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