Lunch at Kentucky State Reformatory, 2008. Click above to view more of Tim Gruber's photos.
The DOC confirms that it has neither prison hospices nor immediate plans to build any. By 2020, according to the state's DOC Master Plan, Massachusetts will need three "new specialized facilities" to house an estimated 1,270 prisoners with medical or mental health issues that would preclude them being housed in "regular" prisons. "We don't have have a position on compassionate, geriatric, or any other type of release," a DOC spokeswoman told me via email. "That's up to the Legislature." And while Massachusetts legislators have introduced a bill "establishing criteria for the compassionate release of terminally ill inmates," it has yet to make it past the "study" stage.
By 2010, according to the Vera Institute, 15 states and DC had approved some form of "geriatric release," while others had medical- or compassionate-release programs that could potentially apply to frail, aging prisoners. But "the jurisdictions are rarely using these provisions," its report notes, thanks to fearful politicians, a less-than-sympathetic public, narrow eligibility criteria, and red tape that discourages inmates from applying and can draw out the process indefinitely. Nobody has aggregated the state-to-state data, but it appears that the number of prisoners released under these programs totals no more than a few hundred.
"Sixteen billion [dollars] a year. Think about that number. It has to wake up some people."
Jack Donson, who spent 23 years as a case manager for the federal Bureau of Prisons, points to the shortcomings of the Elderly Offender Pilot Program, part of 2008 federal legislation called the Second Chance Act. The law made the criteria for early release so strict, and the paperwork so extensive, Donson says, that it applied to only a few dozen inmates nationally. "I actually referred the first offender in the country" to the program, he notes on his website. "The bureaucrats deemed this offender dangerous to the community," because of a record of violence 30 years earlier, "yet he had been incarcerated in a camp setting (without a fence), was a model inmate with an outstanding work ethic who even participated in unescorted medical furloughs in the community."
Little has changed in the interim. But Hood believes America is approaching a politically expedient moment. "You spend $68,000 to watch an inmate who is truly hospital-bound? I think most people would get that. They would understand that if there's another way to do it—let's do it outside the prison," he says. "Sixteen billion a year. Think about that number. It has to wake up some people."
"States just can't support the burden anymore," agrees former state warden Carl ToersBijns. "The only solution will be to release them or to ignore them." If we choose the latter, he cautions, prison death rates will skyrocket.
Of course, ignoring elderly prisoners after release could be just as devastating. The ACLU's Fathi emphasizes that institutionalized old folks will require plenty of help transitioning back into the community and getting the services they need. "For many elderly prisoners," he says, "particularly those with serious medical needs, simply pushing them out the prison door will be tantamount to a death sentence."
James Ridgeway wrote this article with support from a MetLife Foundation Journalists in Aging Fellowship, a collaboration of New America Media and the Gerontological Society of America.