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The Osborne Association Report, May, 2018, The High Costs of Low Risk - The Crisis of America’s Aging Prison Population

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The High Costs
of Low Risk:
The Crisis of America’s Aging Prison Population

The Osborne Association
May 2018

Executive Summary

Executive Summary
During the past four decades, we have experienced the most sustained and widespread
imprisonment binge in recorded human history. The facts are all too familiar and are finally
receiving widespread, even bipartisan, attention: The United States has roughly 5 percent of
the world’s population, yet is responsible for nearly 25 percent of the world’s incarcerated
population. With an estimated 2.3 million people in confinement, one out of every 32 adults
under correctional control or community supervision, and roughly one-third of all adults with
some sort of criminal record, the U.S. surpasses all other countries in sheer numbers and per
capita incarceration and criminalization rates. The disparate impact on people and communities
of color is also part of this disturbing landscape: black youth are 5 times more likely to be
incarcerated than white youth;1 one in 3 black men is expected to spend time in prison
(compared to one in 17 white men);2 and close to 2/3 of women in prison are women of color.3
According to the NAACP, “If African Americans and Hispanics were incarcerated at the same
rates as whites, prison and jail populations would decline by almost 40%.”4
The population of a prison system is a function of the number of people who enter and how long
they stay. Although crime rates are lower than they were 10 years ago,5,6 and thirty-six states have
reduced their imprisonment rates,7 extreme sentence lengths and narrow release mechanisms
have led to a growing crisis of older adults in America’s prisons. By 2030, the population of people
aged 50 and older is projected to account for one-third of all incarcerated people in the U.S.,
amounting to a staggering 4,400 percent increase over a fifty-year span.8 Addressing this crisis is
perhaps one of the most salient and pressing challenges facing corrections administrators—and
therefore, states and taxpayers—over the next 20 years.
In recent years, organizations working for criminal justice reform and formerly incarcerated
people have called for increased attention to the issue of aging in prison. In 2014, when the
Osborne Association first issued a white paper on this subject, the looming crisis had begun to
receive attention in a variety of media outlets. In New York, diverse stakeholders—including
direct service providers, those directly affected, City and State government agencies, and
researchers—came together to form the New York Aging Reentry Task Force. This Task Force
developed a unique model for case management and community-based support for older
people in and returning from prison, and convened a symposium at Columbia University which
resulted in the release of a comprehensive report, Aging in Prison: Reducing Elder Incarceration
and Promoting Public Safety.9 Four years later, as the number of older people in prison continues
to climb, much has been learned that has informed the debate. As detailed in this updated
white paper, some correctional systems have begun to take steps to better support currently
incarcerated older people. Several books, reports, and articles in the past few years have called
into question the notion that criminal justice reform only applies to those convicted of nonviolent offenses, and have recognized that warehousing individuals for decades is an entirely
insufficient and counterproductive response to violent crime.
i

Executive Summary

In spite of these important efforts, much work remains to be done across the country to
improve conditions of confinement, encourage decarceration, and build community supports
for formerly incarcerated elders. While new reports and articles increase knowledge and
understanding, this crisis continues to grow with an increasing number of people dying in
prison: in 2014 (the most recent year for which data was collected) 2,044 older people died in
federal and state prisons, the first time in recorded US prison history that any age demographic
surpassed 2,000 deaths in a single year. Given these chilling figures, this updated white paper
aims to educate, but also to call to action policy makers and those in positions of power to
enact meaningful and lasting changes to better support currently incarcerated older people,
release them in greater numbers, and support them in their return to the community.
This report synthesizes updated research and more recent data, as well as new thinking about
decarceration, violence and punishment, healing, public safety and victims’ experiences and
perspectives. It also draws on the voices and knowledge of older people who have come
home, and the experiences of practitioners doing groundbreaking work. Within this updated
framework, this paper provides the overall landscape of the issues affecting older people
in prison, including how we got here and the impact this crisis is having nationally, with a
particular focus on New York. The first section discusses the most significant contributing
factors to the dramatic growth in the numbers of people aging in prison: lengthy sentences,
narrow release mechanisms, and society’s approach and response to violence. Sections Two
and Three examine the experiences and challenges faced by older people while incarcerated
(including the impact on corrections of providing care and custody to an aging population) and
upon reentry. Section Four offers examples of programs and approaches designed to address
the needs of older people in prison and upon their return to the community.
Section Five presents recommendations that include the full range of policy and practice
reforms needed to address the crisis. Implementing these recommendations will require
decision-makers to confront the current punishment paradigm which has roots in and
perpetuates racial injustice, and criminalizes addiction and mental illness. The five areas of
recommendations from this section include:
ONE: Improve conditions inside of prisons and jails for those aging within them,
including strengthening staff capacity to recognize and address age-related issues,
and adopting policies and practices that consider age-related concerns;
TWO: Improve discharge planning and reentry preparation for older people
within correctional facilities;
THREE: Expand release mechanisms that have specific salience for older people,
including compassionate release and medical parole, presumptive parole for
older adults, and improving the quality of information parole boards receive by
implementing geriatric assessments within correctional settings that inform care
and release plans;
FOUR: Improve the reentry experience of older people coming home by increasing
community supports and receptivity, including addressing their housing, medical/
health, mental health, post-incarceration, financial, family, and employment needs.

ii

Executive Summary

FIVE: Shift the response to violence by expanding the range of services offered
to victims and survivors of crime beyond just “more incarceration,” and reducing
excessively long sentences for all crimes of conviction, including for violent crimes.
In spite of recent federal calls for more incarceration, there is persistent support for criminal
justice reform and growing momentum to address the human and economic cost of aging in
prison. The fields of gerontology, physical and mental health, philanthropy, and corrections
have a unique opportunity to unite to identify and support innovative and effective solutions
to improve the lives of those aging in prison, while also developing and implementing the
necessary socio-structural architecture to effectively address long-term mechanisms of
diversion, release, and reentry.
Austerity-driven approaches to shrinking budgets, new questioning of society’s addiction to
punishment, and increasing public discomfort with mass incarceration create an opportunity to
seriously address the epidemic of America’s graying prison population and to imbue the justice
system with values and policies that are humane, cost-effective, and socially responsible. The
time is now.

iii

About the Osborne Association
The Osborne Association is a New York-based nonprofit organization founded more than
85 years ago by prison reformer Thomas Mott Osborne. Osborne’s innovative, effective,
and replicable programs offer a wide range of services at every point from arrest through
community reentry, focusing on families, employment, education, and treatment. Osborne
programs serve the community by reducing crime and its human and economic cost, and
provide opportunities for reform and rehabilitation through public education, policy advocacy,
and alternatives to incarceration that respect the dignity of people and honor their capacity to
change. Osborne serves more than 11,000 currently and formerly incarcerated individuals and
their children and families across multiple sites in New York City and the Hudson Valley, and in
more than 30 New York State prisons and New York City jails (Rikers Island).
www.osborneny.org | info@osborneny.org

About the Osborne Center for Justice Across Generations
The Osborne Center for Justice Across Generations is the policy arm of the Osborne Association,
initially focusing on two main areas: aging in prison, and children and families affected
by incarceration. The Center develops and promotes solutions built on the principles of
rehabilitation, restorative justice, reconciliation, relationships, and reinvestment. Supported
by data and research, our solutions are grounded in decades of practitioner-based expertise
within the criminal justice system as well as affected communities; our knowledge of best and
promising evidence-based practices across the globe; and our close connection to and deep
respect for the individuals and communities Osborne serves.

Acknowledgements
This white paper has been informed by the work, passion, and expertise of many people, including:
Mujahid Farid, Laura Whitehorn, Kathy Boudin, Laura Roan, Dr. Rachael Bedard, Lynn Cortella,
the members of the Aging Reentry Task Force, the work of RAPP (Release Aging People in Prison),
Danylle Rudin (of the Florence V. Burden Foundation), and numerous others who experienced
lengthy incarceration and courageously shared their stories, including Ismael, Louise, Patty, Jody,
T., and Deborah. We are grateful for Adam Wilson’s stimulating discussions, comments, and
skillful editing; to Rocco Lotito for fact-checking and citation assistance; and to Jedd Flanscha for
his design talents, patience and persistence. A special thank you to the Aging Reentry Task Force
and the Center for Justice at Columbia University for their 2015 report Aging in Prison.
Recommended citation: The Osborne Association (2018),
The High Costs of Low Risk: The Crisis of America’s Aging Prison Population.
Copyright 2018.
Authors: Elizabeth Gaynes, Tanya Krupat, David George, and Colin Bernatzky
Designed by Jedd Flanscha
A list of resources, including a PDF version of this report, is available at www.osborneny.org/aging.
iv

Table of Contents
8	

Introduction: The National Crisis of Graying Prisons

12	 Part I: The Roots of the Crisis
12	 Long Sentences
13	 Discretionary Parole and Compassionate Release
18	 Questions of Violence and Risk

22	 Part II: The Impact
22	 Health and Accelerated Aging
25	 Familial and Social Costs
27	 Economic Vulnerability
27	 Strain on Correctional Systems
29	 Dying in Prison

32	 Part III:  The Reentry Experience
32	 Housing
34	 Benefits and Healthcare
34	 Technological Change
35	 Employment
35	 Trauma of Long-term Incarceration
	

37	 Part IV: The Work Being Done from the Inside Out  
40	 Part V: The Work to be Done: Recommendations
46	 Conclusion: Toward a New Paradigm of Justice
48	 Appendices
52	 End Notes
v

Introduction

“I hope my story will get the parole board to
reconsider denying older people parole and
instead give them a chance to come home and
contribute to society in a meaningful way.”
Gloria Rubero
Member of the Aging Reentry Task Force
Age: 67 | Years in prison: 26

8

Photo and Content taken from Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety.
Center for Justice at Columbia University (2015).

