Introduction

Many correctional facilities have incorporated into the planning the use of specialized facilities and resources to respond to the variety of needs and individual attention required by the elderly. A study by Walsh (1992) on a random sample of elderly inmates over 55 revealed that elderly inmates in fact have different needs than younger inmates. Essentially, he found that older inmates need more preventive care, orderly conditions, safety, and emotional feedback and support from families. On the other hand, younger inmates desire more freedom, social activity (i.e. basketball, weightlifting), and mental stimulation.

According to a survey report by the National Institute of Corrections, 23 of 50 Departments of Corrections (DOCs) indicated that they provide services for elderly inmate care (National Institute of Corrections, 1997). Of these 23, fifteen states, including Arizona, Louisiana, Pennsylvania, and Ohio, provide consolidated medical care at one or more main sites. The most common approaches used to provide specialized medical for elderly inmates include: chronic clinics, preventive care, and increased frequency of physical examinations (National Institute of Corrections, 1997). Florida, Texas, and several other states use additional approaches, such as physical therapy, work opportunities, and special recreation to respond to the medical needs of elderly inmates. Currently, Maryland prisons conduct intake and annual screenings for those over age 50; however, there is not a separate prison facility exclusively for elderly inmates.

Staffing and training issues are another concern for aging prison population. Many experts feel that staff who deal with the elderly must have specialized training to understand the social and emotional needs of older offenders, including the dynamics for death and dying, medical and nutritional concerns, procedures for identifying depression, and referral processes (Chartier, 1999). In addition, correctional staff should be able to recognize the difference between the normal aging process and the disease process (Duckett et al., 2000) There are 16 DOCs, including Maryland, that provide special training for security staff on working with chronically ill, terminally ill, and/or elderly inmates, according to the National Institute of Corrections (1997).

Health care is undoubtedly the most critical issue when discussing the aging prison population, for a variety of reasons. First, all prisoners in general are not eligible for Medicare and Medicaid benefits as individuals outside of prison. Rather, they are offered a more sub-standard type of health care. Secondly, other life issues tend to compound these prisoners' lives, including strained relationships with family and friends, adjustment to prison life, and dealing with age-related illnesses (Ducket, et al, 2000). Most data on medical costs suggest older offenders (those age 60 and over) cost nearly three times as much as the average offender under normal prison conditions. This is primarily due to the fact that the elderly offenders require continual care and observation more than younger offenders who usually can care for themselves. These higher costs have led to the use of several cost control method by prisons throughout the United States. These methods include hospice, telemedicine, privatization of medical care, inmate co-payments, and managed care (Duckett, et al., 2000). A recent study by the National Institute of Justice (NIJ) found that using telemedicine saved three prisons more than $59,000 by avoiding the need to transfer prisoners to the medical center (Telemedicine, 1999). Another $27,500 was saved when the use of telemedicine prevented about 35 trips to local specialists (Telemedicine, 1999).

Telemedicine is a rapidly evolving field in the healthcare industry and in prison facilities as well. Essentially, it refers to the use of electronic communication and information technologies to provide or support clinical care at a distance. In other words, doctors can treat patients via telemedicine systems, which work over phone lines and employ a camera, microphone, blood pressure cuff and stethoscope for starters. According to Anderson, Texas, Oklahoma, Tennessee, Michigan, Massachusetts, and Virginia are using telemedicine to provide for their prison populations (1999). Experts say this form of healthcare can significantly reduce the time and costs of patient transportation and reduce risk to the physicians caring for the incarcerated population.

Many states, including areas of Maryland, are entering into privately managed care agreements to provide mandated health care for criminal offenders. In addition, some of these managed care systems include mental health services as well. The most common mental health illnesses are: depression, senile dementia, and substance abuse (primarily alcohol abuse) (Duckett et al.). If implemented correctly, managed care systems care can promote efficiency, reduce unnecessary costs by eliminating unneeded services and promote preventive health care even in offender populations (Impact, 2001).

According to Jack Kavanaugh, assistant commissioner in the state Divisions of Corrections in Maryland, the agency is investigating whether it can safely move older prisoners serving life sentences from maximum security prisons to less secure facilities, including nursing homes for inmates confined to bed (Stuckey, 2001). In addition, a report on prison medical care for terminally ill, chronically ill, and elderly inmates, showed that the Maine DOC currently uses nursing homes beds for very frail and medically compromised elderly inmates (National Institute of Corrections, 1997).

Another option prisons utilize to handle the aging prison population prisoners is compassionate release, which is available in Maryland as well as 21other state DOCs. This form of release offers medical parole for chronically and terminally ill inmates whose needs are better met in the community.

