The prison community faces its own battle against rising medical costs, with the elderly constituting the fastest-growing sector of inmate population. Experts say inmate medical-care costs are about $3 billion a year and several states are allowing the early release of older, ailing inmates. Report and slideshow on CNN.

White fuzz covers his bald head. His sallow skin sags. A wheelchair and cane support limp legs.This is not the typical image of a prison inmate. But 73-year-old George Sanges is among the burgeoning elderly population behind bars, a group expected to continue to grow as baby boomers age and states implement longer sentences.Sanges, who is serving a 15-year sentence at Men’s State Prison in Georgia, has cerebral palsy and takes multiple medications twice a day. His condition has worsened since he entered prison in 2005 for aggravated assault against his wife of 48 years. Twice while in prison, he was rushed to the hospital for heart problems. “They help me here,” Sanges says. “Everybody is very nice to me.”

As health care sparks debate across the nation, the prison community faces its own battle against rising medical costs. The elderly constitute the fastest-growing sector of the inmate population, experts say. It is a group that needs more frequent and costlier treatment, which states are required to provide under the cruel and unusual punishment clause of the Eighth Amendment to the U.S. Constitution.

An analysis of Bureau of Justice Statistics data found that the male prison population over age 55 ballooned by 82 percent in eight years, from 48,800 inmates in 1999 to 89,900 in 2007. The definition of “elderly” varies by state. The National Corrections Institute, a prison research organization, calls inmates over 55 elderly, and some states place inmates over 50 in that category. An inmate’s body ages faster than the body of someone not in prison.

Georgia, one of the 10 largest prison systems in the country, spends about $8,500 on medical costs for inmates over 65, compared with about an average of $950 for those who are younger, corrections officials say. Across the county, inmate medical care costs about $3 billion a year.

Men’s State Prison holds the largest number of sickly elderly inmates in Georgia. The medium-security facility, in a quaint rural town, is enclosed by barbed wire just like any other prison. But inside, inmates play card games and checkers rather than shooting hoops or lifting weights. The oldest inmate here is 89. There are veterans who served in World War II.

Gang fights here are rare, though there is still bickering and catfights from the wheelchair seat. Diapers, breathing machines and hospital beds wrapped in plastic for easy cleanup are visible in almost every corner of the hostel-style room where prisoners sleep.

Every inmate here has a medical condition; dementia, hypertension and diabetes are the most common, the warden says. “With the elderly population, we’re beginning to run something comparable to nursing homes,” says Sharon Lewis, medical director for the Georgia Department of Corrections. “This is one of the unhealthiest populations found anywhere. They really lived life hard.”

In the last few decades, a growing number of prisons have improved their quality of medical care, says Edward Harrison, president of the National Commission on Correctional Health Care, an accreditation organization based in Chicago, Illinois.

Elizabeth Alexander, director of the ACLU’s National Prison Project, says investigations revealed that inmates were often denied access to certified doctors in the 1970s. In some instances, inmates were providing medical and dental care to one another. There continues to be lawsuits filed against prisons and jails for providing poor medical care, she says, but overall, the care has vastly improved.

Some states, such as Virginia and Pennsylvania, have built geriatric prison facilities that resemble mini-hospitals, equipped with medical devices and oxygen tanks. Prisons are being licensed as acute-care settings with a crew of registered nurses, correctional health experts say.

Placing elderly prisoners into separate facilities or wings can help the state consolidate costs. Nearly 75 hospice programs exist in prisons — up from less than 10 a decade ago, says Carol McAdoo of the National Hospice and Palliative Care Organization.

“I would argue that the health care that is rendered behind bars is better than what is received in the general population,” says CEO Rich Hallworth of Prison Health Services, a private medical corrections company in Tennessee that serves 172 jails and prisons around the country.

To ease budget woes in California, one bill up for debate would allow nonviolent elderly prisoners to be released into hospice care or monitored with ankle bracelets. In the past few years, Georgia officials say, the state has released more frail and dying inmates on medical reprieve than ever before. Other states, including New York and Virginia, have also allowed early release of ailing elderly inmates.

But critics, including victims’ advocacy groups, have scrutinized this policy. Will Marling, executive director of the National Organization for Victims Assistance in Virginia, said most victims believe offenders will strike again after they are released.

“If a person is sentenced to life, we know they are naturally going to get old,” Marling said. “A life sentence should mean life.”

