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California prisons lack adequate facilities, staff to care for aging population

By Sam Robinson and Erin Dobrzyn

Providing medical and end-of-life care to elderly inmates in state prisons cost California millions each year. Improvements in medical and elder care have largely been lawsuit driven, and still are not fulling meeting the needs of inmates, according to medical staff.

Prisons are not designed for the elderly, which increases the risks for older inmates, said Reverend Keith Knauf, director of Pastoral Care at the California Medical Facility (CMF) in Vacaville. Narrow walkways, lack of rails in showers, stairways, and even climbing into a top bunk all present challenges to the elderly. Additionally hearing, eyesight, and mobility impairments in addition to mental deterioration can make older inmates easier targets for predators in general population.

The number of inmates 55 years old or older in United States prisons has increased by more than 2,000 percent since the 1980s. Elderly inmates are the fastest growing demographic group in our state and federal prisons.

Many of these aging inmates are in prison serving life without parole sentences due to the “war on drugs” and “three strikes” laws of the 1980s and 90s.

“One out of three inmates is sentenced to life terms. We have more than 300 men 80 years or older currently,” said Joyce Hayhoe, director of Communications and Legislation for the California Correctional Health Care Services (CCHCS) in Stockton.

California prisons are home to 25 percent of the nation’s life-sentenced population, according to the Sentencing Project. Many of these inmates are serving life sentences because of the state’s tough “three strikes” law that was passed in 1994.

Aaron Grice sits in his hospital bed.
Aaron Grice, an inmate in the CMF hospice unit believes his cancer could have been caught earlier with better access to healthcare for inmates.

“We have more than 5,000 inmates serving life without parole in the California Department of Corrections and Rehabilitation (CDCR),” said Hayhoe.

Despite efforts to ease issues of overcrowding in the state’s 33 prison facilities, the number of aging inmates continues to climb.

“Over the past five years measures like AB 109 have got rid of young inmates, not those with illness or the older ones,” said Hayhoe. “Health Care for this aging population is going to be expensive.”

In an effort to reduce prison capacities California passed AB 109 in 2011. Part of this measure diverts some inmates convicted of less serious felonies to county jails. However, as Hayhoe noted, most of these inmates were 20 to 40 years old.

“We let go of our younger inmates,” said Hayhoe as she stressed the high costs of sustaining an older prison population.

“Over the past five years measures like AB 109 have got rid of young inmates, not those with illness or the older ones,” said Hayhoe. “Health Care for this aging population is going to be expensive.”

The average annual cost of healthcare for an inmate younger than 55 is $30,000 to $40,000. The average for an inmate older than 55 jumps to $70,000 to $100,000 depending on any chronic conditions and end-of-life needs, according to a recent report from the American Civil Liberties Union.

“The aging population of incarcerated people is a huge challenge,” said Knauf. He explained that prison adds 10 years to the health age of the average prisoner which makes the issue even worse.

Knauf, along with Dr. Joseph Bick, chief medical officer at CMF said most of the advancements made by California in caring for sick and elderly inmates have been lawsuit driven for decades.

A key class-action lawsuit against CDCR was filed in 2001. Federal court determined California was not providing a constitutional level of medical care to the State’s inmates and was ordered to make improvements. However, four years later upon review, the court found the state had not made enough progress and was still not meeting minimum standards.

In 2005 a federal Receivership was established by the court to oversee medical care in California’s prisons. J. Clark Kelso, known by state officials as “Mr. Fix It,” was appointed as the Receiver. Kelso’s office provides oversight on all aspects of mental and health care in the day-to-day operations of the state prisons.

Both Hayhoe and Bick said the biggest challenge facing CDCR in terms of providing adequate medical care to inmates was the recruitment and retention of qualified medical staff.

“It is not a first choice job, especially for remote locations,” said Bick. He added most people studying health care do not consider working in a prison and the public perception on the value of the work is low. He believes that state needs to address the issue by improving pay and benefits for medical workers in prisons.

Patient inmates in the Hospice Unit at CMF questioned the state’s ability to treat issues in a timely manner, and its desire to try treatments that could extend their lives.

“I had told the doctor I needed a chest x-ray but it took them six months to do it,” said Aaron Grice, 66, who has thymus cancer that has spread to his liver, is now in the Hospice Unit. “Had they caught this sooner I wouldn’t be here.”

Grice, who has been in prison for 32 years, said he initially received treatment that was supposed to shrink the tumor in his chest, but it did not work.

“It is not a first choice job, especially for remote locations,” said Bick.He added most people studying health care do not consider working in a prison and the public perception on the value of the work is low.

“I see these commercials for different cancer treatments, and I wonder why the state doesn’t try these to see if they could help me,” said Grice. “I also think they spend money on generic medications, and they don’t want to spend money on better meds because it is cheaper.”

Grice did say the staff at CMF does what it can to keep him, and the others, comfortable in the end of life process.

In 2013, in response to the Receivership, CDCR opened the Stockton facility in order to alleviate the strain on medical and mental health services at other California prison facilities, said Hayhoe. The facility does not have long term care beds or spaces for inmates who require 24-hour nursing care.

The CMF which also provides medical and mental health services to more than 2,500 inmates does have some space for elderly and chronically ill inmates.

CMF which has an annual operating budget of approximately $299 million offers 58 assisted living and 57 skilled nursing spaces, which are always full. The facility also offers CDCR’s only Hospice Unit that has 17 spaces, which again are always utilized.

“I see these commercials for different cancer treatments, and I wonder why the state doesn’t try these to see if they could help me,” said Grice.

Knauf believes he has seen positive changes in the care of inmates since the Receivership has been in place. Prior to it, Knauf said he had seen several patient inmates who would arrive at the Hospice Unit with serious hygiene issues, but now they look a lot better.

There were 2,475 inmates receiving care at CCHCS at the end of 2016. CCHCS has an annual budget of approximately $170 million. Six months after it opened, CCHCS was temporarily shut down due to an outbreak of scabies and unsanitary conditions. However, those issues appear to now be resolved.

The “three strikes” population in California state prisons peaked in 2012 with nearly 9,000 inmates, but today is down to a 15 year low of approximately 6,500, according to state data.