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Vera Inst Aging Prisoners Increasing Costs and Geriatric Release Apr 2010

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It’s About Time
Aging Prisoners, Increasing Costs,
and Geriatric Release

CENTER on Sentencing and Corrections

APRIL 2010

istockphoto.com/mrrabbit2502

Tina Chiu

Executive Summary
As harsher policies have led to longer prison sentences, often with
a limited possibility of parole, correctional facilities throughout the
United States are home to a growing number of elderly adults. Because
this population has extensive and costly medical needs, states are confronting the complex, expensive repercussions of their sentencing
practices. To reduce the costs of caring for aging inmates—or to avert
future costs—legislators and policymakers have been increasingly willing to consider early release for those older prisoners who are seen as
posing a relatively low risk to public safety.
This report is based upon a statutory review of geriatric release provisions, including some medical release practices that specifically refer
to elderly inmates. The review was supplemented by interviews and
examination of data in publicly available documents.
At the end of 2009, 15 states and the District of Columbia had provisions for geriatric release. However, the jurisdictions are rarely using
these provisions. Four factors help explain the difference between the
stated intent and the actual impact of geriatric release laws: political
considerations and public opinion; narrow eligibility criteria; procedures that discourage inmates from applying for release; and complicated and lengthy referral and review processes.
This report offers recommendations for responding to the dis­­par­ities
between geriatric release policies and practice, including the following:
> States that look to geriatric release as a cost-saving measure
must examine how they put policy into practice. For instance,
they should review the release process to address potential
and existing obstacles.
> More analysis is needed to accurately estimate overall cost savings to taxpayers—and not just costs shifted from departments
of corrections to other agencies.
> More effective monitoring, reporting, and evaluation mechanisms can improve assessments of the policies’ impact.
> Creative strategies allowing older individuals to complete their
sentences in the community should be piloted and evaluated.
> Finally, to protect public safety, states should consider devel­
oping relevant risk- and needs-assessment instruments, as well
as reentry programs and supervision plans, for elderly people
who are released from prison.



It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

From the Center Director
Throughout the United States, state corrections systems face significant challenges: many prisons are operating over capacity, budgets have been cut, and
decisions about who goes to prison and for how long are made by policymakers
who often lack good information about the impact of their actions.
State legislatures and corrections departments are tackling these challenges by
looking for new ways to reduce their prison populations without jeopardizing
public safety. Some states, like Colorado, are considering evidence-based riskassessment tools to help paroling authorities make better-informed decisions
about safe releases, while others, like New York, are using such tools to inform
supervision and violation decisions.
This report examines an underused strategy that is increasingly attracting attention as a way to reduce the prison population, save costs, and maintain public
safety. Geriatric and medical release policies target inmates whose advanced age
or waning health limit the risk they pose to the community. Because the cost of
maintaining these individuals in state prisons is significantly higher than that for
younger inmates, releasing older inmates has the potential to save corrections
departments substantial amounts of money. Nevertheless, many states that have
enacted such policies have not realized a decrease in their prison populations or
the savings they may have anticipated.
The lessons from this analysis of mostly ineffectual geriatric release provisions can
also be applied to other areas of criminal justice policy. Perhaps the most important lesson is that intent is not enough to achieve a legislative or agency policy’s
desired impact. Policymakers must use available data to understand their corrections population and not be overly restrictive in defining the subset eligible for
early release. Instead, they must craft policies and legislation to ensure that exceptions and procedural requirements do not overwhelm a provision’s intent. To
achieve their maximum impact, policies must be based on evidence and proven
outcomes. Finally, legislation and policy change alone are usually not sufficient:
attention and resources must also be directed toward careful implementation.

Peggy McGarry
Director, Center on Sentencing and Corrections

Introduction
During the past three decades, the
United States’ prison population has
increased sixfold. Research shows
that this growth has been driven
not by more crime, but by policies
that send more people to prison and
keep them there for longer periods of
time.1 One consequence of this trend
is a large and increasing number of
older inmates.
Geriatric prison populations
present a challenge to state offi­
cials struggling to control costs in a
weakened economy, rendering early
release for some prisoners, especially
those who did not commit violent
offenses, increasingly viable. Because
older inmates are typically viewed as
less of a threat to public safety than
their younger counterparts, many
states have implemented policies to
release elderly individuals as a poten­
tial cost-cutting measure. In 2008
and 2009, for example, several states,
including Alabama, North Carolina,
and Washington, enacted policy
reforms that would allow some older
inmates to serve the remainder of
their sentences in the community.
Yet such policies have not resulted
in a sizable release of elderly adults;
some of these states have never
released a single older prisoner using
geriatric-specific provisions.
This report examines some factors
that may account for this dis­parity.
First, it provides an overview of
older prisoners, including how states
define “elderly,” a summary of the
population’s specific needs, and the
justification for geriatric release.
Next, it provides a snapshot of



release mechanisms in a number of states. Finally, it
offers explanations as to why geriatric release policies are
not being implemented as intended, along with recom­
mendations to help put these policies into more wide­
spread practice.

