Tuesday, March 08, 2011

Prison Hospice - A Perfect Storm

The Aging Prison Population

The aging of the prison population in the United States can be attributed to what some have called a perfect storm in the world of corrections. With an increase in tough on crime legislation - including harsher sentencing, curtailing the powers of judges, and the elimination of parole throughout the Federal Bureau of Prisons, the U.S. correctional system is finding itself saddled with a booming elderly population of long timers and the chronically ill.

The rumblings of this storm are just beginning. From the early 1990s until now, the number of state and federal inmates age 50 and older has grown an astonishing 172 percent. Some estimates claim that within the next fifteen to twenty years, over 20 percent of the United States prison population will be classified as elderly.

How Old is Elderly?

While 50 may seem too young to be called elderly in the free world, several important factors hasten the aging process for those behind the walls. The amount of stress experienced by inmates navigating the harsh realities of prison life; financial and familial stress due to incarceration; withdrawal from chronic substance abuse; and the lack of access to adequate medical care prior to and during incarceration, all contribute to accelerating the aging process. It is estimated that an inmate ages an average of 7 to 10 years faster than their counterparts in the free world.

The Costs of Healthcare

Since the mid 1990’s, prison healthcare spending in the United States has increased 27 percent, from $2.7 billion to $3.4 billion a year. The average cost of healthcare per inmate rose 31 percent during that same period, from $5.62 to $7.39 a day. The annual cost of incarcerating elderly, chronically or terminally ill inmates has therefore risen dramatically - to an average of $65,000, compared to about $27,000 for a healthy inmate in the general prison population.

What’s Killing the Inmates?

Correctional institutions house a growing number of inmates with terminal illnesses. Most systems define inmates as terminally ill if they are known to have a fatal disease and have fewer than 6 months to live. Each year more than 2,500 men and women die in United States prisons, and while it is widely assumed that the leading cause of death in prison is AIDS, most deaths can be attributed to other illnesses such as cancer, liver disease, hepatitis, chronic obstructive pulmonary disease, and congestive heart failure.

A Compassionate Alternative

As a nation, our consciousness about how we die has expanded over the past twenty years to include many alternatives and options. But these changes are only just beginning to enter the world inside our prisons and jails. Dying with dignity is particularly challenging in a prison setting, where individuals are often both physically and emotionally isolated from friends and family. In the past five years, two approaches have gained momentum for meeting the needs of terminally ill prisoners: the utilization of compassionate release, and the development of prison based hospice programs.

While laws vary from state to state, terminally ill prisoners who pose no threat to themselves or society and have family members willing to care for them may be granted compassionate release from prison. But sadly, compassionate release has become more of a political process than a medical one; with many prison administrators and legislators thinking twice about releasing terminally ill prisoners in the current tough-on-crime climate of this country.

Even when compassionate release is granted, often it comes too late, with the terminally ill prisoner passing away before the paperwork is completed. Thus a prisoner’s greatest fear of dying in prison becomes a reality. But there is an alternative for those faced with the prospects of dying in prison – which is prison-based hospice care.

What is Prison Hospice?

Over the past decade, hospice programs have become increasingly common in communities around the country, and the movement is also slowly gaining a foothold among state, federal, and municipal prison administrations. Currently there are 58 prison hospice programs throughout the United States, with exceptional programs operating in Oregon, New York, Minnesota, California, Kentucky and Iowa.

In the community hospice model an interdisciplinary team (IDT) consisting of the family members, physicians, nurses, social workers, counselors, clergy, and trained volunteers cares for the patient, offering support based on their particular areas of expertise. Together, they provide comprehensive care aimed at relieving symptoms and giving social, emotional, and spiritual support.

The prison hospice model, however, has additional elements that distinguish it from the community hospice model in the free world. Added to the IDT within the correctional setting is the crucial element of security. Maintaining safety within the walls and for the public at large is the primary function of a prison, and this must be maintained even in a hospice setting.

Once the security component is effectively added to the IDT, the decision of whether to incorporate inmate hospice volunteers vs. community hospice volunteers into the program must be made.

Inmates as Caregivers

In any hospice setting, whether it is in the free world or behind bars, volunteers play an important role in planning and giving hospice care to their patients. They are instrumental in providing companionship and may listen, reassure, share worries and concerns, hold a hand, help feed, or just sit quietly with the patient.

For some prison hospice programs, inmate hospice volunteers are not included in the program, for fear that they may find it difficult to follow the rules of hospice, steal from or abuse their patient in some way. In such cases the community hospice sends in community volunteers to administer care and compassion to the dying inmate.

While this practice is noble and well intentioned it must be recognized that the connection a dying inmate has with a community hospice representative is not as strong as the connection that patient would have with a fellow inmate who understands the plight of dying in prison – because he himself may be dying in prison one day.

On the whole, it has been seen that inmate volunteers are deeply invested in their hospice and offer exceptional care and companionship to their patients – often exceeding the expectations of prison administrators. The inmate volunteers are well aware that the success of the hospice rests upon their shoulders and in turn will guarantee there will be a hospice program for them when their time comes.