By Bruce Omtvedt, Brooke Martin and Patti Esposito
According to the 2012 American Civil Liberties Union (ACLU) report, “At America’s Expense: The Mass Incarceration of the Elderly,” seven years from now in 2030, there will be around 400,000 geriatric-age inmates within the criminal justice system. Geriatric populations are typically considered age 50 and older. As reported by The Sentencing Project, just under half of those serving sentences for life without parole are also age 50 and older with one in four being over 60 years of age. In 2020, The Sentencing Project surveyed departments of corrections from all 50 states, which revealed that more than 55,000 Americans are incarcerated in state and federal prisons with no chance of parole. This reflects a 66% rise in people serving life without parole (LWOP) since 2003.
Accessing Care Within the Correctional System
Data1 shows an increase in needed healthcare services, such as behavioral health (dementia, acute stabilization, serious and persistent mental illness, and substance abuse, use, and addiction), dialysis, infusion (chemotherapy), general medical clinical care (medical exams, triage, x-ray), physical therapy, dental services, optometry services, dietary needs, skilled nursing, as well as an increase in assistive devices and end-of-life care. As inmates age within the justice system, healthcare diagnoses can become more chronic with an increase of comorbidities, or simultaneous medical conditions, over time.
Increased access to care is important to establish for those serving life sentences and for inmates who will be released back to the community. According to the Federation of American Scientists’ 2015 report “Offender Reentry: Correctional Statistics, Reintegration into Community, and Recidivism,” 95% of the inmate population within correctional and detention facilities will return to the community. To improve access to wrap-around services and integrating those services prior to release, many states are expanding Medicaid services to improve care transitions. In January 2023, California’s Centers for Medicare and Medicaid Services (CMS) approved Section 1115 that expands Medicaid services for incarcerated adults and youth up to 90 days before release. Although many incarcerated individuals still remain ineligible for services, this is one way to bridge the many gaps in justice with wrap-around services, so reentry is stabilized, supportive, and successful.
Aging Populations Within Existing and New Facilities
Moving forward, it is critical to consider how we will build adequate and supportive facilities. When planning a new facility or renovating an existing one, consider these best practices to better support the aging population:
- Incorporate universal Americans with Disabilities Act (ADA) practices, meaning all spaces are designed as accessible. This eliminates the need for moving inmates with varying needs and abilities because all cells and spaces are accessible. According to American National Standards Institute (ANSI) 117.1.2017, the ADA turning radius is now 67” versus the original 60”. Many states are moving to adopt this larger radius. When planning for the future, accommodate for the larger turning radius as assistive and mobility devices continue to grow in size.
- Plan for decreased mobility. This means when renovating or planning for the future, confirm beds are low bunks and include medical beds where critical care is needed.
- Plan for people-of-size populations. These are inmates that are significantly overweight and will likely require larger wheelchairs and assistive devices. People-of-size rooms require greater clearances, larger showers, bariatric toilets, bariatric beds, heavy duty bariatric patient lifts, and enlarged door widths, as well as an egress pathway with appropriately sized doors.
- Review showers, toilets, sinks, video visitation/tele-psych/telemedicine booths, and dining tables and chairs, to meet varying ability needs while maintaining a ligature-resistant environment.
- Plan for increased care staff posts for certified nursing assistants (CNA) where populations need more aid, typically in dementia units or skilled nursing units.
- Build in the infrastructure for better communication: nurse calls, intercoms, and alerts for those with visual, hearing, or speech impairment. Alerts include flashing lights, speaker systems, vibration devices, improved braille and signage for wayfinding, visual monitor boards for announcements, and other solutions.
- Provide comfort rooms, also referred to as quiet or calm rooms, where inmates or patients can excuse themselves to re-focus and relax from something that may be triggering them.
- Integrate room acoustic design in all areas: cells, dayrooms, meeting spaces, classrooms, dining, and corridors. Meet Health Insurance Portability and Accountability Act (HIPAA) requirements in all medical and mental/behavioral health areas for patient confidentiality.
- Design spaces according to special patient needs. For example, those inmates with cognitive decline and dementia diagnoses benefit from:
- A designated continuous walking path in the dayroom and outside, which supports comfort found in walking a looped path with no dead-end areas within their housing unit.
- Dining, CNA services, and general exam areas located within a housing unit.
- Careful review and selection of visuals and color contrasts that do not cause confusion, distortion, avoidance of an area (on all surfaces), or patterns that seem to come alive in a discomforting way; and elimination of patterns and implementation of solid colors when possible.
- Dimmable circadian rhythm lighting: aligning the lighting levels to nature to prevent confusion and behavioral problems due to hypersensitivity to light levels within the environment.
- Eliminating tampering or distraction: removing all visible pulls, locks, alarms from patient access where possible. Determine if mirrors are needed within this patient unit. As dementia progresses, patients may see themselves as a stranger in the mirror causing confusion and agitation.
- As correctional facilities continue to care for their aging inmate populations, these statistics and best practices will provide a good start in assessing facilities’ built environments, operations, needed future changes, and implementation.
Data Reference 1: https://nicic.gov/projects/correctional-healthcare; https://www.prisonpolicy.org/reports/chronicpunishment.html; https://www.kff.org/uninsured/issue-brief/health-coverage-and-care-for-the-adult-criminal-justice-involved-population/; https://www.aafp.org/about/policies/all/incarceration.html
Bruce Omtvedt, AIA, is an Associate Principal & Justice Market Segment Leader at Dewberry. firstname.lastname@example.org
Brooke Martin, AIA, CCHP, NCARB, LEED GA, is an Associate and Justice Architect at Dewberry. email@example.com
Patti Esposito, RA, LEED AP, DBIA, is a Senior Associate and Justice Architect at Dewberry (West Coast). firstname.lastname@example.org
Editor’s Note: This article originally appeared in the March/April 2023 issue of Correctional News.