Characteristics of Hospice and Palliative Care Programs in US Prisons: An Update and 5-Year Reflection

Abstract

Individuals with terminal illness are dying behind bars and many state prison administrators have incorporated on-site hospice and palliative care services. Little is known, however, about these programs since a 2010 study of prison hospice characteristics. We provide an updated description and reflection of current hospice and palliative care programs in state prisons serving incarcerated persons with terminal illness. A cross-sectional survey was sent to representatives of all known prisons offering hospice and palliative care programs and services (N = 113). Questions were drawn from an earlier iteration regarding interdisciplinary team (IDT) membership, training length and topics, peer caregivers, visitation policies, bereavement services, perceived stakeholder support, and pain management strategies. Additional questions were added such as estimated operational costs, peer caregiver input in patient care, and the strengths and weaknesses of such programs. Frequency distributions were calculated for all study variables. Responding representatives (n = 33) indicated IDTs remain integral to care, peer caregivers continue to support dying patients, and perceived public support for these programs remains low. Reduced enthusiasm for the programs may negatively influence administrative decision-making and program resources. Further, peer caregiver roles appear to be changing with caregivers charged with fewer of the identified tasks, compared with the 2010 study.

“We Are All Humans and Deserve a Decent Way to Go”: Examining Professional’s Experiences With Providing End-of-Life Care in Correctional Institutions

“…Similar to those found in community-based hospice programs, the NPHA and GRACE programs recommended that those who are pursuing curative treatments in corrections should be able to receive hospice care through interdisciplinary teams, which include physicians, nurses, mental health representatives, social workers, and chaplains (Novisky, 2018; Prost et al, 2020; Yampolskaya & Winston, 2003). Ideally, those working in EOL units, both medical and correctional staff, should have extensive training in EOL care practices within correctional settings (Loeb et al, 2013; Masters et al, 2016).…”

“…To provide adequate health care for inmates who are diagnosed with chronic or terminal illnesses, prison systems have implemented EOL care programming (Mezey et al, 2002). In the most recent review, Prost and colleagues (2020) determined that approximately 148 correctional facilities across the United States offer some type of EOL care.…”

“…The majority of prison EOL care programming follows the standards of practice and guidelines proposed by The National Prison Hospice Association (NPHA) and the Guiding Responsive Action for Corrections in End of Life (GRACE) project (Loeb et al, 2013; National Hospice and Palliative Care Organization, 2009; Ratcliff & Craig, 2004). Despite reports of the following standards, very few facilities are accredited through larger institutions such as the National Commission on Correctional Healthcare, Joint Commission for the Accreditation of HealthCare Organizations, or even state Health Departments (Prost et al, 2020).…”

“…Moreover, hospice care should be available to inmates of all security levels and family members of terminally ill inmates should be permitted to visit often (Cloyes et al, 2016; Yampolskaya & Winston, 2003). Many facilities share the same criteria as community-based EOL care, which involves a 6-month prognosis and a signed do-not-resuscitate order by the inmate and their attending physician (Prost et al, 2020; Yampolskaya & Winston, 2003). Along with the various components and criteria, scholars have also examined the perceptions of various professionals working in EOL care settings in correctional institutions (Cloyes et al, 2016; Flanagan & Flanagan, 2001; Maull, 1998; Wright & Bronstein, 2007a, 2007b).…”

Caring, sharing, preparing and declaring: how do hospices support prisons to provide palliative and end of life care? A qualitative descriptive study using telephone interviews

“… 5 , 6 Prost and colleagues suggest that this population already possess risk factors for poor physical and mental health prior to imprisonment, and that these are further exacerbated by being in prison. 10 People in prison are more likely to require palliative care at a younger age than those outside of prison.…”