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Why Elderly Incarcerated People Struggle to Find Care After Prison

Thousands of elderly people are released from U.S. prisons each year, and advocates say states urgently need to scale up their capacity to provide them with compassionate care.

Amisha Nakhwa/Unsplash

Why Elderly Incarcerated People Struggle to Find Care After Prison

Thousands of elderly people are released from U.S. prisons each year, and advocates say states urgently need to scale up their capacity to provide them with compassionate care.

When Michael Jarrett was released to the 60 West nursing home in 2016, after over three decades in prison, it felt like he had died and gone to heaven. The home is a long-term care facility in Rocky Hill, Connecticut, that caters specifically to people affected by the criminal legal system. In a recent call with The Appeal, Jarrett, now 71 and facing various health issues, expressed relief at having a place to live that was not a prison or a shelter.

At 60 West, Jarrett can play games and participate in activities—which, before the pandemic, included trips to restaurants and sporting events. The facility also provides him with clothing and other essentials. After more than three decades of incarceration, Jarrett said it’s comforting to finally have a safe space for his personal belongings. He’s learned how to use a cell phone and a tablet with the help of the facility’s technology support staff, nicknamed the Geek Squad. But, most importantly, Jarrett said, he feels like the staff members at 60 West are invested in his well-being. “This place really tries to take care of the people that are here,” he said.

Across the country, the need for eldercare for people like Jarrett is growing rapidly alongside reforms aimed at reducing the elderly and infirm prison population. In New Orleans, District Attorney Jason Williams has prioritized releasing “geriatric lifers” and people who have been incarcerated since the 1960s and 70s. In New York, the Release Aging People in Prison campaign is pushing lawmakers, including Governor Kathy Hochul, to pass a comprehensive bill that would grant opportunities for parole to incarcerated people aged 55 and over who have already served 15 years or more. In Pennsylvania, state Representative Joshua Kail, a Republican, has introduced a bill to expand the state’s medical release program. These state-level efforts have built on broader advocacy that has arisen in the past few years urging the release of more elderly and medically vulnerable people from prisons and jails amid the COVID-19 pandemic.

Proponents point to a variety of justifications for releasing elderly people from prison. Many of these individuals were incarcerated in their youth, and advocates say they have long since paid their debt to society. They also point to research showing that people tend to “age out” of criminal behavior—a phenomenon experts call the “age-crime curve.” (A 2010 report found that homicide rates peaked at age 19.) The move would benefit states financially as well; studies suggest it costs between three and nine times as much to incarcerate an elderly person as it does a younger person, owing to the expense of medical care.

But as the chorus of voices pushing for elder release grows louder, another problem has emerged: It is incredibly difficult to secure eldercare for the formerly incarcerated. Due to social stigma, a lack of preparedness for a rapidly aging population, and the perpetuation of excessive prison sentences and lifelong punishment, success stories like Jarrett’s are few and far between. A recent study estimated that at least 60,000 people aged 50 or older will be released from prison annually, and advocates say states urgently need to scale up their capacity to provide compassionate care for these individuals, who often have nowhere else to turn.

Michael Jarrett works in a flower box in the courtyard of 60 West, in Rocky Hill, Connecticut.
Michael Jarrett works in a flower box in the courtyard of 60 West, in Rocky Hill, Connecticut.
Courtesy of 60 West

The proliferation of elderly and infirm people in U.S. prisons stems from the tough-on-crime era of the 1980s and 90s, when mandatory minimums and other stringent sentencing laws led to prosecutors seeking longer sentences than ever before. Spending decades subjected to poor diet, stress, and inadequate health care has hastened aging for many of these prisoners, compounding health problems and increasing the vulnerability to disease.

In 2012, the Human Rights Watch report “Old Behind Bars” shed new light on the rising number of elderly incarcerated people and helped frame the topic as a human rights and public health issue, according to Dr. Tina Maschi, a professor at Fordham University’s Graduate School of Social Service. “The fact is that it went undetected and, when detected, there was a lack of an adequate response,” she said.

The problems associated with an aging prison population begin long before most individuals are considered for release. Some state departments of corrections have created prison annexes and sometimes entire facilities—often referred to as “nursing home prisons”—specifically to detain the elderly.

The Zephyrhills Correctional Institution, in Florida, is one of these. It houses elderly and infirm people, many of whom are bedridden, use wheelchairs, or are incapacitated. At the height of the pandemic, New York sent nearly 100 elderly incarcerated men to the upstate Adirondack Correctional Facility, creating a nursing home prison at a time when civilian nursing homes were among the most dangerous settings for COVID outbreaks. The California Men’s Colony, in San Luis Obispo, imprisons so many elders with Alzheimer’s and other cognitive disabilities that it has created a program to train the healthy incarcerated men to care for those with dementia.

Though most elderly prisoners will eventually be released, they face a variety of barriers to post-incarceration eldercare, largely stemming from a lack of resources and planning. Parole requirements vary by state and are often contingent on a parole board approving parolees’ living arrangements. Because many elderly parolees exit prison with serious health care needs that may require a skilled nursing facility, incarcerated people are sometimes cleared for medical parole only to spend months—or even years—further deteriorating in prison while they wait for a bed to open up.

