August 18, 2014
By Aubrey Bittel
|Linda Redford, Ph.D.|
The number of aging men and women incarcerated in U.S. prisons has increased by 500 percent in the last several decades. But most prisons are unprepared to provide this rapidly growing group of prisoners with adequate health care, which can cost as much as nine times more than for younger inmates.
Linda Redford, Ph.D., director of the Geriatric Education Center and the Rural Interdisciplinary Training Program at the Landon Center on Aging at the University of Kansas Medical Center, has developed and implemented programs to help prisons meet the needs of the country's aging prisoners.
"Ten years ago, prison administrators didn't consider addressing the special health care challenges of elderly inmates as a problem," Redford says. "Health staffs were more focused on diseases such as AIDS and hepatitis in the prisons' general populations. Geriatric training wasn't a priority."
With the widespread implementation of habitual offender laws (also called three-strike laws) and more severe punishments for drug-related crimes, prison populations have swelled. Inmates are serving longer sentences and encountering more age-related health problems as a result. Older inmates face many of the same health issues that non-incarcerated seniors deal with, but treating them in prison is a complicated and costly process. In the case of a physical health issue such as disease or accident, inmates are usually transported to a nearby medical facility where they are treated by hospital staff and constantly guarded by one or more prison officials. If they recover to an adequate condition they are moved back to the prison, but many die in the hospitals. If they suffer from Alzheimer's disease, dementia or other mental illnesses, they are often left in general population, despite the danger they may pose to themselves and others. Corrections officers, who are not generally trained to know the difference between normal behavioral problems and those associated with geriatric illnesses, often punish prisoners who are not in full control of their actions.
In an effort to change this attitude, Redford began training sessions at several prisons in the Midwest, beginning with prison staff at Jefferson City Correctional Facility, a maximum security state prison in Missouri. She started by trying to educate correctional officers on specific behavioral signals they may observe in older inmates.
"The officers need to be able to recognize the difference between someone who is acting out and someone suffering from dementia," Redford says. "We also engaged the health staff, who had previously been more focused on communicable diseases. A dialogue was opened between the health staff and the correctional officers, allowing information regarding specific inmate's behavior and health conditions to be used in determining care and discipline."
But Redford is not just spreading awareness of geriatric issues with prison officials — she is also holding training sessions with inmates in prison facilities in Kansas and Missouri. Many inmates who attended the training sessions are now trained in palliative and hospice care and have become daily living attendants for prisoners affected by Alzheimer's, dementia and other geriatric conditions. Responsibilities and freedoms vary between facilities, but in hospice units the trained inmates often care for one or two patients, and they typically live in close proximity, sometimes even within the same cell. They assist patients with getting dressed and bathing, getting medications, transporting them throughout the unit, organizing activities such as crafts and board games, and overseeing approved exercises. All trained inmates work on a volunteer basis.
"They're an amazing group, and they are very carefully chosen," Redford says. "Yes, some of them have committed violent crimes, but they see this as a form of redemption. They can't help their victims, but they can help other people."
Redford says health education for the staff as well as the inmates can change the entire culture in these prisons. She believes that having guards who are more patient and understanding with the older inmates can help a prison's general population see more humanity in themselves. It has also driven many of the inmates to take an active interest in their own health.
"They ask questions; they're hungry for information," Redford says." They now know how empowering it can be for them to take responsibility for their health and well-being."