Caregiving Behind Bars: Correctional Officer Reports of Disability in Geriatric Prisoners

Abstract

Despite increasing numbers of geriatric prisoners, little is known about geriatric disability or health care in prison. Although correctional officers often act as a liaison between prisoners and the healthcare system, the role of officers in recognizing geriatric disability has not been characterized. The goals of this study were to assess officers' assessment of disability in their assigned geriatric prisoners and to contrast their views with reports from the California Department of Corrections and Rehabilitation (CDCR). Questionnaires were given to 71 officers assigned to 618 randomly selected geriatric prisoners in 11 prisons. Information about 41 additional prisoners identified by correctional officers as "high risk" was also analyzed. Prisoner disability and health were determined through correctional officer questionnaires (activity of daily living (ADL) impairment, geriatric syndromes, level of care), chart review (medical diagnoses), and CDCR data (demographics, disability designation). Overall, 211 (34.1%) geriatric prisoners were unknown to their officer. Of the 407 known prisoners, officers reported that 5.0% had ADL impairment and 3.1% were unsafe. Discordance between officer and CDCR reports of disability was common, with officers reporting higher disability rates. The 41 high-risk prisoners were more likely to have ADL impairment (22.0% vs 5.2%, P<.01) and geriatric syndromes such as falls and incontinence than the random sample. Overall, nearly one-third of geriatric prisoners were unknown to their assigned officer. Officers identified more disability than the CDCR, and prisoners they identified as high risk had nursing home-level functional impairments. Significant improvement in disability assessment is needed for officers and the CDCR.

Elderly Sexual Offenders

“…Many individuals required special housing. Further, diagnoses and getting their needs met can be impeded by the need to go through correctional officers who may not recognize the illness or impairment [20].…”

Balancing Punishment and Compassion for Seriously Ill Prisoners

“…Prognosis is difficult to establish for conditions such as advanced liver, heart and lung disease, and dementia (28–29) - increasingly common causes of death and disability in prisons. (30–32) Moreover, for patients with more predictable prognoses such as cancer, functional trajectories are variable and unpredictable, often declining only in the last weeks of life. (33,34)…”

Older and incarcerated: policy implications of aging prison populations

“…Consequently, most research in the area, corrections departments in many U.S. states, and many European countries consider incarcerated people “older” or “aging” beginning around age 55 (Vallas, 2016; Williams et al, 2009; 2012). The special needs of aging incarcerated populations have been recognized by the United Nations as critical, both because realigning policy and practices to account for them improves their effectiveness and efficiency, and also because not addressing them can result in human rights violations (Maschi et al, 2013).…”

“…Medical and correctional experts describe other ways health problems are more difficult to manage in prison (Bretschneider and Elger, 2014; Mann, 2013; Williams et al, 2009; 2012). For example, they often go undetected and undertreated in correctional facilities, or may be unnecessarily exacerbated by conditions of confinement like shackling for transport or long-term isolation.…”

“…Further, many correctional officers remain ill-equipped to identify and respond to those in need of healthcare or at risk for adverse health events like falls (Williams et al, 2009). County jails are often even less prepared to provide adequate health care, but as prison reform in the U.S. focuses on decarceration at the state and federal level, these local facilities – as has happened in California – are likely to experience recurring problems related to overcrowding and an influx of aging inmates (Bird and McConville, 2014; Lofstrom et al, 2016).…”