A humane response to a growing health care crisis

The U.S. prison system faces a health care crisis as the population rapidly ages, providing a troubling glimpse into the challenges facing the country as a whole. By 2050, the U.S. elderly population is expected to increase 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 aged 55 and over increased by 280%while the number of young adults increased by only 3%. Since then, the number of elderly residents has continued to grow. THE ACLU estimates that older people will represent 1/3 of the total prison population by 2030.

As the demographics of the prison system and the country change, facilities will be forced to adapt to meet the unique needs of their aging populations. Although some prisons have taken steps to provide palliative care to a limited number of residents, many facilities are not equipped to care for large numbers of elderly people, a report of the Office of the Inspector General confirms this. Medical release and medical parole are an option reserved for the privileged few who qualify, but these programs are often underutilized and difficult to navigate. In response to these challenges, some nonprofit organizations have stepped up to address gaps in care for incarcerated people, while state and federal governments work to create long-term change. The Humane Prison Hospice Project has created a unique model that could alleviate the growing prison care crisis in the decades to come. Humane trains residents to serve as hospice and palliative care caregivers and to support the grief of their aging and dying peers. This cost-effective and humanitarian approach benefits caregivers, care recipients, medical staff, and the facilities that implement it, and could serve as a scalable model for meeting the needs of aging adults in the broader community.

The dangers of aging in prison

Prisons can be generally unsanitary places for people of all ages due to several environmental and systemic factors, but older adults are particularly vulnerable to mental and physical health problems. Incarcerated people over the age of 50 are more likely to be diagnosed with dementia and other mental health issues than their non-incarcerated peers. Older residents also suffer from chronic illnesses at higher prices than younger residents, and many are diagnosed with comorbid physical and mental health conditions. Incarcerated people with chronic illnesses do not always benefit medical exemption compulsory labor and may be required to work in dangerous environments without accommodation.

Caring for incarcerated people: challenges and solutions

In the United States, incarcerated people have the right to adequate health care, guaranteed by the Constitution, but older residents require more extensive and more expensive care than their younger counterparts. The U.S. Government Accountability Office reports that the Federal Bureau of Prisons spent more than $9 billion on health care between 2009 and 2016, citing the aging prison population as one of the main factors contributing to these costs. In Texas, the costs of incarcerating seniors have increased by more than 250 million dollars between 2012 and 2019.

These funds are used to provide medical care to elderly and ill residents, which requires increased staffing, and to make facilities more accessible to people with reduced mobility. The California Medical Facility in Vacaville, Virginia, opened the first prison hospice unit in 1993. The hospice was originally built to care for incarcerated people dying of AIDS, but in recent years, the he unit has evolved to meet the needs of the facility’s aging population. . Oak Park Heights State Penitentiary in 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 corrections departments have established “prison retirement homes” in some facilities. However, these existing units are not able to house all the incarcerated people who need extensive care: the CMF hospice has only 17 beds. Despite rising health care costs, the majority of prisons in the United States do not offer palliative care programs; out of more than 1,566 state prisons in the country, 75 offer palliative care.

A humane approach to healthcare in prison

Peer care can transform the way aging and dying residents receive care in U.S. prisons, while reducing facility costs and providing a range of benefits to residents and staff. During the pandemic, the Humane Prison Hospice Project team developed a new program in collaboration with Dr. Michele DiTomas and her colleagues at California Correctional Health Services, to apply their peer care delivery model to the center California Medical Center and Central California Women’s Center. . As part of the new program, volunteers are required to complete a 15-module course on hospice and palliative care, with a focus on the experiences of an incarcerated population. Peer supporters then work alongside other medical staff as part of a multidisciplinary team to meet the health care needs of an aging population and occupy the space between residents and staff to advocate for the needs of recipients of care. The program builds on established communities within prisons, allowing individuals to receive care from people they trust. “What we found is that there are communities of care in many prisons across the country,” says Laura Musselman, director of communications at Humane. “There are people who have come together to take care of each other. And these pre-existing communities of care are where we start.

The peer care approach eases the burden on medical staff who are often overworked and under-resourced, while creating a supportive environment for all members of the prison community. “Even small acts of compassion add up over time and can help further build a culture of empathy and respect,” reflects Musselman. “We hope that (this program) will have the potential to influence attitudes, behaviors and health outcomes facility-wide.” »

How to Establish a Peer Hospice/Palliative Care Program

Humane helped support the creation of hospice and palliative care programs at 5 California prisons, 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 the participation of community members and local organizations to create a program that meets the needs of their specific population.

To establish a peer care program at a facility in your area, Humane recommends the following three steps as a starting point:

1. Research programs and resources currently available in your community.
2. Develop relationships with a local prison community through volunteer opportunities with established groups that have a relationship with the facility.
3. Collaborate with hospice organizations, end-of-life caregivers, and prison administrators to create a comprehensive hospice and palliative care program.

There is still work to be done to address the health care crisis facing seniors in prison, and once they are released. The task may seem daunting, but community care models offer a human-centered approach that can fill some of the gaps in hospice and palliative care for incarcerated adults and their non-incarcerated peers.

To learn more, visit humaneprisonhospiceproject.org.

THE Well-being Blog supports the essential health and wellbeing of all individuals, to raise awareness, reduce stigma and discrimination and change public discourse. The Well Beings campaign was launched in 2020 by WETA, PBS’ flagship station in Washington, DC, beginning 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 continues its award-winning Wellbeing campaign with upcoming documentary film Provision of careproduced by Bradley Cooper and Lea Pictures, premiering in 2025 on PBS.

For more information: #WellBeings #WellBeingsLive wellbeings.org. You are not alone. If you or someone you know is in crisis, whether or not they are considering suicide, please call, text or chat to 988 to speak with a trained crisis counselor. To reach the Veterans Crisis Line, dial 988 and press 1, visit VeteransCrisisLine.net to chat online or text 838255.