Releasing our Elders; Health Care Reform and Prisoners.

From the list-serve/newsletter of www.curenational.org (Citizens United for the Rehabilitation of Errants)

-------New Vera Report Shows Difference between Geriatric Release Policy and Practice-------

Harsh sentencing policies have made correctional facilities throughout the United States home to a growing number of older adults. Yet most states with provisions for releasing older prisoners rarely use them, despite the relatively low risk eligible inmates would pose to public safety and the opportunity for potential cost savings.

“It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release” examines statutes related to geriatric release in 15 states and the District of Columbia, identifies factors that help explain the discrepancy, and offers recommendations for those who would address it.

“The upshot is that there’s a difference between what states would like to do—save money by releasing older prisoners—and what actually happens,” says the report’s author, Tina Chiu. “If states want the result of geriatric release policies to be consistent with that objective, they should review the release process to address potential and existing obstacles.”

The Vera Institute of Justice is an independent nonprofit organization that combines expertise in research, demonstration projects, and technical assistance to help leaders in government and civil society improve the systems people rely on for justice and safety.

------------------------------ Health Care Reform and Prisoners------------------------

Thirteen million people are incarcerated in jails annually.

Three and a half million of this 13 million are incarcerated more than once during the year.

 The Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act (together referred to as "the health reform law" expands health insurance coverage by expanding Medicaid, the federal-state health insurance program for low income people, to cover everyone under 133 percent of the federal poverty level (FPL). For uninsured individuals above 133 FPL the bill sets up state-based "health insurance exchanges" or regulated insurance marketplaces where individuals and small businesses can compare and purchase private health insurance policies. (They will function something like websites like Travelocity or Orbitz, but for health insurance.) Lower income individuals will be eligible for tax subsidies to buy insurance on the exchanges.

The health reform law does not change the current inmate exclusion for Medicaid and other federal health programs. Convicted inmates are also ineligible for insurance from the exchanges. However, pre-conviction inmates remain eligible and they also remain subject to the individual mandate to carry health insurance.

Regardless of the insurance arrangements covering prisoners, jails will still have a legal obligation based on the /Gamble /decision by the Supreme Court to provide medical care for all prisoners regardless of conviction status. How this obligation will be satisfied or impacted by the health reform legislation has not been addressed.

 There are two additional references to the criminal justice system in the health care bill. First, "conviction for a relevant crime of patient or resident abuse" disqualifies a person from being hired
as a health care worker, and second, the Federal Bureau of Prisons is specifically included in the Interagency Working Group on Health Care quality.

The Legal Action Center reports that the final health care bill incorporates many key elements on addiction and mental health services, as follows:

Includes substance use disorder and mental health (SUD/MH) services as required benefits in the basic benefit package for individual and small business health plans;

Requires that all plans in the health insurance exchange comply with the Wellstone/Domenici Parity Act in providing SUD/MH benefits in the same way as all other covered medical and surgical benefits;

Expands Medicaid eligibility for all Americans up to 133 percent of the federal poverty level and require newly eligible parents and childless adults receive coverage that includes SUD/MH services provided at parity;

Includes SUD and MH prevention strategies and efforts in the bill's chronic disease initiatives;

Includes the capacity of the mental and behavioral health workforce as high-priority topics in the bill's National Workforce Strategy section; and

Includes insurance reforms and consumer protections critical for individuals seeking or in recovery, including prohibiting insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on health status, and placing annual or lifetime caps on insurance coverage.

The Elderly in Prison

Upcoming Events

December 10: International Human Rights Day.

December 17: International Day to End Violence Against Sex Workers (Tucson Memorial).

December 18: Sex Workers Outreach Project Protest at the AZ DOC in Phoenix.

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From James Ridgeway's blog, the Unsilent Generation:

(hit it: he's an outstanding journalist, he's always well-sourced,and he's done some great work on prisons and the Angola 3 for Mother Jones)

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The Graying of America’s Prisons

December 7, 2009 

The following appears as Part One of a two-part Special Report on The Crime Report (TCR), which is “a collaborative effort by two national organizations that focus on encouraging quality criminal justice reporting:  The  Center on Media, Crime and Justice, the nation’s leading practice-oriented think tank on crime and justice reporting, and Criminal Justice Journalists, the nation’s only membership organization of crime-beat journalists.” I’ll post Part Two as soon as it appears on TCR.



Frank Soffen, now 70 years old, has lived more than half his life in prison, and will likely die there.

Sentenced to life for second-degree murder, Soffen has suffered four heart attacks and is confined to a wheelchair.  He has lately been held in the assisted living wing of Massachusetts’ Norfolk prison. Because of his failing health and his exemplary record over his 37 years behind bars—which includes rescuing a guard being threatened by other inmates—Soffen has been held up as a candidate for release on medical and compassionate grounds.

