As the number of older prisoners soars, more inmates are dying in prison of diseases that afflict the elderly, new data from the Department of Justice show.
A total of 3,483 inmates died in state prisons and 444 in federal prisons in 2014, the highest numbers on record since the bureau started counting in 2001, according to data issued last week by the department’s Bureau of Justice Statistics. In addition, 1,053 inmates died in local jails, where suicide is on the rise.
The greatest number of deaths in state prisons occurred in Texas (409), Florida (346), and California (317). But such deaths actually declined in California by 13 percent between 2013 and 2014, and in Texas by 7 percent.
The U.S. has the world’s largest prison population, with over 2 million people behind bars. While that population has been shrinking in recent years, deaths in custody have climbed steadily.
The deaths reflect a dramatic shift in the prison population: The number of federal and state prisoners age 55 or older reached over 151,000 in 2014, a growth of 250 percent since 1999.
In 2013, 35 percent of the 29,100 prisoners age 65 or older were under the jurisdiction of the three largest state prison systems — 13 percent in California, 12 percent in Texas, and 9 percent in Florida, according to the Justice Department.
As a percentage of the total prison population, older inmates are a relatively small but fast growing group. According to the Public Policy Institute of California, a nonpartisan think tank, the share of the state’s prisoners age 50 and older grew from 4 to 21 percent between 1990 and 2013. At the same time, the percentage age 25 and younger fell from 20 to 13 percent.
The institute noted that aging offenders tend to have greater health care needs that present a particular challenge, both in terms of meeting constitutionally-mandated requirements and controlling costs.
California housed more than 82,000 inmates in local jails and about 136,000 in state or federal prisons in 2014. For years, California’s state prison health system served inmates so poorly that many died for lack of medical care.
A federal judge in 2005 ordered a receiver to take over the state’s prison health system and oversee reforms. Care for inmates has since improved somewhat, but the California’s inspector general reported in 2015 that it remains “inadequate” at some prisons, including Corcoran and Salinas Valley state prisons. The federal receiver has restored state control to nine prisons of 35 but still oversees health care at the remaining institutions, according to Jeffrey Callison, assistant secretary for communications at the California Department of Corrections and Rehabilitation.
Nationally, as the older population grows, prisons have begun to serve as nursing homes and hospice wards caring for the sickest patients. The majority of state prisoners who died in 2014 were 55 years or older, and 87 percent of state prisoners died of illnesses, according to the report. The most common illnesses were cancer, heart disease and liver failure.
These deaths point to how dramatically prisoners’ health care needs are changing. Older prisoners have complex medical problems, are vulnerable to violence, and may require intensive care at the end of life, said Gabriel Eber, senior staff counsel at the American Civil Liberties Union’s National Prison Project, which files class-action lawsuits on behalf of prisoners seeking better mental health and medical care.
“The prisons are not equipped to handle the geriatric population,” he charged.
For instance, Eber recalled one case of a veteran in his 80s who suffered from Alzheimer’s disease and other ailments. Housed with the general inmate population in a large urban jail, the man kept getting into fights and pulling out his catheter. The inmate, who developed an infection and died, should have been kept in a medical unit at the outset, Eber said.
Eber said Thursday’s data raise a question: “Do we need to be keeping all these people behind bars?”
California has responded to the burgeoning elderly population by referring certain prisoners who are 60 or older and incarcerated at least 25 years for possible parole, according to the Prison Law Office at San Quentin. It appears to be a small program, however. As of December 31, 2014, “elderly parole” was given to 115 prisoners.
The prison data don’t include deaths that occur in privately run federal prisons or deaths by execution.
For prisoners clamoring to spend their dying days at home, U.S. prison jurisdictions have some laws on the books, often called “compassionate release” or “medical parole,” allowing for early release if prisoners are very sick and not a threat. But in practice, very few inmates are set free through these programs, said Dr. Brie Williams, director of the University of California Criminal Justice and Health Project in San Francisco.
Williams and others have called for expanding these programs — in part to alleviate strained state budgets. Inmates are not eligible for Medicaid, so state prisons and jails pay full freight for their medical care, which may include expensive trips, chaperoned by guards, to emergency rooms or specialists in hospitals. Medical care for older prisoners costs three to nine times more than for their younger peers, according to Human Rights Watch.
Williams has lobbied for compassionate release programs to include prisoners who have significant functional decline or cognitive impairment — not just those who are deemed to have six months or a year to live, which has historically been the standard and is difficult to predict.
But many of these older inmates committed violent offenses, such as murder or rape, and political pressure from victims’ advocates and the public makes it hard to release prisoners early, said Dr. Marc Stern, a criminal justice consultant who served as medical director of Washington State’s corrections department from 2002 to 2008.
Stern said when he oversaw the medical component of Washington’s compassionate release program, the first prisoner he approved for release “went horribly.” The man had claimed he was so debilitated he couldn’t walk. But once the prisoner was set free, TV news cameras caught him walking outside his home, manicuring his lawn, Stern said. The state threw the man back behind bars — and grew much more cautious about whom it released, Stern said.
Massachusetts also cracked down on early release after a former prisoner, Dominic Cinelli, killed a police officer in 2010 while out on parole from a life sentence.
That fatal shooting had far-reaching effects for other ailing prisoners. Dianne Babcock, of Vermont, was lobbying for her dying husband to be released from Massachusetts prison. She described her husband, John Babcock, as a “career criminal” whose heroin addiction had driven him to rob banks. He spent over two decades behind bars. At the end of his life, he developed liver cancer from Hepatitis C. At age 57, she said, he was “in tremendous amounts of pain.”
“He would’ve been lucky if he could’ve walked to the bathroom,” she said. Prison health officials cleared Babcock for early release, but the state parole board wouldn’t let him out, and he died in prison in 2011.
“I wanted him to be able to come home and live what remaining time he had left in some sort of comfort,” she said. “That didn’t happen.”
Meanwhile, Williams has been watching the population of older prisoners continue to grow, outpacing the general population of the U.S. As this trend continues, she said, prisons and jails need to catch up.
“I’m talking about a massive expansion of the field of palliative care into the correctional system,” she said, “so it’s integrated into the fabric of correctional care.”
CORRECTION: An earlier version of this story incorrectly reported the number of prisons whose health care had been restored to state control. The federal receiver has restored state control to nine prisons out of 35 institutions, not one.
Senior Editor Barbara Feder Ostrov contributed to this report.
This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.