Prison health care experts agree that states facing persistent fiscal quandaries need to rethink the way they handle their aging and ailing inmates.

In his January State of the State address, Gov. Jack Markell said Delaware needs a plan to address spiraling health care costs in the state’s prisons, especially for the growing population of elderly inmates serving lengthy sentences.

Referring to the problem as a “ticking time-bomb,” the governor warned that unless the state acts, it won’t be long before Delaware’s correctional system is forced to open nursing homes inside prison walls.

In the same breath, Markell alluded to the possibility of early release provisions for sick and elderly prisoners, a notion legislators from both parties reacted to with skepticism.

However, prison health care experts agree that states facing persistent fiscal quandaries need to rethink the way they handle their aging and ailing inmates.

Last year, Delaware spent $42 million on health care for its population of roughly 5,500 inmates. Of that, $2.5 million was spent on hospitalization costs, according to Jim Welch, chief of the Department of Correction’s Bureau of Correctional Health Care Services.

More than one-third of those hospitalization fees were for inmates older than 50, a group that comprises just 13% of the total prison population.

Welch said out of the 14 inmates who each racked up more than $50,000 in health care costs in 2008, eight were between the ages of 60 and 75.

One inmate in his 60s suffering from liver failure and heart disease cost the state upward of $500,000 in total health care costs, Welch added.

Edward Harrison, director of the National Commission on Correctional Healthcare, said the aging of inmate populations nationwide and the resulting health care cost burdens can be traced back to minimum mandatory prison terms and truth-in-sentencing laws that became popular in the 1980s.

“More people are serving out their full length rather than being paroled early,” he said. “It’s less discretion for judges to make decisions about the length of a term; rather, the terms are legislated without any leeway, or without as much as there had been earlier. People are spending more time behind bars and the average age is going up.”

Just like elderly people on the outside, older inmates are at a higher risk for serious chronic conditions like heart disease and diabetes.

On top of their normal predisposition to health problems, Welch said the prison environment itself ups the risk even more.

“The data out there is showing that for every year you’re in prison, you are actually chronologically older because of the stresses in prison,” he said. “You’re really not 50, you’re about 59 or 58; if you’re 70, you’re late 70s.”

Markell said he hasn’t put together any specific plans to address health care costs for elderly inmates, but he’s cognizant of the possible backlash any plan to release prisoners early surely would provoke.

“It’s incredibly expensive to provide health care within prison walls, the question is, is there a less expensive but still safe alternative? That’s something were going to have to work on for a period of months,” he said. “I think everything is on the table with the very important caveat that it has to be safe and it has to keep an eye on reducing costs.”

Dr. Ronald Shanksy is a former director of the Illinois prison health care system who now serves as a court-appointed monitor for Delaware’s DOC.

He believes the only viable solution for Delaware and other states is to set up a thorough, unbiased medical parole review process that sets politics and emotion aside.

Since most sick and elderly inmates would qualify for Medicare or Medicaid if they weren’t incarcerated, it’s an effective way to cut costs, he argued.

“Those patients should really be offloaded to nursing homes, particularly if they are no physical threat to anybody. Then you have the federal government picking up a bigger piece, if not all, of the expenses,” he said. “For me that’s the most reasonable way to do it. There certainly is an underlying principle of vindictiveness; that particular emotion conflicts with what is really in the state’s best interests.”

Shansky said his position isn’t popular with politicians who fear being labeled as “soft on crime,” but those who reject the idea are shortsighted.

“It has nothing to do with tough or not tough on crime,” he said. “You’ve got a variety of federal programs designed to offload some of the financial burden, and states, almost without exception, don’t take advantage of it out of political stupidity.”

Welch said Delaware’s prisons are already doing what they can to improve the health of all inmates, including a decision last year to serve heart-healthy meals in prison cafeterias.

But Welch said the prison system can’t force exercise or keep inmates from getting snacks from the commissary, at least not without a legislative mandate.

Supposing the system doesn’t move toward more parole leniency for the old and infirmed, Welch said DOC could cut costs by rethinking how it houses those inmates.

Even though Markell has articulated the negative side of setting up a nursing home within the state prison system, Welch said that might not be such a bad idea.

“You may not be able to significantly decrease the medical care costs, but you may be able to decrease some of the security costs, if we can put them in a setting that’s not as security intensive as some other settings,” he said. “If you have a lot of persons who are elderly and you house them in one area, you could save some because you then would have a scale issue, a number of people who require the same type of care in one building.”

By the numbers
$5,792.44 — Amount spent on health care per inmate by the Department of Correction
5,506 — Total number of inmates in Delaware prisons, as of Feb. 4. Of that,
562 are age 50-59
92 are age 60-64
51 are age 65-69
26 are age 70 or older
$39.8 million — Total budgeted for prison health care in fiscal year 2010

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