A recent survey of 41 states and the U.S. Bureau of Prisons by Corrections Today, found there were almost 125,000 inmates 50 or older, but fewer than 10,000 beds in facilities dedicated to older inmates.
The Corrections Today report predicts the nation's older inmate population could increase tenfold in the next decade and the associated health costs could double that.
There are many complicating factors too. Most of the elderly inmates at Men's State Prison in Georgia are serving lengthy sentences for crimes committed when they were younger, officials said. A "three strikes law" passed in the 1990s, contributed to much of the growth in the state's geriatric prison population.
Three strikes laws are statutes enacted by state governments in the United States which require the state courts to hand down a mandatory and extended period of incarceration to persons who have been convicted of a serious criminal offense on three or more separate occasions. These statutes became very popular in the 1990s. Twenty four states have enacted some form of habitual offender laws.
Elsewhere also, arrests of elderly offenders have risen, but little is known about why the elderly commit crimes.
That these measures have not meant any crime rate decline is a different story. The fact is the prison population increases in the process, and, with it, the burden on the exchequer.
Some states, such as Virginia and Pennsylvania, have built geriatric prison facilities that resemble mini-hospitals, equipped with medical devices and oxygen tanks. Prisons are being licensed as acute-care centers with a crew of registered nurses, CNN reports.
A drop in the number of paroles granted to inmates who remain eligible is a factor in Virginia's increasing number of older inmates. Truth-in-sentencing reforms that in 1995 led to stiffer, no-parole sentences for violent crimes are expected to contribute to Virginia's aging prison population in coming years.
At Deerfield, wheelchairs and walkers line aisles in the secured assisted-living dormitory, where it would be easy to confuse the frail residents with those in nursing homes. Experts say substance abuse, little or no health care before imprisonment and the stress of living behind bars, can leave a 50-year-old inmate physiologically 10 to 15 years older than his chronological age.
In general, older inmates require more supervision and medical and mental-health care, as well as special diets, mobility aids and special housing. Deerfield, Virginia's only prison dedicated to geriatric inmates and inmates with special medical needs, accommodates 1,080 inmates, 90 of them in wheelchairs and 65 percent over the age of 50.
According to the Virginia Department of Corrections, in the fiscal year that ended June 30, 2007, the annual cost per inmate at the Deerfield Correctional Center was $27,985, compared with $23,246 per capita system-wise and $16,000 to $17,000 a year at medium-security dormitory facilities.
Elizabeth Alexander, director of the ACLU's National Prison Project, says investigations revealed that inmates were often denied access to certified doctors in the 1970s. In some instances, inmates were providing medical and dental care to one another. There continue to be lawsuits filed against prisons and jails for providing poor medical care, she says, but overall, the care has vastly improved.
"I would argue that the health care that is rendered behind bars is better than what is received by the general population," says CEO Rich Hallworth of Prison Health Services, a private medical corrections company in Tennessee that serves 172 jails and prisons around the country.
But things are not that hunky-dory. In August last three federal judges found that overcrowding is the primary cause of unconstitutional conditions in California's prisons, such as the system's inability to provide competent and timely health care for prisoners. The judges also found compelling evidence that reducing the prison population is the only way to address the problems.
The judges issued a 184-page order for the state to come up with a plan to reduce the prison population by up to 40,000, to 137.5% of the systems design capacity (currently the prisons house 160,000 prisoners, which is nearly twice as many as the facilities are designed to hold) within two years. The judges gave the state 45 days to come up with its plan.
The first plan submitted by the state government was turned down by the court, and the case is still on.
There is now a bill up for debate in California to allow nonviolent elderly prisoners to be released into hospice care or monitored with ankle bracelets. In the past few years, Georgia officials say, the state has released more frail and dying inmates on medical reprieve than ever before. Other states, including New York and Virginia, have also allowed early release of ailing elderly inmates.
But critics, including victims' advocacy groups, have scrutinized this policy. Will Marling, executive director of the National Organization for Victims Assistance in Virginia, said most victims believe offenders will strike again after they are released.
If a person is sentenced to life, we know they are naturally going to get old," Marling said. "A life sentence should mean life."
That apart, two of the biggest obstacles to delivering quality health care to inmates are the huge size of the nation's prison population, numbering about 2.3 million with an estimated caring cost of $7 billion a year, and the high percentage of mentally ill inmates, making it difficult to hire enough trained staff, it is felt.