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 firstname.lastname@example.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. 233 Broadway, 12th Floor Tel: (212) 334-1300 New York, NY 10279 Fax: (212) 941-9407 www.vera.org