From grooming prisoners to care for their oldest and frailest fellow inmates to creating special medical units on and off prison grounds, several states are raising their level of geriatric correctional care .

Earlier this year, Connecticut prison officials contracted with a private firm to run 60 West, a nursing home providing round-the-clock care for incapacitated and other severely ill inmates transferred from correctional institutions elsewhere in the state.

Before the facility opened, in March 2013, Connecticut authorities countered local residents’ complaints and questions about the safety of 60 West with their own rebuttal.

“There does come a point when inmates are so disabled that they pose no safety threat, when they’re just lying in a bed,” said Michael Lawlor, the Connecticut Department of Correction’s undersecretary for criminal justice policy and planning.

“The question becomes whether [caring for those persons] should be done in a nursing home or a prison.”

The Connecticut initiative is just one of several around the country signifying a shift in how correctional systems provide health care for prison populations that increasingly are older and more infirm.

In California, a federally mandated reform of the state’s correctional health care system has yielded a new 54-building prison hospital complex (opened in June, 2013) where half the 1,722 beds are reserved for aging and other patients requiring long-term nursing care.

Meanwhile, 50 inmates have been released through a 2011 California law permitting compassionate parole for old, very sick prisoners.

In Minnesota, which also has released aging, ailing prisoners who aren’t considered a public safety threat, a special prison unit has been constructed exclusively for geriatric patients.

Geriatric Units

Kansas converted an empty facility that used to house juvenile offenders into a unit exclusively for geriatric prisoners.

State corrections officials in Missouri have developed “enhanced care units” in two maximum security men’s prisons and contracted with Kansas University Medical Center’s Landon Center on Aging to train inmates to assist with the bathing, feeding and other daily care of frail, older patients.

The Kansas center is helping Mississippi and West Virginia set up hospices for prisoners who are nearing their deaths.

“Back about seven or eight years ago … when we talked about the aging of the prison population and what an issue it was going to be, [people] looked at us like we had eight eyes,” said Linda Redford, a nurse and doctoral researcher who teaches family medicine at the university. “During the last two years or so, it became a major issue nationally.”

Redford, who also directs the institution’s Geriatric Education Center, correctional health training, hospice and related programs, added: “At many of the recent [conferences], people have gotten really serious and interested in how different states are dealing with this.”

The search for alternative and innovative prison health care alternatives is driven in part by budget worries in states where financial pressure has dampened legislators’ appetite for spending on prisons.

“If you get too many [aging and ill] inmates, you’ll end up having to [reconfigure] space and build whole new wings,” Lawlor told The Crime Report. “That’s a huge additional cost, [and] everybody’s trying to figure out the best way to manage this.”

Overcrowded Prisons

But concern about prison overcrowding is also a factor.

“[As] prison sentences got longer, more life sentences got handed out,” said Bill Sessa, a spokesman for the California Department of Corrections and Rehabilitation.

“We ended up with more inmates who are getting older … That’s a result of sentencing laws, not [corrections’ policies].”

Given the lifestyles of many prisoners, he added, a disproportionate number of them entered prison sicker than, perhaps, the average person would be.

“And as they get older, their health definitely deteriorates,” said Joyce Hayhoe, director of legislation and communications for California Correctional Health Care Services, the body assigned to temporarily oversee California’s prison health care.

The temporary agency results from a federal court order for the state to improve the medical care it provides to prisoners.

In California, an estimated 40,000 inmates will never be released from incarceration, according to Health Management Associates‘ Donna Strugar-Fritsch.

“That’s the size of the whole Michigan prison population,” she said. “I tell my clients that once the dust settles on [federal] health care reform, [long-term care] for inmates will be the only thing anyone is talking about. It is that big.

“Lots of prisons systems are mulling over how to provide for the [long-term care] needs of inmates, because the inmate population is aging at a staggering rate.”

Strugar-Fritsch, whose Lansing, MI-based firm consults on correctional and other kinds of health care, observed that Connecticut may be “the furthest ahead on a community-based solution—which is very challenging to create.”

Mirroring the nation’s growing tally of older prisoners, Connecticut’s own increasing count finds that 6,665 of the state’s 17,605 inmates are 31 or older. Roughly 3,100 are at least 46 years old, and 375 at least 60 years old. Five are at least 80 years old.

Connecticut’s nursing home for inmates currently houses 30 people.

The oldest is a 79-year-old with late-stage dementia. A 33-year-old occupant with terminal brain cancer is expected to die within months. The youngest resident is a 28-year-old who was severely burned in a fatal drunk-driving accident for which he was faulted and convicted.

“He has no fingers, no use of his hands or feet. He can’t stand up. He needs constant care,” Lawlor said. “We’re talking about people who cannot clean themselves after they go to the toilet, who can’t use the bathroom by themselves … ”

“Their families are disengaged,” added Dr. Kathleen Maurer, health services director for the Connecticut corrections department. “They usually have no place to go.”

State funds cover half the health care costs at 60 West; Medicaid pays the other half. Incarcerated patients do not qualify to have any of their medical care covered by Medicaid, insurance for the poor that is regulated by the federal government but financed with a combination of federal and state funds.

There’s a lot riding on 60 West’s success.

“All eyes are on [Connecticut],” said Tom Sullivan, inmate health director at the Maryland Department of Public Safety and Correctional Services inmate health director.

A New Model?

Sullivan, who also serves as southern regional representative of the American Correctional Association Coalition of Correctional Health Authorities, says prison authorities around the country are anxious to see if a standard geriatric health care approach—facilities such as “a real nursing home”—can be applied effectively to penal populations.

Adding to the concern is the awareness that the challenge of providing geriatric care likely will get bigger in years to come.

The Minnesota Department of Corrections “has identified long-term population trends which show that we will need additional geriatric services in the future,” spokesman John Schadl said.

“We are currently exploring options for meeting those needs—options [that] may include expanding services within existing prisons or contracting with outside providers for secure nursing care services.”

Katti Gray is a contributing editor at The Crime Report. She welcomes responses from readers.