Caring for aging inmates is a growing expense
Elderly prisoners cost more because almost all expenses related to their health care must be borne by state tax dollars
By Jean Mikle
The Associated Press
TRENTON, N.J. — Convicted of three counts of robbery when he was still a young man, Steven Thomas has been in prison since December 1982. Now 62, frail and suffering from a relapse of Hepatitis C, he's one of an increasing number of inmates in New Jersey's correctional institutions who have grown old behind bars.
”I did a robbery when I was 27, 26 years old, and I've been locked up ever since,” Thomas told the Asbury Park Press of Neptune while sitting at the edge of his hospital bed in a hospice unit at South Woods State Prison in Bridgeton. “I wouldn't want to die here.”
Since 2000, the number of prisoners over age 50 in New Jersey's state prisons has jumped nearly 90 percent. Now nearly 3,000 older prisoners are in the state's eight adult correctional institutions.
The older prisoner population has continued to soar even as the number of adult offenders incarcerated in New Jersey state prisons has declined by 7 percent since 2009, to about 17,000 last year, according to state Department of Corrections figures.
Older prisoners are also the fastest growing segment of the U.S. prison population. An estimated 246,000 people over 50 were behind bars last year, according to a 2012 American Civil Liberties Union report.
The growing number of older prisoners, like Thomas, represents a potential fiscal time bomb for the state and nation: Elderly prisoners cost more because almost all expenses related to their health care must be borne by state tax dollars.
If it costs New Jersey an average of $71,000 to care for each elderly inmate, as one study suggests, that would cost taxpayers $21.3 million -- about double the cost for the same number of younger, healthy inmates.
Some states, including Louisiana, have moved to make it easier for older, nonviolent offenders to be released early, while others have created separate housing accommodations.
As of 2008, at least 13 states had units set aside solely for elderly prisoners, according to a 2010 Vera Institute of Justice report.
In New Jersey, Department of Corrections spokesman Matt Schuman said there are no “special or unusual arrangements for the aging inmate population.” Older inmates are mixed in with general inmates.
”Is it morally and financially the right thing to keep them in prison?” said Tina Maschi, a Fordham University professor who is conducting a study on New Jersey's older inmate population in an effort to develop programs aimed at improving the mental and physical health of elderly prisoners. “In prison, are we turning a blind eye to the fact that we need to take a look at these older people differently?”
Schuman said the DOC is concerned about the growth in the older inmate population, but plans no changes “in the immediate future.” He said department officials will continue to closely monitor the situation. Down the road, there may be rising medical costs and “possibly a requirement for specialized housing,” Schuman said.
There is some disagreement among researchers and corrections experts as to the age at which an inmate becomes elderly.
The National Institute of Corrections considers prisoners over 50 to be “elderly” or “aging.” That's because those who wind up behind bars have more frequently engaged in unhealthy behaviors -- like using narcotics or drinking -- than the general population. And they've also been less likely to receive regular medical care. Once they're locked up, the stress of prison life tends to prematurely age people, corrections experts say.
Since 1981, the number of prisoners over 55 has grown from about 9,000 nationwide to 124,900 last year. It's estimated to reach more than 400,000 by 2030, according to the ACLU report. Researchers in the study used the 55 and up age group to show the dramatic growth in numbers of inmates since there is not enough data tracking 50 and up inmates over time.
Starting in the mid-1970s, a nationwide push to get tough on crime included enactment of mandatory minimum sentences and three-strike laws that sends offenders to prison for life if convicted of three serious offenses.
The result: the U.S. prison population soared, growing at 11 times the rate of the general population from 1980 to 2010. There are about 2.3 million people behind bars in the U.S., and with more inmates serving longer sentences, the number of elderly prisoners has also jumped.
In 2012, more than 70 percent of the inmates in New Jersey's state prisons were serving sentences that included mandatory minimum terms before parole, according to the corrections department.
”We have created this situation where people are destined to do long terms in a criminal justice system that was not designed to be a long-term care facility,” Maschi said. “We have a group of older people in prison with varying levels of health and mental health, and what do we do about that now?”
A 2012 ACLU study estimated that it costs nearly $70,000 a year to house a prisoner over 50, compared with an average of $34,135 for a younger inmate. The increase is primarily driven by much higher healthcare costs for the older population.
In New Jersey, the annual cost to house all inmates ranged from about $31,000 at Bayside State Prison in Maurice River Township to approximately $58,000 at the Edna Mahan Correctional Facility for Women in Clinton. The corrections department does not break down cost figures by age, corrections spokesman Schuman said.
