One of Fernando Murillo's greatest fears is dying in prison.

The 38-year-old former gang member, serving a sentence of 41 years to life for second-degree murder when he was 16, says it is that fear which helps him empathize with the terminally ill inmates he looks after at a California prison hospice.

Murillo's work in the 17-bed hospice unit at the medium-security California Medical Facility in Vacaville, about 55 miles northeast of San Francisco, includes helping dying prisoners take a shower or go to the bathroom. But there is another, more important element to the job, he says.

"I listen to people's regrets, their stories, their happiness, their joy. I listen to their confessions," Murillo says.

"I befriend somebody when they're perfectly healthy, walking around, I'll take care of them when they're unable to talk and eventually hold their hands when they're taking their last breaths."

He and his fellow inmate workers take that work seriously. When someone under their care has 72 hours left to live, they never leave his side. "No prisoner dies alone" is their motto.

The hospice, set up during the height of the AIDS crisis in the early 90s, was the nation’s first licensed prison hospice. It now houses more inmates who are dying because of old age diseases, as the over-60 population swells in US prisons, mirroring the aging of the general population.

Reuters visited two California prisons recently to look at the challenges states face, as improved medical care, long sentences from tougher crime laws and a steady increase of older adults entering prison have contributed to an extraordinary rise of elderly inmates.

In contrast to the rest of the prison of concrete slab jail cells, hospice patients have beds with colorful quilts in individual rooms or curtained-off cubicles, many with private televisions and radios. The walls of the common areas are decorated with pictures and completed jigsaw puzzles, and a tropical fish tank sits next to a row of wheelchairs and walkers. A sparse concrete outdoor area known to inmates as the “dog run” was recently turned into a garden, with a wooden gazebo, grass and swing chairs for inmates to use.

Six months to live

To be admitted to the hospice, a prisoner must have six months or less to live and sign a do-not-resuscitate order, instructing medical staff not to use life-prolonging treatment if his heart stops beating or he stops breathing.

The 25 inmate workers and volunteers, who are known as Pastoral Care Workers, received 70 hours of training, mostly in video form, in a curriculum directed by the prison's chaplain, Keith Knauf. He says the videos cover everything from how to lift patients to how to comfort them when they are dying.

Knauf also recently arranged for a social worker to talk to the workers about compassion fatigue, a type of overload that can arise from experiencing serial death and result in having less concern or empathy for others.

That is something 29-year-old Kao Saephanh, whose nickname is Cowboy, knows to guard against. Serving a 21-year sentence for murdering a man when he was 17, he is the hospice's barber, in addition to his regular duties. He spends up to 16 hours a day in the hospice, only returning to his cell to sleep.

Visits from his family give him time to decompress when it all gets too much, he says, like it did when a friend he knew from cutting hair outside the hospice unit died after suffering from Amyotrophic lateral sclerosis (ALS), a condition that affects nerve cells in the brain and the spinal cord.

"When he passed, that was really difficult for me. I mean I felt numb for like a week or two," he says. "But most of the time, I mean, we learn that death is a part of life."

Jane Ross of Reuters reported from Vacaville, California.