Introduction

Introduction:
The National Crisis of Graying Prisons
The aging prison population represents a national, human-made, systemic epidemic that
has been decades in the making. Although there is no commonly agreed-upon age at which
an incarcerated individual is “old”—definitions range from 50 to 65—medical practitioners
and corrections professionals agree that adverse life circumstances both during and prior to
incarceration lead to accelerated aging. Put simply, people who have been incarcerated very
often have the physiological attributes of much older people.10 Given existing trends and
projections, it is clear that the number of older people in prison will continue to rise unless
meaningful action is taken. Most older people in prison (disproportionately people of color)
have already spent decades behind bars, pose little or no risk to public safety, and often
require significant age-related medical care. Numerous reports and articles in the last four
years document and discuss various aspects of this issue (see Bibliography in Appendix A). It
should be noted that while this report focuses on the majority of incarcerated older people
who entered prison at a younger age and have served long terms behind bars, there has been
an uptick in the number of people arrested at age 55 or older. This group of older people tells
a different story and further research is needed to better understand the underlying causes of
this disturbing trend, which may reflect other issues such as chronic or recent homelessness,
mental illness, or addiction.
Figure 1:

Number of People Aged 50 & Older in U.S. State Prisons: 1993-2013
320,000
280,000
240,000
200,000

243,800

160,000
120,000

121,000

80,000
40,000
0

45,000
1993

2003

2013

The sharp increase of older people in prison has occurred within the context of small, yet
significant reductions to the overall population of people incarcerated in federal and state
prisons, and as crime nationwide has decreased. According to a 2018 analysis by the Pew
Charitable Trusts, 35 states reduced crime and imprisonment simultaneously between 2008
9

Introduction

and 2016.11 Since 1999, New York State has seen a significant drop in crime and reduced its
prison population by more than 30 percent, yet during the same time period its incarcerated
population aged 50 and older nearly doubled.12 Nationally, from 1993 to 2013, the U.S.
state prison population aged 55 or older nearly quadrupled from 26,300 (3% of the total
population) to 131,500 (10% of the total population).13 Furthermore, the record-breaking
numbers of incarcerated elders are sure to continue to increase as the majority of currently
incarcerated middle-aged people are serving sentences that will carry them well into their
older years while in prison.14

By 2030, the population of incarcerated people aged 55 and older in state and
federal prisons is projected to be over 400,000. This is more than one-third of
all people in prison in the United States, amounting to a staggering 4,400 percent
increase over a fifty-year span (and this doesn’t include those age 50 to 54).15

Figure 2:

U.S. Crimes and Prison Rates: 1993-2013
U.S. Crime Rate per 1,000 People

U.S. State Prison Rate per 100,000 People

80
75
70
65
60
55
50
45
40
35
30

700
600
500
400
300
200
100
0
1993
2003
U.S. Crime Rate

2012

1993

2003

People Aged 40-55
People Aged 55+

2013
All Ages

By comparison, the estimated 274,000 people aged 50 or older in U.S. state and federal prisons
is greater than the entire incarcerated populations of nations like Mexico, Iran and Indonesia, all
large countries that incarcerate at a relatively high rate.16

If older people in state and federal prisons in the U.S. comprised their own
prison system, they would be the 7th largest prison system in the entire world lagging
behind only Thailand, India, Russia, Brazil, China and the entire U.S. system.17
Within the United States, the states with the biggest prison populations have seen the most
significant increases in the number of confined older people. We have observed this firsthand
in New York State, where the Osborne Association provides direct services and programs in 27
prisons and 8 jails. New York alone has 10,337 incarcerated older people18 and is among five
states in the union with an incarcerated older population in excess of 10,000 people, including
Texas (28,502), California (27,806), Florida (21,620), and Pennsylvania (10,214).19 Furthermore, in
New York, California, Pennsylvania, Michigan, Texas, Georgia, Ohio, Florida and Illinois, roughly 20
10

Introduction

percent of the entire prison population is comprised of older people, a rate that is only expected
to rise unless states begin releasing higher rates of older people.20 Such numbers and percentages
of older people are a relatively new phenomenon and a direct result of the combination of four
decades worth of lengthy sentences and unforgiving release decisions.
Figure 3:

Incarcerated Population by Country: 2017
2,145,100

USA
1,649,804

China
672,722

Brazil

600,262

Russia
India
Thailand
USA (Only People Aged 50+)

419,623
330,774
274,000

Indonesia

236,812

Turkey

229,790

Iran

225,624

Mexico

208,689

Incarcerated Population

As astounding as these numbers are, their implications become more troubling when
considering the circumstances of many older incarcerated people. Most aging people in prison
were sentenced in their teens,21 twenties and thirties; most were the victims of violence and/or
experienced trauma before they committed harm. After decades of incarceration, older people
present little to no public safety risk. In fact, older people have the lowest recidivism rate of
any age cohort in U.S. prisons.22 Nationwide, 43.3 percent of all released individuals recidivate
within three years, while only seven percent of those aged 50-64 and four percent of those
over 65 return to prison for new convictions—the lowest rates among all incarcerated age
demographics.23 Similar rates can be found across almost all states. For instance, in New York,
those aged 65 and older released in 2012 (the most recent year for which data is available) and
followed for 3 years had a new commitment rate of just 4 percent,24 as illustrated in Figure 4.
Figure 4:

Recidivism Rates in NYS Prisons by Age: 2012-2015
13.1
4.2
33.4%

57.4
9.2

82.7

Recidivism Rates in NYS for People of All Ages
Remain at Liberty

Source: DOCCS 2012-2015 Recidivism Data25

Recidivism Rates in NYS for People 65+

Return to Prison on
New Commitment

Return to Prison on
Parole Violation

11

Part 1: The Roots of the Crisis

Part I: The Roots of the Crisis
Far from an inexplicable anomaly, the soaring aging prison population is the logical
consequence of three forces operating simultaneously and with a racially disparate impact:
1.	 extreme sentencing,
2.	 limited opportunities for release, and,
3.	 a punishment paradigm that is especially unrelenting in its response to violence.

Long Sentences
In 1973, New York Governor Nelson Rockefeller proposed strict sentencing guidelines that came
to be known as the Rockefeller Drug Laws. This “tough-on-crime” approach became a national
movement, and by the 1980s the federal government and many states had adopted mandatory
minimum sentencing policies, including so-called three-strikes laws. Despite the growing body
of research showing that long sentences are limited in deterring future crimes and promoting
public safety, the number of people serving life sentences more than quadrupled since 1984.26
Figure 5:

U.S. State Prison Sentences for People Aged 65+: 2013
31%

69%
Non-Life Sentences

Life Sentences

A recent report by the Sentencing Project entitled Life Goes On: The Historic Rise in Life
Sentences in America, found that “by 2012, one in nine people in U.S. state and federal prisons—
nearly 160,000 people—were there under life sentences.”27 This increase in life terms is not
exclusively due to decades-old punitive policy, but to more recent policy changes as well. The
report found that despite recently popularized efforts to reform the justice system for so-called
“nonviolent” individuals, life sentences increased by 11.8 percent between 2008 and 2012.
12

Part 1: The Roots of the Crisis

Moreover, the use of life without parole (LWOP) has increased more than 22 percent since 2008,
encompassing 49,081 people at the time of the report’s publication in 2013.28 As a result, more
than 31 percent of currently incarcerated people in state prison ages 65 and older are serving
life sentences or death sentences.29
These figures draw attention to the fact that criminal justice reform that only focuses on
those incarcerated for non-violent crimes will not address the crisis of those aging in prison.
Furthermore, the increase of life sentences is inconsistent with research and science that
demonstrates “aging out of crime” by the time people reach their 40s.30 It underscores the
need to address our underlying emphasis on endless punishment for violent crime.31
Figure 6:

The Rise in Life Sentences: 1992-2012
220,000
200,000
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
1992

2003
Life Without Parole

2008

2012

Life Sentences

Source: Sentencing Project: Life Goes on: The Historic Rise in the Life Sentences in America

The number of people serving life sentences
has more than quadrupled since 1984.
Like long sentences, underused or largely ignored release mechanisms—primarily, parole and
compassionate release—exacerbate this crisis.

Discretionary Parole and Compassionate Release
Throughout the country, even as the number of parole-eligible older people in prison has
skyrocketed, states and the federal government are generally reluctant to grant parole release,
all but ensuring that large numbers of people will grow old in prison.
Restrictive parole practices and policies vary greatly from state to state. Whereas the federal
government and fourteen states32 have eliminated parole release mechanisms, most states
allow for at least some incarcerated people to be paroled by way of a Board of Parole—an

13

Part 1: The Roots of the Crisis

“…when I think back to 1987 and today is 2016 and how 25 years
of my life was spent inside those prison walls, it seems like a lifetime.
I spent half of my life in prison. I cannot believe that happened,
that I spent 25 years in there.
The crime is the crime and it is serious, but you are
sentenced for that crime in court and you do the time for it.
The board is resentencing us. They need not be allowed to resentence
us. They resentenced me… And I don’t minimize what happened.
I have to live with it every single day. I always took responsibility for
what happened. It’s on me…. I made my 8th parole board and was
released at 55. It was surreal.”

