At least one-third of the U.S. prison population will be over 50 by 2030, according to a white paper released Thursday by the Osborne Association.

The association, a New York-based advocacy group that works with justice-involved people and their families, cited figures showing that even as states are working to reduce prison populations, the number of older adults in prison and jail is projected to grow by a “staggering 4,400 percent” in the 50-year period between 1980 and 2030—to an estimated 400,000 people.

According to statistics quoted by the researchers, adults over 50 comprised just three percent of the total incarcerated population in 1993, representing 26,300 individuals.

“Justice isn’t served by keeping elderly people locked up as their bodies and minds fail them and they grow infirm and die,” said Elizabeth Gaynes, president and CEO of the Osborne Association, which advocates for improved conditions in prisons and jails, better discharge planning, and expanded compassionate release of the elderly and infirm.

“It’s both inhumane and inefficient.”

According to the report, entitled “The High Cost of Low Risk: The Crisis of America’s Aging Prison Population,” extreme sentences doled out during the tough- on-crime era, as well as limited mechanisms for compassionate release, have driven what is now a costly and inhumane crisis that the corrections system is unequipped to manage.

The medical costs of caring for a burgeoning elderly population behind bars alone will add to the strains of resource-strapped corrections systems, many experts have said.

According to data analyzed by the American Civil Liberties Union, it costs twice as much to incarcerate someone over 50; in some cases, it may cost up to five times more when medical costs are added.

Between 40 percent and 60 percent of prisoners over 50 have some type of mental illness or cognitive impairment, according to data from the Bureau of Justice Statistics. Some prisons are setting up makeshift hospice wings and opening nursing wards for people with serious cognitive degeneration.

Elsewhere, inmates suffer from such pronounced dementia that they are unable to follow rules, and may not remember why they are incarcerated. For many with cognitive, visual, or hearing loss, a diminished capacity leads to behaviors that are mistaken for disobedience, subjecting them to punishments such as solitary confinement.

See also: Solitary Confinement Policies at ‘Tipping Point’ in U.S., say Reformers

“Prisons were never designed to be geriatric care facilities and this surging elder incarceration comes at a high cost,” wrote the authors of the Osborne report.

At the same time, research by the Pew Center on the States shows that incarcerated people over 50 pose little public safety risk, and have the lowest recidivism rate as any other inmate demographic.

The majority of people graying in detention were arrested for violent crimes in their teens, 20s and 30s.

The authors argue that addressing this crisis requires what they call a “new paradigm of justice,” involving a shift in how we respond to violence.

The majority of people graying in detention were arrested for violent crimes in their teens, 20s and 30s, according to the report, Yet, it adds, “the low risk of recidivism for older people described earlier holds true for people who are convicted of the most serious acts of violence, particularly homicide-related offenses.”

See also: When Should Older Americans with Alzheimer’s Lose Access to Guns?

The report cites several victims advocates who argue against incarceration as a primary response to violent crime, since it fails to address underlying causes of individual violence in society, including poverty, trauma, isolation and inequity.

“Exposure to violence is especially prevalent amongst those aging behind bars, though decades may have elapsed since such harm was both survived and committed,” a fact that underscores the potential for preventative interventions that address trauma, wrote the authors.

As one example of a more targeted approach to violence, Michigan last year “became the third state in the country to offer a trauma center for victims of crime within a hospital in Flint to promote healing and prevent future crime.”

Health and Accelerated Aging

The report also calls for improved conditions in prisons and jails, including universal guidelines and training for prison staff to help them recognize age-related issues.

Those who are aging in prison have a higher rate of serious medical issues compared to the general population, in addition to health problems correlated with socioeconomic factors. Communicable and chronic diseases such as hepatitis, HIV, tuberculosis, arthritis, hypertension, ulcer disease, prostate problems, respiratory illnesses, cardiovascular disease, strokes, Alzheimer’s, and cancer are far more prevalent in the older prison population compared with the overall prison population.

The cost of housing elderly inmates now represents an estimated $16 billion-a-year burden on taxpayers, and growing.

While there is more bipartisan support for decarceration when it comes to nonviolent offenders, the urgent need for a new approach to violent crimes is underlined by the runaway cost of housing elderly inmates: now an estimated $16 billion-a-year burden on taxpayers, and growing.

Narrow doorways, stairs, and lack of handrails all pose architectural problems for inmates with limited mobility, as do facilities like cafeterias and medical units, which can be spread far apart. The report also notes that older individuals may struggle getting to and from their beds, especially a top bunk; and that geriatric incontinence and other physiological issues that accompany old age “can be extremely difficult to handle with dignity in an environment lacking privacy, leading to harassment and feelings of shame, isolation, and depression.”

Upon release, older adults face greater rates of homelessness, low employment, increased anxiety, fragmented community and family ties, chronic medical conditions, and increased mortality rates, according to the report.

Policy Recommendations

“The issue of aging people in prison can be interpreted through several lenses: an unintended consequence of ‘tough-on-crime’ policies, a human rights crisis, a matter of economic urgency, a public health crisis, an extension of a racialized punishment paradigm, or a reflection of the critical shortcomings of our criminal justice system,” write the authors.

“Any serious and sustainable attempt to resolve this crisis must address the needs of those aging in prison,” in addition to shifting our response to violence away from mass incarceration and long sentences.

In support of a solution, the Osborne Association makes a number of specific policy recommendations, grouped into five clusters:

Improve conditions inside of prisons and jails for those aging within them,

including strengthening staff capacity to recognize and address aging issues, and

adopting policies and practices that are age-considerate;

including strengthening staff capacity to recognize and address aging issues, and adopting policies and practices that are age-considerate; Improve discharge planning and reentry preparation for older people within

correctional facilities;

correctional facilities; Expand specific release mechanisms for older people;

Improve the reentry experience of older returning citizens by increasing

community supports and receptivity, including addressing their housing, medical/

health, mental health, post-incarceration, financial, family, and employment needs;

community supports and receptivity, including addressing their housing, medical/ health, mental health, post-incarceration, financial, family, and employment needs; Shift our response to violence by expanding the range of services offered to

victims and survivors of crime, and by reducing excessively long sentences for all crimes

of conviction, including for violent crimes, that drive the crisis of aging in prison.

These recommendations and the full report can be explored in more detail here.

This summary was prepared by TCR Deputy Editor Victoria Mckenzie. Readers’ comments are welcome.