Background
Elderly adults are a rapidly growing cohort of the nation’s
prison population. According to the U.S. Bureau of Justice
Statistics, between 1999 and 2007 the number of people
55 or older in state and federal prisons grew 76.9 percent,
from 43,300 to 76,600, and the number of those ages 45 to
54 grew 67.5 percent.2 (See figures 1 and 2.)
In some states, the increase in the number of older pris­
oners has been dramatic. In North Carolina, for example,
from 2001 through 2005 the elderly inmate population
grew faster than any other inmate age group. While the
state’s general prison population increased by 16 percent,
the number of inmates 50 and older grew by 61 percent
to 3,490—almost 10 percent of the total.3 In Virginia, the
population over age 50 increased almost sixfold from

Figure 1: Prison population ages 45 years and
older, 1999 to 2007

1990 to 2008, from 715 to 4,678, or roughly 12 percent
of the prison population.4 In Oklahoma, the number of
inmates 50 and older grew from 879 in 1994 to 3,627 in
2008, an increase from 6.4 percent of the prison popula­
tion to 14.3 percent.5 State policy choices that result in
longer prison terms—such as mandatory minimums,
truth-in-sentencing laws, and the abolition of parole—all
but guarantee that the number of older prisoners will
continue to rise.6

Defining Who Is “Old”
There is no national consensus about the age at which an
inmate qualifies as “old” or “elderly.” The U.S. Census Bu­
reau defines the general “elderly” population as those 65
and older, but the National Commission on Correctional
Health Care uses 55 as its threshold for “elderly” inmates.7
At least 27 states have a definition for who is an “older
prisoner,” according to a recent survey: 15 states used 50
years as the cutoff, five states used 55, four states used 60,
two states used 65, and one used age 70.8
Although most 50-year-olds are not considered elderly,
the aging process appears to accelerate for people who

Figure 2: Percentage of total prison population, ages 45 years and over, 1999 to 2007

250,000
45 to 54

55 or older

16
45 to 54

200,000

55 or older

Percentage

Number

14

150,000

12
10
8

100,000

6
4

50,000



It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

2007

2006

2005

2004

2003

2002

2001

2000

1999

2007

2006

2005

2004

2003

2002

2001

2000

1999

2

are incarcerated.9 Some contributing elements include
a person’s poor physical or mental health prior to incar­
ceration—often the result of factors such as substance
abuse, lack of access to health care or inadequate care,
poverty, and lack of education—as well as the physical
and psychological stresses associated with prison life it­
self. Specific stressors include separation from family and
friends; the prospect of living a large portion of one’s life
in confinement; and the threat of victimization, which
disproportionately affects older inmates.10 For these
reasons, correctional administrators, health practitioners,
and academics agree that an incarcerated person’s physi­
ological age may exceed his or her chronological age.11

Soaring Health Care Costs
Compared with their younger peers, older inmates have
higher rates of both mild and serious health conditions,
such as gross functional disabilities and impaired move­
ment, mental illness, increased risk of major diseases,
and a heightened need for assistance with daily living
activities. Hearing loss, vision problems, arthritis, hyper­
tension, and dementia, for example, are all more common
among older inmates, who are also more likely to require
frequent dental and periodontal work. According to the
Journal of the American Medical Association, inmates
older than 55 have an average of three chronic conditions
and as many as 20 percent have a mental illness.12 Their
need for medical services and devices (such as walkers,
wheelchairs, hearing aids, and breathing aids) is conse­
quently greater as well.
As a result of these conditions, elderly individuals use
a disproportionate share of prison health-care services.
They have five times as many visits to health facilities per
year than similarly aged people who are not incarcerated,
and any treatment they receive beyond the prison gates
carries additional costs in time and travel by correctional
staff.13 To accommodate such prisoners, states may need
to refit or build space for treatment and housing, includ­
ing secure nursing homes. In 2008 at least 13 states had
dedicated units for older inmates, six had dedicated pris­
ons, nine had dedicated secure medical facilities, five had
dedicated secure nursing-home facilities, and eight had
dedicated hospice facilities.14
Because of these needs, prisons spend about two to

three times more to incarcerate geriatric individuals
than younger inmates; according to a 2004 report from
the National Institute of Corrections, the annual cost to
imprison an older person was an estimated $70,000.15 In
fiscal year 2006-2007 North Carolina spent an average of
$5,425 per inmate who was 50 and older to provide them
with medication and dental, medical, and mental health
care—more than four times what it spent on younger
inmates.16 In Virginia, a study for the Appropriations
Committee of the House of Delegates estimated that the
Department of Corrections could save up to $6.6 million
if 62 individuals—15 percent of the population eligible for
geriatric release—were released in 2010.17
The growing number of elderly inmates, the rising costs
of medical care and incarceration, and the possibility of
longer life expectancies resulting from improved pre­
vention and treatment will increase the strain on state
correctional budgets, given that prisoners are not eligible
for Medicaid or Medicare benefits. Viable alternatives to
keeping older adults incarcerated are attractive because
of potential cost savings.

