Prison Hospice

END-OF-LIFE CARE FOR AN AGING INMATE POPULATION

America’s incarcerated population is aging, raising the question of how we can provide for a rising number of inmates who are in need hospice care. In an article titled “As America’s Incarcerated Age, the Need for Hospice Rises,” Next Avenue explores the efforts of institutions to address the concern. Minnesota, notes the article, “launched its hospice program for inmates in 2006. The state’s department of corrections defers to hospice specialists at a third-party organization, HealthEast Hospice. Once approved, social workers counsel the inmate patient through pain, comfort management, nutrition and social needs.”

Also highlighted in the article is the Louisiana State Penitentiary prison known as Angola, which will enviably make decisions about end-of-life care options for the 80% of its 6,500 inmates serving life sentences. Both Minnesota and Angola, notes the article allows families to visit the dying inmates “in an attempt to replicate hospice practices as they would occur in the community.”

The “tough-on-crime” initiatives that brought mandatory minimum sentencing in the 70s and 80s helped ensure that prisons would find themselves in this position eventually. While The Pew Research Center has showed some states taking steps to decrease overall prison populations, prisoners over the age of 55 increased by 280% between 1999 and 2016.

“Everyone knows in our department that our offenders are getting sicker,” says Joan Wolff, the health services administrator at Oak Park Heights Correctional in Oak Park Heights, Minn. “They’re getting older and their sentences are getting longer.”

For many, hospice care seems to be a way to address both the needs of aging prisoners and the states that face logistical and budgetary concerns. At Angola, hospice patients are cared for in studio apartment-type rooms with basic amenities. “It gives the families and the inmate some privacy,” says Jamey Boudreaux, a social worker and CEO for the Louisiana-Mississippi Hospice and Palliative Care Organization (LMHCPO). “‘They have a bathroom in each one of those,’ Boudreaux says. ‘They’ve painted walls, and they put curtains on to try and take a little bit of the jail aspect away.’”

Still, a shadow hangs over the rooms, which Boudreaux says were once solitary confinement units, the site of inhumane treatment of Angola prisoners for over a century. “When an inmate came close to death [at Angola] they simply put them on a stretcher in a room so that they wouldn’t disturb anybody else,” Boudreaux says. “When they stopped moaning, they literally tied up the sheet [the person] was laying on, dug a hole, dumped their bodies and then covered them up.”

This led Boudreaux to join others in crafting the LMHCPO program for inmate volunteers to sign up for 40 hours of training to become part of a four-person rotation of hospice caregivers. The program has been so successful that it has inspired about 80 hospice programs nationwide. States like California and Nevada have built other volunteer models for non-hospice related medical programs as well.

Still, options exist outside of the wall of the prison. Some criminal justice advocates are pushing for “compassionate releases” for terminally ill inmates. Every state except Iowa has such compassionate release or conditional medical release for terminal illness in place, but “very few people are getting out” says Mary Price, the general counsel for Families on Mandatory Minimums (FAMM). “We really want to shine a light on the failings of these programs and spur lawmakers and policymakers to do a better job,” Price says. “Every program can stand improvement, and some could stand to be torn down and written right from the bottom up.”

Boudreaux urges for caution when considering releasing inmates. “‘While I like the idea of compassionate release,’ he says, ‘you have to make sure that it’s compassionate.’” Sometimes the most compassionate care is actually to stay within the prison, where the people you trust and have spent so much of your life with can care you for. “‘The guys— they know each other,’ he says. “‘They’ve been locked up together for 35 years together. That is their family.’” (Next Avenue, 8/3, www.nextavenue.org/greying-prisons-hospice) (Summary per Hospice News Network, 8/14/18)