Most of the elderly inmates at Men’s State Prison in Georgia are serving lengthy sentences for crimes committed when they were younger, officials said. A “three strikes law” passed in the 1990s contributed to much of the growth in the state’s geriatric prison population.

But there remains a group of elderly inmates who committed violent crimes during their golden years, proving the point that many victims worry about.

Research has shown that arrests of elderly offenders have risen. Their imprisonment has also contributed to the aging inmate population, but little is known about why the elderly commit crimes.

With his sight nearly gone, George Sanges peers through thick glasses at an old photograph from his locker. After several seconds, he slowly distinguishes his wife’s face.

“That’s Betty,” he says.

Sanges cannot explain why he attacked his wife. He was 69 years old then, a grandfather without a criminal history.

“I got in trouble,” he repeats several times. “I’m really sorry.”

janchavarie Aging Population, Economic Issues, Georgia, Inmate Health Care

From a feature article in the New York Times:

Allen Jacobs lived hard for his 50 years, and when his liver finally shut down he faced the kind of death he did not want. On a recent afternoon Mr. Jacobs lay in a hospital bed staring blankly at the ceiling, his eyes sunk in his skull, his skin lusterless. A volunteer hospice worker, Wensley Roberts, ran a wet sponge over Mr. Jacobs’s dry lips, encouraging him to drink.   “Come on, Mr. Jacobs,” he said.

Mr. Roberts is one of a dozen inmates at the Coxsackie Correctional Facility who volunteer to sit with fellow prisoners in the last six months of their lives. More than 3,000 prisoners a year die of natural causes in correctional facilities.  Mr. Roberts recalled a day when Mr. Jacobs, then more coherent, had started crying. Mr. Roberts held his patient and tried to console him. Then their experience took a turn unique to their setting, the medical ward of a maximum security prison. Mr. Roberts said he told Mr. Jacobs to “man up.” Mr. Jacobs, serving two to four years for passing forged checks, cursed at him, telling him, “‘I don’t want to die in jail. Do you want to die in jail?’  “I said no,” said Mr. Roberts, who is serving eight years for robbery. “He said, ‘Then stop telling me to man up,’ and he started crying. And then he said that I’m his family.”

American prisons are home to a growing geriatric population, with one-third of all inmates expected to be over 50 by next year. As courts have handed down longer sentences and tightened parole, about 75 prisons have started hospice programs, half of them using inmate volunteers, according to the National Hospice and Palliative Care Organization. Susan Atkins, a follower of Charles Manson, died last month in hospice at the Central California Women’s Facility at Chowchilla after being denied compassionate release.

Joan Smith, deputy superintendent of health services at the Coxsackie prison, said the hospice program here initially met with resistance from prison guards. “They were very resentful about people in prison for horrendous crimes getting better medical care than their families,” including round-the-clock companionship in their final days, Ms. Smith said.  The guards have come to accept the program, she said. But still there are challenges unique to the prison setting. Some dying patients, for example, divert their pain medication to their volunteer aides or other patients, who use it or sell it, said Kathleen Allan, the director of nursing. She added that patients can be made victims easily, “and this is a predatory system.”   But she said the inmate volunteers bond with the patients in a way that staff members cannot, taking on “the touchy-feely thing” that may be inappropriate between inmates and prison workers.

At Coxsackie, 130 miles north of New York City, administrators started the hospice program in 1996 in response to the AIDS epidemic using an outside hospice agency, then changed to inmate volunteers in 2001. The change saved money and was well-received by the patients.   Perhaps more significant, said William Lape, the superintendent, was the effect the program had on the volunteers. “I think it’s turned their life around,” Mr. Lape said.

John Henson, 30, was one of the first volunteers. When he was 18, Mr. Henson broke into the home of a former employer and, in the course of a robbery, beat the man to death with a baseball bat. When he entered prison, with a sentence of 25 years to life, he said, “I thought my life was over.” At Coxsackie he met the Rev. J. Edward Lewis, who persuaded him to volunteer in 2001. “You go in thinking that you’re going to help somebody,” Mr. Lewis said, “and every time they end up helping you.”

