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What happens when the whole arc of your life is cramped in a 10-foot concrete square? For years, the United States has sent people to prison for life, without fully thinking through the human consequences of aging prisoners’ dying behind bars. Ad Policy

After two decades of steady growth, fueled by harsh Drug War sentencing policies, the portion of the incarcerated population over the age of 50 rose to more than 243,000 by 2013. According to an analysis by the Osborne Association, by 2030, fully one in three imprisoned people will be at least half a century old—born around the time of Reagan’s first election, and probably incarcerated under the types of tough-on-crime policies that are now widely repudiated as inhumane. If they are eventually freed, they may rejoin a world that’s generations out of sync, perhaps without family, housing, or job prospects, carrying a lifetime’s burden of illness and trauma.

The largest incarcerated elderly populations can be found in the states with the most elderly people: Texas, Florida, and California, where services for the aging are severely under-resourced inside and outside the prison system. But aging prisoners don’t even qualify for standard Medicaid and Medicare once out of prison, and for the roughly two-thirds who are scheduled to be released, many face a “free” life that is isolated from their families and communities, excluded from social services, rife with poverty and stigma.

Not surprisingly, these seniors’ enfeebled state comes with recidivism rates much lower than their younger counterparts’. The Osborne report cites low security risk as a reason to make parole procedures more generous and grant “compassionate release” on medical grounds, because “the costs of incarcerating an aging prison population can be reduced without threatening public safety.” But the system has little mercy for imprisoned elders: A New York Times investigation revealed that, over the past four years, “the Bureau of Prisons approved 6 percent of the 5,400 applications received, while 266 inmates who requested compassionate release died in custody.”

While these aging prisoners are too old to do harm, they’re often not fit enough to live well in prison. They are systematically denied basic recreational and physical activity, with little access to doctors and counselors. Since aging is challenging even in the healthiest settings, prison is known as an environment of “accelerated aging”—when preventable suffering becomes chronic deterioration. Sometimes prisoners’ vulnerability exposes them to abuse and exploitation from predatory security officers or fellow inmates. Often, researchers observe, the aging body “can lead to behaviors mistaken for disobedience or aggression”—leading to dangerous punitive measures like solitary confinement, which is internationally condemned as a form of torture. Their mental state might interfere with their legal prospects as well: Researchers report that some applicants “must be reminded of their crime prior to a parole hearing.” How can they prove good behavior when they’ve forgotten “why they are there or whether they are remorseful”?

Sixty-three-year-old Stanley Mitchell, who spent 35 years imprisoned in Maryland before being released in 2013, described in the report the link between social conditions in prison and health:

When you don’t have no hope and you think this is just going to be it for you, it obviously affects you mentally and, in some cases, physically. I’ve seen individuals stop taking care of theirself, and they develop all kinds of crazy diseases, diabetic, high blood pressure. Current Issue View our current issue

Abuse and illness could be mitigated by providing trained staff who can discern the signs of aging, like physical and cognitive damage, so that miscommunication doesn’t create potentially fatal crises.

But worse than neglect behind bars might be life outside for elderly returnees. On parole, they are excluded from Medicare benefits and other public services. Often they are barred from public-housing complexes and, as a result, unable to reunite with family. The loneliness is doubly punishing because maintaining social networks could affect the risk of staying out of prison in the future. On their own, without access to steady employment and with no savings, poverty and homelessness are all aging returnees can “retire” to.

The parole system is supposed to supervise them, but critics say it is inaccessible and often harms rather than helps. Parole boards of appointed officials, operating with little oversight, often fixate on the original offense, not the individual’s background and current conditions.

One interviewee, 63-year-old Richard, recalled, “Nine denials turned into an extra 18 years for a total of 43 years in prison. [A life sentence] became more real with every parole board denial; there was less and less hope.”

Indefinite, lifelong punishment, whatever the crime, is incompatible with a humane view of how an individual’s conscience grows and evolves over a lifetime, and it betrays the fundamental principle of equal justice. The Osborne report says that a fairer assessment system would place more emphasis on age as a behavioral factor, because “as people age out of crime and transform, parole boards should consider these dynamic, current factors rather than emphasizing the static ‘nature of the crime.’” The researchers argue:

One point that is lost when we only think of the older people as frail, sick and dying is that we are losing the positive contributions, wisdom, transformation and desire to give back that characterizes many older incarcerated individuals.

Applying a humane ethos to incarcerated seniors can be both healing for individuals, and emancipatory for the struggling communities shattered by the family separation and trauma of mass imprisonment over the years.

But the issue won’t be resolved by awarding backward-looking justice toward the end of life. Decarceration of society starts before the sentence begins, through wholesale, democratic implementation of non-carceral, nonpunitive restorative-justice and rehabilitation programs in communities. Any restructuring of the institutions of justice must be conscious of how punishment affects the whole life cycle, the Osborne report argues, through “an understanding of transformation, healing, accountability as well as the desire of survivors of crime who are increasingly calling for less incarceration and healing.”

Surviving on the inside is hard enough. No one deserves a de facto permanent sentence after formal release. At any stage in life, a just sentence requires a fair end, so that a person’s real freedom can finally begin.