by Douglas Ankney

"When [our] extra bedding is taken, it does no good to grieve it. Any way they want to punish [us] is backed up by coworkers,” Mindy, a 71-year-old prisoner, told The Appeal.

In the United States, a 50-year-old individual is generally not considered elderly. But the same is not true for those who are incarcerated and who have endured years of inadequate medical care, diets lacking in nutrition and an environment pervaded with constant stress, chaos and violence. Such conditions accelerate the aging process. One public health study found that each year a person spends in prison can shorten their life expectancy by two years, as PLN reported. [See: PLN, Apr. 2026, p.18.]

People aged 55 and above are increasingly caught up in all parts of America’s criminal legal system, including arrests, pretrial detention and imprisonment. From 2000 to 2021, this demographic increased its share of all adult arrests from 3% to 8%. From 2020 to 2021, the segment of people in jail who were 55 or older increased by 24%, a greater proportion than any other age group; other age groups saw an average increase of 15%. And from 1991 to 2021, the percentage of prisoners aged 55 and older in state and federal facilities ballooned from 3% to 15%. In particular, as of 2020, 30% of all persons serving life sentences were 55 or older (approximately 61,400 persons).

The costs of incarcerating this demographic are exploding. The amount per person spent to incarcerate people varies widely by state. Arkansas, for example, spends an average of $48.94 per prisoner each day, while Massachusetts averages $773.45 per day. The main factors contributing to incarceration costs are: (1) security—including staffing, building and maintaining facilities; (2) daily necessities—food, clothing, furnishings and programming activities; (3) administrative costs for operating the agency; and (4) health care.

For the last category, prisoners are the only segment of the American population that have a constitutional right to healthcare. This is because a prisoner cannot seek their own medical care, and if the government does not provide care, the prisoner will receive none. For this reason, the Supreme Court of the U.S. (SCOTUS) has ruled that allowing a serious medical need to go untreated violates the Eighth Amendment of the U.S. Constitution. See: Estelle v. Gamble, 429 U.S. 97 (1976).

But SCOTUS has never said that a prisoner deserves good healthcare, so as PLN has extensively reported, the medical care provided to prisoners and jail detainees is often substandard, resulting in permanent injury and even death. Yet the amount of money the federal Bureau of Prisons (BOP) and state departments of correction (DOCs) spend to provide the shoddy medical care is staggering and increases as prisoners grow older. While the exact numbers, state-by-state, remain obscure, a 2015 analysis by the Pew Research Center revealed that the BOP and state DOCs spent $8.1 billion annually on medical costs for persons in their custody. But that 11-year-old figure does not reflect the current costs nor the recent increase of elderly prisoners. It is not uncommon for the various states to report increases in medical costs of $100 million in the past decade.

A recent report from The Appeal showed that the California Department of Corrections and Rehabilitation (CDCR) spends $300 million each year to house approximately 740 elderly women at two facilities, in spite of the fact that the CDCR’s own data shows that the risk of recidivism sharply declines with age.

Oak Park Heights is Minnesota’s most secure prison. One wing appears more like a nursing home than a cell block, with men in hospital gowns sleeping in adjustable beds, wheelchairs crowding hallways while nurses make rounds and board games cluttering bookshelves. About one in five of Minnesota’s prisoners is over 50 years old (more than three times the number of 50-plus-year-olds in 1999). Thirteen of those prisoners are octogenarians and one is 93 years old. Minnesota’s prison healthcare costs have more than doubled in the past 10 years, with a sharp increase of 45% from 2022 to 2025. All told, the Minnesota DOC spent $134 million on healthcare in 2025, up from $93 million just three years ago. And the projected budget for 2026 is expected to reach $146 million.