Lower Recidivism Rates
Such alternatives also make sense from a public safety
perspective. Researchers have consistently found that age
is one of the most significant predictors of criminality,
with criminal or delinquent activity peaking in late ado­
lescence or early adulthood and decreasing as a person
ages.18 Older offenders are less likely to commit additional
crimes after their release than younger offenders.19 Stud­
ies on parolee recidivism find the probability of parole
violations also decreases with age, with older parolees
the least likely group to be re-incarcerated.20 A 1998 study
found that only 3.2 percent of offenders 55 and older
returned to prison within a year of release, compared
with 45 percent of offenders 18 to 29 years old.21 Likewise,
a 2004 analysis of people sentenced under federal sen­
tencing guidelines found that within two years of release
the recidivism rate among offenders older than 50 was
only 9.5 percent compared with a rate of 35.5 percent
among offenders younger than 21.22 Given these statistics,
releasing some elderly inmates before the end of their
sentence poses a relatively low risk to the public.



State Approaches
to Releasing Older
Inmates Vary
Fifteen states and the District of Columbia define pro­
cesses for releasing geriatric inmates. These processes
vary from state to state and include discretionary parole,
inmate furloughs, and medical—or compassionate—
release. Some states have enacted release statutes that
specifically target older inmates. Others have added agespecific criteria to parole procedures or medical release
statutes. Other states have developed laws that deal with
both geriatric and medical release. In defining geriatric
release laws, this report includes statutes that focus
explicitly on elderly prisoners as well as a subset of medi­
cal release statutes that refer specifically to age or agerelated medical conditions.23 (See figure 3.)
To be eligible for geriatric release, inmates must meet
a number of requirements, usually related to their age,
medical condition, and risk to public safety. The eligibility
requirements may also include restrictions that preclude
consideration: many states make inmates ineligible for
geriatric release due to the severity of their offense of
conviction, and in some states older prisoners may not
be eligible until they have served a minimum length of
their sentence. Some states define eligibility broadly, giv­
ing wide discretion to the releasing authority, such as a
parole board. Other states define eligibility narrowly and
require the releasing authority to make certain findings
before releasing an inmate.
Most states that permit the early release of older pris­
oners have set the age of eligibility at 60 or 65. Louisi­
ana has the lowest age of eligibility, 45. Most eligibility
requirements include certain physical conditions, such as
a chronic infirmity, illness, or disease related to aging, or
that the inmate is physically incapacitated or in need of
long-term care.
Maryland, Virginia, and Wisconsin are among the
states whose eligibility requirements for geriatric release
do not include specific physical or medical conditions.
Instead, they set thresholds for age and minimum length
of sentence served. In Maryland, eligible prisoners must



be 65 and have served at least 15 years of their sentence.
In Virginia and Wisconsin, people 65 and older must serve
five years and those 60 to 64 must serve 10 years before
applying for geriatric release.
Statutes in Connecticut, Missouri, Oregon, Texas, Wash­
ington, and Wyoming do not specify an age but refer to
age-related physical or mental debilitation as one of the
eligibility criteria. Missouri, for instance, requires that
inmates be sufficiently “advanced in age” that they are
“in need of long-term nursing home care.” Wyoming
allows medical parole for inmates who are “incapacitated
by age to the extent that deteriorating physical or mental
health substantially diminishes” their ability to take care
of themselves in a prison setting.
Procedures for releasing older prisoners also vary across
states. Policies may establish conditions of release, includ­
ing housing restrictions or periodic medical exams; define
revocation procedures, such as automatic revocation if
an inmate’s medical condition improves; and identify
who is authorized to make a release recommendation (for
example, department of corrections personnel or medical
examiners). (See figure 4.)

Examining the Gap
between Intent
and Impact
Given that many state policymakers have expressed an
intention to permit the release of elderly inmates who are
not a threat to public safety, it is remarkable that geriatric
release policies have had little impact. As of early 2009,
neither Maryland nor Oklahoma had released an older
prisoner under geriatric release provisions. From 2001 to
2008, Colorado released three prisoners under its policy.
Oregon has released no more than two prisoners per
year. From 2001 to 2007, Virginia released four inmates.24
From 1999 through 2008, New Mexico released 35 pris­
oners under its combined medical and geriatric parole
program, but how many of these prisoners were elderly
is not clear.25 Missouri appears to have made the greatest
use of its provision, which applies to both geriatric and
terminally ill individuals, having released 236 inmates

It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

Figure 3: States with Geriatric-Related Release Policies

State

Statutory/
Administrative Provision

Minimum
Age

Eligible Applicants

AL

Ala. Code §§ 14-14-1 to 14-14-7

55

Must be 55 years or older and suffer from a chronic life-threatening
infirmity, life-threatening illness, or chronic debilitating disease related
to aging.

CO

Colo. Rev. Stat. §§ 17-1-102; 1722.5-403.5

65

Must be 65, incapacitated, incapable of caring for oneself, not a threat
to society, not likely to re-offend, and not convicted of certain felonies.

CT

Conn. Gen. Stat. § 54-131k

-

Must be physically or mentally debilitated from age or illness, incapable
of being a threat to society, and have served half of their sentence.

DC

D.C. Code § 24-465

65

Must be 65 and have a chronic, age-related problem that arose after
sentencing.

LA

La. Rev. Stat. Ann. § 15:574.4(A)(2)

45

Must be 45 and have served 20 years of at least a 30-year sentence.

MD

Md. Code Ann., Crim. Law § 14101(g)

65

Must be 65 and have served at least 15 years of a sentence for a crime
of violence.

