(Photo: andrea lehmkuhl/Shutterstock)

During the sentencing of Thomas DiFiore, a leader of the infamous Bonanno crime family, Stephanie Clifford of the New York Times noted a trend: At 71, DiFiore is one of the “oldfellas,” a generation of aging Mafiosi who are now being prosecuted in the sunsets of their long lives of crime.

Many of these gangsters’ defense teams seem to be trying to use their clients’ old age to their advantage. “In courtrooms, they can be found displaying catheter bags or discussing the state of their kidneys in hopes that a judge will agree to a short sentence,” Clifford wrote. They tell tales to the court of their complicated prescription drug regimens, heart procedures, insulin shots, and catheters. (Not that judges are necessarily buying it; DiFiore’s “high blood pressure, stress, swelling of kidneys, swelling of skin, lung problems, vision issues” didn’t win him leniency in the end.)

But as cynical a ploy as it may be, these “geriatric gangsters” raise an important issue—the rapidly growing elderly prisoner population, and the exploding costs of caring for them behind bars. With advanced age inevitably comes chronic health conditions, prescription drug needs, and both physical and mental disabilities. None of which come cheap.

"Releasing this low-risk prison population to spend their final years at home, and not in a state-supported prison serving as a de facto nursing home, would save taxpayers up to $40 million a year."

From 1992 to 2012, the population of prisoners who are 55 and older has increased by 550 percent. According to a 2012 Human Rights Watch study, the number of federal and state prisoners 65 and over increased by 63 percent between 2007 and 2010. (By comparison, the prison population as a whole increased by 0.7 percent over that same period of time.) Elderly prisoners can cost two to three times as much as younger prisoners to incarcerate. And Medicare, which covers the health care costs for tens of millions of people over 65 in the United States, does not cover health care for the tens of thousands of people over 65 and behind bars.

The World Health Organization recommends that prisons immediately increase their health care budgets in anticipation of the continuing rise of this population, create separate housing areas for them, and develop teams of caretakers who are trained to address the particular needs of the aged. Health issues like sensory impairment, cognitive decline, and incontinence are not only common with the elderly, but they “may pose unique risks in prison,” the WHO argues in its report “Prisons and Health.” The report also stresses the need for palliative or hospice care for prisoners nearing the end of life.

But must the feeblest, frailest prisoners wait until the very end to leave? As the Human Rights Watch study argues, “their continued incarceration does little to serve the principal purposes of punishment: retribution, incapacitation, deterrence, and rehabilitation.”

Research has shown that offenders “age out” of most types of serious crimes—which is why some advocates, like Marc Mauer, director of the Sentencing Project, say sentence caps are a good idea. Others have argued for the compassionate release of prisoners who pose no risk to society, or who are nearing death. The inmates’ criminal records would remain, but they would serve out the remainder of their sentences either in nursing homes, or else back in their communities on parole.

In 2013, the Bureau of Prisons did change policies to allow for elderly prisoners with serious medical conditions who have already served at least 50 percent of their sentences in prison—or those without medical conditions, who have served 75 percent—to apply for early release from prison. Top-down policies and on-the-ground practices do not necessarily align, however. An earlier Vera Institute report on elderly prisoners had found that, even in states that do have policies allowing for the early release of geriatric inmates, prisons rarely take advantage of them, “despite the potential of reduced costs at minimal risk to public safety.”

It remains to be seen whether that will change as the population continues to age—and at greater and greater cost. Missouri, whose surging elderly prisoner numbers have led prisons to recruit other inmates to care for their aging cell mates, now has legislation pending that would allow elderly, non-violent prisoners to apply for release after serving 25 years. And a state representative in Florida—a state perpetually famous for its aging population both in and out of jail—recently wrote that “releasing this low-risk prison population to spend their final years at home, and not in a state-supported prison serving as a de facto nursing home, would save taxpayers up to $40 million a year.”

As the slogan of one advocacy organization fighting for the compassionate release of elderly prisoners goes, “If the risk is low, let them go.” This may not apply to the spry, 70-something head of the Bonanno crime family, but it certainly may apply to many other aging inmates.

True Crime is Lauren Kirchner's weekly column about crime and criminal justice issues.