A report from The Sentencing Project entitled Nothing but Time: Elderly Americans Serving Life Without Parole shines additional light on the high cost of incarcerating the elderly. And life without parole (LWOP) sentences are certain only to add increasing costs annually. For example, one in five of those imprisoned in Georgia state prison is over 50; among them, there are 588 people serving LWOP sentences (an increase of 800% since 2000). Based on Georgia’s annual per-prisoner expenditure of $24,070, the state pays $14 million annually to hold them—and that’s not counting the significant medical costs for which the per-prisoner expenditure doesn’t account.

Medical costs for these elderly prisoners are nine times that of non-elderly prisoners. The Pennsylvania DOC reported that, as of the end of 2019, there were 10,697 prisoners in their custody over age 50, who together accounted for 23% of the state’s prisoner population. This number was double that of the year 2000. Pennsylvania spends $3.2 million per month on medications for prisoners, the bulk of which is to treat elderly prisoners. Unlike Minnesota, Pennsylvania operates three long-term care facilities.

These three facilities house prisoners in need of long-term daily nursing care, dialysis, or who are wheelchair bound or suffering other geriatric ailments. One of the three facilities, Laurel Highlands, holds 70 people aged 50 or above who are serving LWOP sentences and have served 20 or more years in prison. It is estimated that it costs a minimum of $12.8 million per year to house those 70 elderly individuals. And the fact they “qualify” to be housed at Laurel Highlands is itself evidence that they are too infirm to inflict most possible harms. Altogether, there are 2,906 people in Pennsylvania’s prison system serving LWOP sentences who are aged 50 or above—and 1,885 of them have served 20 years or more. If just that subset of people was released, the state would save $79 million every year.

In the Illinois DOC, 1,585 incarcerated people are serving LWOP sentences and 833 (52.5%) of them are at least 50 years old and have served 20 years or more of their sentences. Since the state pays $34,000 per year to house each prisoner, Illinois is investing $27.4 million annually to continue their incarceration. And that sum doesn’t even include their additional medical costs.

The BOP shows the same lack of wisdom and fiscal responsibility. In 2013, the BOP spent 19% of its budget, or $881 million, to imprison older adults. The BOP reported that this group was “the fastest growing segment of its inmate population” (growing by 25% over just that year while the rest of the population decreased by 1%).

According to a 2025 report titled Trapped in Time that was released by the American Civil Liberties Union (ACLU) and the Prison and Jail Innovation Lab (PJIL) of the University of Texas at Austin, “[a]s of 2021, an estimated 114,601 people aged 55 and older were living in a state or federal prison, and nearly 16,000 of them had spent over half their lives serving their sentences.” Neither the BOP nor state DOCs systematically track the amount of time currently imprisoned people have already served. But the ACLU and the PJIL managed to develop a pie graph estimating the breakdown of time served in all 50 states based on the Corrections Statistical Analysis Tool (CSAT) from the Bureau of Justice Statistics (BJS).

Of U.S. prisoners aged 55 or older, 51% (roughly 58,000 elderly men and women) have already served 10 years or more of their sentences. Thirty-one percent (35,526) of elderly prisoners had already served 20 or more years. And 16% (18,336) had already served 30 years or more. Eleven of these people were initially incarcerated in 1965, more than 60 years ago, when they were teenagers and not yet emotionally developed. Yet many of them are condemned to die in prison for the immature decisions they made back then.

In 2022, men made up 93% of all prisoners and 95% of all prisoners age 55 or older. Of that 95%, a majority (57%) were aged 60 or older, and 28% were 65 years or older. However, among elderly women prisoners, 50% were aged 55 to 59; 28% were 60 to 64; and 21% were 65 or older. By race, more elderly incarcerated women were white (49%) than Black (17%), Hispanic (11%), American Indian (2%), Asian (1%) or any other race (20%). And more elderly incarcerated men were white (39%) than Black (30%), Hispanic (17%), American Indian (1%), Asian (1%), or any other race (12%).