MO

Mo. Rev. Stat. § 217.250

-

Must be advanced in age to the point of needing long-term nursing
home care.

NC

N.C. Gen. Stat. §§ 15A-1369 to 1369.5

65

Must be 65 years or older and suffer from chronic infirmity, illness, or
disease related to aging; and be incapacitated to the extent that they do
not pose a public safety risk.

NM

N.Mex. Stat. § 31-21-25.1

65

Must be 65, have chronic illness/infirmity/disease related to aging, and
must not be a danger to themselves or society.

OK

Okla. St. Tit. 57, § 332.7

60

Must have committed their crime before 7/1/1998, be 60 years of age,
and have served at least 50% of a sentence imposed under applicable
truth-in-sentencing guidelines.

OR

Ore. Rev. Stat. § 144.122(1)(c)

-

Must be elderly and permanently incapacitated in such a
manner that they are unable to move from place to place without assistance of another person.

TX

Tex. Gov’t. Code § 508.146

-

Elderly, physically disabled, mentally ill, terminally ill, or mentally
retarded individuals or those who have a condition requiring long-term
care, and are not a threat to public safety based on their condition and
a medical evaluation.

VA

Va. Code Ann. § 53.1-40.01

60 or 65

People age 60 who have served 10 years or those who are age 65 and
have served 5 years.

WA

Wash. Rev. Code § 9.94A.728

-

Have a serious medical condition that is expected to require costly care
or treatment and are physically incapacitated due to age or medical
condition or expected to be so at the time of release.

WI

Wis. Stat. § 302.1135

60 or 65

Must be age 60 and have served 10 years or age 65 and have served 5
years; may seek petition for release to extended supervision.

WY

Wyo. Stat. Ann. § 7-13-424

-

Must be incapacitated by age to the extent that deteriorating physical
or mental health substantially diminishes their ability to provide self-care
within a correctional facility.



Figure 4: Elements of Geriatric and
Medical Release Policies
The following items may be defined either in a
statute or by agency policy and protocol.
Eligibility requirements
>	Minimum age
>	Minimum time served
>	Medical needs
Types of exclusions
>	Conviction offenses
>	Previous criminal history

from 1998 through 2008. This figure, however, may reflect
a large proportion of people who were terminally ill; at
least 64 percent of this group has died since being
released.26
Several dynamics account for the relatively low
impact geriatric release mechanisms have on states’
elderly inmate populations. These include components
of states’ policies that may make the process of releasing
older inmates less effective or efficient. For example, the
statutes may define the eligible population narrowly, as
noted earlier, or procedural issues may cause confusion
or delays. Four contributing factors may be restricting the
number of older inmates that states release: political con­
siderations and public opinion, eligibility requirements,
application procedures, and referral and review processes.
These four topics are discussed below.

Application
>	Parties eligible to make application
>	Agency to which application is made
Evaluation
>	Public safety or risk assessments
>	Medical conditions (if applicable)
>	Party responsible for making evaluations
>	Existing parole guidelines
>	Agency responsible for final release decision
Conditions of release
>	Release plan
>	Predetermined release location
>	Program participation
>	Monitoring
>	Reporting requirements
>	Level of supervision (if applicable)
>	Length of supervision (if applicable)
Revocation
>	Reason(s)
>	Responsible agency
>	Procedures



Political Considerations and Public
Opinion
Politics and public sentiment present obstacles to fully
using statutes already on the books. Releasing older
inmates can be viewed as politically unwise, fiscally
questionable, or philosophically unpalatable.
The decision to grant early release to any prisoner can
be politically risky, regardless of potential cost savings.
Data or predictions about older inmates’ relatively low
rates of recidivism may not sway public opinion. A com­
monly cited reservation is that offenders placed in nurs­
ing homes may prey upon an already vulnerable popu­
lation. A Mansfield University survey of Pennsylvania
residents in 2004 found that only 45 percent of respon­
dents favored the early release to parole for chronically
or terminally ill inmates, even if they posed no threat to
society.27
Many opponents of geriatric release question whether
cost savings will be realized. Most analyses of the impact
of such policies focus on the cost savings to correctional
agencies and, therefore, reveal only part of the fiscal pic­
ture. Policymakers and taxpayers want to know whether
costs are simply being shifted to other state agencies,
such as social service or health departments, or to the
federal government through Medicare or Medicaid reim­
bursements after individuals return to the community.
For many other opponents, the desire to keep individu­

It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

als confined may trump any other considerations. As Will
Marling, executive director of the National Organization
for Victim Assistance, said, “If a person is sentenced to
life, we know they are naturally going to get old. A life
sentence should mean life.”28

