Health costs of ag­ing pris­on­ers

More states con­sid­er­ing early-release pro­grams for older, in­firm in­mates

Modern Healthcare - - Front Page -

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.