The term “geriatric” can apply to a prisoner as young as 50 in some prison systems, and it describes the fastest-growing segment of the U.S. incarcerated population. As Prison Policy Initiative (PPI) reported on August 2, 2023, the number has quintupled over the past 30 years, totaling 186,000 prisoners 55 and over in 2022.

Arriving at a Pennsylvania state prison in 1972 to serve life without parole for a murder and aggravated robbery committed when he was just 16, Andre Gay recalled: “I was basically a blank slate.” Older prisoners mentored him until he eventually became an elder himself. Catching a glimpse of himself in a mirror one day, he said that “I literally did not recognize who I was looking at. I had changed so much.”

Prison officials who also failed to notice now find so many gray heads in their cells that they’re scrambling to provide the aging cohort constitutionally adequate healthcare. Vermont Department of Corrections (DOC) Commissioner Nick Deml said that “[w]hen you think about geriatric medical needs, many of the prisons across the United States are not equipped or weren’t designed that way, and so the systems are grappling with how to retrofit or make do with the facilities that we have.”

Agreed Texas Department of Criminal Justice Executive Director Bryan Collier, “You don’t usually build prisons with nursing home-type housing or geriatric housing or even wheelchair housing.”

Adapting for older prisoners involves retrofitting costs to make cells wheelchair accessible, adding more cells because fewer upper bunks can be used, plus extra outlets for CPAP machines. When prisoners are mobility-limited, food and healthcare must be delivered to their cells, requiring additional staff.

“Staffing is a challenge,” acknowledged Michigan DOC Director Heidi Washington. “What I’m more focused on going into the future is some more specialized staff that have an expertise in dealing with the aging population.”

A Transitional Care Unit at the Minnesota Correctional Facility in Oak Park Heights has been expanded twice in two decades to now include 54 beds, a dialysis clinic and 24/7 nursing care. Each cell has a glass door, so “we can visualize what is happening with the patient as we walk by the door,” explained the state DOC’s associate director of nursing, Joan Wolff.

However, Minnesota has just two such units with a combined capacity of 150, a fraction of its 1,400 prisoners over age 50. Dan Pfarr, CEO of Minnesota reentry nonprofit 180 Degrees, said the units won’t make up for years of substandard healthcare that now means “[f]or men coming out of prison, 40 is the new 60, 60 is the new 80.”

Gay was released from his Pennsylvania cell in July 2022, after the Supreme Court of the U.S. ordered new sentencing hearings for those like him given life without parole for crimes committed as juveniles. Now 68, he works to secure release for other prisoners. “The prison administration, their culture, I wouldn’t even call it benign neglect. It was just indifference,” he said. “Prison is not good for anybody. A lot of times, the elderly have it the worst.”

Joan Sehl’s partner, Terry Dreibelbis, is over 70 and also incarcerated in Pennsylvania. Sehl said that the state DOC is “not set up to take care of elderly people that are now full-time patients,” adding: “So what happens is fellow inmates are their nurses.”

The larger problem traces back to sentencing, explained Vera Institute of Justice Director of Sentencing Marta Nelson. “It all stems from the longer sentences and the longer length of time that people have had to spend serving sentences in the United States, really starting from the ’70s and ’80s, but which became quite well known in the ’90s.”

Many who went to prison then are still there because of policy choices like “mandatory-minimum” sentences and “three-strikes” sentencing enhancements. The Violent Crime Control and Law Enforcement Act of 1994 also doled out prison construction funds to states, adding incentive to hold more prisoners for longer terms.

“So it’s really a story of how we choose to punish people,” Nelson said.

A 2021 Sentencing Project report found more U.S. prisoners serving life terms than the total number imprisoned for any length of time 50 years earlier. Though data on related expenses is spotty, Nelson pointed to a 2015 report from the Office of the Inspector General of the federal Department of Justice, which found that the federal Bureau of Prisons (BOP) spent five times as much on medical care at lockups with the highest proportion of elderly prisoners compared to those with the lowest percentage.

Yet there is a political cost to releasing any prisoner, even one who is very old. “You have somebody who is in prison for, say, murder,” Nelson explained. “Well, OK, this person literally couldn’t hurt a fly. And yet at one point in time, they created a great deal of harm. So how can we release them?” As she noted, politicians are really “afraid of the narrative about what it means to revisit what this person did.”

Going forward, Correctional Leaders Association Executive Director Kevin Kempf said that “we just have to be really careful about who we incarcerate. That’s the bottom line, because sometimes prisons don’t make people better. We make people worse.”  

Sources: NPR News, PPI, Sentencing Project

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