After Colorado lawmakers passed a bill last year that streamlined the process of medical release, 23 incarcerated people were approved for parole but remained in prison because the state Department of Corrections could not find a nursing home willing to admit them. Many facilities reportedly cited their criminal records as a cause for denial. The state has asked for funding to incentivize skilled nursing facilities to accept people who have been cleared for release from prison.

In June, the Tampa Bay Times reported that, in Florida, many elderly people convicted of sex offenses end up living in motels after prison, because nursing homes routinely deny them admission. They are often forced to rely on an “ad hoc network of care,” the paper reported, including social workers and landlords, who struggle to provide for their medical needs.

Insufficient oversight of care facilities can lead to abuses of elderly people after prison. At California’s Golden Legacy Care Center, a formerly incarcerated resident was shackled to his bed and denied medical care, according to an LAist investigation. The outlet reported earlier this year that medical parolees from California’s Department of Corrections were being transferred to the nursing home even though Medicaid officials had deemed it “one of the most troubled facilities in the nation.”

As demand for nursing home services increases among an aging prison population, supply has failed to keep up. The home where Jarrett lives, 60 West, and its sister facility, MissionCare, in Holyoke, Massachusetts, are the only skilled nursing facilities in the nation that specialize in serving “hard to place” individuals, including the formerly incarcerated or people with substance abuse issues or mental illness. Both facilities pride themselves on providing comprehensive eldercare in a “safe, secure environment that is inclusive, compassionate and free of stigma.”

About half of the current residents at 60 West were transferred from the Connecticut Department of Corrections, but officials at 60 West estimate that they reject as many as one-third of all applicants for not meeting admissions requirements. Many other nursing homes in the state won’t even consider patients coming from prison, said Jessica DeRing, the administrator at 60 West, who previously worked at another long-term care facility in Connecticut.

“The majority of patients at 60 West come to us because no one else will take them,” DeRing said. Many of the people at the facility have medical needs, such as dialysis or cancer treatment. Some are sent there after their prison sentences end, but others have been given compassionate release, which is often reserved for people with a terminal illness. In some cases, incarcerated people are released to 60 West for short-term palliative care, giving family members an opportunity to say goodbye. A few months ago, Francis Smith, the longest-serving incarcerated person in Connecticut, was released to 60 West at the age of 97, after being sentenced for murder in 1950.

Unlike the “nursing home prisons” that hold many elderly and infirm incarcerated people, 60 West is not a carceral setting. The services it offers are not correctional in nature, and the facility does not remand people back to prison if their health improves. Some facilities take in incarcerated people who are very sick for the sole purpose of rehabbing them until they’re well enough to go back to the corrections system, said David Skoczulek, a spokesperson for 60 West. “That is not our mission,” he said.

Residents at 60 West can move around freely, have personal phones, and have the same federally protected rights as the residents of any regular nursing home, including freedom from restraint, the ability file complaints without fear of retaliation, the right to freely manage one’s own money, and privacy in living arrangements—none of which exist in a correctional setting.

Convincing the public to support this sort of eldercare for the formerly incarcerated presents its own set of challenges. In 2013, local officials and residents of Rocky Hill fought the proposal to create 60 West, arguing the facility was a prison, not a nursing home, Skoczulek said. Community members protested at the state capitol; real estate agents complained that property values around the facility would plummet; town officials sued unsuccessfully to block the project; even prison guards joined the opposition.

Local officials who supported the plan stressed that residents of 60 West posed no public safety threat, in part because only people who were medically debilitated would qualify for admission.

“The neighbors and other stakeholders that push back have this concept in their mind that these are walking, talking younger people,” Skoczulek said. “In reality, they’re very, very much skilled-nursing patients.”

Maschi argues that the persistent bias against people who have been in prison is dehumanizing and makes it harder for elders to find stable living situations after incarceration. “The fear creates barriers,” Maschi said, adding that those barriers prevent the public from extending compassion to people who are vulnerable or nearing the end of their lives.

As the incarcerated population ages, more states are taking notice of how geriatric people are treated in—and after—prison. Some officials have begun exploring the use of skilled nursing facilities to serve elders exiting the prison system, using 60 West as a blueprint. But this sort of expansion requires buy-in from state corrections departments and politicians, who are often opposed to decarceration efforts.

Officials in Virginia had approached the 60 West team to discuss the possibility of building a similar facility in their state, according to Skoczulek, but, since then, a Republican governor took office and the project appears to have been put on hold indefinitely. The leadership at 60 West has also been in conversations with officials in three other states about the possibility of expansion, Skoczulek said, but no new facilities have been approved.

Despite the lack of progress, DeRing is hopeful that more states will follow the 60 West model and commit to building up the necessary infrastructure to provide compassionate eldercare for people with criminal records.

“In my experience, the people who we admit aren’t the people that committed those crimes anymore,” she said. “That’s what many people don’t understand. We’re talking about 16-year-olds and 20-year-olds who committed a terrible crime and made one terrible mistake. And then they spent the next 40 to 50 years paying for it.”

For Jarrett, who uses a wheelchair after undergoing amputation of his legs, one of the joys of being at 60 West is learning to become self-sufficient. He’s spent the past 40 years living in communal settings and says he eventually wants an apartment of his own. For now, however, he’s happy to enjoy the little things many people on the outside take for granted.

“I’m looking forward to going to a real grocery store,” Jarrett said. “I could probably spend four hours just looking at everything that wasn’t there when I went in.”

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