Types of Elderly Offenders

According to research on the aging prison population in the United States, there are three types of elderly offenders: 1) first offenders - those sentenced to prison after age 50, 2) those incarcerated at a young age and grow old in prison as a result of a life sentence, and 3) prison recidivists - those who have embraced a criminal career and served multiple sentences (Chartier, 1999; Morton, 2001.) However, using a classification of elderly offenders developed by geriatric specialists Craig-Moreland and McLaurine, they have added a fourth category called chronic offender. This offender has a propensity for criminal activity but has never been confined before (Neeley, Addison, & Craig-Moreland, 1997). They also stated that the prison recidivist could be an asset in a separate living unit situation with older inmates; as they can help first and chronic offenders become adjusted to prison live.

Related Issues Concerning Aging Prison Population

Gary Rosenfeldt, executive director of the Ottawa-based national office of Victims of Violence, highlights an important point about older offenders and how many states are considering compassionate or early release insomuch they pose little threat to the community they reenter. He states that potentially there could be cases where murderers and sex offenders feign illnesses of disabilities in order to receive a bid for early release. Rosenfeldt adds that "potential threat and proper punishment must outweigh cost factors or compassionate grounds for release-even if offender is terminally ill" (Harris, 2000a). Furthermore, some police officers, correctional professionals, and politicians have strong objections to "making it easier" on these aging inmates (Duckett, et al., 2000). Victims and their families are the major proponents on the retribution side of the debate because they believe that justice must be served, even if it means not giving in to the plethora of special needs required by many of these aged criminals. Options, such as compassionate release, spell the word "fear" instead of "inmate rehabilitation" for most victims and their families.

Facts on Aging Prison Populations in Other States

Of the 16, 776 inmates in Connecticut in 1999, there were 6,609 male and 37 female inmates age 50 and over, representing 4.4 percent of the inmate population (Mayko, 1999). The next largest group of inmates, 6,982, were between the ages of 31-45 (Mayko, 1999). Since 1999, their current prison population has reached 17, 459.

In Florida, the elderly inmate population, using age 50 as the baseline, increased every month in the year 2000. As of December 2000, the total number of inmates 50 or older was 5,873 (FDOC, 2000). Florida has special units for both male and female older inmates, and a chronic disease clinic where inmates are seen every 90 days.

Kentucky reported 1,106 inmates, or 8.4% of the inmate population, was age 50 or older (Georgia, 2000). Kentucky also has a 50-bed convalescent care center with medical service and a 58-bed skilled nursing facility to complement the center.

Louisiana reported 2,099, or 14.1 % of the inmate population, was age 50 or older. This state has the highest percentage of older inmates in the nation (Georgia, 2000). Currently, they are building a "special needs" facility for chronic and geriatric inmates.

North Carolina reported 1,327 inmates, or 5.7 of the inmate population, was age 50 or older (Georgia, 2000).

Oklahoma has approximately 357 inmates over the age 60. Currently, 7 percent of the Oklahoma prison population is 50 and over (Cotner, 2001).

Ohio reported 3,346 inmates, or 7% of the inmate population, was age 50 or older. Ohio also has a 400-bed facility dedicated to older inmates (Georgia, 2000).

As of December 2000, South Carolina had 373 inmates admitted at age 50 and older (SCDC, 2000). Of these 373, 67 were admitted at age 62 and over.

According to the U.S. Bureau of Prisons, in Federal prisons there were 9,509 females and 117, 613 males incarcerated as of June. Of these, 1,056 women and 13,833 men are 50 or older (Mayko, 1999).

According to a recent article, Canada revealed that its aging offender population doubled between 1990 and 1998 (Harris, 2000b). Another article by Harris states that the Correctional Services of Canada (CSC) now holds 3,752 offenders aged 50 years of older in prison and halfway houses (Harris, 2000b). This unprecedented number was spawned by a surge in convictions for historical sex crimes like rape, pedophilia, and incest (Harris, 2000b). In addition, a 1998 report compiled for Correctional Service of Canada show 73% of 50-plus prisoners entered the federal system as first-time offenders (Harris, 20000c). Currently, Ontario has the largest number of aging offenders, with 1,117 in prison and halfway houses (Harris, 2000c). A report on Quebec's prison population suggested that increases in older offenders were a result of changed practices of the courts and change in penal policy (Landreville, 1995). The courts have chosen to select alternatives for younger offenders causing this population to decrease, while imposing harsher sentences on older inmates, thus increasing their population.

Georgia

The Georgia DOC attributes the growing trend in elderly inmates to five trends that have converged over the past decade. The first is a fundamental shift towards a more retributive and punitive response to crime. The second is the trend toward a severe curtailment of discretionary release from prison. The third is the massive increase in prison capacity over the past two decades. The fourth is the overall aging of the United States population in general. Finally, the fifth is increase ist incarceration rate, which ranks eighth among the fifty states.

