"Longer mandatory sentences and more life sentences without the possibility of parole have significantly helped to boost the prison population over two decades," said study co-author Dr. Cynthia Massie Mara, associate professor of health care administration and policy at Penn State Harrisburg. "It's inevitable that, as this larger population ages within the prisons, it will require greater long-term care. Also, more prisoners, including younger ones, require daily living assistance due to physical disabilities from injuries or from diseases such as AIDS or hepatitis C. "In the past, when only a few inmates needed long-term care, the staff simply recruited individual prisoners to help out, but little is known about the number of inmates who now need long-term care or about the way in which long-term care is provided to prison inmates," says Mara. "As more inmates require this kind of help nationwide, correctional administrators and state policymakers would greatly benefit by assessing their populations and facilities, and developing policies that address long-term care needs while maintaining security requirements."
Mara and Dr. Christopher K. McKenna, associate professor of management science at Penn State Harrisburg, conducted the study, which is the first comprehensive research of long-term care in a prison system.
The researchers surveyed corrections health care administrators of all 25 state correctional institutions (SCIs) in Pennsylvania. They selected and toured seven facilities and conducted group interviews with staff and inmates. Activities of daily living include bathing, dressing, eating, going to the bathroom, moving from the bed to a chair, and getting from place to place.
They found that 22 SCIs reported having at least one inmate needing assistance, and that 1.8 percent of Pennsylvania's total state inmate population requires daily living help. Inmates ranging from 18 to 89 years of age were reported as having at least one daily living impairment, but nearly 24 percent of inmates 65 years and older are affected. Within the total group, the percentage of women inmates needing assistance is 1.88 percent.
The study identified several models or strategies being used to provide long-term care, but the strategies were mainly developed ad-hoc, or as needed, rather than from a comprehensive plan. Also, the SCIs are likely to use a combination of methods, rather than a single one. For example, an inmate needing help with AIDs may go to the infirmary for various services. He may move too slowly for the regular shower line and can shower in the infirmary.Those SCIs without an infirmary may transfer such an inmate to another SCI with an infirmary. Another strategy calls for physical adjustments to an inmate's cell such as adding grab bars near the toilet in the cell, or assigning an inmate to a bottom bunk or to the first tier of cells. The staff also modify showers for inmates in wheelchairs or use devices such as lights, rather than bells, for deaf inmates to signal dinnertime. One SCI, Laurel Highlands, is dedicated to housing and caring for inmates who need assistance. The area with the most infirm inmates is self-contained, and inmates need to leave the unit only for visits and chapel. Prisoners with less severe impairments can still hold paid jobs. "But there is a waiting list for this long-term care facility, and transfer here is not possible for women inmates or for high-security risk inmates," says McKenna.
Penn State researchers say that the care of infirm, aging inmates who need long-term care can cost up to $70,000 a year per person, according to general estimates. Across the nation, policymakers and planners in various state corrections departments should conduct comprehensive assessments of their populations and existing facilities, the team suggests. "First, states should identify inmates who currently need long-term care and inmates who are likely to require care in the future," Mara says. "Other issues include staff and training needs, inmates helping other inmates, safety of older inmates, women inmates who need long-term care, modification of jobs for inmates who need assistance, release planning, hospice care, buildings and grounds, and cost of care." Local community organizations could play a greater role in long-term care in prisons; many are currently included in the planning at some institutions, says McKenna.
"This is such a new phenomenon -- the aging of inmates in larger numbers," says Mara. "When there were just a few, the younger inmates pitched in, and informal networks were set up. But informal networks, although helpful, are limited. When a greater portion of the population is or will be affected, then formal programs and policies are necessary to provide proper care because corrections staff will face more non-traditional challenges and duties." Mara notes that the issue also is affecting other nations with aging prisoners population, such as Canada, France, Australia, Japan and Korea. The study received funding from the U.S. Department of Justice's National Institute of Justice and supportive collaboration from the Pennsylvania Department of Corrections.
The Penn State researchers have published their findings in the journal Public Policy and Aging Report. They presented parts of the study at recent conferences of the Gerontological Society of America, Academy of Criminal Justice Sciences, American Political Science Association and the World Congress of International Political Science Association. Dr. Mara will discuss the development of hospice care at prisons at the November meeting of the Northeastern Political Science Association meeting.
Journal
Public Policy & Aging Report