"Nursing Homes Surrounded by Razor Wire": Geriatric Prisons, An Interview with Barry Holman

From 1997-2002 Barry Holman was Research and Public Policy Director at the National Center on Institutions and Alternatives, NCIA, where he conducted research on the rising number of elderly prisoners, organized two conferences on elderly prisoners and worked with other non-profit groups to encourage the possibility of community supervision of elderly prisoners. We interviewed Barry by phone about a new type of prison: geriatric prisons for older prisoners.

Justice Matters: We’re hearing more about older prisoners these days…. and “geriatric prisons.” When corrections officials say “geriatric prison,” what age range are we talking about? Besides being older, what characteristics will the prisoners in this type of prison have?

Barry Holman: What’s considered an “older” prisoner varies. Different prisons and states have different ranges varying from 50 and over to 65 and over. In some circumstances for these special units, states combine very old prisoners with the terminally ill… really, what we’re talking about is prisoners who can’t be housed in the general population, some because of age and some because they have a medical condition. There are some people in prison who are functional at age 70 or 75: they’re able to get to and from the commissary… they can get around. They stay in general population. But there’s also the very old, the frail and the very sick. Essentially these special units we’re talking about are nursing homes surrounded by razor wire… people who need intensive nursing and assistance with daily living.

JM: Wow, when you put it like that… help me understand… what’s the rationale behind keeping “the very old and the frail” behind razor wire?

BH: What I’ve heard from some correctional professionals is, “People have a sentence to serve, and they have to serve it in a correctional facility. Our job is to provide that facility and provide them the care they need.” This sounds well-meaning, but there is a false sense that correctional staff shouldn’t be involved in policy decisions. I found this quite disheartening, that – for instance – the head of a state’s prison medical service felt as though they should just keep quiet and leave the decision making to others. Of course, there are some in the system who disagree. One warden from South Carolina I worked with, who had risen up the ranks from a correctional officer, he was vocally opposed to the idea of having seriously ill and elderly people in prison.

Really, this is just a function of determinant sentencing. It’s about making people serve the whole sentence regardless of the circumstances. Thanks to determinant sentencing, the number of elderly prisoners is growing. Surveys of state DOC’s (Departments of Corrections) show that:

• In 1979 there were about 6,500 prisoners over the age of 55. (Source: Survey of state DOC’s by Bureau of Justice Statistics).
• In 1990 there were more than 19,000 prisoners over the age of 55 (Sourcebook of Corrections Stats by BJS, 1995 version).
• In 1997 there were roughly 50,000 prisoners over the age of 55 (Survey done by NCIA).

The survey that we did at NCIA (National Center on Institutions and Alternatives) in 1997 showed that there had been a tremendous increase in the number of older prisoners – a seven-fold increase over the course of a generation. And a majority of all these prisoners over 55 – just over half– were in for non-violent convictions. In the Federal system, though, 97% of prisoners over 55 were serving time for non-violent convictions.

After the study I was involved with an effort to pull together a pilot project. We would’ve moved some elderly prisoners out of correctional settings into community-based supervision and care. Some of them might have wound up in a nursing home with security, or some in intensive supervision while they resided with family or other community members. The idea was to do individualized planning based on their specific security and care needs.

JM: Sounds interesting… but it doesn’t sound like it happened.

BH: No, it didn’t. This was a pilot project for the federal system, and we heard from Senators who wanted to know which prisoners from their state might wind up in the demonstration project. The concern was that it might look bad for them later if they approved it.

The perception is that “There’s a sentence and we have to stick with it no matter what.” There are public relations concerns about releasing any prisoner, no matter how minor the crime. There’s also a fear that we would be facing a situation similar to what happened in the 1980’s, when people were dumped out of mental health institutions and out onto the street. The argument is that at least in prison they’re getting care, maybe even better care than they would be getting in the community. But the idea that we’re doing them a favor by keeping them inside is perverse.

JM: But we are concerned that people who need medical care should get it. How does care for the sick or the frail in prison compare to what they could get on the outside?

BH: If you put sick people on a bus and dump them homeless on the street … well, yes, they would be in trouble. But if you do case planning to deal with security and medical needs, organize an appropriate place to stay and connect them with other supports, that’s different. The pilot project was going to be with low-level offenders and we wanted to incorporate better supervision. You can save a lot of money by keeping people in the least restrictive place possible. Plus there’s just the human side of it. Talk to any older prisoner and their biggest fear is that they’re going to die behind bars.

It doesn’t have to be prison every time for everyone. We’re better served on a number of fronts if we were smarter with these dollars. The cost of incarcerating elderly prisoners is triple the cost of the average prisoner. It’s very inefficient to house the very sick and very old in prison… take for example, a rural facility that has someone who needs dialysis. The transportation costs for that are high. Now for some, that becomes an argument for a central prison with all the most ill prisoners… so it can be done cheaper… but beyond the cost there’s just the inhumanity of it. This type of thinking has nothing to do with public safety or what’s really the appropriate way to treat people, it makes them a commodity and dehumanizes them.

JM: To take that example you just used, some people are very functional on dialysis. Certainly just because someone is old doesn’t mean they can’t be very active. We can’t explain this as just “these folks are helpless because they have a medical condition or because they’re old.”

BH: Yes, which comes back to the need for individualized planning. Does it make sense to have this person here? Does it further public safety? Is it a good use of public funds?

JM: Let’s say, though, we’re not talking about people with drug or theft convictions, but maybe a prisoner who’s serving a life sentence for murder or another serious crime. I’m one of these people in a situation where someone is serving a life sentence for murdering a member of my family. I can totally understand how it could be hard for a surviving family member of a murder victim to hear about a person convicted for that murder getting “out early” to be moved to a nursing home. What would you say about those situations?

BH: First, it’s important to note what I’m talking about doesn’t automatically mean releasing people early. We’re talking about individual assessments based on a number of factors, including the nature of the situation, the opinion of mental health experts… people looking closely at how well this person could function safely in the community and whether or not they pose a threat.

And we also know that causing someone else to suffer doesn’t make up for suffering that was caused to someone in the past. It just can’t. There aren’t simple ways to just end people’s pain. Healing doesn’t come from the suffering of another person. There might be a role for victims’ family members or survivors in that process, and the prisoner themselves, to assess the risk and determine which way to go. We need to get beyond formulaic justice that doesn’t help anyone and needlessly hurts many.

JM: Recently the Bureau of Justice Statistics released statistics on reported deaths in state prisons and jails. They said prisoners over the age of 45 make up less than 20% of the prison population (17%, actually), but are two-thirds of people dying in prison. And it’s possible that this report has substantially undercounted deaths inside, so the problem might be even greater than that. What does that statistic tell us?

BH: Well, first that report tells us there are too many people dying in prison. If someone’s been sentenced to a life sentence without possible parole, then we can expect that person will eventually die in prison. There will be accidents and unexpected deaths.  We expect a small number of those. But we should expect people with non-violent convictions, who don’t pose a public safety risk and can be supervised and served in the community, they should not be dying in prison from disease or illness. That’s just a travesty.It’s a question for our conscience.

Like the US population as a whole, the prison population is aging quickly. Unless we change our policies, our laws and our attitudes toward them, many will needlessly languish and die in prison for decades to come.

Barry Holman is now Director of Research and Quality Assurance for the Washington DC Department of Youth Rehabilitation Services. He was interviewed by Kathleen Pequeño for the Summer 2005 issue of Justice Matters.