Health costs of aging prisoners
More states considering early-release programs for older, infirm inmates
Fresh efforts are under way in the states to reduce prison populations, partly driven by severe state budget shortfalls, and as a result, more aged and infirm inmates are being considered for release.
But it’s unclear how many prisoners could be released under newly expanded state laws and what the cost benefit would be.
“The unfortunate part is we don’t know much about the implementation of these policies,” says Alison Lawrence, policy specialist for the criminal justice program at the National Conference of State Legislatures in Denver. “We don’t know if this is a great budget savings.”
It’s no wonder that states are looking at releasing older inmates. Incarceration costs for a prisoner over age 55 run about three times as much as the average prisoner, largely because of higher medical spending. Care for patients incarcerated in state prisons must be paid for entirely by states, but once the offenders are released, they qualify for Medicare or Medicaid.
Same problem, inside or out
As in the outside world, healthcare costs in prison continue to climb.
In Wisconsin, for instance, healthcare costs for adult prisoners more than tripled, from $28.5 million in 1998 to $87.6 million in 2005. In the same time period, the prison population rose by 25%.
Meanwhile, the overall prison population is growing old. Out of the more than 1.4 million males confined to state or federal prisons in 2008, nearly 150,000 were age 50 or older. Some 15,800 were 65 or older, according to the U.S. Justice Department’s Bureau of Statistics (See chart). For women, out of 105,300 in total, 8,700 were over age 50, with only 600 age 65 or older.
Caregivers and experts on prison healthcare define incarcerated over age 50 as elderly, because their overall health usually is more on par with the average 60-or 65-year-old living in free society. This is partly because of the stresses of prison life, and also because of lifelong poverty, poor nutrition and often drug abuse. The aging prison population is partly the result of tougher sentencing guidelines that started in the 1970s, including three-strikes laws. One in 11 prisoners nationwide is serving a life sentence–in some states as many as one in six prisoners have been sentenced to life in prison without possibility of parole.
“All this created a boom in aging prisoners,” says David Fathi, director of the National Prison Project at the American Civil Liberties Union.
New release policies and programs to reduce recidivism could be turning the tide, however. The Pew Center on the States reported this month that for the first time in nearly 40 years, the number of state prisoners had declined.
Prison populations fell in 27 states, but grew in 23 others since a year ago, according to the report. “These numbers highlight just how much the decisions by state policymakers impact the size and cost of prison systems,” says Adam Gelb, project director of the Public Safety Performance Project at the Pew Center.
Medical release could reduce the prison population further. Forty-one states have laws on the books that allow for medical release from state prisons.
Expanding early release
In recent years, states have revised these laws to allow more aged and infirm prisoners to qualify, Lawrence says. Fifteen to 20 states have amended their early release laws in the past two to three years. “States are streamlining the process or expanding eligibility,” she says.
Last year, Maine, New York and Wisconsin broadened the criteria for medical release. In Maine, eligible inmates were redefined under a new law from “terminally ill” to those who have a “terminal or severely incapacitating medical condition.” Wisconsin revised the definition “terminally ill” in its medical-release law to “extraordinary health condition.” Inmates must be at least 65 years old and have served at least five years of their sentence, or be at least 60 years old and have served at least 10 years, according to the new Wisconsin law.
In the past, medical release has not often been used, the ACLU’s Fathi says. “The absolute number of prisoners released under compassionate release is tiny,” he says.
In California, where prison spending accounts for more than 10% of the state’s general fund, a federal three-judge panel last August ordered Gov. Arnold Schwarzenegger to release at least 40,000 state prisoners over the next two years because constitutionally unacceptable overcrowding endan-
Calif. prison system receiver Kelso has proposed early release for the most infirm.
Fathi says tougher sentencing laws have led to an aging prison population.