Before hospice, Mr. Henson said he had given little thought to the consequences of his crime. Then he found himself locked in a hospital room with another inmate, holding the man’s hand as his breathing slowed toward a stop. Like many men in prison, the dying man had alienated his family members, who rejected his efforts to renew contact. In the end, he had only Mr. Henson for companionship. When the prison nurse declared the man dead, Mr. Henson broke down in tears. “They just came out,” he said. “I don’t even know why I was crying. Partly because of him, partly because of things that died within me at the same time.”   Mr. Henson, dressed in prison greens and with his blond hair buzzed short, spoke directly and without hesitation. “I was just thinking about why I’m in here and the person’s life that I took,” he said. “And sitting with this person for the first time and actually seeing death firsthand, being right there, my hand in his hand, watching him take his last breath, just caused me to say, ‘Wow, who the hell are you? Who were you to do this to somebody else?’ ”

Ms. Allan, the nursing director at Coxsackie, said that with a number of inmate volunteers, “You can identify in each of these guys something inside them driving them to do this. It’s a desire to redeem themselves, so even when it gets hard they’re able to plow through it. “  She added, “I think Mr. Henson made me a better mother.”

Benny Lee, 38, has spent half his life in prison for manslaughter, and for most of that time, he said, “the only thing I regretted was getting caught.” Four months ago he began as a hospice volunteer, feeling he needed a change. “I’m trying to offer some payback,” he said.   On a recent afternoon, Mr. Lee was scheduled to sit with Eddie Jones, 89, who was dying from multiple causes. Mr. Jones, who was convicted of murder at age 70, said, “I can talk with them better than staff members, because staff members have their minds made up about how things should be.”    Mr. Lee said he does not know how Mr. Jones’s death will affect him. “I’m hoping it will have an effect, period,” he said. “Growing up and in prison, I put up walls. But I have to be more emotionally receptive to these guys. This is going against everything I’ve tried to do. But I realize it’s a change I have to make.”

Mr. Lee said hospice was forcing him to learn to trust people. “It’s helping me mature,” he said. “My views of life and death are changing. I was unsympathetic when it comes to death. I’ve had friends die, and I was callous about it. Now I can’t do that. I’ve come to identify with these guys, not because we’re inmates, but because we’re human beings. What they’re going through, I’ll go through.”

jakking Aging Population, Inmate Health Care, New York

Prison health care costs are soaring in Kansas as once experimental drugs and procedures are becoming standard treatments.  From Fox 4Kc.

The Kansas Department of Corrections spent $46.5 million in the most recent fiscal year on inmate health care, up 116 from 2000.   Health care now totals 17 percent of the department’s total operating costs.

Secretary of Corrections Roger Werholtz said HIV and hepatitis C were once considered terminal illnesses. But now, he says people are being managed with those illnesses for extended periods of time.  And he says the department is obligated to extend that care when medically indicated.

There is no reason to think the prison health care costs are liking to decrease as the prison population ages and their health needs increase.

jakking Aging Population, Inmate Health Care, Kansas

Without fanfare, the Alabama Department of Corrections has released its first inmate under a new law that allows for medical furloughs of geriatric, incapacitated or terminally ill prisoners who meet certain requirements. Report from the Birmingham News.

According to the department, the inmate released was Omar Shariff Rahman, a 56-year-old who was serving life without parole at Donaldson Correctional Facility. “Having met required release criteria — determined to be geriatric and terminally ill — he was released to the care of his family on Tuesday, April 21st,” a department statement said. In an e-mail, Corrections spokesman Brian Corbett said he understood that Rahman died about 30 hours later …

Under the regulations devised to carry out the Alabama Medical Furlough Act, a geriatric inmate is 55 or older, “suffers from a chronic life-threatening infirmity,” a life-threatening illness, or from “a chronic debilitating disease related to aging” and poses no danger to himself or society. The regulations define a terminally ill inmate as someone “deemed to have an incurable disease that would, within reasonable medical judgment, produce death within 12 months.” The regulations also define an incapacitated inmate as someone suffering from “a permanent, irreversible physical or mental condition” that prevents him from being involved in a crime or from committing violence, and needing help to meet his daily living and health care needs.

