Between 1990 and 2012, the population of Americans aged 55 or older rose by roughly 50 percent. Meanwhile, for the first time in decades, the cumulative population of state and federal prisoners declined slightly. In contrast to these fluctuations, however, the number of aging prisoners—inmates of age 55 years or older—confined within state prisons increased nearly 550 percent over a twelve-year period.
Comprising a comparatively small 10 percent of the overall state prison population, aging prisoners cost the corrections industry about 8 percent more to incarcerate than younger age groups due to the increased vulnerability to disease and other health issues attributable to aging. Considering that the growth in population of inmates younger than 55 was just 9 percent, it is clear how a large portion of a prison’s budget could be easily spent providing healthcare for this older segment of inmates.
Regulations ensure care, increase financial burden
The 1976 Supreme Court ruling in Estelle v. Gamble affirmed that prison administrators have an “obligation to provide medical care for those whom it is punishing by incarceration.” Failure to do so violates Constitutional protections against cruel and unusual punishment, however, only if “deliberate indifference” to the medical needs of an inmate can be proven. However, groups such as Human Rights Watch have objected that this affirmation is ambiguous, that prison health care standards remain comparatively low due to the difficulty in proving “deliberate indifference,” and that there is a lack of uniform medical standards and practices from one facility to the next.
As with most industries, any regulation that leads to improvements often leads to increased costs, and the effect on prison budgets in the wake of Estelle v. Gamble was no exception. Since healthcare costs increase proportionally with age, the growth of the aging prison population makes it easy to understand that existing budgeting strategies may become inadequate to meet legal responsibilities to provide quality healthcare in the correctional system.
One of the largest contributors to the higher cost of care is represented by the increased prevalence of chronic health issues in the aging population. A 2014 study, which examined the costs and policies driving healthcare spending in state prison systems, found that Hepatitis C presents in 17.4 percent of the prison population, compared to only one percent of the general population. This is also the case with other chronic conditions—such as HIV infection, mental illness, and substance abuse—that are more prevalent within the prison population. Nearly 65 percent of state-incarcerated inmates, for example, met the inherent criteria for substance abuse disorders.
Because these illnesses and disorders are often pre-existing, undiagnosed, and therefore, untreated prior to incarceration, taxpayers are often left holding the bag for the full balance of an inmate’s medical costs upon incarceration.
Innovative programs seek to reduce inmate healthcare costs
Due to the unpredictable nature of emergency situations, it is difficult to accurately budget for healthcare needs. Up to 30 percent of the total allocation of a prison budget can be spent on prisoner health. In 2012, Washington D.C. spent $33 million, or nearly a quarter of their total corrections budget, on inmate health care. Not included in that substantial expenditure were transportation, supervision and payroll costs associated with the off-site medical care often needed by aging prisoners. The United States Bureau of Prisons estimates that over $50 million is paid each year to correctional officers across the nation for overtime.
The Bureau of Prisons introduced several ways of offsetting costs to taxpayers. Though not eligible for Affordable Care Act coverage, many inmates may be eligible to have some of their off-site care covered by Medicaid. Additionally, improved screening and telemedicine—the remote screening, diagnosis and treatment of patients using telecommunications technology—can offer cost-cutting services.
Some facilities require an inmate to pay a co-payment in exchange for basic medical care. Typically, these costs are negligible—no more than five dollars—and are paid by the inmate from commissary funds or earnings from a prison job. Prisons may permit direct purchase of over-the-counter drugs as a means to pass on the costs of commonly utilized medications to prisoners.
Further means of reducing costs related to aging populations can come in the form of a medical or geriatric parole for the terminally ill and elderly, often called compassionate release. To date, early parole for age or medical conditions has been used sparingly, and the process is often lengthy, due in large part to the opposition to compassionate release especially when it relates to violent offenders. Most opponents believe that, regardless of the severity of the crime, sentences should be carried out as ordered, and that age or health should not be a determining factors when weighing early release options. When compassionate release does occur, however, the results are promising. Recidivism rates for the elderly and infirm are significantly lower than the 41 percent re-incarceration rate for younger offenders. If successful, compassionate release programs could also be instrumental in alleviating the overcrowding which has been plaguing correctional facilities nationwide for years.
Shifts in public policy and technology may ease the burden
The aging of our general population is reflected in the penal system, where health care expenditures are increasing for correctional facilities. While healthcare for inmates will always present fiscal challenges on both a state and federal level, age and population shifts, changes in public policy, and the continued development of remote medical technologies will be key to alleviating some of the burden felt by correctional facilities.