Eligibility Requirements
In developing geriatric release statutes and procedures,
policymakers often exclude individuals convicted of
violent offenses or sex offenses and those sentenced to
life imprisonment. For these populations, punishment as
a goal of incarceration may outweigh considerations of
correctional cost savings or the prospect that age has ren­
dered a person less dangerous. Although this rationale is
understandable, the result is that geriatric release policies
may apply to only a small subset of older inmates.
In 2008, one in 11 U.S. prisoners—more than 140,000
individuals—were serving a life sentence; 29 percent
of them (roughly 41,000 people) have no possibility of
parole.29 In Pennsylvania, a 2003 study of inmates 50
and older found that older prisoners were more likely to
have been incarcerated for serious offenses, including
rape, murder, robbery, aggravated assault, and burglary;
66 percent were serving maximum sentences of 10 years
or more, with 21 percent serving life sentences.30 A 2006
report on North Carolina prisoners showed that almost
60 percent of inmates ages 50 and older were serving
sentences for violent or sex crimes, including sexual
assault, habitual felonies, and murder in the first or
second degree. Most were serving a sentence of life or of
10 years to life.31 As larger numbers of people convicted
of seri­ous and violent crimes grow old in prison, categori­
cally excluding them from consideration may result in
fewer releases and less potential cost savings.
Similarly, states that restrict geriatric release to inmates
who have a grave physical condition or terminal illness
are likely to discharge only a small number of people.
Washington State, for instance, released only 22 prison­
ers in five years under its original “extraordinary medical
placement” statute, which sanctioned such placement
only for those inmates who are physically incapacitated
due to age or a medical condition.32 In 2009, the legisla­
ture modified the eligibility criteria to include inmates
who are not yet infirm but are expected to be physically

incapacitated at the time of their release. As a result of
this change, not only will more prisoners be eligible for
placement, but the state Department of Corrections (DOC)
could avoid incurring higher medical costs by releas­
ing some individuals before they become gravely ill in
prison.33 The Washington State DOC has projected that
it could release as many as 44 offenders older than 55
between 2009 and 2011, for an estimated savings of up to
$1.5 million.34

Application Procedures
Some application procedures may discourage older pris­
oners from seeking geriatric release. Virginia’s geriatric
release provision, for example, is limited to offenders who
have no convictions for Class 1 felonies and are either
at least 60 years old and have served at least 10 years of
their sentence, or at least 65 years old and have served
at least five years of their sentence. This provision was
adopted in 1994 as part of the state’s truth-in-­sentencing
(TIS) reform package. Although this provision was origi­
nally applicable only to offenders sentenced under TIS
laws, in 2001 lawmakers expanded geriatric release to
apply to all state prisoners.
To be considered for geriatric release, inmates must
apply to the Virginia Parole Board. Relatively few do this,
however. According to the Virginia Criminal Sentencing
Commission, only 39 of the 375 eligible inmates—roughly
10 percent—applied in 2004. In 2007, only 52 out 500
eligible individuals applied.35 These low numbers might
reflect a procedural conundrum. Once inmates are eligible
for discretionary parole release, they are automatically
considered for parole annually. However, those who apply
for geriatric release forfeit that year’s automatic parole
hearing. Because the parole board will not consider cases
on both grounds in the same year, parole-eligible indi­
viduals have little incentive to apply for geriatric release.
On the other hand, people convicted under the state’s TIS
laws—who are by definition ineligible for discretionary
parole release—have only the option of applying for geri­
atric release. As more of them become eligible for geriat­
ric release, Virginia could make more frequent use of its
provision by automatically reviewing their cases, rather
than relying on individuals to apply for consideration.36



Referral and Review Processes
The process of referral and review is often complex and
lengthy. It takes time to follow geriatric or medical re­
lease procedures, such as identifying potentially eligible
inmates, compiling relevant information for review by
the parole board or another releasing authority, develop­
ing release plans, and securing housing and medical care
in the community. Delays are not uncommon, especially
when staffing is inadequate or processing is inefficient.
Alabama attempted to expedite release proceedings
by specifying a time frame for the Board of Pardons and
Paroles to decide whether qualified inmates would be
granted medical or geriatric parole, in part because some
inmates had died while waiting for their parole applica­
tions to be reviewed.37 After several failed attempts to
change the paroling process, in 2008 the legislature
created a discretionary medical furlough program,
administered by the Department of Corrections. Geri­­atric
inmates—persons 55 years of age or older who suffer
from a chronic life-threatening infirmity or illness or a
chronic debilitating disease related to aging and who
pose a low risk to public safety—are now eligible for
medical furlough, unless they were convicted of capital
murder or a sexual offense. Still, even under the medical
furlough program, releases can be time-consuming: as of
August 2009, only three inmates had been released under
the statute.38
In Texas, a review of staffing and the referral process
resulted in expanded use of geriatric or medical release
and more efficient procedures. In 1991, the Texas legis­
lature created the Medically Recommended Intensive
Supervision (MRIS) program to allow for the early release
of nonviolent offenders who are deemed not to be a risk
to society because of their medical conditions. Under the
program, the Texas Correctional Office for Offenders with
Mental or Medical Impairments (TCOOMMI) identifies
inmates who are “elderly, physically disabled, mentally
ill, terminally ill, or mentally retarded” and recommends
their cases to the Board of Pardons and Paroles (BPP).
Violent offenders and those who used a weapon as part of
their offense are not eligible.
In the years following its creation, few elderly inmates
were released through MRIS. Overall BPP approval rates
for MRIS had been declining through fiscal year 2002,

