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Both Correctional Custody of Aging Prisoners and Nursing Home Reform Need Transformational Change

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Richard T. Moore
February 14, 2021

What do prisons, especially given a growing population of aging inmates, have in common with nursing homes? Although many people might not initially equate nursing homes with prisons, there are other points of comparison. Neither prisons or nursing homes offer much in the way of choice, independence, privacy or dignity to the residents. Nursing home residents aren’t able or routinely permitted to leave on their own. Prisoners are not normally able to leave except on parole, the expiration of their sentence or through means of escape. Both prisons and nursing homes, along with cruise ships, experienced high volumes of COVID-19 cases.

In a July 2020 editorial in the Journal of the American Medical Directors Association, Philip D. Sloane, MD, wrote:

“While at first glance cruise ships, prisons and nursing homes are very different institutions, in fact they share many commonalities. Each is a densely populated congregate setting with cramped housing units that do not lend themselves well to sheltering in place. Each prepares meals in a central kitchen and serves them to large gatherings. Each sponsors activities that bring large groups together on a regular basis. Each has relatively large numbers of staff who have extensive contact with the residents and work under demanding conditions for modest pay. Each has medical resources that compete with other, nonmedical priorities. Each has healthcare regulations that, while extensive, could not possibly have fully prepared them for COVID-19; instead, in the face of an impending outbreak, rapid, nimble responses were needed, and these have proven hard to initiate and coordinate in all 3 settings. Each setting can be considered high risk for amplifying infectious diseases, because the conditions that prevent disease dissemination are nearly impossible to achieve.”

Some scholars have argued that nursing home residents would be better off in prison than in long-term care facilities. Even before the pandemic, blogger Jacqui Lee opined, “Going to jail curtails freedom. Becoming frail and needing concentrated medical attention requires a nursing home. In both cases, in my opinion, freedom is restricted. The prisoner through his actions and life choices is locked away and denied freedom. Prisoners, however, have a right to appeal and have legal aid; sometimes I think their rights may be more easily available than the nursing home residents are.”

Randy Wedel, in a letter to the editor, published by The Daily Oklahoman, in 2012, expressed a similar view, stating, “When convicted offenders with assets go to jail, many serve their time, keeping their net worth intact, while elderly people needing nursing home care must spend most all their money before being eligible for Medicaid. At taxpayer expense, inmates get nutritious food, healthcare, dental care and access to quality education. On Medicaid, people get decent care but not the perks of prison.”

There appears to be another side to these arguments suggesting that prisons have too many older, non-violent inmates, and don’t have the facilities to properly care for older adults. In fact, Maura Ewing of the Marshall Project, arguing the case for better care for older prisoners wrote, “America’s prison population is rapidly graying, forcing corrections departments to confront the rising costs and challenges of healthcare in institutions that weren’t designed to serve as nursing homes. By 2030, the report said, one-third of all inmates will be over 55. At the same time, it is widely accepted that prisoners age faster than the general population because they tend to arrive at prison with more health problems or develop them during incarceration.”

In Rocky Hill, Connecticut, “From the outside, the 95-bedsingle-story facility set back from the road looks like any other nursing home. But many of the elderly and ill residents are actually paroled prisoners, and the home is being watched nationally as a potential game-changer for states grappling for ways to care for their aging inmate populations.” In a first-in-the-nation project approved by CMS, “Ailing inmates who qualify for nursing home-level care and who the state deems are not public safety risks are referred to 60 West. Medicaid covers half the cost of their care, which will save the state about $5 million annually.”

While converting unused skilled nursing facilities to minimum security homes for aging prisoners could be the answer to some public policy issues present in most states, such as cost and care of older prisoners and repurposing of under-utilized nursing homes, policymakers still need to address nursing home reform.

One concept shows promise for bringing transformational change to skilled nursing facilitie—the Green House Model that’s appearing in more states and in VA facilities. Founded on the belief that everyone has the right to age with dignity, the model seeks to de-stigmatize aging and humanizing care for all people. The homes are small-scale, self-contained and self-sufficient facilities that put older adults at the center with private rooms and bathrooms, and attractive common areas. States could repurpose older nursing homes for minimum security facilities, and only permit new nursing homes if they follow the Green House model.

Author: Richard T. Moore has served in both elective and appointed public office at local, state, and federal levels of government. He served for nearly two decades each in the Massachusetts House and Senate, as well as being chosen as President of the National Conference of State Legislatures. A former college administrator and adjunct assistant professor of government at Bentley University and Bridgewater State University, Mr. Moore is a long-time member of ASPA serving terms as Massachusetts Chapter President and National Council member. He currently serves on the board of Dignity Alliance Massachusetts advocating for older adults and people with disabilities. [email protected]

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