Thursday, May 20, 2010

Rethinking Prisoner Release Policies from a Geriatrics Perspective


Tina Chiu of the VERA Institute of Criminal Justice recently wrote a report It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release on the status of geriatric and end-of-life prisoner release policies in the U.S. There's a strange contradiction: despite the existence of geriatric early-release laws in several states, few older prisoners are actually being released early. We were asked to contribute a response from the medical perspective. From a geriatrics point of view, the lack of functional assessment seems like a gaping hole in current prisoner release policies.
Cross-posted to the VERA Current Thinking Blog

We agree with Tina Chiu that current geriatric prisoner release policies need to be reexamined and reworked. What’s needed is a new set of guidelines that criminal justice systems can use proactively to identify older individuals who are appropriate for early release. In order to consider the competing agendas of cost, safety, and justice, an interdisciplinary team that includes clinicians, social workers, criminal justice experts, economic advisers, and legislators should help create these guidelines.

From a medical standpoint, the criminal justice system should add the metric of functional impairment to the assessment of older prisoners for potential early release. Early-release guidelines that do not reflect functional assessment fail to take advantage of the strongest predictor of future cost and prognosis for older adults. In nursing homes, hospitals, and geriatric clinics, functional assessment is the most important tool to understand an older patient’s health and physical abilities and for predicting his or her future health care needs and prognosis. Functional assessment focuses on describing people’s ability to complete the activities necessary for independence in their daily life, such as bathing, eating, and toileting. Numerous large studies have shown that functional impairment is a strong predictor of high health care costs, health care utilization, future functional decline, morbidity and mortality. Criminal justice departments could use functional assessment as a tool to identify older prisoners whose impairment minimizes the community’s safety risk, whose health is likely to decline, and who are expensive to keep incarcerated.

If the justice system is to use this type of assessment appropriately, however, more research is needed to develop an effective functional assessment tool for incarcerated populations. This is because little is known about the functional ability of older prisoners and even less is known about the daily activities necessary for older adults functioning in the prison setting. For instance, while instrumental activities of daily living (such as being able to do laundry, cook, take transportation, shop, and use a telephone) are used to assess the need for assistance among non-incarcerated older adults, most people in prison rarely perform these tasks, if ever. Instead, it might be more useful to assess older prisoners’ ability to complete other activities, such as being able to hear orders from staff or to climb on and off an assigned bunk.

To implement early-release policies for older men and women, the already overburdened correctional system is being asked to develop a new release process that triggers serious concerns about safety, fairness, and cost-shifting. We strongly believe that prison systems should not have to undertake this task alone. Health care professionals, legislators, and community leaders must be involved in this process. Such an interdisciplinary approach would help offset some of the burden on the criminal justice system and would help ensure that release guidelines incorporate critical concepts from each field.

by Jessamyn Conell-Price and Brie Williams

3 comments:

Jeanne Lahaie said...

I had never stopped to think about what it must be like for seniors who are incarcerated until I heard Brie Williams speak on the subject at UCSF. I then took a prison health elective, which further opened my eyes. When it came time to give a lecture to the Diversity Council at Kaiser, I was able to raise awareness of this population and in my research found that many prisons are providing similar care to nursing homes for their seniors and disabled. CNN had a piece on this last November: http://www.cnn.com/2009/CRIME/11/13/aging.inmates/index.html.

This post is timely, because I was just talking with Marion Fields, my hero and a retired RN from the SFVA who provides the Bay View Hunters Point Adult Day Health Center with its only nursing services. We were talking about some volunteer work I'll be doing there, but also some advocacy for Keep the Arboretum Free (www.keeptheaboretumfree.org). In doing so I found out that the Bayview Hunters Point Multpurpose Senior Center has a senior ex-offender program (http://www.bhpmss.org/senior_ex-offender_program) that sounds wonderful. Wouldn't it be great if every adult day health center offered such assistance?

Helen Chen said...

Thank you for a very thoughtful and timely post. Compassionate early release for incarcerated elders is the right thing to do and should be supported by medical assessment of the inmate's function and prognosis. However, I worry that the elder may be released into a world that already lacks sufficient infrastructure to care for frail elders, and in particular those with high care needs and limited financial and family resources.

Robert said...

I am a psychologist (and also licensed as an attorney) at a long-term care facility. I am looking for information re: the current trend to get inmates out of prison which appears to be led by a view of paroling "low risk" medically impaired persons. The issue I'm seeing, is that while they may be medically impaired from a corrections standpoint (thus costly), they often retain significant function, such that they create a real risk for other patients. Also, not all of the inmates released are "elderly." Many have significant medical issues, but are still ambulatory, and fairly cognitively intact. All too often, it seems they are defined as "too medically impaired to be a danger" but in an environment of a nursing home, their peers are often even more impaired and vulnerable(not being able to get into an assigned bunk or hear orders may leave the inmate much more functional than our other patients). As I see it, a major issue is that regardless of history, the Federal and State patient rights statutes/regs apply, and these were not written with people with crimnial backgrounds in mind. Do you have any thoughts/resources to manage correctional "referrals." I put referrals in quotes because all too often, we find out the patient is on parole after admission; somehow that information gets left out... Finally, do you have any numbers re: inmates being shifted into long-term care facilities? The last big study seems to be the on by GAO back on 2006 and I think it is already dated because of States need to cut prison costs and parole medically impaired inmates.