Louise
Age: 59 | Years in prison: 25
Sentenced to 15 to life; denied parole 7 times

14

Photo credit: The Osborne Association

Part 1: The Roots of the Crisis

administrative body made up of some number of members or commissioners (and sometimes
the state’s Governor) who determine whether an individual is granted parole release followed
by community supervision.

“Nine denials turned into an extra 18 years for a total of
43 years in prison. [A life sentence] became more real with
every parole board denial; there was less and less hope.”

Richard
Age: 63 | Years in prison: 41

Although many older people in prison have spent years working to transform their lives by
completing institutional programming, earning advanced college degrees, and becoming assets
to society, parole boards often and repeatedly judge them based on immutable events and past
circumstances, rather than whom they have become.33 From in-prison program participation,
to victim and prosecutorial input, to algorithmically based risk and needs assessments, parole
boards have a great deal of discretion when evaluating which factors to weigh most heavily.
However, despite the relatively large number of factors parole boards must legally consider,
boards nationwide typically rank three completely static factors as most significant in their
decision making process: the nature of the offense for which an individual is incarcerated,
the severity of the offense, and prior criminal record.34 Placing such disproportionate weight
on these three factors while virtually ignoring rehabilitation, remorse, and redemption is
ultimately what leads to high rates of parole denials, often adding years to the sentence
intended by the court, and disproportionately affecting those with parole-eligible life sentences
and older people.
Low rates of release have been well reported in New York, Missouri, Georgia, Texas and other
states throughout the country. In California, where state prisons house more people serving
a parole-eligible life sentence than any other state in the country (34,000), the parole board
granted release to only three to sixteen percent of life-serving applicants between 2000 and
2009.35 After each parole board denial, people frequently wait multiple years—and in some
cases, decades—before they are able to reappear in front of the board. Such long periods of
time between parole board hearings significantly contribute to the increase of aging and older
people in prison.
Another release mechanism available in 36 states and the federal prison system is
compassionate release, also known as medical parole. Though details vary, eligibility generally
requires that individuals have a terminal illness, or non-terminal but debilitating and chronic
illness (usually with exclusions for certain types of convictions). As the numbers of those
aging in prison have risen nationally, one would expect to see rising rates of release through
compassionate release, but use of this release mechanism have remained quite low. In New
York, the number of people granted medical parole have remained consistently small during
15

Part 1: The Roots of the Crisis

the first 22 years (1992 through 2014) that medical parole was available, despite significant
and consistent increases in the number of people age 60 and above who are incarcerated.36
Another barrier can be the bureaucratic processes and timeframes that may not correspond or
respond to medical prognoses, including an individual’s sudden or unexpected decline. In New
York, during the first twenty-two years of medical parole, 21% of people who filed a medical
parole application died before it was even reviewed.37

Herman Wallace
1941-2013 | Years in prison: 41

Herman Wallace, one of the ‘Angola Three’ who spent 41 years in solitary confinement, was
released from prison on October 1, 2013, due to his severe medical conditions and advanced
liver cancer. He died less than three days later.38 After more than 40 years in confinement and
with seriously ailing health, 89-year-old Mohaman Koti died only two months after he was
released to a nursing home in New York.39
Calls for increased use of compassionate release at the federal level have been steadily
increasing. In 2016, the Inspector General issued a report examining older incarcerated
individuals within the Bureau of Prisons (BOP). The report’s complete recommendations are
included here as Appendix B. Their investigation “determined that aging [incarcerated people]
engage in fewer misconduct incidents while incarcerated and have a lower rate of re-arrest
once released; however, BOP policies limit the number of aging [incarcerated people] who
can be considered for early release and, as a result, few are actually released early.”40 In early
August 2017, a bipartisan group of United States Senators called on the federal Bureau of
Prisons to explain why, despite a 2013 report by the Department of Justice Inspector General
recommending expanded use of compassionate release, none of the 203 applications from
older incarcerated individuals for compassionate release in the 13 months following the report
were approved.41
The underuse of compassionate release mechanisms can be attributed in part to narrow and
exclusionary criteria.42,43,44 Eligibility for compassionate release is often limited to those over a
16

Photo credit: The Advocate.

Part 1: The Roots of the Crisis

certain age or convicted of certain offenses, leaving vast numbers of individuals in the prison
population—including those convicted of certain violent crimes—excluded from consideration.
Overall, the majority of older people in prison do not qualify for medical parole because of the
extreme health requirement (near death or near total physical or cognitive impairment).

“The very people whose release from prison would not
threaten public safety are being kept behind bars as
they age and grow infirm.” 45

Mujahid Farid
Co-founder of the Release Aging People in Prison (RAPP) Campaign
Age: 68 | Years in prison: 33
Sentenced to 15 to life; denied parole 10 times

Extremely long prison terms that lead to aging and dying in prison are not only driven by the
requirements of the laws of parole and sentencing as carried out by judges and parole boards,
but by the influence and virtually unfettered discretion of prosecutors. While practices vary,
prosecutors have historically largely sought the longest possible sentences, with some then
actively opposing parole release years or decades later.46 In addition to parole opposition on
individual cases, some district attorneys oppose statewide parole reform efforts, as seen in
Michigan in 2015.47,48 However, recent examples of district attorneys adopting a different
approach provide hope: Philadelphia’s newly elected district attorney has stated he aims to shift
“from a culture of seeking victory for prosecutors to a culture of seeking justice for victims.”49

Photo credit: RAPP website, www.rappcampaign.com/about

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Part 1: The Roots of the Crisis

Questions of Violence and Risk
Long sentences and parole denials are intertwined with the U.S. national stance and approach to
violence: how we understand it, approach it, heal from it, and prevent it. Without first grappling
with such questions, it is unlikely that the population of older people in prison will decrease.
People who grow old in prison are typically convicted of violent or relatively violent crimes
and given long sentences as young people in their teens, twenties and thirties. According to
a recent report by The Sentencing Project, “Most people serving life sentences were
convicted of serious violent crimes: 64% have homicide convictions and 14% were convicted
of aggravated assault, robbery, or kidnapping.”50 When individuals with convictions for
violent crimes are considered for parole release often decades later, the “nature of the crime”
tends to override their current risk assessment score, essentially freezing their level of risk to
public safety at the age of conviction, rather than their current age and risk (or lack thereof),
denying them their freedom as a result. According to a months-long investigation by The
Marshall Project:
“…in many states, parole boards are so deeply cautious about releasing
prisoners who could come back to haunt them that they release
only a small fraction of those eligible—and almost none who have
committed violent offenses, even those who pose little danger and
whom a judge clearly intended to go free.”51
Perhaps counter to popular belief, the low risk of recidivism for older people described earlier
holds true for people who are convicted of the most serious acts of violence, particularly
homicide-related offenses.52
As the number of older people in prison continues to rise, many observers recognize that our
current criminal justice system inadequately, and often counterproductively, addresses the
causes of violence in society. In her recent report, Accounting for Violence: How to Increase
Safety and Break Our Failed Reliance on Mass Incarceration, victim’s rights advocate, Danielle
Sered writes:
“…Incarceration treats violence as a problem of ‘dangerous’ individuals
and not as a problem of social context and history. …Most violence is
not just a matter of individual pathology—it is created.” 53
Both Sered and many other victim’s advocates agree that instead of stemming from inherent
dangerousness and aggression, individual violence is driven by trauma, poverty, inequity, lack of
opportunity, shame, isolation, and proximity to violence—all of which are also core features and
practices of our current system of incarceration.54
Nearly everyone who commits violence has also survived it.55 Exposure to violence is especially
prevalent amongst those aging behind bars, though decades may have elapsed since such harm
was both survived and committed. Although a person’s survival and victimization does not
excuse violence against others, it does highlight the preventive potential of providing resources
and opportunities to address earlier trauma. Recognizing the importance of addressing trauma
and victimization, Michigan recently became the third state in the country to offer a trauma
18

Part 1: The Roots of the Crisis

center for victims of crime within a hospital in Flint to promote healing and prevent future
crime.56 There is growing recognition that our reliance on incarceration as the main response to
violence ignores earlier trauma and also provides little opportunity for healing and justice for
the victims of crime.57

“To talk responsibly about violence, it is essential to place the
people who survive it at the center. This does not currently
happen. Legislators have enacted draconian criminal justice
laws in the names of survivors. Others have drawn on crime
victims’ stories to motivate sympathy, horror, and outrage.
But the one thing rarely done is to ask the full range of
survivors what they want.” 58

