The documentary Fault Lines: Dying Inside: Elderly in Prison brings to light the problems the United States faces as its prison population rapidly ages. In fact, the aged population of prisons is growing exponentially. According to Mirka, whereas elderly inmates made up only 5.7% of the prison population in 1992, they made up 8.6% of the prison population in 2002. (Mirka, 2004, p. 423) According to Tanvi Misra, by 2014, individuals aged 50 years or older made up 18% of the prison population. Legislation designed to be tough-on-crime often exacerbates this problem. (Misra, 2014) According to Mirka, harsher sentences and innovations like the three strike law that involve mandatory sentencing mean more inmates behind bars at one time. Many prisons are facing budget problems, even though, according to Sari Horwitz of the Washington Post, the Bureau of Prisons spends nearly as much on healthcare for prisoners as the government spends to fund the budget of the Bureau of Alcohol, Tobacco, Firearms and Explosives and the US Marshals Service. (Horwitz, 2015)

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This exponential increase in aging prisoners creates several problems for correctional managers. As the prisoner population ages, prisoners with chronic conditions become more numerous. Prisons are often ill-equipped to handle their needs. Yet because prisoners cannot legally face cruel or unusual punishment, managers must legally meet their needs, even if budgets make doing so challenging. The cost of caring for elderly inmates may surpass budgets.

Correctional managers are also charged with maintaining the safety of inmates. Elderly prisoners are often more vulnerable than other prisoners in the general population. This means that when younger inmates and older inmates are kept in the same facility, correctional managers may have a difficult time keeping elderly inmates safe from harm.

Furthermore, as Jamie Fellner of Human Rights Watch observes, prisons are not designed to take care of the needs of the elderly. For instance, says Fellner, “difficult to climb to the upper bunk, walk up stairs, wait outside for pills, take showers in facilities without bars and even hear the commands to stand up for count or sit down when you’re told.” (Horwitz, 2015)

Finally, as the prison population in general grows, prisons often face a shortage of workers. Budgetary constraints and underfunding may make it hard to offer new workers incentives to work at prisons, even when meeting the needs of prisoners and the public may depend on hiring them.

Solutions
Part of the solution to the problems caused by America’s aging prison population should be legislative. Because meeting the healthcare needs of elderly patients costs 3 times more than meeting the needs of younger inmates, it would greatly reduce the burden placed on the prison system if some elderly prisoners were released into the general population and cared for outside of the system. Mirka suggests that the creation of medical parole for aging prisoners could allow this. (Mirka, 2004, p. 423)

This may not be an option that is palatable to the general public in some cases. Public outcry might prevent the release of certain elderly prisoners into private or public nursing facilities. Inmates who have committed particularly brutal crimes or who may not need the same level of care as the most ill inmates could be taken on inside prison in two different ways. Mirka suggests that the development of prison nursing homes or of the creation of nursing wings in prisons could address the health problems of many inmates. Developing dedicated nursing wings might allow administrators to obtain funds ear-marked for healthcare, rather than prisons. It would also separate many of the most vulnerable inmates from the general population, reducing instances of violence and therefore, eliminating the medical costs that these may incur. (Mirka, 2004, p. 423)

In order to address problems with cost, prisons might need to be creative. In Fault Lines, the narrator observes that prisoners in some facilities have been trained as orderlies and that they are involved in the care of elderly inmates. This is a particularly good solution because inmates can be employed at low salaries, but can still benefit from the training they receive. It might be able to help prepare them for jobs or life outside of prison and it helps them establish good behavior and character. It also allows managers to save money in the employment of personnel. Mirka also suggests that graduate students can be offered fellowships to work inside prisons, which would allow them to gain impressive work experience, while allowing correctional managers to keep their administrative costs reasonably low. (Mirka, 2004, p. 423) The steps that should be taken, then, in order to help solve the problem of America’s aging prison population are the following: 1. Establish nursing wings and prison nursing facilities, which isolate elderly prisoners from the general prison population, in order to better meet their needs and to reduce the costs incurred by injuries due to violence against vulnerable elderly prisoners. 2. Encourage legislators to reconsider mandatory sentencing and to allow medical parole for the elderly. 3. Train inmates as orderlies. 4. Offer fellowship incentives to graduate students in medical school.

Critics may object to this plan for several reasons. Some may worry that prisoners who are given medical parole might escape. In answer to this objection medical parole could be limited to patients who have significant problems with mobility. Others may object to the idea of using other inmates as orderlies because of concerns about safety, but training inmates as orderlies and giving them a constructive role to play in prison life would be safer than simply keeping elderly inmates among the general prison population without providing other inmates with constructive outlets.

Perhaps the strongest argument against the solutions proposed here is that releasing elderly inmates early would cause pain to the families of victims. One critic wrote, in a letter to the editor appearing in The New York Times, that “Releasing [elderly prisoners] does a disservice to the loved ones of their victims, who accepted — sometimes very bitterly — that these criminals would not be put to death in exchange for the promise that they would never walk free again.” (Lipps, 2013) Yet in cases where prisoners are immobile, they are hardly being granted freedom by being moved into private care facilities. Furthermore, in many cases, victims are actually footing part of the bill of the care of inmates who receive medical care in prison. Allowing families to assume responsibility for elderly inmates might prevent this.

    References
  • Horwitz, S. (2015, May 2). The Painful Price of Aging in Prison. Retrieved November 12, 2015, from The Washington Post.
  • Lipps, E. B. (2013, August 21). Should Sick and Elderly Prisoners Be Set Free? Retrieved from The New York Times: http://www.nytimes.com/2013/08/22/opinion/should-sick-and-elderly-prisoners-be-set-free.html?_r=0
  • Mirka, M. (2004, July 28). Aging Prisoners Stressing Health Care System. Retrieved November 11, 2015, from JAMA.
  • Misra, T. (2014, September 10). Prisons Are Facing Aging Populations, Too. Retrieved from Atlantic Cities: http://infoweb.newsbank.com/resources/doc/nb/news/1504500669410130?p=NewsBank