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The Landscape of Long-term Care in State Correctional Institutions

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

By Courtney Haun
March 23, 2018

Just like all other populations within the United States, the population behind bars is continuing to grow older. But, state correctional policies for elderly inmate care highly vary. Part of these differences may be attributed to the overall goal individual states have with their correctional policies and the state’s unique characteristics. Some of these characteristics include their crime, incarceration and population rates, with each at an all-time high.

As these rates have increased, expenditures related to correctional provisions have also increased. Of course, one direct cost based on state’s criminal system policy decisions is health care for inmates. And, many individuals who are incarcerated do not receive proper care. Illnesses range from mental disparity and communicable diseases to simple life changes through the aging process. With the rise in the number of older prisoners, through the Eighth Amendment of the United States Constitution, their right to timely access to health care services and medical needs is not occurring.

Options of Care

Based on an article by Stateline, there are an array of approaches being taken by states to care for elderly inmates. Within all of these alternatives endure costs and backlash from the community. Examples of these approaches include:

  • “medical parole;”
  • private nursing homes;
  • “compassionate release;” and,
  • public long-term care facilities.

To further emphasize the shape of the issue, the number of elderly inmates is projected to triple by 2030.

State Philosophies

These approaches are, partially, predicated on state’s philosophies of crime and punishment. Retribution is one type of philosophy that encompasses the idea of “letting the punishment fit the crime” or giving “an eye for an eye.” Incapacitation focuses on the reduction of the physical opportunity for crime and deviance. The rehabilitation philosophy is that punishing can serve as the treatment and reform offenders. The last major punishment philosophy is deterrence, which emphasizes punishments as having the greatest potential for deterring misconduct when they are severe, certain and swift in their application. In recent years, states have eliminated or restricted parole eligibility, more so favoring the incapacitation philosophy.

Cost-effective Options

Regardless of the philosophy practiced, the decision a state makes when it comes to the care of their elderly inmates will have a significant impact on the state’s budget and use of resources. Based on data from 2011, nationwide spending on health care expenses was $7.7 billion. Furthermore, it appears certain forms of care are more cost-effective than others. Telehealth, outsourcing care, financing through Medicaid and geriatric parole appear to be promising options for cost-containment. However, despite the cost savings, many states choose other types of care options. This, in part, may be based on the state’s ideology, budget for corrections and overall inmate/parole population.

The large differences in state’s health policies and procedures speak to the dominating issue of the aging population, at large. As health care resource become more sparse for the entire population, the unduly issue of how to care for inmates is also of concern.  Specifically, the nation must consider regulations for elderly inmates as an important topic that needs to be further addressed. As with many other types of policies, more research needs to be given to the issue. With the state’s different sets of characteristics, it seems as though a logical approach to the problem would be finding the most cost-effective, safest, legal decision for elderly inmate health care would be the best answer.

Training for Care

But, what does this cost-effective, safe option look like? This question brings forth other aspects to consider when it comes to the care of elderly inmates. In part, specific training is needed for workers to address needs for elderly inmates. Without proper education and training for staff within correctional institutions, knowing how to handle life and death of elderly inmates may be obsolete. With proper training, there may be a better opportunity for successful incarceration as well as the transition to another type of facility or parole option. Of course, training is linked to the budget of the states, how they care for their elderly inmate population and what policies exist regarding training.


Whether a state’s primary objective is to protect the public or to elude crime control, many of the current correctional decisions and policies are unconstitutional. Although health care for inmates is just one example, it is evident that there are a plethora of costs connected to the criminal justice system which the states incur. Because the landscape of each state is different, one single, perfect solution is nearly impossible. But, many correctional decisions could be made pivoting towards a more positive outcome for elderly inmate care.

Author: Courtney Haun, MPH, Ph.D. Student, Auburn University [email protected]

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