Danielle Sered
One former NY State Parole Commissioner reflected on thousands of individuals who came
before her for parole hearings:
“I would guess that 80% of 77,000 interviews I participated in as a
commissioner were with people who suffered early life traumas such
as sex abuse, violence, and concussions. Our older imprisoned have
gained maturity, non-violent adaptive behaviors and more often the
punishing effect of their crimes on them and their families, leading
them to introspection over time. They become different people by
demonstrating different responses.” 59
This also raises the question of how effectively we respond to the needs of victims of crime.
The Alliance for Safety and Justice, a national organization that brings together diverse
crime survivors to advance policies that help communities most harmed by crime violence,
quantified the wants, needs, and beliefs of crime survivors in their 2016 report: Crime
Survivor’s Speak: The First-Ever National Survey of Victims’ Views on Safety and Justice. Results
from the survey found that half of all crime victims have been a victim of a violent crime and
that two of three victims reported “not receiving help following the incident, and those who
did were far more likely to receive it from family and friends rather than the justice system.”60
This survey also found that the majority of victims preferred holding people accountable
through options beyond prisons, and supported shorter prison sentences and more spending
on prevention and rehabilitation.61
Despite better understanding of the causes of, cures for, and responses to violence,
current criminal justice “reforms” that focus primarily on “nonviolent” crimes often harden
punishment for those convicted of violent crimes by increasing sentence length and
decreasing opportunity for redemption and release. For example, in New York, many of
the same state elected officials advocating for less punitive responses to so-called non19

Part 1: The Roots of the Crisis

“I saw my mother sober once. She wore a dress
and makeup and looked presentable, and she sat
us down and said, ‘I am your mother. I drink. I
am not going to stop.’ For the next ten years, she
embarrassed me. She would come around drunk,
and our relationship was built on trying to protect
her. My brother and I were very protective of my
mother. Everyone in the neighborhood knew that
we would hunt you down and beat you senseless
if you made fun of her or did not render her any
assistance if she needed it. Early childhood trauma,
there was much of it.”
Ismael with his wife, Reina
Age: 56 | Years in prison: 29

20

Photo credit: The Osborne Association

Part 1: The Roots of the Crisis

violent and drug crimes are simultaneously pushing for longer sentences and more punitive
responses for people convicted of the most serious crimes—even if such crimes were
committed decades ago and the convicted person is now old and infirm.62 Such calls for more
punishment are often enacted on behalf of crime survivors, although the broad range of
survivors are rarely asked what they want and need.63

At a rate of 3 to 1, crime victims prefer holding people
accountable through options beyond prison.64
The current approach is shortsighted, counterproductive, and will only exacerbate the graying
of U.S. prisons, all but ensuring that the issue plagues the nation for decades to come. By
doing so, we will continue to be forced to spend billions on incarcerating the aging, elderly,
incapacitated, immobile, and infirm, in spite of their mounting physical, mental, and social
needs, and the minimal risk to public safety they pose.

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Part II: The Impact

Part II:
The Impact
We have now reached what Fordham University Professor Tina Maschi calls a “critical omega
point,”65 in which both the sheer number and the specialized needs of the aging prison
population have begun to surpass correctional facilities’ capability to provide effective
and humane care. This sustained incarceration of older people bears major ethical, social,
communal, health, safety and economic implications—and without decisive action, our criminal
justice system is at serious risk of collapsing under its own weight.

Health and Accelerated Aging
Compared to their non-incarcerated peers, aging individuals in prison present with an array
of serious medical issues that are exacerbated by their incarceration. Individuals aging in
prison experience health challenges that correlate with socioeconomic factors. That is, the
same demographic groups that are disproportionately arrested and incarcerated—people
of color and individuals with little to no socioeconomic capital—are also more likely to be at
risk for poor health prior to their incarceration. Thus, the composition of, and relative health
status within today’s prison population has been called a “distorted reflection of the general
population” in that its constituents typically enter prison having had less access to primary care,
a greater likelihood of co-morbid factors such as substance use, and greater health needs.66,67
Within prison, we see a high prevalence of communicable and chronic diseases (including
hepatitis, HIV, tuberculosis, arthritis, hypertension, ulcer disease, prostate problems, respiratory
illnesses, cardiovascular disease, strokes, Alzheimer’s, and cancer) in the older prison population
compared with the overall prison population. Elders in prison also demonstrate a greater risk of
injury, victimization, ailing health, and death than their younger counterparts.68
Incarceration not only compounds existing health issues and heightens the risk of further
health problems, but causes incarcerated people to age at a much faster rate than people in the
community.69 The phenomenon of accelerated aging, which can be attributed to the prevalence
of environmental stressors coupled with a lack of access to holistic healthcare in an individual’s
life both before and during incarceration, means that the body of an incarcerated 50-yearold often has a “physiological age” that is 10 to 15 years older.70,71 Furthermore, correctional
facilities rarely—if ever—provide education about healthy aging, or provide access to key
components of healthy aging (nutrition, exercise, family, and community).72
While incarcerated people in the United States are the only citizens with a constitutional right
to healthcare, they often do not receive the necessary breadth or quality of care. People in

22

Part II: The Impact

prison are dependent on staff for their medication, face limited dietary choices, and can have
greater difficulty with self-care and disease management practices. People with diabetes, for
example, are typically prohibited from keeping glucose monitoring devices, insulin, or syringes.
Especially detrimental to incarcerated older people is their limited access to physical activity.
Exercise is vital for the overall health of all people, and this is especially the case for the aged, as
adequate exercise is associated with better health outcomes, slowed aging, and the prevention,
stagnation and reversal of disease and disability.73

“When you don’t have no hope and you think this is just
going to be it for you, it obviously affects you mentally and,
in some cases, physically. I’ve seen individuals stop taking
care of theirself, and they develop all kinds of crazy diseases,
diabetic, high blood pressure.” 74

Stanley Mitchell
Age: 63 | Years in prison: 35
Was released from a Maryland state prison in 2013

Mental health is a similarly serious concern among this population.75 One study found that 40
percent of older incarcerated people had a diagnosis of cognitive impairment, a prevalence rate
that far exceeds their peers in the outside community.76 Higher rates of depression, anxiety,
trauma, and stress have also been found among older incarcerated adults.77,78 Furthermore,
the poor physical and mental health of aging people in prison places them at greater risk
for dementia and other severely debilitating forms of cognitive impairment. Unfortunately,
mental health diagnoses among older incarcerated people remain both underreported and
undertreated.79,80 Data from the Bureau of Justice Statistics indicate that roughly 40-60 percent
of imprisoned individuals aged 50 and older are reported to have a mental illness, yet only
one in three have access to treatment.81 Existing research shows that corrections officers have
reported cognitive impairment in older incarcerated people at nearly five times the rate as that
reported by prison officials, displaying a critical knowledge disparity within the bureaucracy
that bears potentially serious consequences for currently incarcerated older people who
may not receive the care they need.82 At the same time, early warning signs for the onset of
dementia and other mental health diagnoses can be hidden by the rigid routine of prison life.
Cognitive, visual, and aural impairment (for example, failing to hear the orders of a correctional
officer) can lead to behaviors mistaken for disobedience or aggression, and can subject
individuals to institutional punishment, such as solitary confinement—further compromising
the well-being of those most in need of care.83
Individuals with profound dementia are sometimes incapable of understanding that they are
incarcerated (let alone understanding why they are there or whether they are remorseful) and
must be reminded of their crime prior to a parole hearing.84

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Part II: The Impact

“Two years after I went inside all the kids moved
out of state. From then on it was difficult for
them to visit. After they moved they didn’t come.
For 15 years I didn’t see my kids. It’s very difficult
when you can’t see your kids. It’s important
to keep contact and communicate with your
family while you’re inside.”
Patty
Age: 64 | Years in prison: 18

24

Patty (pictured above) holding a photo of her and two of her grandchildren

Photo credit: The Osborne Association

Part II: The Impact

Familial and Social Costs:
While the most palpable consequences of incarceration affect the individual at the
psychophysical (body and mind) level, they also ripple outward to affect individuals, families,
communities, and social structures in ways that are less immediately tangible. Incarceration
leads to disrupted, fragmented communities, and the continued imprisonment of elders (who
are often parents and grandparents) bears a significant cross-generational impact on children,
families and their incarcerated loved ones. In places where housing affordability may force
people to move including out of state, maintaining family ties can be particularly difficult.
Visiting can be onerous enough for many living in the state in which their incarcerated loved
one is confined, as the remote locations of many prisons require long-distance travel. This
obstacle becomes even more difficult when family members and the incarcerated person are in
different states. With sentences that span decades, the likelihood of family members moving
away increases.

“My mom died a week before my release and I was unable
to attend the funeral. I miss her. My mom was my life.
My mom was my everything-just like I am with my kids.”

