Caring for elderly inmates

Get-tough-on-crime policies that mandated incarceration for decades have had an unplanned-for consequence: The number of elderly inmates in federal and state prisons is increasing far faster than growth overall. With those graying prisoners come all the problems associated with aging: dementia, incontinence, dental problems, chronic illness. In fact, aging accelerates in prison. Prisoners are deemed “elderly” at 55 by the National Commission on Correctional Health Care because inmates tend to be about 10 years older physiologically than their chronological age.

“The fastest growing segment of the prison population is people aged 50 and older, and the states are not preparing for them,” says Ralph Spinelli, a 74-year-old Ph.D. student at the Goldman School of Public Policy, and a criminal justice reform activist.

From 1995 to 2010, the number of prisoners aged 55 and older nearly quadrupled while prison populations overall grew just 42 percent, according to a Human Rights Watch report.

“Even if you don’t care about the welfare of those inmates – and you should, because many of them will be getting released and returning to society – think about all the money you’re spending.”

Failing to meet the physical, medical and nutritional needs of aging leads to more severe health conditions that require expensive treatments, Spinelli points out. But what will be even more costly for states will be the flood of lawsuits from both advocacy groups and the prisoners themselves.

Spinelli, who served prison time in the 1970s and the 1990s – the latter when he was in his 50s -- details his experiences in a new book, “Prison as Punishment,” ( The story of his incarcerations in two different prison systems casts a light on policies that can lower recidivism and help parolees become productive, law-abiding citizens.

He offers these suggestions for addressing our aging prison population:

•  Create a policy to mandate that prisoners get assigned lower bunks beginning at age 50.

It’s difficult to climb up and down from a top bunk as you get older, and many older men tend to be up and down more often during the night as enlarged prostate glands require frequent urination, Spinelli says.

“Instituting that policy wouldn’t start a riot -- the younger guys aren’t going to get angry about it. And after it has been in place a little while, it just becomes the way things are,” Spinelli says.

Such a policy would also be a simple way to acknowledge inmates’ humanity -- something that’s lacking in prison and has a detrimental effect on rehabilitation, he says.

•  Allow inmates to buy, or families to send, special personal hygiene items.

No prison that Spinelli knows of allows inmates to purchase adult incontinence pads at the canteen, or to have their family send them.

It’s not that they’re trying to be cruel -- they just don’t think about those things,” Spinelli says. “It’s younger people running the prisons.”

In order to allow a new item, administrators have to plan protocol for everything from how to determine who’s eligible, perhaps requiring a doctor’s prescription, to how to dispose of them.

“All of that can be done, of course, but until someone realizes items like Depends are needed, it won’t be done.”

•  Provide basic preventive medical care.

While prison infirmaries address illness, injury and acute health issues, they don’t generally screen for problems that become more common as we age.

“In California, a woman has to have a detectable lump in her breast to get a mammogram,” Spinelli says.

While he was in prison in the 1990s, he recognized he had a number of prostate cancer systems. He requested a common lab test that serves as a screening for prostate cancer and was denied.

“When I got out, I had prostate cancer,” he says. “I’ve had 13 surgeries and it has metastasized.”

Spinelli says the measures he suggests don’t have to cost a lot and in some cases, would cost nothing. Providing some preventive medical care will help avoid expensive, taxpayer-funded treatments, whether in prison or when older inmates are released. It will also prevent time- and money-draining litigation that states can ill afford.

“We send people to prison as punishment, not for punishment,” Spinelli says. “Growing old in prison is punishment enough.”

Ralph Spinelli is a prison reform activist working on his Ph.D. at the University of California Berkeley’s Goldman School of Public Policy. At 61, he earned his Bachelor of Science degree from the University of San Francisco, and delivered the commencement speech during his graduation.



Published: Dec. 4, 2014 - Volume 13 - Issue 34