationwide, out of a total federal prison population of over 200,000. In Pennsylvania, after a lengthy study conducted by a special Advisory Committee on Geriatric and Seriously Ill Inmates, the state also launched a pilot project. Total prisoners released in one year: eight to ten.