Hospice Care for the Incarcerated in the United States: An Introduction

Abstract

Prison populations throughout the Unites States are growing; the 1990s saw an average 6.5% per year increase. Average inmate age is increasing, as are both the number and rate of inmate deaths. Aging inmates experience health concerns typical of the general, free, aging population. Inmates have higher incidence of health complications associated with various circumstances, risk behaviors, and associated medical conditions. These circumstances include prison violence, incarceration-related constraints on exercise, and diet. Inmates are more likely to have a history of alcohol abuse, substance abuse or addiction and sex industry work. Risk-behavior conditions include human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), hepatitis B and C, liver disease, tuberculosis, endocarditis, and cardiomyopathy. Hospice is increasingly the preferred response to the health and care needs of terminally ill inmates. Implementing hospice behind bars has some unique challenges in addition to those inherent in hospice work. This series will provide an in-depth look at four hospice programs for inmates in the United States.

Older and Geriatric Offenders: Critical Issues for the 21st Century

“…Although research has not maintained records of the specific number of facilities with formal hospice services, some have estimated the number of states with hospices to be in the vicinity of 25-with several including California, Texas, and New York having multiple hospices throughout the state (Anno et al, 2004;Linder & Meyers, 2009)-and growth projected to continue well into the 21st century (Hoffman & Dickenson, 2011). In the process, heightened attention is being placed on examining issues such as admission standards, need for interdisciplinary care, narcotics, special privileges, family support, and discharge procedures (Linder & Enders, 2011;Linder, Enders, Craig, Richardson, & Meyers, 2002). It is now well accepted, for example, that administration follow a mixed-model approach to care-pushing for curative treatment and transitioning over to a palliative-based focus only after no improvement to medical statuses can be achieved (Dubler, 1998).…”

Characteristics of Prison Hospice Programs in the United States

“…21 By extension, Linder and colleagues argue that hospice care should be standard treatment for terminally-ill prisoners because hospice care has been the standard of quality health care for those who are terminally-ill in the community since the 1970s. 15 Terminally-ill patients may experience social abandonment or personal isolation that comes when friends and acquaintances stop visiting them because of an inability to cope with issues of death, a lack of knowledge about what to say or do, or simply a lack of awareness of what the patients are experiencing. Hospice care tries to fill this gap of diminished social support, a concern that is ever greater for those in prison who have either lost contact with friends and family or who have little contact because of limited visitation opportunities in prison.…”

HIV, alcohol dependence, and the criminal justice system: a review and call for evidence-based treatment for released prisoners

“…Since the widespread introduction of highly active antiretroviral therapy (HAART) nationally and the introduction of chemoprophylaxis of opportunistic infections (OIs), mortality among prisoners has markedly decreased7 and HIV/AIDS is no longer the leading cause of prison-related death nationally 32. Excellent adherence to HAART suppresses HIV viral load and increases CD4 cells, thereby keeping HIV-infected persons healthy and free from complications from HIV and non-HIV–associated complications 33, 34.…”