Specialized Healthcare in Correctional Facilities

Escalating inmate healthcare costs continue to be a concern for the criminal justice industry. The Department of Justice estimates that by the end of this year, the U.S. prison population will exceed two million-an increase due in part to mandatory sentencing for repeat offenders, a trend toward longer sentences, and the rising number of older people in the United States prison population.

The length of time people spend in jail and the increasingly older inmate age-and condition-is greatly affecting healthcare costs and procedures. Last year, 17,000 inmates housed by The Bureau of Prisons were aged 50 and older. Inmates are categorized as elderly at age 55. Outside of the justice system, individuals aged 50 and over are expected to comprise 33 percent of the United States population by the year 2010. Currently, Americans in the 65 and older age range are the fastest growing age group in the United States with more than 34 million Americans over the age of 65-eight million more than in 1980. It’s going to be quite hard for people like this to invest for when they retire. If you are looking for information on investments, you can download your free equity release guide from keyadvice.co.uk.

Older-or geriatric-inmates, as well as those who are terminally ill, put a greater strain on prison healthcare resources than do other inmates because they require more care and services. And the cost of medical services for these inmates is four to five times higher than other groups, mainly because prescription drugs are very expensive. Some geriatric and terminally ill individuals are prescribed as many as 10 to 20 bottles of medication, according to the American Medical Association. Additionally, older people-more than any other age group-are likely to have adverse reactions to medications.

Identifying Needs

Currently, all inmates entering the criminal justice system are screened for healthcare needs and an effort is made to identify those inmates requiring special consideration. While attempts are made to provide inmates with the same quality care and range of services available to the general public, it is not always possible. According to the National Health Systems Administrator, as of 1996, many prisoners were diagnosed as having one or more medical disabilities, such as hearing impairment, mental illness, disfigurement, or loss of an extremity. In some instances, facilities are poorly equipped to handle gerontological diseases so problems sometimes go untreated until they become chronic.

Treatments for inmates diagnosed with chronic illnesses, such as HIV/AIDS, TB, kidney diseases, hepatitis C, and psychiatric conditions require expensive treatments. At last tally, medical care for the general prison population was $5.75 per offender. However, the cost for elderly inmates was nearly three times higher at $14.50. And age-related health problems occur earlier in prisoners.

To control costs, strategies implemented by more than half of the Department of Corrections facilities include managed care, inmate co-pay, and contract services/privatization. Other cost management approaches include bulk pharmacy purchases, secondary medical opinions, pre-authorization of elective surgery, medical furloughs, and negotiating per diem rates for hospital-based care. However, identifying needs is only the beginning-having a system to effectively handle patients with special needs is essential.

Consolidating Care

Providing general healthcare services within a jail or prison environment places unusual constraints and responsibilities on doctors, nurses, and other healthcare professionals who must contend with security, sickness, substance abuse, infectious disease control, and others. And those problems often are compounded when patients are geriatric, chronically, or terminally ill.

In an effort to address healthcare needs for all patients, campus-style facilities that centralize or consolidate healthcare services are starting to appear-but the change is encouraging. As little as three years ago only 15 Department of Corrections facilities had consolidated-at one or more sites-their medical care for elderly inmates, only 23 for the terminally ill, and almost none for chronic care.

Care for elderly inmates at these centralized facilities include clinics, preventive care, and frequent physical examinations. Additionally, more than half of the Department of Corrections facilities offer special nutrition/dietary care, 24-hour physician access, specialized housing, and the use of inmate aides to provide non-medical assistance (i.e., reading, pushing wheelchairs, etc.).

Medical care for terminally ill inmates includes contracted hospital beds for acute or long-term care-as needed-and access to prison wards in public hospitals. Common approaches to caring for the terminally ill involve special counseling, hospice care, using inmates to provide non-medical assistance, compassionate release, special housing, (including the placement of terminally ill inmates in areas with special designs or furnishings), and individualized visitation policies. Additionally, some criminal justice facilities policies address the use of pain medications for terminally ill inmates. Nationally, 824 terminally ill inmates were placed in regular Department of Corrections infirmaries or prison hospitals in 1997 while 152 terminally ill inmates were placed in formal hospice settings within the correctional system. During that same year, at least 96 inmates were released from prison on parole or received another form of compassionate release.

However, when dealing with chronic illnesses, instead of following the trend toward the consolidation of medical care, nearly all agencies are providing medical care at specialized clinics or offer other programs such as special housing, telemedicine, computer-based administration of medical services, and/or separate infirmaries.

Healthcare Design

Correctional buildings today often demand on-site clinics, convalescent hospitals, infirmaries, psychiatric facilities, acute care, and medical centers. Studies indicate that most existing prisons are not designed structurally or programmatically for geriatric inmates but are instead geared toward young, physically active inmates. During the 1980s, many prisons were designed with living units and support services buildings scattered over large areas, requiring inmates to walk long distances to obtain meals, medical services, and other necessities-a setup not conducive to older or sickly prisoners’ needs. Additional problems or obstacles encountered by those inmates include stairs, overcrowding, limited climate control, and other architectural barriers.

Specific planning and programming is now recommended to make criminal justice facilities better suited to house older inmates. Ideas include designs or modifications that make the facilities ADA-compliant, interiors that provide older inmates with more space, more privacy; and more control over their environments, including acoustic control, temperature regulation, and lighting. It also makes sense to cluster older inmates within one area for security, supervision, and support. They also should be assigned lower bunks to prevent falls and may require hospital mattresses, extra bedding, and more heat/air conditioning depending on climate and medical condition.

When designing for terminally ill inmates, prison administrators are developing formal hospice programs primarily to enhance the quality of care given to dying inmates. According to Elizabeth Craig of the National Prison Hospice Association, “hospice care is known to be effective in providing a compassionate environment for dying persons and their families. In general, the cost of hospice care is less than that of traditional treatment.” Some Department of Corrections facilities have formalized hospice programs and already are offering palliative care. And, in an effort to make patients more comfortable and provide emotional support, Department of Corrections’ hospices grant special privileges to terminally ill inmates. The most common privilege is a relaxed visitation policy. Hospice residents also are often allowed to keep additional personal property, make special food requests, and often are provided special diets. Additional privileges can include smoking rights, access to clergy and social workers, and the opportunity to participate in planning their memorial services.

Frank H. Roberts, associate AIA, is director of Durrant Justice in Phoenix. Durrant is a nationwide architectural, engineering, construction management, interior design, planning, and security system design firm. Roberts can be reached at (602) 275-0113.