Prisoners over 50 in New Jersey's state correctional facilities have the same health issues common in senior citizens anywhere. Some struggle with high blood pressure or failing eyesight. Some need canes or walkers to get around. Others may need heart bypass surgery or suffer from cancer or dementia.
But unlike those on the outside, prisoners don't qualify for Social Security payments and aren't eligible for Medicaid or Medicare. New Jersey has made prisoners give a $5 co-payment for their medical costs since the mid-1990s, if they are the ones who request medical care, Schuman said.
The co-pays can come from money prisoners earn while working or from contributions from their families.
Most of the inmates health care costs are paid for by the corrections department. Maschi said her survey of 667 inmates 50 or older showed 20 percent had vision problems, 17 percent suffered from arthritis, 15 percent had high blood pressure and 11 percent said they had difficulty walking. Nearly one-third had some type of mental illness.
Like all other inmates in New Jersey state prisons, older offenders receive a “Heart Healthy” diet, consisting of foods low in fat and sodium and high in fiber, following guidelines set by the American Heart Association. Schuman said a prisoner with a particular health problem can receive a different therapeutic diet, if ordered by a physician.
In addition to more medical problems, older inmates, who often are more feeble than their younger counterparts, have a greater chance of being preyed upon by younger inmates looking for easy targets, experts say.
”I remember a former deputy commissioner of corrections saying to me, 'You don't want to get old in prison,'” said Ed Martone, director of public education and policy at the New Jersey Association on Correction, an advocacy group for current and former prisoners. “To fellow travelers in prison, this guy is now a mark, and vulnerable, and I can take his stuff.”
Some states have responded to the growing number of elderly inmates by establishing separate prisons to house them, or unique programs to address their distinct needs. In Nevada, the “True Grit” program has helped reduce infirmary visits for about 200 prisoners by offering music and art therapy and physical exercise, including wheelchair basketball.
California is building a 1,700-bed prison to house medically infirm prisoners. In 2006, New York opened a special prison unit for the cognitively impaired at its Fishkill facility. Most of the prisoners in the unit suffer from dementia. Washington state has an assisted living unit at one of its prisons.
Other states, like Louisiana, have passed laws making it easier for some elderly prisoners to be released after a parole hearing at which their risk for committing future crimes is assessed. Releasing some older prisoners early could shift the cost of their care from states to their family members, and make them eligible for federal programs like Medicaid, experts say.
New Jersey is one of 39 states that have medical parole laws, which allow for the release of seriously or terminally ill prisoners, according to the 2010 Vera Institute of Justice Report.
Sick inmates in New Jersey prisons may apply for medical parole, corrections spokesman Matt Schuman said. The Parole Board makes the final decision. But approval of such requests is “very rare,” he said.
The Vera Institute found that even states that have specific geriatric release policies rarely release older inmates. From 2001 to 2008, Colorado released three older offenders. Virginia released four from 2001 to 2007.
The ACLU report urges states to adopt a program similar to Louisiana's, allowing low-risk older offenders to leave prison. The report points to decades of research that shows crime rates decrease steadily after age 24. Almost no crimes are committed by those over 65. Research also shows that older offenders are much less likely to return to prison after they are released.
A 1998 study by Barry Holman, “Nursing Homes Behind Bars: The Elderly in Prison,” found 3.2 percent of prisoners 55 and older returned to prison within a year of their release, compared with 45 percent of offenders 18 to 29 years old.
But it's not a politically popular stance to call for early release of prisoners. Martone said his organization has not heard of any push to advocate for a geriatric release law in New Jersey. There is a belief that someone who is sentenced by a judge should not have his sentence reduced by the Parole Board, he said.
”What happens if he gets out because he's so ill, has a rebound and commits another crime?” Martone said.
Maschi, the Fordham professor, said even if prisoners are released, there may be no place for them to live. Often family members have passed on or may not be able to care for the former inmate. Those behind prison walls need treatment that includes not just care for their bodies, but also input from mental health professionals, she said. Nearly one-third of the older prisoners in Maschi's study had serious mental health issues.
Steven Thomas spends his days at South Woods State Prison in a small room that's part of a an 80-bed extended care unit at the medium security facility.
Sick inmates in the unit come from facilities all over the state, where they are treated by doctors and nurses in a unit that's similar to a small hospital, according to Social Work Supervisor Rosalind Williams.
Thomas, who is from Jersey City, dreams of someday leaving South Woods and seeing his three children. He said he regrets his criminal past and would like to go home before he dies. He was denied parole at a hearing in August 2012. His next parole hearing will not be until 2017.
”I did what I did, and I take responsibility,” he said. “I am totally remorseful for what I did.”