Prison Health Care Crisis Mounts as Incarcerated Population Ages


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State and federal prisons have a long track record of failing to provide adequate medical care to the people in their custody, leading to preventable and premature deaths that are rarely scrutinized. The rapidly aging prison population is now putting more strain on a system that is already failing, Vox reports.

“Health care behind bars is bad even in the best scenarios,” Mike Wessler, the communications director at the Prison Policy Initiative, told Vox. “And that’s kind of by design in a lot of respects: Prisons are not places that are therapeutic or designed to heal; they are places that are designed to punish.”

Being in prison, with often unconstitutional levels of inadequate medical and mental health care, violence, and poor sanitation, can take years off a person’s life. 

Studies have shown that a 59-year-old in prison has the same morbidity rate as a nonincarcerated 75-year-old and people in prison are much more like to show signs of cognitive decline, including dementia, at an earlier age than the general population.

Many so-called “natural” deaths in prisons have been found to be the result of medical neglect, Vox reports, citing the example of Walter Jordan, a 67-year-old man in an Arizona prison who died in “excruciating needless pain” from cancer that he could have survived if he had received adequate care.

Antonio Arnez Smith, 45, was severely emaciated when he was released from Kilby Correctional Facility in Montgomery, Alabama, last fall. He was in excruciating pain, completely incapacitated, and covered in bed sores after suffering medical neglect at the prison, his family said. He died just four days later.

The Covid-19 pandemic starkly demonstrated how infectious diseases disproportionately affect people in prisons, where older people are at even greater risk. Deaths among incarcerated people rose by almost 50% in the first year of the pandemic, Vox reports, and unlike in the general population, older people in prison saw the highest surge in mortality.

Many prisoners were released during Covid, saving countless lives and showing that reducing the prison population by releasing people who are older and pose no risk to public safety is an effective strategy to address the prison health care crisis.

Yet the prison population is rising again, and so is the proportion of older people in prison.

The percentage of people 55 or older in the U.S. prison population has increased from about 3% in 1991 to 15% by 2021, according to Vox. And the total number of older people in prison is also on the rise, from about 166,000 in 2020, to about 178,000 in 2021 and 186,000 in 2022.

The growing number of people aging in prison can be traced to decades of harsh and extreme sentencing that has made incarceration a permanent punishment for many Americans.

“These extreme sentence lengths paired with narrow release mechanisms—meaning fewer ways to actually leave the system—led to this huge crisis of older adults in American prisons,” Lauren-Brooke Eisen, a senior director at the Brennan Center for Justice, told Vox. “Because what you had is more people coming in, people staying for longer, and then fewer avenues for release because of mandatory minimums, because of three strikes [laws], because of life without parole.”

Rising arrests of older people also contribute to this trend, Vox reports. The percentage of adults arrested who were 55 or older quadrupled from only 2% in 1991 to 8% by 2021, and between 2000 and 2020, arrests of people over 65 increased by nearly 30%—despite the tendency for people to age out of crime. 

Vox points to the nationwide surge in policing of people who are unhoused, people with untreated mental health disorders, and people with substance use disorder—all of whom are getting older—to explain at least part of the increase in arrests of older people. 

People experiencing cognitive decline, including dementia, are especially vulnerable during police encounters. Experts told Vox that arrest or jail time can be especially harmful to people with dementia because of their mental and physical vulnerability.

And as substance use disorder among older people rises and reliance on law enforcement instead of a public health approach to this disease increases nationwide, arrests of older people for drug-related offenses have surged, Vox reports. Drug-related arrests of people over 50 rose by 92% between 2000 and 2018—faster than any other group.

The so-called “graying” of the prison population is contributing to mounting costs at the state and federal level. Vox reports that health care spending by the Bureau of Prisons rose from $978 million in 2009 to $1.34 billion in 2016, and cites the example of Texas, where a 65% increase in the population of people 55 or older between 2012 and 2019 correlated with a cost increase of more than $250 million.

Even tough-on-crime lawmakers recognize that spending millions on a failing system that leaves far too many people to die in prison is unsustainable at best.

“[N]obody’s tougher on crime than me,” former state Sen. John Whitmire told the Texas Tribune, “but once you’ve incarcerated a guy past the point that he’s a threat to anybody, I’d like to save that $500,000 to put him in a nursing home as a condition of parole, take that money, and spend it on either other public safety efforts or prison costs.”

Expanding eligibility for compassionate release and parole to allow older people to obtain medical care outside of prison is a more humane approach, according to Vox. Executive pardon and commutation powers, and support for programs that would reduce arrests of older people by addressing poverty and homelessness, could also be part of the solution. 

Ultimately, there is an urgent need to reduce the number of people aging—and dying—in prison. 

“We have far too many people in our prisons,” Ms. Eisen told Vox. Releasing older people who aren’t a threat to public safety is an especially quick option. “This is a population that shouldn’t be behind bars.”