Another study commissioned by Georgia DOC found that inmates aged 50 and older were twenty times more likely to be assigned to special medical beds than inmates younger than age 50 (Georgia, 1998). Furthermore, the study concluded that although inmates 50 and older only comprised 6% percent of the overall inmate population, they consumed over 12% of the total inmate medical expenditures.

Maryland

According to Duckett et al. (2000), these are some of the statistics on Maryland's aging prison population. Based on data gathered from 1990 to 2000, Maryland DOC housed 23,795 offenders with 1,287 offenders older than age 50. Of the 1,287 offenders, 240 were older than age 60 and twelve older than 74. Of the 240, 116 were Black, 114 White, 2 other, 232 males, and 8 were females (6 Black, 2 White). The most serious offense for inmates age 51 to 60 and 60+ was murder. Finally, they projected that by 2010, the total prison population in Maryland will be approximately 32,000, with 2500 prison inmates between ages 51 and 60, and 480 aged 61+.

The health concerns of these inmates include: 23 with memory impairment, 8 who require continual medical care, 38 with heart problems, 14 with lung disease, and 13 with senile dementia.

Currently, the care for the elderly prison population in Maryland appears to be sufficient. Maryland's DOC reported in its 1999 Correctional Action Agenda Plan II, that new construction or renovation of an existing facility is not necessary at this time (Duckett, et al, 2000). On the other hand, some criminal justice professionals believe these prisoners would benefit from a specialized facility.

Regardless of these conflicting opinions, the elderly population is expected to boom, especially between 2010-2020, when the "baby boom" generation enters its elderly years. Therefore, it is important that policymakers and other criminal justice professionals incorporate the types of statistics and information discussed so they can adopt "proactive plans" to provide for these elderly inmates in future years.

Norman Cox, president of Corrections National Corporation, announced they want to build a complex in Pennsylvania to handle the needs of elderly federal inmates. This new complex, currently on hold, would have a capacity of 786 for inmates suffering from chronic health problems and who are mostly over 50 years of age. The plan is to draw chronically ill inmates from the 20 federal prisons and camps within a 250-mile radius, which would include Connecticut (Mayko, 1999). A similar, 326-bed prison facility, was built for aging state and county inmates by Just Care Inc., out of Montgomery, Alabama (Mayko, 1999).

Overview of Recommendations for Aging Prison Populations by Selected States

Maryland (by Duckett et al., 2000.)

1. Improve and upgrade the state's information system to enable policymakers to assess the current and ongoing status of different interventions.
2. Find alternatives to spending - Division of Corrections must first seek a method of tracking healthcare expenditures that can be analyzed.
3. Include and collaborate with all relevant stakeholders when planning or developing new programs.
4. Consider age as a mitigating factor during criminal sentencing of an elderly offender.
5. Develop a joint sentencing commission/DOC subcommittee to explore sentencing effects and alternatives.
6. Consider community confinement and structured supervision for specific nonviolent offenders. The Coalition for Federal Sentencing Reform estimates savings of almost $900 million to the nation's criminal justice system if all elderly offenders over age 55 were reassigned to supervised release.

Florida (taken from report by Duckett et al., 2000)

1. Adopt age 50 as the chronological starting point in the definition of elderly inmates.
2. Increase the use of citizen volunteers to assist both staff and elderly inmate population.
3. Design a training program for those staff working in facilities with high number of elderly inmates to increase awareness of the special needs of the elderly inmate population. The program should be designed and taught by individual with formal training in gerontology.
4. Seek new funding resources to support research and programming related to the elderly populations.
5. Incorporate into state DOC's comprehensive correctional master plan the potential growth of the elderly inmate population and its associated needs.

Oklahoma (Wheeler, Connelly, & Wheeler, 1995)

1. Develop and maintain baseline date on the elderly offender to facilitate needs assessment, legal compliance, and planning.
2. Modify existing classification systems to facilitate mainstreaming of the elderly if consistent with their physical and mental health needs.

Canada (Correctional Services of Canada, 2000)

1. Make various modifications, since most prisons were not designed to handle elderly inmates and their special needs. These include commodes, showers, and bathtubs with handrails. Also, the physical layout, conditions, social structure and social realities may need re-designing.
2. Provide a separate unit within the same institution or a completely separate facility for elderly inmates, thus centralizing care and alleviating fears about younger offender populations.
3. Require correctional staff to have some form of medical training. For example, require compulsory "registered nursing" (RN) courses for correctional staff, which may also be a cost-effective alternative to equipping correctional facilities with increased health care professional.
4. Incorporate programs that promote life skills and reintegration into the community.

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