10

and out of 352 individuals released through special needs
parole during fiscal years 1996 through 1999, only 16 were
elderly.39 A management audit in 2002 found delays or
problems in the utilization of MRIS for all eligible prison­
ers. One factor identified as contributing to the delays
was staff resources, which were insufficient to process
referrals, complete interviews, compile relevant medical
information, and coordinate case presentations to the
parole board.
In response to this problem, TCOOMMI contracted the
Department of Aging and Disability Services (DADS) for
case management services. The DADS staff conduct all
pre-release interviews, handle federal entitlement
applications, and coordinate post-release services, includ­
ing placement in nursing homes, hospices, or at other
facilities.40 To ensure that staff make timely referrals
for offenders with terminal illnesses or long-term care
needs, TCOOMMI also made unit physicians responsible
for initiating referrals. (Previously, TCOOMMI would
request medical summaries for any referral received from
internal or external sources, a process that typically had
unit medical staff completing paperwork for offenders
whose conditions were not deemed clinically appropriate
for early release.) The streamlined referral process helps
target appropriate inmates for release and reduces paper­
work and processing times.41
Few states regularly examine their use of parole for
elderly offenders and modify procedures based on con­
tinual analysis. Those that do—Texas is one example—
are in a better position to maximize their use of release
mechanisms for older prisoners.

Recommendations	
Early release for older inmates has attracted attention
because it promises cost savings at relatively low risk to
public safety. However, the practice can be at odds with
other criminal justice goals, such as retribution or
incapacitation. Because of this conflict, geriatric release
policies can be difficult to implement effectively.
1.	 States that want to reduce corrections spending
by releasing elderly inmates should generate

It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

comprehensive estimates of the overall cost sav­
ings to taxpayers—not just to corrections agen­
cies. These can address the political and practical
concerns that geriatric release merely shifts costs
to other state agencies, the federal government,
or localities. Such analyses will not only inform
discussions about geriatric release policies and
practices, but can also result in a more trans­
parent decision-making process. Once geriatric
release policies are in place, states should contin­
ue to examine them to make sure they are work­
ing as intended and as efficiently as possible.

assessment instruments that can identify people
within this population who are at low risk of
recidivism. As part of an effective release policy,
such instruments would be more reliable than
individual judgment at identifying risk levels and
the type of supervision an older prisoner would
need in the community. Risk and needs assess­
ment instruments would be especially useful
in states where eligibility for geriatric release is
defined by age rather than by a physical incapaci­
tation that prevents someone from being a threat
to society.

2.	Applying the principle that “what gets measured
gets done,” states should measure and monitor
geriatric release mechanisms and require report­
ing about how they are used. Alabama, New
Mexico, and Washington require annual reports
to the legislature on applications, grants, denials
for release, and returns to custody. States—espe­
cially those that employ general medical release
policies—should also collect and report data
pertaining to the age and medical condition of
inmates who are released. Assessing this basic
information will help officials see the results of
geriatric release over time and gauge whether
policies are having the desired impact.

5.	States that do not restrict geriatric release to
people who are terminally ill, severely incapaci­
tated, or bedridden may need to develop creative
strategies so that older, but not entirely infirm,
individuals can complete their sentences in the
community. Testing nontraditional approaches
to reducing the geriatric population would be
worthwhile; in 2009, for example, the Federal
Bureau of Prisons initiated a two-year Elderly
Offender Home Detention Pilot Program to allow
certain inmates 65 and older to complete their
sentences while under confinement and supervi­
sion in their own residence. Supportive housing
and the medical home model—which refers to
an approach to providing comprehensive, coordi­
nated primary care, not placement at a residen­
tial facility—may also be promising, but addition­
al housing and health care options are needed.

3.	States should also be sure to examine the geri­
atric release process at every stage to identify
and address potential and existing obstacles. For
example, are eligibility requirements and exclu­
sions too narrow, resulting in too small a pool of
inmates who qualify? Are application procedures
confusing or burdensome? Are cases reviewed in
a timely fashion? Are releases frequently denied
at the final stage of the process? In addition to
evaluating their own systems on an ongoing ba­
sis, states should review the policies and practices
of other jurisdictions to help identify factors that
can make geriatric release more or less effective.
4.	Because public safety is an overriding concern
when it comes to releasing elderly prisoners,
states should consider developing and validating

6.	More information is also necessary to develop
and implement effective reentry programs and
supervision plans for elderly people who are
released from prison. One place to start is by
adapting existing reentry programs to address
the medical, mental health, housing, employ­
ment, and social needs of older individuals. Postrelease supervision should be modified to address
geriatric issues, and parole officers should be
trained to understand the needs of older parolees.
Since little is known about what older, formerly
incarcerated people require to succeed in the
community, stakeholders—including correctional

11

administrators and staff; probation and parole
staff; current and former inmates and their fami­
lies; health care practitioners; service providers;
researchers; and policymakers—must collaborate
to develop innovative solutions to working with
this population.
7.	States should consider lowering the age at which
inmates are defined as “elderly.” Doing so would
make more individuals eligible for geriatric
release and potentially increase cost savings. This
recommendation may be more politically fea­
sible if states combine a lower age threshold with
geriatric-specific risk and needs assessments,
establish reentry programs and supervision plans
(as discussed earlier), or develop pilot programs
for releasing inmates who are 55 to 60 years old.