Between 2001 and 2018, more than 30,500 prisoners aged 55 or older died in prison. The overwhelming majority of these deaths (97%) were from illnesses. Elderly prisoners experience higher rates of serious, chronic health problems compared with those prisoners who are younger. And the incarcerated elderly experience higher rates of serious and chronic health conditions when compared to their non-incarcerated counterparts, with 73% of all incarcerated persons reporting one or more chronic medical conditions.

These chronic conditions included arthritis, hypertension, heart problems, tuberculosis, diabetes and hepatitis. Yet these medical conditions and others often are either undiagnosed or poorly treated. This is due to multiple factors. For one, healthcare staff at many prisons operate at dangerously high vacancy rates. In some prisons, staff vacancy rates are above 50% and the prisoners are kept on continuous “mandatory lockdown.” Confined in cells without social interaction and proper medical care can make ill prisoners sicker.

Closely associated with the effects of staff shortages is the “medical profit motive.” Prisons and jails generally contract with private, for-profit companies to provide medical care to prisoners. These are often “capitation contracts,” meaning these for-profit companies are paid a certain amount “per person” to provide medical care to those incarcerated.

These contracts provide the perverse incentive of delaying and denying medical care to prisoners in order to reduce the amount of money the private companies spend on each prisoner and thereby increasing the companies’ profits. According to a 2025 Prison Policy Initiative report, many prison healthcare providers restrict access to medical care to reduce costs and keep revenues up. See: Cut Rate Care, PPI (Feb. 2025).

“I went blind [because] my vision and other medical problems were diagnosed 14 years ago, but never treated. I am in unbearable pain 24/7. I can no longer walk because of the pain,” a person over the age of 70 who has been incarcerated over 25 years and serving a life sentence said. In addition to problems with their physical health, elderly prisoners often suffer from deteriorated mental health. Prison environments—characterized by violence, instability and harsh conditions—exacerbate these mental disabilities.

Data reveals that more than 70% of people in America’s jails and prisons have a diagnosed mental illness, substance use disorder or both. Approximately 33% of incarcerated persons have a serious mental illness such as schizophrenia, bipolar disorder or post-traumatic stress disorder (PTSD). The records from one state showed that almost 81% of its incarcerated people over age 55 had been diagnosed with a substance use disorder. Prisons, however, remain ill-equipped to offer needed care. Most carceral facilities in America do not employ an adequate number of mental health professionals to meet the needs of their incarcerated populations, which leads to undue suffering, acts of self-harm and preventable suicides.

Older prisoners often suffer from cognitive impairments. Data from the American Community Survey revealed that from 2008 through 2022, almost 21% of prisoners aged 55 or older reported cognitive challenges, while only 8% of non-incarcerated people of the same age group reported cognitive challenges. And research suggests that by 2050, the number of incarcerated people living with dementia will triple.

Cognitive impairments are severely debilitating. Rigid institutional rules are a difficult and confusing maze for people unable to keep up and follow daily routines. Elderly prisoners with mild dementia wander into restricted areas or forget to return to their cells on time, leading to disciplinary charges and penalties.

Additionally, older prisoners with cognitive impairments often violate the unwritten rules of prison life, such as touching another prisoner’s property or forgetting to clean the cell toilet or sink after use. This can lead to physical injury, retaliation, bullying, and/or exploitation by other prisoners. The mere fact of age and the concomitant decline in physical and mental abilities interferes with elderly prisoners’ daily routines that can make life unmanageable. Ordinary tasks like “standing for extended periods of time (such as waiting in long lines for medication, food, showers), climbing to upper bunks, lifting heavy objects on a work detail, or even chewing tough foods … can be exceedingly difficult for elderly incarcerated people.”

While elderly people not incarcerated experience similar difficulties, they can control their circumstances. But incarcerated elderly people cannot. For example, an elderly incarcerated person who is in danger of falling must still climb into an upper bunk when the staff refuses to assign them to a lower bunk. And the elderly prisoner must still report to work and lift heavy objects if that is their assigned job. Failure to do either of these may result in disciplinary action against the prisoner.