Patty
Death may be the biggest strain on families and communities. Many incarcerated older people
remain in prison as their parents, siblings, and loved ones die “on the outside.” At the same
time, many children of incarcerated older people have never known their parents outside of
confinement, nor ever will

25

Part II: The Impact

Ebony Underwood
Founder and CEO of #WeGotUsNow
“Having had my father in prison for over half of my life, the most pressing experience has
been the loss of time. My father was sentenced to life without parole for drug conspiracy
charges. As a young person, I could never fully grasp the full meaning of such a conviction
on our lives. More than 25 years later, I’ve experienced the emotional roller coaster of such
a devastating sentence. I am one of four children and my father has maintained a solid,
connection with us all despite prison walls. He has always encouraged us to do better
and be better people. In addition, his actions have modeled those words by being a model
incarcerated person and never having had any infractions in his over 25 years in federal
prison. Therefore, as a tight-knit family we have collectively experienced the high hopes
of the changes in laws only to be let down by the lack of retroactivity in those same laws,
thereby, making it impossible for my father to obtain relief in his sentence.
What’s also been difficult is to watch my dad age through the years—remembering him as
a young, vibrant man in his early 30s at the beginning of his sentence to see him now as a
gray-haired elder who the younger incarcerated people refer to as Mr. Underwood. The most
heart-wrenching experience has been watching my paternal grandmother crying on visits
with my dad. Her one wish was for her son to come home, especially because so much time
had passed. Sadly, she passed away in the fall of 2016 and I believe it was due to a broken
heart, that she would never see her son outside of prison walls again.
Life without parole is a treacherous experience that my family has had to endure for decades.
It has been a way of life for my siblings and I as children and now, we are adults, with
children of our own who, too, must experience visiting their Grandparent in prison. Prison
life extends beyond the prisoner. It is the family who is also imprisoned, emotionally and
physically, attached to our loved ones like a ball and chain. My one question for this socalled system of corrections is: In a system of corrections, at what point is someone considered
corrected? What does a life sentence really mean in a system entitled, ‘corrections?’ For me,
it has meant a complete loss of time that I will never, ever get back with my father.”

26

William Underwood (middle), Ebony Underwood (right) and her three siblings.
Photo credit: Ebony Underwood

Part II: The Impact

Economic Vulnerability
As Bruce Western and others working at the intersection of sociology and economics have
demonstrated, there is a clear loss of economic productivity and family stability that stems
from incarceration: approximately two in three imprisoned men were the main earners for the
households prior to their incarceration and are likely to have difficulty securing employment
upon release due to their conviction status (especially if it is classified as violent), lack of social
capital, and inexperience with technology essential to the modern-day workforce. Those
who are able to find work will earn on average 40 percent less than those without a criminal
conviction.85 Outside of the absence of vital financial supports, incarcerated older people who
are grandparents and great grandparents are not able to provide the essential relief that many
in the outside community rely on, including childcare and school supports. These compounding
factors are further complicated other consequences of very long sentences: lack of family ties,
employer discrimination, and minimal work prospects give many older people no choice but to
rely on limited public benefits for housing, healthcare, food, and other basic needs.
While incarcerated, older people—like all those incarcerated—are required to work in prison
jobs in which pay can range on average from $0.14 to $0.63 an hour.86,87 There is no age at
which they can stop working and the meager “salaries” do not provide enough to defer the
costs to their families of their absence nor the costs of maintaining ties to them.

Strain On Correctional Systems
Unsurprisingly, large-scale incarceration of older people has proven to be enormously expensive.
If the prison population continues to age at the same rate, and available release mechanisms are
not used, correctional systems could soon find themselves in unsustainable financial territory,
resulting in cost-cutting measures that lead to overcrowding and compromise their ability to
provide sufficient health care, as has been well-documented in California’s prisons.88 While it is
not necessarily malicious that incarcerated older adults do not always have their needs met, it is
indicative of the systemic shortcomings inherent to these correctional structures.
It is conservatively estimated that the United States currently spends more than $16 billion
annually on incarceration for individuals aged 50 and older.89 Existing analyses calculate that, on
average, it costs approximately twice as much to incarcerate someone aged 50 and over and in
some cases, may actually cost up to five times more.90 According to a Pew Charitable Trust report
(2016), “In 2013, nearly half the $58 million that Virginia [Department of Corrections] spent on
off-site prisoner health care went to the care of older prisoners.”91 The April 2017 report by the
Office of the New York State Comptroller, New York State’s Aging Prison Population, noted that
while costs associated with health care for older adults are not readily available, healthcare
costs generally rise as people age.92 In New York, where annual prison healthcare costs are
approximately $380.6 million, it is estimated that the cost of incarcerating an older person can
rise to between $100,00093 and $240,000 per individual.94 The annual cost of a bed on the Unit
for the Cognitively Impaired in New York State’s Fishkill Correctional Facility—the first of its kind
in the country—is $93,000, compared to $41,000 for the general population.95

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Part II: The Impact

A separate analysis by the U.S. Department of Justice’s Office of the Inspector General found
that health care costs were much higher for older incarcerated people than younger incarcerated
people in the federal Bureau of Prisons.96 These runaway costs cannot be attributed to any single
factor, but are the expected consequence of current policies imposed upon a population that
has significant physical, medical, and other emotional and social needs.
Security adds an additional layer of cost, planning, and complexity, as medical procedures
that cannot be provided on-site require a secure trip to a medical facility under the constant
and costly supervision of corrections officers. Once there, it costs approximately $2,000 per
24 hours to guard individuals receiving medical care outside of prison.97 In short, the unique
needs of elders and the commensurate costs for their care are compounded by additional and
unavoidable expenses of correctional supervision.
Prisons were simply not designed to be long-term care facilities, as there are architectural
limitations that pose significant problems to the aging population: stairs, narrow doorways,
wheelchair inaccessibility, and the lack of handrails are just a few ways in which prisons are
structurally unequipped to deal with the needs of this population. Cafeterias, medical units, and
other necessary facilities may be spread far apart within a prison, making daily life difficult for
individuals with mobility impairment. Aging individuals may also require additional time to eat
meals or struggle getting to and from their bed, especially on a top bunk. Geriatric incontinence
and other physiological difficulties unique to old age can be extremely difficult to handle
with dignity in an environment lacking privacy, leading to harassment and feelings of shame,
isolation, and depression.98 What’s more, it would be extremely expensive to adequately
retrofit prisons or construct new age-appropriate facilities.
Even if prisons are made more “age-friendly,” most people and the communities from which
they come would be better off with people returning home. However, many older adults
continue to face challenges once they are released. As strong community pressure and media
attention results in the release of some currently incarcerated older people, and the release of
many more depends in part on the success of those already home, it essential that community
based and senior serving organizations understand and address the unique needs of recently
released older people.

“By establishing innovative policies providing for early release
of more of the elderly prison population, leaders in New York
State can effect important change in addressing the problem of
mass incarceration in the United States—effecting considerable
cost-savings while ensuring the safety of the community.” 99

Brian Fischer
Former Commissioner, New York State Department
of Corrections and Community Supervision (DOCCS)

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Part II: The Impact

In addition to these measurable costs, there is hidden and hard-to-calculate spending by
states on repeated parole denial appeals by or on behalf of older people, attorneys’ fees, court
proceedings, and new parole hearings.

Dying In Prison
In addition to the health, family, and economic costs resulting from the incarceration of elders,
many aging people pay the ultimate price of continued imprisonment: death. Life sentences
and multiple parole denials have proven fatal for many older people throughout the country. A
recent report by The Sentencing Project states:
In California, death before parole is not an uncommon outcome for lifers. A press
spokesman for the corrections department has stated that ‘most lifers will die in
prison before they get out on parole,’ and state records reveal that more lifers with
murder convictions died in prison than were paroled between 2000 and 2011.100
The same report cites a 1998 press release titled “More Violent-Crime Lifers Die in Prison than
Are Paroled” in which the Georgia State Board of Pardons and Parole stated: “Parole for a life
sentence is a rare commodity.”101 In New York, although people aged 55 and older represented
a small minority of people incarcerated between 2009 and 2012, they represented the majority
of people who died in prison.102 In total, between 2009 and 2012, 501 incarcerated people died
while in confinement in a New York State prison, a number more than double the 184 people
who were capitally punished nationwide during the same four year period.103
Such staggering numbers across separate prison systems are even more striking when looked
at as a whole: more than 29,500 people age 55 and older died in federal and state prisons
between 2001 and 2014.104 In 2014 (the most recent year for which data was collected) 2,044
older people died in federal and state prisons, the first time in recorded U.S. prison history
that any age demographic surpassed 2,000 deaths in a single year.105 Releases can be rare even
when individuals can no longer walk or physically attend to their daily activities of living, raising
questions about the public safety threat they would pose if released. Between 2010 and 2015,
Pennsylvania only granted 9 compassionate releases despite a state prison population of over
50,600; 1 of these were granted in 2015 when the incarcerated geriatric population numbered
6,458.106,107 Each year about 180 people die in Pennsylvania’s prisons.108

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Part II: The Impact

“It shouldn’t be acceptable that my patient, who posed no danger to the community and
who had a family who loved him, should have died incarcerated. He deserved the chance
to make peace at the end of his life, to be with family. If we value sparing other people
this kind of death, we need a fairer, more functional and quicker system that makes
compassionate release a real possibility.” 109

Rachael Bedard
MD, geriatrician/palliative care specialist whose nearly paralyzed
patient died of liver cancer while imprisoned in New York

Although older incarcerated peoples’ physical ailments are what most commonly lead to death,
individuals’ psychological well-being is often similarly devastating. In some cases, the effects
of dementia become so pronounced that individuals have difficulty even remembering why
they are incarcerated.110 As is the case in the outside community, serious cognitive impairment
among those aging in prison is a growing issue. High rates of dementia and similar mental
health difficulties associated with old age have led some prison systems to open full units
dedicated to meeting the unique needs of the population before they are released or die. For
instance, the NYS system has a separate unit dedicated exclusively to address the needs of the
seriously cognitively impaired.111
The death of John MacKenzie in 2016 in a New York State prison draws attention to how
the psychological impact of multiple parole denials can turn parole-eligible life into a death
sentence.112 Though many believe that John MacKenzie was an exceptional person, his
experience of growing old and dying in prison is all-too-common.

