Elderly Prison Inmates: Specifying Priorities for Care and Staff Training

Melissa Inglis, East Central University & Tracy Tully, City University of New York, Borough of Manhattan Community College

Geriatric inmates are the fastest growing demographic in United States prisons, accounting for approximately 16% of the total prison population (Metla, 2015). Despite this alarming statistic, criminological research on the topic of   geriatric inmates is lacking. While many state agencies are attempting to conduct research about this topic, there are few scholarly studies on the aging prison population in the United States. Even fewer scholarly studies address the subject of geriatric care and staff training in correctional facilities. 

This is an important topic due to the high number of elderly inmates currently incarcerated as well as the high number of inmates who are growing old in prisons. According to the Bureau of Justice, the number of prisoners age 55 or older sentenced to more than 1 year in state prison increased 400% between 1993 and 2013, from 26,300 (3% of the total state prison population) in 1993 to 131,500 (10% of the total population) in 2013 (Bureau of Justice Statistics, 2016). Additionally, the number of sentenced federal prisoners age 65 or older grew at 94 times the rate of the overall prison population between 2007 and 2010 (Fellner, 2012). Chow (2002) found that the increase in the elderly federal prison population has been occurring since at least 1989 and has been of high concern to federal prisons, yet not a great deal has been done to address this increase in the population.

Explanations for the Rising Prison Age

In a 2006 release, the Council of State Governments presented the idea that more persons over age 50 are being arrested, and suggested that this is a contributing factor to the increase in the elderly prison population in Southern states.  However, a recent analysis of the trends and patterns of offences committed by the elderly in America over a 25-year period (1980-2004) confirms that demographics alone cannot account for the disproportionate growth of the elderly prisoner population (Feldmeyer & Steffensmeier, 2007; Porporino, 2015). 

A second explanation for the rise in older prisoners reflects the general aging of society. As of May 2016, the elderly comprise just over 14.5 percent of the total population (The United States Census Bureau, 2016). Get-tough-on-crime reforms of the 1980s and 1990s is a third contributing factor in the growing numbers of older prisoners. Mandatory minimum sentences, three-strikes rules and truth-in-sentencing laws established in recent decades are keeping inmates in prison for longer periods of time (Tonry, 2013; Upton, 2014). Finally, inmates are living longer, meaning prisons continue to swell (Abner, 2006; Upton, 2014). 

Consequences of Rising Prison Age

A monumental consequence of the aging prison population is the increase in health -related cost. One of the leading costs, which is specific to elderly inmates, is that of services for mental illness such as Alzheimer’s disease, substance abuse disorders, anxiety disorders and Schizophrenia (Aday & Krabill, 2005; Cox & Lawrence 2010; Maschi & Aday, 2014; Maschi, Kwak, Ko & Morrissey, 2012). Much recent literature suggests that the cost of caring for an older person in prison with such diagnoses is three times more than the average healthy geriatric inmate (Maschi, Viola & Sun, 2013; Reimer, 2008; Swanson, Frisman, Roberston, Lin, Trestman, Shelton, Par, Rodis, Buchanan & Swartz; 2013).  Additional costs include prison conditions, such as poor temperature regulation and lack of proper ventilation, which often exacerbate medical problems for geriatric inmates (Reimer, 2008).

Another consequence of the aging prison population is death in prison. Aday (2005/2006)  presents research addressing  inmate perception of growing old in prison and the lack of dignity which is involved with elderly inmates dying in prison. According to their findings, elderly inmates are inadvertently treated poorly because prison policy does not address the needs of older inmates (Aday, 2006; Crawley, 2005). This issue will be revisited in the section of this paper that addresses prison policy for elderly inmates. Although it is not the goal of prison policy to discriminate against elderly inmates, it is often inherent in the broad policies. 