Many elderly prisoners have serious dental problems—only a fraction of them reports having a full set of teeth. The absence of teeth forces prisoners to leave many items on their meal trays uneaten, limiting their diets and nutrition at a time when it is most essential to staying alive. Elderly people often need additional time to eat their food, time that is often not provided due to the regimented nature of prison schedules. While the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 apply to U.S. carceral facilities just the same as any other public institution, prisons have routinely been found to violate the ADA.

Under the ADA, prison officials are obligated to maintain access for disabled prisoners equal to the access any other prisoner has to programs, services, education, visitation, work assignments, and health care. They must also provide reasonable accommodations and modifications of prison facilities and policies (e.g., mobility aids, hearing aids, sign language interpreters, and accessible showers). But prisons across the United States and its territories repeatedly fail to comply with the ADA.

Classrooms, law libraries, gymnasiums, and even dining halls often do not have ramps to enable access by prisoners in wheelchairs. Fire alarms and announcements made over intercoms and loudspeakers go unheard by deaf prisoners. No interpreters are provided to deaf and blind prisoners to allow them to communicate with staff, participate in disciplinary hearings, or understand legal and medical documents. The elderly within America’s carceral facilities are the most vulnerable to the worst outcomes in the event of natural disasters, environmental challenges, and public health emergencies. Past natural disasters have revealed that many correctional agencies’ emergency response plans are horribly deficient.

In 2005, Hurricane Katrina revealed what Louisiana’s prison staffers do when thousands of prisoners are trapped behind bars: the staff evacuated and abandoned the prisoners. In 2024, Hurricane Milton saw a similar callous and cowardly performance by Florida’s prison staff when they refused to evacuate 28,000 incarcerated people located in evacuation zones. Elderly people with mobility issues are least likely to survive floods.

Elderly prisoners suffered greatly during the COVID-19 pandemic. In Texas, 83% of the prisoners who died from COVID-19 during the pandemic were over 55 years old, despite the fact that this age group comprises only 15% of the Texas prisoner population.

Additionally, it often appears as if cruelty is inflicted upon the elderly prisoners simply for cruelty’s sake. “Mindy” entered a California prison in her early fifties. (Mindy withheld her last name due to fear of retaliation). Now at age 71, Mindy told The Appeal, “[w]e all sleep on metal bunks that are akin to cookie sheets with pot holder mattresses. This creates back and hip problems that would not exist with something as simple as a mattress topper. We even offer to purchase them, but they say ‘no’.” Back pain has brought suffering to Mindy for the past 15 years. A recent X-ray revealed a lack of cartilage around her hip and degeneration of her spine, painful conditions that are aggravated by sleeping on the “potholder thin” mattresses.

Mindy has a “senior card” and was once chairperson of The Golden Girls (a group for aging women prisoners). The senior card technically permitted Mindy to have two mattresses, two pillows and two blankets. While chairperson of the Golden Girls, Mindy made copies of the prison’s operating procedures that plainly stated Golden Girls were allowed the extra bedding. Mindy told The Appeal “[b]ut when they do searches, some officers take [the extra bedding] even if you have the paperwork on your bed. And when the extra bedding is taken, it does us no good to grieve it.” Mindy said staffers retaliate against prisoners who file grievances. “Any way they want to punish us is backed up by coworkers.”

In the prison where Mindy is incarcerated, alarms sound multiple times each day. When an alarm sounds, prisoners must immediately drop to the ground. The alarms generally last between 10 and 30 minutes but some last up to 60 minutes. Due to her age, Mindy was provided a mobility vest that permits her to remain standing. However, Mindy has plantar fasciitis and arthritis in her feet. “I can only stand for about 5 minutes before it becomes painful,” Mindy said.