“Legitimate hope is laudable…
false hope is utterly inhumane.”
John MacKenzie

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Part II: The Impact

John MacKenzie
1946-2016 | Years in prison: 40
In 1975 John MacKenzie was sentenced to 25 years to life in prison after fatally shooting
a police officer. Shortly after being sentenced, MacKenzie sought opportunities to atone.
He earned college degrees, mentored other incarcerated people and was not cited for a
single disciplinary infraction since 1980. MacKenzie was perhaps best known for the
extraordinary degree to which he took responsibility for his crime and expressed his
remorse. In the 1990s he started an in-prison program that gave victims of crime the
opportunity to speak directly with incarcerated people about the impact of homiciderelated crimes. However, after becoming parole eligible in 2000, MacKenzie was denied
parole ten times, adding an additional 15 years to his sentence for a total of four decades
behind bars. The parole board always denied his parole request in the same way, stating
that MacKenzie’s crime showed “a serious disregard for the law.” Despite the board’s
frequent denials, MacKenzie’s personal transformation did not go unnoticed: the New
York State Court of Appeals twice ordered de novo (new) hearings after MacKenzie had
been denied parole. The second time, State Supreme Court Judge Maria Rosa held the
Board of Parole in contempt of court and issued a fine of $500 per day until the board
held a new hearing for MacKenzie. The judge stated, “It is undisputed that it is unlawful
for the parole board to deny parole solely on the basis of the underlying conviction. Yet
the court can reach no other conclusion but that this is exactly what the parole board did
in this case. No other basis has been stated by the parole board for the denial of parole in
either of its determinations in December 2014 or December of 2015.”
Despite the contempt order and issuance of a second de novo hearing, MacKenzie
was denied parole the 10th time he went to the board. He died by the act of suicide
nine days later at the age of 70.113,114,115

John MacKenzie pictured above with one of his two daughters

Photo Credit: “After Being Denied Parole 10 Times, Elderly Prisoner Allegedly Commits Suicide at Fishkill Prison.” Democracy Now!

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Part III: The Reentry Experience

Part III:
The Reentry Experience
In 2013, an interdisciplinary group came together in New York City to form the Aging Reentry
Task Force, focusing on the reentry needs of older people coming home and developing
solutions. The Task Force’s Steering Committee included the NYC Department for the Aging,
Release Aging People in Prison (RAPP), Be the Evidence Project/Fordham University, Columbia
University’s Center for Justice, the Osborne Association, and formerly incarcerated individuals.
The larger task force also included representatives from the fields of corrections, gerontology,
philanthropy, health, and reentry. This Task Force convened a symposium at Columbia
University in 2014 that led to the issuing of a comprehensive report and the development of
one of the nation’s first case management models for currently incarcerated older people, and a
community-based program model for older people upon reentry.116
What the Task Force concluded—and many other articles and reports concur—is that while
reentry is full of challenges for most individuals of all ages returning from prison, older adults
face additional obstacles and heightened complexities including greater rates of homelessness,
low employment, increased anxiety, fragmented community and family ties, chronic medical
conditions, and increased mortality rates.117,118,119

“I lost my parents and all my aunts, uncles and cousins while
I was inside. I receive $251 for rent from public assistance.
I’m 62 years old and all I want is a decent place to live, a job
and to drive again.”

Elvin
Housing
Though recently released older people are not a monolithic population and recognizing the
wide diversity of experiences is important, there are some commonly faced obstacles, including
access to housing. Family is often the de facto reentry program, providing newly released
people with a place to live. However, given the general lack of social connectedness and
fractured family ties that often results from long-term incarceration, finding safe, secure, ageappropriate, affordable housing is next to impossible for recently released older people.
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Part III: The Reentry Experience

This problem is compounded in places where gentrification, lack of affordable housing, and
homelessness can unite as the perfect storm against finding appropriate housing. In New
York State in 2014, 59 percent—1,635 people—of released older people were “undomiciled” or
homeless upon release, meaning they were released directly to a shelter, halfway house, hotel,
motel, or community-housing placement.120 This problem has persisted; in 2016, 1,699 released
older people were classified by DOCCS as “undomiciled,” 1,198 of whom went directly from a
prison to a homeless shelter.121

In 2016, 1,198 people aged 50 or older in NYS were
released directly from prison to a homeless shelter.

Figure 7:

Homelessness among people age 50 and older released from
a NYS prison to NYS community supervision: 2014-2016
Release Year
Type of Homeless Placement

2014

2015

2016

Total Releases

Shelter

751

1,025

1,198

2,974

Non-Shelter

884

540

501

1,925

Statewide

1,635

1,565

1,699

4,899

Source: NYS DOCCS (2017)122

The complexity of this problem differs by region. Despite the fact that the majority of people
in New York State prisons now hail from areas outside of New York City, most recently released
older people return to the metropolitan area.123 While those returning to big cities like New
York City face tremendous challenges finding an affordable place to live because of soaring
housing prices, others returning to potentially more affordable rural and suburban areas also
face significant challenges, including finding stable housing and accessing supportive services. A
recent report, The Long Road Home in Rural America, surveyed adult community corrections staff
in rural areas, and finding stable housing emerged as the most prevalent reentry challenge.124
Housing needs still persist even for those returning home to family and community networks.
People in need of long-term geriatric-appropriate housing may find that families are not
equipped or willing to handle the staggering medical expenses, and that a high level of care is
required for chronic health conditions.125 Furthermore, aging individuals with criminal records
are often discriminated against or stigmatized by nursing homes and hospice care, leaving
them with few options and unmet needs. Such discrimination and inaccessibility often leaves
older people no choice but to seek refuge in inadequate, unregulated halfway houses that may
be headed by predatory landlords who fill living spaces well beyond legal capacity, and do not
provide conditions at all conducive to the well-being of older people.126

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Part III: The Reentry Experience

Access to Benefits and Healthcare
While care within correctional facilities is beginning to garner greater attention, there are
still too few models of care for formerly incarcerated elders living in the community. Large
gaps in knowledge regarding the health and healthcare needs for this population persist,
and the existing evidence has not been effectively communicated to community healthcare
providers.127 Older adults with cognitive impairment or mental illness are likely to experience
even greater difficulty transitioning to the community.
Older people coming home from prison after serving long sentences are eligible for some
benefits, but they may not know how to enroll in benefits and entitlements and can experience
months-long delays before they are finally covered.128 The limited supply of medication
provided upon release by state correctional departments can run out prior to a communitybased initial healthcare visit.129 For those re-entering from jail or a shorter prison sentences,
benefits may be able to be reinstated or renewed, but this is the minority of older people
transitioning back from incarceration.
Benefits such as Social Security and Supplemental Security Income are suspended during
incarceration and compensation for work in prison is staggeringly low. As a result, opportunities
to build a meaningful financial cushion to help prepare for reentry are all but nonexistent. Many
who have been in prison since their young adulthood may not have paid into the Social Security
system long enough to be eligible for Social Security or Medicare upon release, and even those
who would be eligible for Medicare are not able to receive care under the program as long as
they are under parole supervision.130
Low income—including food insecurity—is likely to exacerbate existing health conditions
and increase the reliance on expensive, inefficient emergency services as a substitute for
primary care: a 2008 Urban Institute study found that one-third of returning individuals used
emergency services within the first year of release.131

Technological Change
For all the needs and challenges facing people coming home from prison, modern-day
technology is essential to accessing support (and employment, as discussed in the previous
section). Yet nearly all older people are released without ever having had the opportunity to
use a cell phone, the Internet, or a contemporary computer during their confinement. Critical
technology has changed so significantly that the elder reentry experience can become even
more difficult, frustrating, and intimidating. Technological changes have also transformed the
pace of life and greatly reduced interpersonal interaction. Many returning older people find the
fast-pace of life alarming. Returning from prison to find the majority of people looking down
at their cell phones, plugged into music or appearing to talk into the air while connected to a
Bluetooth earpiece can increase a sense of isolation, disconnectedness, and lack of belonging.132
Trying to navigate a bureaucracy via automated phone systems or the internet can frustrate
even the healthiest digital native, and can be traumatizing for an older person who may just
give up.

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Part III: The Reentry Experience

The fast-paced, digital environment is entirely foreign to older people returning home after
25 or more years and becomes an added barrier to employment (discussed further below). Job
searches and applications are all online, and employers look to see which computer programs
applicants have mastered. With the exception of individuals coming home from the federal
system (where there is email access), formerly incarcerated older people will have no experience
completing tasks that are now basic requirements in many jobs: composing an email,
scheduling a meeting on Outlook or Google, or scanning or sending an attachment.

“Everything surprised me. Everything was new. Everything was different.
Flat-screen TVs. Laptops. Going to the bank with a card. Trying to ride
the train. Filling out paperless applications. Going to the grocery store and
scanning my own food, checking my own self out. Getting in a car and
watching it have a camera to see how you’re backing up. Everything.
I felt like I just landed here and I had to learn everything all over again” 133

Ramona Brant
Ramona Brant served 21 years in prison on a life without parole sentence. Granted clemency
by President Obama in 2016, she was released at age 51, and passed away 2 years later.