A third consequence of the aging prison population is the need for special housing, There is some debate over whether or not elderly inmates should be housed in separate units, separate facilities, or should be integrated into the general population in prisons. Thivierge-Rikard and Thompson (2007) examined different types of housing models for elderly inmates. They found that consolidated geriatric housing does not necessarily improve the care of elderly inmates (Thivierge-Rikard & Thompson, 2007). Furthermore, consolidated housing for elderly inmates led to an increase in medical care that was not specific to diseases associated with old age such as Alzheimer’s and dementia (Thivierge-Rikard & Thompson, 2007). There is a lack of literature examining the relationship between care and housing with regard to elderly inmates.

Overview of Policy and the Aging Inmate Population

There is a substantial need for policy changes with regard to elderly inmates (Ahalt, Trestman, Rich, Greifinger & Williams, 2013; Luallen & King, 2014; Mara, 2002; Williams, Stern, Mellow, Safer & Greifinger, 2012). Scholars have long argued the need for long-term care in prisons (Mara, 2002). By providing elderly inmates with long-term care their overall health may be improved, decreasing prisons costs and increasing quality of life for such a population. As a result, models for long-term care plans were included in this study and suggestions for policy change were presented. 

In addition to long-term care policy, this study will also address policies specific to health care and reentry, areas vastly under researched within the criminal justice literature. Bishop and Merten (2011) assessed   the prevalence of comorbid health impairments in a sample of elderly male inmates in an Oklahoma prison.  They found that comorbid health problems were less likely to occur in inmates who were able to maintain an active lifestyle in prisons (Bishop & Merten, 2011). It can be inferred that prison policy could address this issue by providing more age appropriate physical activities and recreational activities. 

Reentry (the process of returning to the community from jail or prison) of elderly inmates is an issue of concern that is not adequately addressed in prison policy. Many inmates have been incarcerated for much of their adult lives and find reentry into society very difficult. Yates and Gillespie (2000) found that many inmates have grown old in prisons, have become institutionalized, and therefore feel at home in prisons. When these offenders are released, they are often unsuccessful at the reentry process and recidivate back to prison. 

Stojkovic (2007) explains that “systematic abuse” of elderly inmates often occurs as an unintended outcome of broad policies. He goes on to explain that employees are often not trained properly, which leads to abuse of elderly inmates. The main purpose of Stojkovic’s study was to examine issues faced by inmates upon reentry, but he provides information on the effects of prison policy and lack of employee training on elderly inmates while they are incarcerated. 

Cianciolo and Zupan (2004) conducted research on aging prison populations and the training needed for correctional workers in order to address the specific needs of elderly inmates. The authors also found that the current method of training employees was not sufficient in teaching staff how to care for elderly inmates. Similar findings were presented by Masters, Magnuson, Bayer, Potter & Falkowski (2016) in their work Preparing Corrections Staff about Aging Inmates. The authors noted the importance of training correctional staff who work with the elderly population. They emphasized the need to educate staff on special security measures, health services, and mental health diagnoses often present in aging inmates (Masters, Magnuson, Bayer, Potter & Falkowski, 2016). 

Snyder, van Wormer, Chadha, and Jaggers (2009) reported the challenges that social workers face when working with elderly inmates. Although many obstacles are present within prisons, many social workers find it extremely difficult to find employment and housing for elderly inmates who are being released. Interviewees in the current study also discussed this issue. Snyder et al. explained that finding community resources for discharged inmates is among the most difficult challenges for social workers. 

Loeb, Steffensmeier, and Myco (2007) found that elderly inmates are not satisfied with the level of preventive healthcare within prisons. According to their study, elderly inmates expressed anxiety about release from prisons due to their decline in health since their initial incarceration. The inmates from their study also expressed that they felt unprepared to leave prison due to lack of knowledge about how to take care of themselves in the community. The inmates were concerned about issues such as “accessing healthcare, not maintaining their health, and returning to previous behaviors” (Loeb, Steffensmeier, and Myco, 2007, p. 324). This study further investigates these issues. 

There are many issues to consider when evaluating the elderly inmate population in prisons. However, this study will address three of the main issue presented within the literature, prison policy, employee training, and ways to improve life after release for elderly inmates. The current study aims to address the lack of appropriate age related policy, the issue of employee training for staff that have direct contact with inmates and ways to improve the reentry process for the elderly returning to the community. By updating policy and providing training/education for staff, prisons are laying a foundation for elderly inmates to have a more successful incarceration as well as transition back into society. 

