By 2030, it is projected that one in three people behind bars will be considered geriatric, compared to one in five Americans in the overall population.
Greater involvement from nursing home operators and new potential nursing home payment programs are likely needed to address this pressing public health challenge, research wrote in an op-ed published in Health Affairs.
The harsh prison environment often accelerates physical and cognitive decline, leading to higher rates of conditions like dementia and a reduced ability to perform both ADLs and PADLs, wrote the researchers from Brown University and Boston University Chobanian and Avedisian School of Medicine.
“Carceral facilities are not designed to provide long-term skilled nursing facility-level care,” they wrote. “While prisons do have health care services delivered to patients every day, these systems struggle to accommodate care beyond the routine.”
Geriatric individuals cost twice as much to incarcerate as the average-age adult in prison, making health care one of the fastest-growing categories in state budgets. Moreover, withholding appropriate nursing care from this population raises ethical concerns, given that incarcerated individuals have a constitutional right to healthcare under the Eighth Amendment.
Compassionate release laws have been implemented at the state level in some regions to address the health care needs of elderly and frail inmates. In states like Rhode Island and Massachusetts, incarcerated individuals with severe and chronic health conditions, including cognitive impairments and an inability to perform ADLs, may be eligible for early release on medical or geriatric parole.
Researchers said that by financially incentivizing nursing homes to accept patients released from prisons, more individuals could have access to nursing care in the community. This approach has been piloted in Colorado, where the Department of Corrections has requested funding to encourage nursing facilities to accept individuals granted compassionate release.
Researchers also suggested that states could partner with private companies to create nursing facilities tailored for justice-involved elderly individuals. An example of this model’s success is Connecticut’s 60 West Nursing Home, managed by a private organization specializing in caring for disenfranchised populations.
States can also establish state-run nursing facilities that accommodate incarcerated individuals, those who have completed their sentences, or those granted geriatric parole. Several states, such as Florida, New York, and California, have successfully implemented such facilities.
Connecticut-based iCare has a behavioral health program woven throughout a majority of its 12 senior care facilities, the operator has gone one step further to serve parolees in the state that need high acuity services in a skilled nursing setting.
Skilled Nursing News reported that iCare — the operator of the 60 West facility in Connecticut — plans to expand its behavioral health programs for parolees to other states as well in the years ahead, after opening its first dedicated behavioral health unit back in 2002.
“It’s a big national topic. We were the first to do it 10 years ago, and you’d think there’d be more, we’ve responded to a few other RFPs over the years. I’ve only spoken to a couple of dozen states on the topic,” Landi told SNN last year.
Such a program would help with de-densification initiatives in prison systems as well, he said.
“The states definitely know about it, especially in the prison system,” iCare CEO Chris Wright said. “We’ve had several state legislators from other states and officials from state agencies come in and look at this program. They will decide whether to do a [request for proposal, or] RFP, to do the same thing.”
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