Employment
The barriers to employment for people with a criminal record are well-documented, including
less employment and lower wages.134 The stigma of incarceration, coupled with limited work
histories, can stifle employment prospects for any returning individual, let alone an older
person. While 18 states and 150 cities and counties have embraced Ban the Box and other
Fair Chance policies, more than 90% of companies still use background checks in their hiring
decisions.135
For many older people who went in as teenagers or young adults, the employment they seek at
age 50 or 60 or older is their first professional employment. Going on a job interview is not only
anxiety-provoking because of the experience and stigma of incarceration, it is actually a foreign
experience. When this is the case, the resume they present may only consist of jobs they held in
prison, none of which would have included using recent technology: email, social media, or cell
phones, or the internet.
Compounding these barriers, the effects of accelerated aging can turn even the mundane
activities of daily life into significant challenges. Jobs that might be more open to hiring
formerly incarcerated people may also require standing all day, manual labor, or travel between
multiple sites per day. Additionally, the age discrimination faced by all older people when
seeking employment is exacerbated by a criminal record and a history of incarceration.
35

Part III: The Reentry Experience

Despite the myriad factors that can make finding employment difficult for recently released
older people, parole stipulations and social welfare programs often require individuals to work
and to find work within a relatively short timeframe, a mandate that becomes exceedingly
more difficult with an increase in age and time served.

Trauma of Long-Term Incarceration
Even if one is technologically savvy and adequately supported with basic needs met, the
trauma that long-term incarceration inflicts can be especially palpable for older people. Decades
worth of confinement in an environment that is designed to create social isolation and distrust
can have a long-lasting impact beyond prison walls. Older people may grow anxious in public
spaces and have difficulty adjusting. Such responses may be challenging for friends, family, and
people offering community support to understand, and can lead to insensitive reactions and
misunderstandings.
Despite the myriad difficulties faced by currently and formerly incarcerated elders before,
during, and after confinement, there are a growing number of programs and organizations
that seek to: 1) improve conditions for older adults inside correctional facilities; 2) advocate
for increased releases; and 3) connect them to quality community support services and
opportunities upon their release. The following section examines these emerging models in
order to provide a road map for further successes, beginning with the work being done behind
prison walls.

“Even after I got home and had been in the house, I still went through
a lot of different changes. Every time somebody knocked at the door,
I would assume it was the police coming to get me, that they made
a mistake. I was having these terrible dreams. I’d wake up in the
middle of the night soaking wet, screaming.” 136

Stanley Mitchell

36

Part IV: The Work Being Done From The Inside Out

Part IV:
The Work Being Done From The Inside Out
As of 2007, fewer than 5 percent of state correctional institutions in the U.S. provided any form
of geriatric-specific services, and there continue to be few evidence-based models targeting
aging individuals within correctional facilities.137 Ten years later, only 75 U.S. prisons (4.1 percent
of the 1,821 total state and federal prisons) provide hospice services for dying incarcerated
people.138 Despite a small increase in services within correctional facilities, the continued
lack of quality programming can be attributed to inadequate funding, limited institutional
understanding of the needs of older adults in prison, and a sentencing and parole system that
encourages extremely long sentences while discouraging community receptivity.
While current federal reentry policy under the Trump administration is not yet fully articulated,
there are indications that in a number of areas that affect older adults returning from
incarceration—including housing, health care, and other benefits and entitlements—cities and
states may need to increase funding to make up for shrinking federal funds. Regardless of these
changes to federal policy, funding to reentry programs and advocacy to support the release of
currently incarcerated older people lags far behind what is needed to address and reverse this
growing crisis.
Nonetheless, a growing number of correctional administrators, criminal justice agencies, and
social service providers are working to address the increasing numbers and needs of elders
in the justice system. While some programs add reentry services to an agency that already
serves older adults, others add a geriatric lens to a criminal justice organization. Efforts may
be focused on making prisons more age-friendly, on facilitating release, on post-release
re-settlement, or on all of these, spanning the entire continuum: improving conditions of
confinement, developing release plans, expanding post-release services, and supporting
families and communities as they welcome returning citizens home.
Examples of programs that address one or more of these goals:
•	 Incarcerated individuals at California’s Men’s Colony offers the Supportive Care Services
program,139 and incarcerated individuals can become “Gold Coats,” receiving training
from the Alzheimer’s Association to care for the daily needs of fellow incarcerated people
living with dementia and to recognize and report on changes in their behavior.140
•	 Based in San Francisco, the Senior Ex-Offender Program (SEOP) is the first reentry
program in the U.S. that exclusively focuses on the aging population. SEOP’s wraparound
services include transitional housing, case management, pre- and post- release
counseling, transitional support groups, health and mental health services, access to a
certified substance use specialists, and useful provisions such as clothing and hygiene
products. Participants engage in services for an average of 3 to 12 months.141
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Part IV: The Work Being Done From The Inside Out

•	 Ohio’s Hocking Correctional Facility was closed in the month prior to publication of this
report.142 Prior to this, in collaboration with the Area Agency on Aging, chronic disease
self-management and diabetes self-management programs were implemented at the
facility. Created at Stanford University, these six-week peer-led programs are grounded
in empirical research and have had positive outcomes.143 Similar programs have also been
implemented in New Jersey and Oklahoma. In addition to robust in prison services, HCF
offered a one-stop pre-release program providing older individuals with age-appropriate
information on housing, employment training and job searching skills, self-care, available
benefits and educational opportunities. HCF trained staff in managing the unique issues
affecting geriatric populations and strived to ensure that they had the proper supports
and resources available for successful reintegration, including placement in nursing
homes when necessary.144
•	 Nevada’s volunteer-driven True Grit program provides a daily structured living program
intended to address the physical, mental, spiritual, and emotional needs and well-being
of the elders in prison. Activities and services include physical therapy and recreation,
group and individual counseling, therapy dogs, musical groups, choir, theater, a published
journal, and craft-making designed to slow the onset of osteoarthritis through fine-touch
movements. An evaluation shows that the program has decreased the number of doctor
visits and medications used by older people while concurrently enhancing levels of social
support and well-being.145
•	 Virginia’s Deerfield Correctional Center, a medium security prison designed to serve the
elderly and handicapped, provides assisted living services and programming, including
peer tutoring, horticulture, and a library that offers assistance for blind and visually
impaired individuals.146
•	 Angola State Prison’s hospice program trains prison staff and incarcerated volunteers
to care for those dying behind prison walls in accordance with national standards for
community hospice programs.147 The prison’s partnership with University Hospital
Community Hospice in New Orleans allows these services to be provided at no additional
cost. Similar hospice services are provided in at least 75 other prisons in 40 states.148
•	 In New York in 2017, Governor Cuomo announced the creation of a Senior Living Dorm
at the Ulster Correctional Facility for fifty men aged 55 and older, offering programs and
services that are age-appropriate and prepare older adults for successful reentry.149
•	 Release Aging People in Prison (RAPP) is a New York based project led and founded by
formerly incarcerated leaders that aims to mobilize currently and formerly incarcerated
individuals, their families, and allies in efforts designed to break down the punishment
paradigm by increasing parole release for aging people in prison.150 Since 2013, RAPP
has worked in coalition with a diverse network of individuals, advocates, communities,
faith-based groups, and organizations across the country to raise public awareness
about the aging prison population, encourage the increased use of release mechanisms,
and advocate for better housing and supportive services for formerly incarcerated older
people. For more information, visit: http://rappcampaign.com

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Part IV: The Work Being Done From The Inside Out

•	 The Tulane Project for Older Prisoners (POPS) employs a risk assessment approach to
help older incarcerated adults obtain parole, pardons, and alternatives to incarceration.151
Law student volunteers assess recidivism risk among eligible individuals aged 55 or older
by conducting interviews and working with candidates identified as low risk to prepare
them for their parole hearing and even advocate the case before the parole board. For
more information, visit: http://www.law.tulane.edu/PublicInterest/index.aspx?id=12416
•	 The Osborne Association’s Elder Reentry Initiative (ERI) was launched in 2015 after
more than a year of planning work by the multi-disciplinary Aging Reentry Task Force
(see page 29). ERI has partnered with the New York State Department of Corrections
and Community Supervision (DOCCS) to assist older people to prepare for parole
consideration and release, including geriatric assessment, age-specific discharge
planning, and ongoing care management once individuals are home.152 ERI care managers
support currently and formerly incarcerated older people in gaining access to housing,
nursing homes, employment, medical care, and benefits. Originally designed to target
people who have served 10 years or more in prison on a parole-eligible sentence and plan
to return to New York City following release, ERI has expanded to serve older men and
women in NYC jails. For more information, visit: http://www.osborneny.org/programs.
cfm?programID=56
•	 In 2017, The Connecticut Department of Corrections received the first-ever certification
by the Centers for Medicare and Medicaid Services (CMS) for a nursing home that houses
older people who have been paroled because of physical or mental illness or disability.153
According to the Department, the certification gives older people with terminal illness
the opportunity to be released on parole in order to receive more appropriate care in
the outside community. The certification allows the state to receive federal Medicaid
and Medicare matching funds and resources and is hailed by many correctional health
officials as a potential treatment model for incarcerated older people with serious
disability or terminal illness.
•	 The Senior Community Service Employment Program, often referred to as Title V, is a
federal program that provides job-training opportunities for people aged 55 and older
and may offer a viable work-training option for formerly incarcerated people.154
•	 Bostick Nursing Center is a new 100,000 square foot nursing center in Milledgeville,
Georgia, privately developed and managed by CorrectHealth LLP in Atlanta on the
grounds of a former prison. Equipped with a 280-bed geriatric care facility, many of
the facility’s patients are formerly incarcerated older people who are medically frail
and have no families or homes to return to upon release. Other patients are individuals
with severe psychiatric and behavioral health conditions that typically restrict them to
a state institution.155
•	 The Resettlement and Care for Older Ex-Offenders and Prisons (RECOOP) is a program
that promotes care, resettlement, and rehabilitation for currently and formerly
incarcerated older people in the United Kingdom with support services, advocacy,
financial advice, mentoring, housing, and healthcare.156 In 2017, RECOOP hosted Osborne
Association delegates, as part of a joint project that included the Brookdale Center for
Healthy Aging at the Hunter College School of Social Work, to develop and strengthen
programming that supports communities to better integrate re-entering older adults.
39