12

Conclusion
The need to reduce corrections costs without jeopardizing
public safety provides states with an opportunity to
introduce or refine geriatric release policies. The chal­
lenge is to make existing policies more effective and to
identify and assess new approaches to managing an ag­
ing population that is expected to grow. States with provi­
sions for geriatric release can lead the way by making
greater use of them and evaluating the outcomes. States
that have not created such policies can test innovative
strategies and help the criminal justice field learn more
about what works, particularly with regard to reentry and
community supervision for an elderly population that is
ill, infirm, or both.

It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

Endnotes

1	

Pew Center on the States Pew Public Safety Performance Project, One in
100: Behind Bars in America 2008 (2008).

2	

U.S. Bureau of Justice Statistics, National Prisoner Statistics Series, http://
www.ojp.usdoj.gov/bjs/prisons.htm (accessed October 30, 2009).

3	

Charlotte A. Price, Aging Inmate Population Study, (North Carolina:
Department of Corrections Division of Prisons, 2006).

4	

Dr. James E. Arndt et al., A Balanced Approach: Assisted Living Facilities
for Geriatric Inmates (Virginia: Department of Corrections, 2008; prepared
under 2008 Appropriations Act Chapter 879 Item 387-B).

5	

Oklahoma Department of Corrections, Managing Increasing Aging Inmate
Populations (2008).

6	

Pew Center on the States Public Safety Performance Project, Public Safety,
Public Spending: Forecasting America’s Prison Population 2007-2011
(Revised June 2007).

7	

B. Jaye Anno et al., Correctional Health Care: Addressing the Needs of
Elderly, Chronically Ill, and Terminally Ill Inmates (Washington, DC: U.S.
Department of Justice, National Institute of Corrections, 2004).

8	

Anthony A. Sterns et al., “The Growing Wave of Older Prisoners: A
National Survey of Older Prisoner Health, Mental Health and Programming,” Corrections Today (August 2008). 41 states responded to the
survey.

9	

B. Jaye Anno et al., Correctional Health Care: Addressing the Needs of
Elderly, Chronically Ill, and Terminally Ill Inmates (Washington, DC: U.S.
Department of Justice, National Institute of Corrections, 2004).

10	 Jeremy L. Williams, The Aging Inmate Population: Southern States Outlook (Atlanta, GA: Southern Legislative Conference of The Council of State
Governments, December 2006).
11	 Brie Williams and Rita Abraldes, “Growing Older: Challenges of Prison
and Reentry for the Aging Population,” in Public Health Behind Bars:
From Prisons to Communities, edited Robert B. Greifinger (New York, NY:
Springer, 2007).
12	 Mike Mitka, “Aging Prisoners Stressing Health Care System,” Journal of
the American Medical Association 292 (2004), as cited in Timothy Curtin,
The Continuing Problem of America’s Aging Prison Population and the
Search for a Cost-Effective and Socially Acceptable Means of Addressing
It (Illinois: The Elder Law Journal 15, 2007) p.481.
13	 E.F. Fitzgerald et al., “Health Problems in a Cohort of Male Prisoners at
Intake and During Incarceration,” Journal of Prison and Jail Health 4: 61-76
(1984).
14	 Anthony A. Sterns et al., “The Growing Wave of Older Prisoners: A
National Survey of Older Prisoner Health, Mental Health and Programming,” Corrections Today (August 2008).
15	 B. Jaye Anno et al., Correctional Health Care: Addressing the Needs of
Elderly, Chronically Ill, and Terminally Ill Inmates (Washington, DC: U.S.
Department of Justice, National Institute of Corrections, 2004).
16	 Charlotte A. Price, Aging Inmate Population Study, Addendum Report
(North Carolina: Department of Corrections Division of Prisons, 2007).

