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More Prisoners Die Of Old Age Behind Bars

As the number of older prisoners soars, more inmates are dying in prison of diseases that afflict the elderly, new data from the Department of Justice show.

A total of 3,483 inmates died in state prisons and 444 in federal prisons in 2014, the highest numbers on record since the bureau started counting in 2001, according to data issued Thursday by the department’s Bureau of Justice Statistics. In addition, 1,053 inmates died in local jails, where suicide is on the rise.

The U.S. has the world’s largest prison population, with over 2 million people behind bars. While that population has been shrinking in recent years, deaths in custody have climbed steadily.

The deaths reflect a dramatic shift in the prison population: The number of federal and state prisoners age 55 or older reached over 151,000 in 2014, a growth of 250 percent since 1999.

As this population grows, prisons have begun to serve as nursing homes and hospice wards caring for the sickest patients. The majority of state prisoners who died in 2014 were 55 years or older, and 87 percent of state prisoners died of illnesses, according to the report. The most common illnesses were cancer, heart disease and liver failure.

These deaths point to how dramatically prisoners’ health care needs are changing. Older prisoners have complex medical problems, are vulnerable to violence, and may require intensive care at the end of life, said Gabriel Eber, senior staff counsel at the American Civil Liberties Union’s National Prison Project, which files class-action lawsuits on behalf of prisoners seeking better mental health and medical care.

“The prisons are not equipped to handle the geriatric population,” he charged.

For instance, Eber recalled one case of a veteran in his 80s who suffered from Alzheimer’s disease and other ailments. Housed with the general inmate population in a large urban jail, the man kept getting into fights and pulling out his catheter. The inmate, who developed an infection and died, should have been kept in a medical unit at the outset, Eber said.

Eber said Thursday’s data raise a question: “Do we need to be keeping all these people behind bars?”

In jails, the leading cause of death was suicide, which rose from 328 to 372 from 2013 to 2014. Suicides accounted for over a third of deaths in jails. The suicide rate is now 50 per 100,000 jail inmates. That’s the highest it’s been since the Bureau of Justice Statistics started counting in 2000 — but far lower than in the 1980s, when it ran as high as 129 per 100,000, said statistician Margaret Noonan, who wrote Thursday’s report.

Overall, more than a third of jail deaths happened during an inmate’s first seven days behind bars, according to the report.

The prison data don’t include deaths that occur in privately run federal prisons or deaths by execution.

For prisoners clamoring to spend their dying days at home, U.S. prison jurisdictions have some laws on the books, often called “compassionate release” or “medical parole,” allowing for early release if prisoners are very sick and not a threat. But in practice, very few inmates are set free through these programs, said Dr. Brie Williams, director of the University of California Criminal Justice and Health Project in San Francisco.

Williams and others have called for expanding these programs — in part to alleviate strained state budgets. Inmates are not eligible for Medicaid, so state prisons and jails pay full freight for their medical care, which may include expensive trips, chaperoned by guards, to emergency rooms or specialists in hospitals. Medical care for older prisoners costs three to nine times more than for their younger peers, according to Human Rights Watch.

Williams has lobbied for compassionate release programs to include prisoners who have significant functional decline or cognitive impairment — not just those who are deemed to have six months or a year to live, which has historically been the standard and is difficult to predict.

But many of these older inmates committed violent offenses, such as murder or rape, and political pressure from victims’ advocates and the public makes it hard to release prisoners early, said Dr. Marc Stern, a criminal justice consultant who served as medical director of Washington State’s corrections department from 2002 to 2008.

Stern said when he oversaw the medical component of Washington’s compassionate release program, the first prisoner he approved for release “went horribly.” The man had claimed he was so debilitated he couldn’t walk. But once the prisoner was set free, TV news cameras caught him walking outside his home, manicuring his lawn, Stern said. The state threw the man back behind bars — and grew much more cautious about whom it released, Stern said.

Massachusetts also cracked down on early release after a former prisoner, Dominic Cinelli, killed a police officer in 2010 while out on parole from a life sentence.

That fatal shooting had far-reaching effects for other ailing prisoners. Dianne Babcock, of Vermont, was lobbying for her dying husband to be released from Massachusetts prison. She described her husband, John Babcock, as a “career criminal” whose heroin addiction had driven him to rob banks. He spent over two decades behind bars. At the end of his life, he developed liver cancer from Hepatitis C. At age 57, she said, he was “in tremendous amounts of pain.”

“He would’ve been lucky if he could’ve walked to the bathroom,” she said. Prison health officials cleared Babcock for early release, but the state parole board wouldn’t let him out, and he died in prison in 2011.

“I wanted him to be able to come home and live what remaining time he had left in some sort of comfort,” she said. “That didn’t happen.”

Meanwhile, Williams has been watching the population of older prisoners continue to grow, outpacing the general population of the U.S. As this trend continues, she said, prisons and jails need to catch up.

“I’m talking about a massive expansion of the field of palliative care into the correctional system,” she said, “so it’s integrated into the fabric of correctional care.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

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