Current study

This study will address prison policy, employee training and reentry within the aging prison population. Although this study has utilized data collected from two Southern prisons, it is applicable to the general knowledge of the aging prison population in the United States. In this study, much of the information obtained during interviews with employees reflects the information presented in other literature on this topic. However, some of the information obtained in interviews is unlike information from other sources. The 13 interviewees in this study gave information about their first-hand experience with elderly inmates and gave input about their ideas on improving care for elderly inmates in prison and ideas for better transitions into the community after release. 

Findings

Prison Policy

Prison policies are often broad sets of rules and regulations that attempt to cover all situations and all inmates. Due to the effects of aging, elderly inmates find themselves unable to fit into the constraints of these policies. A case manager at one prison cited many problems with prison policy with regard to elderly inmates. This case manager explained that one major issue is bed assignment. In the instance of one elderly inmate, he was assigned a bed near a door that opened to the outdoors. This left him being exposed to rain, snow, and other elements of weather every time a door was opened. The case manager explained that it is extremely difficult to change bedding or housing assignments after they are given. The case manager concluded by stating that prison policy should allow for easier bed reassignment for elderly inmates. This would also address issues of handicap accessible rooms, showers, and bathrooms. According to one officer, even when handicap accessible areas are available, it is often difficult to have inmates reassigned to those areas.

Another policy that needs revision is visitation policy. At one of the prisons in this study, inmates’ visits are terminated if they need to use the restroom. This causes potential problems for elderly inmates who are less able to hold their urine due to medical problems such as enlarged prostates, which are common among older men. While the policy on visitation serves the purpose of reducing the introduction of contraband during visitation, it would be simple for guards to escort and monitor inmates during bathroom breaks to ensure that contraband is not introduced during the visit. 

Medical policies and procedures were a common complaint by staff who were interviewed. While they viewed the medical care as adequate, they felt that it needed to be improved upon. One interviewee who worked with inmates on their job assignments explained that vision and dental care is not adequate. While he felt that the care was better than what the inmates would get outside of prison, he expressed that inmates are sometime unable to perform their work duties due to poor vision and frequent toothaches, which sometimes led to dental visits. According to several interviewees, it takes several months for inmates to receive dentures. This greatly affects quality of life and ability to perform job duties. A primary concern was of vision problems and inmates’ inability to obtain new glasses or current eyeglasses prescriptions. Lack of proper eyewear can lead to headaches and a reduction in the quality of life for inmates.

Another area of concern with regard to prison policy is housing for elderly inmates. While some employees who were interviewed thought that separate housing would be beneficial to inmates, other employees viewed integration of older and younger inmates as positive. Employees who favored segregation for older inmates cited safety concerns for older inmates, and felt that centralized medical care for older inmates would be more cost effective. Furthermore, they felt that housing all older inmates in a centralized facility, closer to hospitals and other medical care would be a cost effective solution to the increasing costs of treating elderly inmates.

Employees who favored integrating younger and older inmates felt that the interaction was positive and beneficial for both younger and older inmates. One interviewee explained that there is often a mentor type relationship in which the older inmates actually begin to calm younger inmates and participate in the rehabilitation of younger offenders. One interviewee who is in charge of work assignment for inmates explained that the work ethics possessed by older inmates often encourages younger inmates to be more productive at their job assignment. Overall, all interviewees thought that medical care should be the most important aspect that is considered when examining housing for elderly inmates. In short, whichever housing setting provides the most adequate medical care provides the best situation for elderly inmates.

In general, it was concluded that prison policies should be based upon levels of mental and physical disability, not necessarily the age of the inmate. Many employees gave examples of drug offenders, specifically methamphetamine users, who were quite young but had many of the same medical problems as elderly inmates. Similarly, many young mentally ill inmates face some of the same obstacles and have the same needs as elderly inmates who have some form of dementia. The design of prison policy should take into consideration physical and mental levels of disability of elderly offenders. This issue will be revisited in the section of this paper discussing geriatric release models.

