Imagine being very old. Not only are you are nearing what appears to be the end of the road, but you are in permanent confinement. Your health is dwindling and you are at the mercy of the “system.” This situation is unfathomable for most people, however, for millions of aging men and women across the United States in correctional facilities, this is an inevitable reality. As the older demographic skyrockets in the general population, so does the number of incarcerated men and women. As these two growing trends converge, correctional facilities are faced with the daunting and unavoidable task of determining what to do regarding the increasing need of health care for older and sicker inmates.
It is no secret that the population of “graying” America is increasing steadily and swiftly. What is not so evident, but no less relevant, is the proportionate growth of inmates in American detention facilities. While in 1900, only about 4% of Americans were ages 65 and older, by 2030, it is projected that 1 in every 5 Americans will be age 65 or older (Himes, 2001). This population surge has not escaped the prison population. Texas saw an increase of 86% in the older inmate population between 1994 and 1998, while California is expected to have a 200% increase in its elderly inmate population by 2020. Futhermore, other projections state that by 2020, older inmates will represent 21%-33% of the total prison population (Rikard & Rosenberg, 2007).
Identical to the non-incarcerated older population, elderly inmates face numerous health issues. Many times inmates’ lifestyles prior to incarceration include substance abuse and poor self-care, so unsurprisingly many face more significant health issues like chronic conditions and psychological disorders. One study found that older inmates, on average, suffered from three chronic illnesses throughout their incarceration (Rikard & Rosenberg, 2007). Older inmates are also at higher risk for age-related problems such as hearing and vision impairment, falls, cognitive impairment, and urinary incontinence (Hill, Williams, Cobe, & Lindquist, 2006). In addition to physical illnesses, mental disorders are more prevalent amongst older inmates than younger inmates. In one Utah prison study, of the older mentally ill prisoners, 57% were diagnosed with depression, 25% with schizophrenia, and 18% with bipolar disorder (Caverley, 2006). As the elderly inmate population grows, clearly so will the need for medical and mental health services and clinics within these institutions.
The economic implications due to these needs are tremendous. Older inmates are three times as more costly to care for than younger inmates, a disproportionate difference. Elderly inmates require items and services such as “24-hour nursing coverage, infirmary beds, physician availability, pharmacy, laboratory, x-ray, and rehabilitative physical care resources” (Rikard & Rosenberg, 2007). In addition to medical provision, there is an emerging need for senior-specific social programs because they can be conducive for the mental well-being of incarcerated elders. However, much improvement is needed in the area of social programming. In a 2004 study of the Department of Corrections and the Federal Bureau of Prisons, it was discovered that a mere 23 states had policies and programs geared towards aging male inmates and only two for older female inmates (Williams & Rikard, 2004). To create programs such as these though would continue to add financial pressure upon detention facilities on both a statewide and federal level.
Although there is no single clear-cut solution, there are several ideas of how to improve the health care situation within correctional institutions. First, in one report, researchers asserted that organizational strategies such as “knowledge and skills management, development of effective teams and redesigning and coordination of care processes” would benefit both the quality and cost of the health care system (Hill et al, 2006). Secondly, more emphasis could be placed on programs such as the Project for Older Prisoners (POPS), which examines nonviolent older inmates for early release and thus far has been a significant success (Rikard & Rosenberg, 2007). Third, the notion of having separate assisted living units or off-site correctional nursing homes is being considered for their benefits of reducing costs (Hill et al., 2006). It is urgent that legislators and corrections administration examine the facts and consider these alternatives in order to address the health care issue.
The visible growth of the general aging population is already creating an awareness and urgency of the emerging need for more health services. With the inmate population in the United States increasing in proportion to their non-incarcerated elderly counterparts, the attainment of medical and mental health services in correctional institutions is one of the most exigent matters facing this specific population.