The elderly population in the US grew by 280% from 1999 to 2016.
The U.S. corrections system faces a health care crisis as the population ages rapidly, providing a disturbing glimpse into the challenges facing the nation as a whole. By 2050, the United States’ elderly population is projected to grow from 58 million in 2022 to 82 million in 2050—a trend already evident in prisons. Between 1999 and 2016, the population of incarcerated adults age 55 and older increased by 280%, while the number of younger adults increased by only 3%. Since then, the number of elderly residents continues to grow. The ACLU estimates that seniors will make up 1/3 of the total prison population by 2030.
As the demographics of the prison system and the country change, institutions will be forced to adapt to meet the unique needs of their aging population. While some prisons have taken steps to provide hospice and palliative care for a limited number of residents, many facilities are not equipped to care for a large volume of adults, confirms a report from the Office of the Inspector General. Compassionate release and medical parole are an option for the select few who qualify, but these programs are often underutilized and difficult to navigate. In response to these challenges, several nonprofit organizations have stepped up to fill the gaps in care for incarcerated people, while state and federal governments work to create lasting change. The Humane Prison Hospice Project created a unique model that can mediate the growing crisis of prison care over the coming decades. Humane trains residents to serve as hospice and palliative caregivers and grief companions for their aging and dying peers. This cost-effective and humanitarian approach benefits caregivers, care recipients, medical staff, and the facilities that implement it, and can serve as a scalable model for addressing the needs of older adults in the broader community.
The perils of aging in prisons
Prisons can be generally unhealthy places for people of all ages due to several environmental and systemic factors, but older people are particularly vulnerable to poor mental and physical health outcomes. Incarcerated individuals over the age of 50 are more likely to be diagnosed with dementia and other mental health conditions than their non-incarcerated peers. Older residents also experience chronic conditions at higher rates than younger residents, and many are diagnosed with co-occurring physical and mental health conditions. Prisoners with chronic illnesses are not always granted a medical exemption from forced labor and may be required to work in hazardous environments without housing.
Caring for incarcerated individuals: Challenges and solutions
Incarcerated individuals in the US have a right to adequate health care, supported by the Constitution, but older residents require more extensive and expensive care than their younger counterparts. The US Government Accountability Office reports that the Federal Bureau of Prisons spent over $9 billion on health care between 2009 and 2016, citing the aging of the prison population as one of the main factors contributing to these costs. In Texas, the costs of incarcerating the elderly increased by over $250 million between 2012 and 2019.
These funds go to providing medical care to elderly and sick residents, which requires increased staffing and to make facilities more accessible to those with limited mobility. California Medical Institution in Vacaville, VA, opened the prison’s first hospice unit in 1993. The hospice was originally built to care for incarcerated people dying of AIDS, but in recent years, the unit has transitioned to serve the needs of the institution’s elderly population. The state penitentiary in Oak Park Heights, Minnesota recently expanded its transitional care unit to meet the needs of its aging population. The unit offers 24-hour nursing care and a clinic where patients can receive dialysis, among other medical treatments. Other state departments of corrections have established “prison nursing homes” in certain facilities. However, these existing units are not able to house all incarcerated individuals who need extensive care – the CMF hostel has only 17 beds. Despite rising health care expenditures, most prisons in the United States do not offer hospice programs; of the more than 1,566 state prisons across the country, 75 offer hospice care.
Hospice at the California Medical Institution was the first of its kind, originally established in … [+]
A humane approach to prison health care
Peer care could transform the way aging and dying residents receive care in prisons across the United States, reducing costs for facilities and providing a variety of benefits for residents and staff. During the pandemic, the Humane Prison Hospice Project team developed a new curriculum in collaboration with Dr. . As part of this new programme, volunteers must complete a 15-module course on hospice and palliative care, focusing on the lived experiences of an incarcerated population. Peer caregivers then work alongside other medical personnel as part of a multidisciplinary team to address the health care needs of an aging population and occupy the space between residents and staff to advocate for the needs of care recipients. The program is based on communities created within prisons, which allows individuals to receive care from people they trust. “What we’ve found is that there are communities of care in many prisons across this country,” says Laura Musselman, Director of Communications at Humane. “There are people who have come together to take care of each other. And those pre-existing communities of care is where we start.”
The peer care approach eases the burden on medical staff, who are often overburdened and under-resourced, while creating a supportive environment for all members of the prison community. “Even small acts of compassion build over time and can help build a culture of empathy and respect,” reflects Musselman. “Hope is this [this program] has the potential to influence institution-wide attitudes and behaviors and health outcomes.”
How to Create a Peer Caregiver Hospice/Palliative Program
Humane has helped support the creation of hospice and palliative care programs in 5 prisons across California, training 118 peer caregivers, and they are currently working to expand their care model for use in other states. Each facility is unique and there is no “one size fits all” approach to care. The Humane Model requires involvement from community members and local organizations to create a program that meets the needs of their specific population.
To create a peer care program at a facility in your area, Humane recommends the following three steps as a starting point:
- Research programs and resources that are currently available in your community.
- Develop relationships with a local prison community through volunteer opportunities with established groups that have a relationship with the institution.
- Partner with hospice organizations, end-of-life caregivers, and prison administrators to create a comprehensive hospice and palliative care program.
There is more work to be done to address the health care crisis facing seniors in prison, and after they are released. The task may seem daunting, but community care models provide a person-centered approach that can fill certain gaps in hospice and palliative care for both incarcerated adults and their non-incarcerated peers.
To learn more, visit humaneprisonhospiceproject.org.
of WELFARE The blog supports the critical health and well-being of all individuals, to raise awareness, reduce stigma and discrimination, and change public discourse. The Well Beings campaign was launched in 2020 by WETA, the flagship PBS station in Washington, DC, starting with the Youth Mental Health Project, followed by the 2022 documentary series Ken Burns presents Hiding in Plain Sight: Youth Mental Illness, a film by Erik Ewers and Christopher Loren Ewers (Now streaming on the PBS app). WETA is continuing its award-winning Well Beings campaign with the upcoming documentary film CAREproduced by Bradley Cooper and Lea Pictures, premiering in 2025 on PBS.
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