Employee Training

When discussing employee training there were two major themes that continuously emerged. All of the officers who were interviewed expressed the need for sensitivity training for correctional officers. One employee explained that many of the younger, newer officers are insensitive to the needs of elderly inmates or are unaware of cognitive declines that can take place in elderly adults. Some officers expect elderly inmates to behave in the same manner as younger inmates and often do not give them the extra time that they need to comprehend directions or even to walk from one place to another within prisons. 

According to several of the staff members who were interviewed, training for prison staff needs to be geared towards officers who are in direct care positions with elderly inmates. One employee expressed that nursing training should be implemented for correctional officers. He explained that some officers feel that it is not within their job duties to change diapers of elderly inmates for example. When working with elderly inmates who are unable to care for themselves, the job duties of correctional officers shift to caretaker rather than guard. Correctional officers should be trained in areas of nursing and caretaking.

Although nurses are on staff and pass out medications, it is suggested that correctional officers could also be performing this as one of their job duties. Medication Administration Technician (MAT) training is a very simple and quick class which any correctional officer could complete. This would eliminate some of the need for nursing staff, and could free some funds to hire more correctional officers. Although nurses are a needed element in staffing geriatric units in prisons, some of their time could be freed if they did not have to administer all medications to inmates. This being said, if officers are trained as geriatric unit specialists, less medical staff may be needed or at least needed to work less hours. This is a potential solution to staffing problems, which were of great concern to all employees who were interviewed. 

It is inferred that more officers would lead to more adequate supervision of inmates, decreased victimization, and thus better treatment for elderly inmates. This inference is supported by the interviews of two correctional officers. They felt that they would be better able to provide adequate care for elderly inmates if they had at least one more officer on their unit. The officers reported low levels of victimization of the elderly. This may be true, but it could also be the outcome of inadequate supervision, and the officers’ inability to witness victimization. This is due to the low number of officers assigned to each unit. Officers reported that between one and two officers usually supervise up to 200 inmates due to staffing problems.

Reentry

It is notable that not all elderly inmates want to be released. Interviewees cited that inmates have told them that they don’t have any family or have lost contact with family, don’t want to be a burden on their family, or that they simply feel at home in prison and have a social support group there. All of these issues are important to consider when discussing reentry of elderly inmates.

Reentry can be an extremely difficult process for all inmates and for elderly inmates in particular. One case manager who was interviewed explained that they do not have the resources to help with the reentry process. This case manager explained that they do not have enough time and that many agencies are not willing to help with the reentry process for offenders. It would be helpful in the reentry process for inmates to have knowledge of the services available to them. Many elderly inmates are unaware of agencies such as Area Wide Aging Services, Social Security and disability benefits, and other forms of aid. 

Many Departments of Corrections have devised Reentry Resource Guides. These guides generally cover much of what an individual needs to know to succeed in the reentry process. However, reentry can prove very difficult for elderly offenders. Due to cognitive limitations, they often need extra assistance with filling out forms, locating businesses, and in general have more difficulty adjusting to life outside of prison. One correctional officer explained that he was transporting an elderly inmate and stopped to get gas. The elderly inmate was amazed because he had not been to a gas station since all gas stations were full service. He told the officer that he did not even know how to pump gas. Small tasks such as this are difficult for elderly inmates to learn upon release. Reentry programs should be implemented while offenders are still incarcerated. Elderly inmates should be taught functions of everyday life before being discharged from prison. Some prime examples of skills that need to be taught to elderly inmates before discharge are computer skills, budgeting skills, self-medication skills, and general technology usage skills. 

Conclusion

Although this is a preliminary study, some important information can be drawn from the interviews conducted with prison employees. Future research should focus on the same topics and questions, but interviews should be conducted with elderly inmates rather than prison staff. A clearer perception of the situation in prisons involving elderly inmates can be obtained by interviewing inmates. The areas of improvements for training prison staff and reentry would benefit in particular from interviewing inmates.

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