The medical furlough law took effect Sept. 1.

jakking Aging Population, Alabama, Early Release, Inmate Health Care

Ohio prison officials have spent more than a decade making plans to deal with its graying population – inmates who are slower, sicker and ultimately cost more money for medical care.  The Cincinnati Enquirer has a long and interesting report:

They made up more than 12 percent of the system’s 46,501 prisoners last year, placing Ohio ahead of the national average of 8.7 percent. Prison officials predict that people 50 or older will comprise one-quarter of the state’s prison population by 2025.   And that’s not just because young inmates are getting old behind bars. State figures show that more and more people over 50 are committing crimes that are putting them into the prison system at advanced ages.     In 2001, 798 offenders were admitted to prison when they were age 50 and over. That number climbed to 4,450 in 2008.

Nearly 300 inmates in Ohio prisons are older than 70, said Terry Collins, who heads the state prison system.   “Our population is graying, which creates issues particularly from a medical standpoint,” he said. “Older offenders need to see the doctor more. They are involved in the chronic care clinics for various illnesses. You also have mental health issues, dementia. That becomes another concern.”    There are prescription drugs, hearing aids, walkers, special shoes, dentures, geriatric chairs and beds.

It impacts the budget each year.  Last year, the Ohio Department of Rehabilitation and Corrections spent nearly $199 million of a $1.8 billion budget on medical services for inmates. That’s a 7.7 percent increase over 2007.   Today, the overall average annual cost of an inmate is $24,590. That’s up from last year, when Ohioans paid $22,587 per inmate. About $3,800 of that expense was for medical services, according to state corrections data …

Nearly every one of the department’s 32 prisons has a geriatric ward of sorts – a cell block set aside for older prisoners who want to get away from the general population, Collins said.   “Some of these people have to have almost constant care,” Collins said. “We have to hire orderlies. I have inmates that push other inmates in wheelchairs because people can’t get around.” Age doesn’t necessarily dictate where inmates are placed. It’s more about how they get around.

jakking Aging Population, Inmate Health Care, Ohio

The Oregon Department of Corrections is planning to build a new prison near Junction City in which, officials say, severely mentally ill inmates would be dealt with far differently than has been possible before.  As reported by the Register-Guard:

The 1,262-bed medium-security lockup just south of town would include 462 beds for mentally ill inmates — double the number at any of Oregon’s existing 13 state prisons.  In addition, the proposed Junction City men’s prison would house up to 214 physically ailing, impaired and aging inmates.   The medium-security prison is planned to open in 2014. It would follow construction of a 532-bed men’s minimum-security prison as part of the same correctional complex, due to open in 2012. Both are contingent on the 2009 Legislature’s approval of $350 million or more of bonds to pay for construction …

Never before has Oregon — nor, do its corrections officials believe, any other state — set out to build a prison that would primarily house inmates with serious medical and mental health needs …

Nationally, the cost of incarcerating an elderly inmate is three times that of a regular one, according to the National Institute of Corrections. Many of them are so impaired that they’re unable to climb stairs, clamber onto an upper bunk bed, or move around without the assistance of walkers or wheelchairs, said William Hoefel, health services administrator at the Oregon Department of Corrections.  Williams said even middle-aged inmates present a medical burden on prisons.  “A lot of these guys have done really horrible things to their bodies and preventative health care has not been high on their lists,” he said. “So a 50-year-old presents a lot more like a 70-year-old, for the purposes of the level of medical care we’re required to provide.”

The full article at the Register-Guard is long and detailed and worth the read.

jakking Aging Population, Inmate Health Care, Mental Health Issues, Oregon

Michigan DOC is considering the release of the sickest old inmates as a way to reduce the heavy cost of health care for this group.

By all accounts, Thomas Lee Ross has quietly served most of his life sentence for a violent armed robbery and kidnapping in Ann Arbor in 1974.   Now – despite objections from a local judge and prosecutors – the 75-year-old inmate could be freed as part of a growing trend by the Michigan Department of Corrections to save costs by releasing prisoners.  A hearing was scheduled in a Jackson prison hospital to help the Michigan parole board determine whether Ross is fit to return to society, despite his criminal history and severe dementia that has relegated him to the prison hospital for years.  The hearing is the third and final hurdle Ross must clear to be considered for a commuted sentence by Gov. Jennifer Granholm, corrections spokesman Russ Marlan said … Marlan said the department spends roughly $300 million of its annual budget on inmate health care, and more than $30 million on the 300 sickest inmates alone. Citing privacy concerns, Marlan said he could not provide details about Ross’ medical care or associated costs. But he said health concerns were the only reason Ross was being considered for release.

jakking Aging Population, Inmate Health Care, Michigan