He is physically incapable of committing a violent crime, has already participated in pre-release and furlough programs, and has a supportive family and a place to live with his son. One of the members of the Massachusetts state parole board spoke in favor of his release. But in 2006 the board voted to deny Soffen parole. He will not be eligible for review for another five years.

The “tough on crime” posturing and policymaking that have dominated American politics for more than three decades have left behind a grim legacy. Longer sentences and harsher parole standards have led to overcrowded prisons, overtaxed state budgets, and devastated families and communities. Now, yet another consequence is becoming visible in the nation’s prisons and jails: a huge and ever-growing numbers of geriatric inmates.

Increasingly, the cells and dormitories of the United States are filled with old, often sick men and women. They hobble around the tiers with walkers or roll in wheelchairs. They fill prison infirmaries, assisted living wings, and hospices faster than the state and federal governments can build them—and since many are dying behind bars, they are filling the mortuaries and graveyards as well.

The care these aging prisoners receive, while often grossly inadequate, is nonetheless cripplingly expensive—so much so that some recession-strapped states are for the first time seriously considering releasing older terminally ill and mentally ill prisoners rather than pay the heavy price for their warehousing. It remains to be seen what will happen when such fiscal concerns run head on into America’s taste for punitive justice. A recent report by the Vera Institute made this clear.

Politicians no doubt did not imagine this Dickensian landscape of the elderly incarcerated when they voted to lengthen sentences and impose mandatory minimums three or four decades ago. But their actions are yielding an inevitable outcome.  While the graying of the prison population to some extent reflects the changing demographics of the populace at large, it owes considerably more to changes in law and policy. And this is likely to continue into the foreseeable future.

According to the Sentencing Project, the United States imprisons five times as many people as it did 30 years ago and more than seven times as many as it did 40 years ago. Our criminal justice system now keeps 2.3 million people behind bars—about half of them for drug offenses and other nonviolent crimes. Twenty-five years ago, there were 34,000 prisoners serving life sentences; today the number is more than 140,000. The fact that each person is spending a longer stretch behind bars means that the falling crime rates of the 1990s do not translate into fewer inmates. It also means that more and more people who committed offenses in their 20s or even their teens are growing old and dying in prison.

The situation is particularly stark in California, Texas and Florida, which have large prison populations with cells crammed to overflowing because of harsh sentencing laws. In California, the population of prisoners over 55 doubled in the ten years from 1997 to 2006. About 20 percent of California prisoners are serving life sentences, and over 10 percent are serving life without the possibility of parole. Louisiana’s prison system now holds more than 5,000 people over the age of 50—a three-fold increase in the last 12 years.

While 50 or 55 may not be old by conventional standards, people age faster behind bars than they do on the outside: Studies have shown that prisoners in their 50s are on average physiologically 10 to 15 years older than their chronological age. Older prisoners require substantial medical care, because of harsh life conditions as well as age. Inmates begin to have trouble climbing to upper bunks, walking, standing on line, and handling other parts of the prison routine. They suffer from early losses of hearing and eyesight, have high rates of high blood pressure and diabetes, and are susceptible to falls.

A recent study by Brie Williams and Rita Albraldes, published as a chapter in the book Growing Older: Challenges of Prison and Reentry for the Aging Population, found that in addition to the chronic diseases that increase with age, older offenders have problems such as paraplegia because of the legacy of gunshot wounds. Many have  advanced liver disease, renal disease, or hepatitis. Still others suffer from HIV-AIDS, and many more from drug and alcohol abuse. Living under prison conditions, they are more likely to get pneumonia and flu.

Many prisons are notorious for not taking their inmates’ health complaints seriously, and there is anecdotal evidence this problem may be compounded when prisoners are elderly. A doctor under contract in one southern prison told me in a recent interview how a diabetic man’s illness was misdiagnosed, resulting in months of excruciating pain and the amputation of toes and part of one foot. Back in prison, the man asked for prosthetic shoes so he could get around by walking; his request was denied.

Another elderly prisoner complained of an earache which went untreated for months.  When it became unbearably painful, the prisoner was shipped to a local hospital emergency room, under contract to the prison. There the doctors found the earache was brain cancer—by then, too advanced to treat.

The exploding prison population has further undermined the already questionable quality of inmate medical care. In California, which has the nation’s largest number of state prisoners, a panel of federal judges earlier this year found that the state of medical care was so poor that it violated the Constitution’s ban on cruel and unusual punishment, and was in danger of routinely costing prisoners their lives. The only solution, the judges said, was to reduce prison overcrowding caused by the states draconian mandatory sentences. The court recommended shortening sentences and reforming parole, which they believed would have no impact on public safety; it has given California three years to comply.

To come in Part Two:  Challenging the status quo for geriatric prisoners