Across the country from Mindy, 69-year-old David Sowers is imprisoned in Virginia. He told Prison Legal News: “I’ve been living inside prison for almost twice as long as I lived on the street.” Incarcerated at age 24 in August 1981, Sowers has been imprisoned for 45 years. Sowers suffers from multiple physical and mental ailments, including arthritis in both hands, hypertension, vision impairments, anxiety and depression. “Those are just the diagnosed problems,” Sowers said. “I also suffer from urinary problems but the poor quality of medical care has prevented me from obtaining a clear diagnosis. A nurse practitioner told me it was due to old age but no diagnostic tests were ever done.”

Sowers described a recent medical trip to the University of Virginia (UVA) Medical Center for a follow-up visit after cataract surgery: “I had to wear the usual restraints. Shackles around my ankles. Hands cuffed in front with the infamous black box clamped over them. The chain wrapped around my waist and through the box, pinning my forearms to my waist. They padlocked the chain so tight I could raise my hands only an inch or so above my waist. And the black box caused the cuffs to dig into my wrists, leaving panful indented creases of about a quarter of an inch.”

Sowers explained that the trip takes over two hours each way. While en route to UVA, Sowers began feeling the urge to urinate. He was able to hold it for several minutes. When the transport van pulled into UVA’s parking lot, he told the guard driving: “I need to piss bad.” The guard told Sowers he had to wait until guards from UVA came to get him. Several more minutes passed. Finally, unable to hold it any longer, Sowers scooted forward on the seat and urinated on himself and the van’s floor.

“I have never been more humiliated,” Sowers said. “The legs and crotch of my jumpsuit were soaked with urine. When I was finally taken inside to see the eye doctor, I was horrified that the doctor, nurses, and other people could see it and smell it.” After Sowers was returned to the prison from UVA, he told the nurses that he would not go on any further medical trips and that he was refusing any further medical treatment that required him to go off site. “I don’t understand why I have to be severely chained up just to see an eye doctor,” Sowers said. “I know this is a prison but I’m 69 years old. I don’t even think about escaping. I have family out there that I want to see before I die. I’m not risking that by doing anything stupid.” He added, “They didn’t even provide a urinal or anything for a four-hour trip there and back. And even if a urinal had been provided, I was chained so tight, I wouldn’t have been able to use it.”

This author is also incarcerated in Virginia. I am 62 years old and have been imprisoned since June 1988. Among my physical and mental health problems are ocular and pulmonary histoplasmosis, arthritis in hips, knees and lower back, hearing impairment, left rotator cuff injury, obesity and PTSD. In November 2024, the nurse practitioner prescribed Nortriptilene for the pain in my rotator cuff. No one told me it was a sleeping aid. It kept me from waking up when I rolled out of my bed. I fell face first, five feet, and slammed into a foot locker and concrete floor. I didn’t put my hands out to brace myself as I was asleep. My jaw was broken in three places; I lost teeth; and injured my chest, right shoulder, and both knees. I had requested a bottom bunk before this fall. My request was denied. None of my ailments met the strict, limited criteria for assignment to a bottom bunk.

My upper bunk is five feet from the floor and is only 26 inches wide. (A standard single bed is 39 inches wide). There is no ladder for access or egress. To access my bunk, I must step onto a stool, then up onto a table top, pivot and then use the heels of my hands to lift myself backwards onto the bed. I was eventually transported to the Medical College of Virginia (MCV) for emergency surgery and installation of two plates to fuse my jawbone. The medical personnel at MCV were polite and professional. It was the trip there and back that I dreaded most.

I had the same dissatisfaction with restraints as Sowers. With my histoplasmosis, I couldn’t run even if I wanted to. Those cuffs mangle my wrists and I can’t use my hands for days afterwards. Because I was convicted before Virginia abolished discretionary parole in 1995, I am parole eligible. Since I’ve been in prison, my parents, aunts, uncles and all four older siblings have passed away. I only have my niece remaining. We have become quite close and she helps me with my investments. I would like to see her in person before I die. I’m not risking all of that for an excursion that ends in arrest and additional imprisonment. Or might even cause harm to another. I harmed too many people getting myself into this mess. I couldn’t bear causing harm to another.