17	 The Center for Excellence in Aging and Geriatric Health and The College
of William and Mary, Study of the Older Inmate Population in Virginia and
Its Budget Implications (Virginia; presentation prepared for the House
Appropriations Committee Retreat 2003).
18	 John H. Laub and Robert J. Sampson. Shared Beginnings, Divergent Lives.
(Cambridge, MA: Harvard University Press, 2003).
19	 Darrell J. Steffensmeier et al., “Age and the distribution of crime,” American Journal of Sociology, 94(4), 803-831 (1989).
20	 Brie Williams and Rita Abraldes, “Growing Older: Challenges of Prison
and Reentry for the Aging Population,” in Public Health Behind Bars:
From Prisons to Communities, edited Robert B. Greifinger (New York, NY:
Springer, 2007).
21	 Barry Holman, “Nursing homes behind bars: The elderly in prison,” Coalition for Federal Sentencing Reform, 2(1), 1-2 (1998). See also Robyn L.
Cohen, Probation and Parole Violators in State Prison, 1991 (Washington,
DC: Bureau of Justice Statistics, 1995).
22	 United States Sentencing Commission, Measuring Recidivism: The Criminal History Computation of the Federal Sentencing Guidelines (May 2004).
23	 Thirty-nine states have medical release policies that apply to prisoners
who are severely or terminally ill, regardless of their age. See Ben Gorman,
“With soaring prison costs, states turn to early release of aged, infirm
inmates.” National Conference of State Legislatures, http://www.ncsl
.org/default.aspx?tabid=14647 (accessed March 15, 2010).
24	 Virginia Criminal Sentencing Commission, Virginia’s Geriatric Release
Provision (Virginia: VCSC 2008).
25	 Sherry Stevens, Deputy Director of the New Mexico Adult Parole Board,
phone interview by Adrienne Austin, New York, NY, February 18, 2009.
26	 David Oldfield, Director of Research and Evaluation for the Missouri
Department of Corrections, phone interview by Adrienne Austin, New
York, NY, February 19, 2009.
27	 General Assembly of the Commonwealth of Pennsylvania, Joint State
Government Commission. Report of the Advisory Committee on Geriatric
and Seriously Ill Inmates. Harrisburg, PA: June 22, 2005.
28	 Stephanie Chen. “Prison health-care costs rise as inmates grow older and
sicker.” CNN, http://www.cnn.com/2009/CRIME/11/13/aging.inmates/
index.html (accessed November 13, 2009).
29	 Ashley Nellis and Ryan S. King, No Exit: The Expanding Use of Life Sentences in America (Washington DC: The Sentencing Project, 2009).
30	 Pennsylvania Department of Corrections, Elderly Inmate Profile
(undated). http://www.portal.state.pa.us/portal/server.pt/gateway/
PTARGS_0_482992_0_0_18/elderlyinmateprofile.pdf (accessed October
18, 2009).
31	 Charlotte A. Price, Aging Inmate Population Study, (North Carolina:
Department of Corrections Division of Prisons, 2006).
32	 Washington State Engrossed House Bill Report, HB 2194, An act relating
to extraordinary medical placement for offenders (As reported by House
Committee on Human Services and Ways & Means: requested by the
Department of Corrections, 2009). http://apps.leg.wa.gov/documents/

13

billdocs/2009-10/Pdf/Bill%20Reports/House/2194.E%20HBR%20PL%2009.
pdf (accessed December 28, 2009).

37	 Carla Crowder, “Medical, geriatric paroles weighed,” The Birmingham
News, January 10, 2004.

33	 Washington State House Bill Report, HB 2194, An act relating to extraordinary medical placement for offenders (As reported by House Committee
on Human Services and Ways & Means: requested by the Department of
Corrections, 2009).

38	 Markeshia Ricks, “It’s tough for terminally ill inmates to receive medical
furloughs in Alabama,” Montgomery Advertiser, August 23, 2009.

34	 Multiple agency fiscal note summary, HB 2194, Washington State.
March 11, 2009. https://fortress.wa.gov/ofm/fnspublic/
legsearch.asp?BillNumber=2194&SessionNumber=61 (accessed
December 28, 2009).
35	 Dr. Rick Kern. Presentation to the Commonwealth of Virginia Senate Finance Committee. Richmond, VA: Virginia Criminal Sentencing Commission. http://sfc.state.va.us/pdf/Public%20Safety/2009/
012309%20Kern%20Presentation.pdf (accessed January 23, 2009.

39	 Carole Keeton Strayhorn, “Public Safety and Corrections,” in Recom­
mendations of the Texas Comptroller (Texas: Comptroller of Public
Accounts, 2000).
40	 Dee Wilson, Director of the Texas Correctional Office on Offenders with
Medical or Mental Impairments. February 20, 2009. Personal e-mail.
41	 The Texas Board of Criminal Justice, The Biennial Report of the Texas
Correctional Office of Offenders with Medical and Mental Impairments
(Texas: 2007).

36	 Dr. James E. Arndt et al., A Balanced Approach: Assisted Living Facilities
for Geriatric Inmates (Virginia: Department of Corrections, 2008; prepared
under 2008 Appropriations Act Chapter 879 Item 387-B).

14

It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release

© Vera Institute of Justice 2010. All rights reserved.
The author thanks Don Stemen at Loyola University Chicago for his examination of this topic while at the Vera Institute, Dr. Brie
Williams of the Division of Geriatrics at the University of California, San Francisco, for her expertise and input, and Alison Lawrence
of the National Conference of State Legislatures and Roger K. Warren of the National Center on State Courts for sharing their
research. The author is grateful to Vera staff members Adrienne Austin and Michael Woodruff for their research assistance and to
Jules Verdone, Abbi Leman, and Robin Campbell for editorial assistance. Finally, thanks to Peggy McGarry and Dan Wilhelm of the
Vera Institute, and Adam Gelb, Richard Jerome, Brian Elderbroom, and Ryan King of the Pew Center on the States for providing
feedback on this publication.
Edited by: Jules Verdone
Photo: istockphoto.com/mrrabbit2502
Additional copies are available from the Vera Institute of Justice, 233 Broadway, 12th Floor, New York, NY 10279, (212) 334-1300.
An electronic version is posted on Vera’s web site at www.vera.org/sentencingandcorrections.
For more information about Vera’s Center on Sentencing and Corrections, contact the center’s director, Peggy McGarry, at
pmcgarry@vera.org.
The Vera Institute of Justice is an independent nonprofit organization that combines expertise in research, demonstration projects,
and technical assistance to help leaders in government and civil society improve the systems people rely on for justice and safety.

Suggested Citation
Tina Chiu, It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release.
New York: Vera Institute of Justice, 2010.

This report was funded by the Public Safety
Performance Project of the Pew Center on the States.

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