The Marshall Project had an interesting article on how the aging prison population is rapidly graying, forcing corrections departments to confront the rising costs and challenges of health care in institutions that weren’t designed to serve as nursing homes. Between 1995 and 2010 the number of inmates aged 55 and up almost quadrupled, owing in part to the tough-on-crime sentencing laws of the 1980s and 90s, according to a 2012 ACLU report. In 2013, about 10 percent of the nation’s prison inmates—or 145,000 people —were 55 or older. By 2030, the report said, one-third of all inmates will be over 55. At the same time, it is widely accepted that prisoners age faster than the general population because they tend to arrive at prison with more health problems or develop them during incarceration.
Caring for elderly inmates can cost up to twice as much as caring for younger ones. Despite these runaway costs, there is no national oversight to determine how prisons handle the challenges of an aging population, says Marc Stern, a consultant in correctional health care. “If a Medicaid or Medicare auditor walked into [a large urban hospital] to do an audit’’ Stern said, “they would say, ‘O.K., where’s your geriatric unit? Where’s your dementia unit?’ It’s part of the audit process, it’s part of the intelligence phase that is part of being part of a national organization.”
Here is a look at some innovative programs in New York, California and Connecticut.
New York: The Unit for the Cognitively Impaired
In the Unit for the Cognitively Impaired at the Fishkill Correctional Facility in upstate New York, residents play board games and bingo. This unit is specially designed to meet the needs of inmates with dementia-related conditions. It is part of the state’s medical hub at Fishkill, a medium-security prison 70 miles north of New York City. The 30-bed unit, opened in 2006, is set up to resemble a nursing home more than a prison ward. The walls are painted white and the lights are bright, intended to elevate and stabilize mood. Inmates are allowed to walk freely around the unit (wandering is common for those with dementia or related conditions). The staff includes specially trained physicians, nurses, clinical psychologists, psychiatrists, social workers, and corrections officers. The average age of the unit’s 24 inmates is 62.
Care in this unit is expensive, which may be why more states have not copied the model. In 2012, according to the state corrections department, it cost $93,000 per bed annually, compared with $41,000 in the general prison population.
California: Gold Coats
California has taken a less expensive and more unconventional approach. Inmates with dementia and other age-related impairments are cared for by healthy inmates (with good records). The Gold Coats—the caretakers wear gold-colored jackets— assist patients with daily tasks such as dressing, shaving, showering, and other personal hygiene issues. They escort patients to the dining hall, and to the doctor. They act as companions, protecting their patients from being bullied, and make sure they get food at meal time. The Gold Coats also lead exercise classes and activities designed to stimulate memory. There are Gold Coat programs at 11 California prisons.
For their services, Gold Coats are paid $50 a month—which is very good by prison job standards. The Gold Coats at the Men’s Colony go through extensive training. Dr. Steed reviews topics like the effect of dementia on behavior, how to communicate with low-functioning patients and how to avoid caregiver burnout. The local chapter of the Alzheimer’s Association has prepared a video specifically for the program, as well as a manual on dementia.
Connecticut: 60 West Nursing Home
It may seem like a logical solution: parole those who are too frail to take care of themselves, much less commit another crime, and place them in nursing homes outside of prison. Officials in Connecticut tried, and failed. So, officials from the state’s departments of Mental Health and Addiction Services, Correction, and Social Services decided to build their own nursing home for those to difficult to place elsewhere.
The 60 West Nursing Home in Rocky Hill, a bedroom community south of Hartford, opened its doors in May 2013. It is run by a private nursing operator, iCare, under a state contract. At present, about a third of the 60 patients there were referred from the Department of Corrections. Most of the other patients were referred from the state’s psychiatric hospital, and a handful from the community—people who showed up at local mental health facilities or a hospital emergency room and who needed nursing-home care.