According to the ACLU and PJIL, “[n]ot only do elderly people suffer substantial harms in prison, but they are also the population least likely to reoffend, making their continued incarceration a questionable policy choice. Research overwhelmingly shows that elderly people are significantly less likely than their younger counterparts to be arrested for an offense. This ‘age-crime curve,’ illustrating how people ‘age out’ of crime, is well-documented by the Prison Policy Initiative.” An analysis of “rearrest data of different age groups from 2012 to 2017 revealed that people aged 24 and younger had the highest recidivism rates, while those 50 and older had the lowest rates.”

The ACLU and the PJIL surveyed all 50 states and discovered that “very few systems meaningfully track recidivism rates in a way that permits breakdown and analysis by demographic factors such as age.” However, data gathered from Colorado, South Carolina and Florida enabled analysis of the three-year recidivism rates of people aged 50 and over. In each of those three states, the recidivism rates for that age group were well below the current national three-year rearrest rate of 66%. Colorado’s elderly prisoners were rearrested within three years at a rate of 18%, South Carolina’s rate was 12%, and Florida’s was 6%.

The ACLU and PJIL further reported that “[a]cademic studies have reached similar conclusions about the low risks presented by releasing elderly people—and these low risks are true even for those convicted of violent offenses. For example, a regression analysis conducted by researchers at the University of Michigan Law School looking across a number of states found that there was “a very low risk for further violent offending by older people who had been imprisoned for a prolonged time following a violent conviction.” (The ACLU and PJIL report cited J.J. Prescott et all., Understanding Violent-Crime Recidivism, 95 Notre Dame L. Rev. 1643 (2020). Readers are encouraged to review Prescott’s article.)

Researchers with the University of Maryland Carey School of Law conducted another study focusing on recidivism in Maryland. In 2012, as a result of a court ruling, 178 elderly, life-sentenced people in Maryland were released after serving an average of 40 years in prison for a violent offense. The 178 became known as the “Unger group” upon reentry. The members of the Unger group consisted of 177 men and one woman. The average age was 63 years, and the average time served in prison was 39 years. At the time of the study, the Unger group had been released for 2.5 years. The researchers tracked the members of the Unger group and after four years, not a single one had been rearrested for a crime more serious than a traffic offense. In fact, not even one member had his or her probation revoked for violations of the terms of release.

Factors that researchers concluded to have contributed to such an astonishingly low re-offense rate included “the availability of social workers to help the Unger group successfully reenter the free world, as well as the remarkable formation of a reentry program by students at University of Maryland Carey School of Law.”

The reentry program consisted of a body of dedicated people to include social workers and students, and members of the Maryland Public Defender’s Office. This team assisted the Unger group in obtaining “housing, state identification cards, Social Security cards, and birth certificates, as well as Medicare benefits, public transit assistance, prescriptions, referrals to reentry programs and more. The extraordinary success of 178 members of the Unger group—once deemed ‘violent’—strongly suggests that thousands, if not tens of thousands, of elderly incarcerated people across the country can safely be released, and with public confidence.”

The report concluded: “[E]lderly incarcerated people do not pose a significant public safety risk upon release. The data and criminal justice research resoundingly show that the older someone becomes, the less likely they are to commit another offense. These findings establish that the older incarcerated population is a prime group for policymakers to target for release without compromising public safety.”  

Sources: ACLU, Trapped in Time: The Silent Crisis of Elderly Incarceration; The Sentencing Project, Nothing but Time: Elderly Americans Serving Life Without Parole; The Appeal; The Marshall Project; Wisconsin Watch; Minnesota Star Tribune.

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