Part V: The Work To Be Done: Recommendations

Part V:
The Work To Be Done: Recommendations
The issue of aging people in prison can be interpreted through several lenses: an unintended
consequence of “tough on crime” policies, a human rights crisis, a matter of economic urgency,
a public health crisis, an extension of a racialized punishment paradigm, or a reflection of
the critical shortcomings of our criminal justice system. Any serious and sustainable attempt
to resolve this crisis must address the needs of those aging in prison and increase their
opportunities to rejoin their families and communities with adequate support. Any solution
must also grapple with the roots of this crisis, which includes shifting how we respond to
violence. While we know enough to act now, research to better understand emerging trends
(such as an increasing number of older people being arrested, often not for the first time) is
also needed. This section primarily focuses on those who have become older while incarcerated
for lengthy sentences and provides concrete and immediate recommendations across the
continuum of incarceration, discharge planning, release, and lasting reentry. It also includes
some recommended improvements that are not specific to older people, but would benefit
incarcerated people of any age.
The recommendations are organized into five sections:
1.	 Improving conditions inside of prisons and jails for those aging within them,
including strengthening staff capacity to recognize and address aging issues, and
adopting policies and practices that are age-considerate;
2.	 Improving discharge planning and reentry preparation for older people within
correctional facilities;
3.	 Expanding specific release mechanisms for older people;
4.	 Improving the reentry experience of older returning citizens by increasing
community supports and receptivity, including addressing their housing, medical/
health, mental health, post-incarceration, financial, family, and employment needs.
5.	 Shifting our response to violence by expanding the range of services offered to
victims and survivors of crime, and reducing excessively long sentences for all crimes
of conviction, including for violent crimes, that drive the crisis of aging in prison.

40

Part V: The Work To Be Done: Recommendations

The first section is the most extensive in part because the aging crisis was first felt inside of
corrections forcing a growing awareness of the disconnect between correctional systems and the
needs of older adults and leading to an understanding of needed reforms as detailed here. Despite
the detail provided in section one, the solutions to addressing this crisis lie largely outside of
corrections so that the needs of older adults can be met in the community and with family.

Recommendation One:
Improve conditions inside of prisons and jails for those aging within them, including
strengthening staff capacity to recognize and address aging issues, and adopting policies
and practices that are age-considerate;
Policies and Protocols
•	 Define and universalize the age at which an incarcerated person is considered ‘aging’
and encourage correctional systems to recognize this population as a unique subgroup with specialized needs.157
•	 Develop and integrate models and best practices for geriatric care into the National
Commission on Correctional Health Care standards.158
•	 Consider and adapt the World Health Organization’s 8 domains of age-friendly
communities for the correctional setting.159
•	 Design and implement geriatric assessments and care plans within correctional
settings that evaluate the needs of older adults starting at age 50, and just prior to
their release to connect them with appropriate community-based service providers.
Geriatric assessments should be re-administered at regular intervals consistent with
the community standard.
•	 For those over the age of 50 detained in jail and pre-trial, utilize geriatric assessments
to consider alternatives to incarceration that meet the underlying issues including
those related to aging (like possible onset of dementia).
•	 Offer advanced care planning and health care proxies for those over age 50.
•	 Amend the disciplinary process to consider administering dementia screenings for
anyone over age 50 who receives a “ticket” (disciplinary charge) if they have no
infraction history within the prior 10 years.
•	 Allow older incarcerated people to “retire” and be provided a pension-like
retirement benefit—to be allowed to stop working at age 65 while permitting
program participation upon request, and continuing income based on prior work
and earnings history.

41

Part V: The Work To Be Done: Recommendations

“Health care professionals and criminal justice administrators
should be coming together …to evaluate people for release…
We need to develop different approaches to their parole that are
informed by their medical state.” 160

Brie Williams
Brie Williams, MD, Professor of Medicine and Director of the Criminal
Justice & Health Program at University of California at San Francisco, and
Director of the Criminal Justice and Aging Project of Tideswell, UCSF

Program Enhancements
•	 Introduce support groups for older adults and geriatric counseling for stress and trauma.
•	 Maximize age-appropriate exercise opportunities and age-friendly, illness informed diets
to prevent earlier onset of aging, disease, disability and terminal illness.
•	 Promote cross-generational learning by allowing younger people newly admitted
into prison to teach older people about technological and transportation updates,
and encourage older long-term incarcerated individuals to “mentor” younger newly
admitted individuals.
•	 Test and measure interventions that decrease medical costs while maintaining
healthcare quality, incorporating existing gerontological models.

Age-friendly environments
•	 Modify structural conditions within correctional institutions through age-appropriate
retrofitting161 and conduct additional research into architectural modifications that may
produce positive outcomes for aging individuals, e.g. minimizing risk of falls.162
•	 Identify activities of daily living that are prison-specific in order to recognize functional
impairment among the incarcerated population.163
•	 Research the benefits of segregating versus integrating incarcerated older people from
the general prison population to help develop effective and appropriate correctional
housing models.164

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Part V: The Work To Be Done: Recommendations

Staff Training
•

Train correctional staff in geriatric care techniques and empower them with the
knowledge to respond to the physical, mental, emotional, and gender-specific needs
of the aging population.165

•

Incorporate ongoing feedback from correctional officers, medical staff, and other
on-site providers.166

•

Train medical providers in the application process for medical parole and
compassionate release.

Recommendation Two:
Expand and implement specific release mechanisms for older people.
•

Implement and expand specific release mechanisms for older people, including
presumptive parole, which assumes that parole-eligible applicants are suited for
release unless they are deemed as posing an unreasonable risk to public safety based
on institutional history, risk assessment, or other validated measure.

•

Mandate that parole boards interview all older parole applicants in person rather than
by video, a practice that is particularly confusing and disorienting to older people.

•

Ensure that parole boards are trained in the effects of long-term incarceration and aging
in prison (including accelerated aging and the low risk to public safety), and take into
account the age at which an individual is appearing in front of them, as well as the age
at which they were sentenced.

•

Increase utilization of compassionate release and medical parole policy by broadening
eligibility criteria and streamlining the process for approval, including the availability
of “fast-tracking” medical parole, should the individual’s condition significantly or
suddenly decline.

•

Provide enhanced Medicaid rates to nursing homes for formerly incarcerated elders and
guarantee that in-prison medical units are equivalent to hospital stays for the purposes
of Medicaid reimbursement.

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Part V: The Work To Be Done: Recommendations

Recommendation Three:
Improve discharge planning and reentry preparation for older adults.
•	 Ensure correctional staff have access to up to date community resources including senior
centers, nursing homes, assisted living, and affordable or supportive housing for older
adults, in order to create tailored discharge plans for older adults.
•	 Apply a family-focused discharge planning model to identify, engage, and incentivize
family members who may be able to support the older person’s reentry, including
offering mediation, enabling a reconnection following years or decades of separation.
•	 Increase access to and training with modern technology, such as cell phones, computers,
email, and the Internet to ensure that incarcerated older people have meaningful access
to and practice with essential technology prior to their release.

“We need to foster an environment of trust and engage in frank dialogue
with the community to allay fears or concerns people may have regarding
formerly incarcerated individuals who are reentering the community.
We...encourage all community members to view our patients in the same
manner as other patients and community-based care recipients” 167

Lynn Cortella
RN BSN, CCHP, CCM, Formerly of NYS
Department of Corrections and Community Supervision
		

Recommendation Four:
Improve the reentry experience of older people coming home by increasing community
supports and receptivity, and addressing their post-incarceration housing, medical 	
health, mental health, financial, family, and employment needs (ensuring that the 	
8 domains of age-friendly communities are realities for older people returning home 	
from incarceration).168
•	 Partner with housing advocates and housing providers in order to increase the supply of
supportive housing that meets peoples’ age-specific and reentry-related needs.
•	 Provide financial subsidies for families to house and better support their recently released
loved ones through a kinship reentry program (similar to kinship foster care).

44

Part V: The Work To Be Done: Recommendations

•	 Ensure continuity of care through specialized transitional planning and follow up
for the aging population, including connection to geriatricians, health insurance and
care coordinators.169
•	 Engage the academic and medical establishments that focus on aging to conduct
research and expand services that identify the needs and concerns of the aging reentry
population and the communities to which they will return.
•	 Develop infrastructure within communities to receive and serve returning elders,
including enhancing the capacity of senior centers, Naturally Occurring Retirement
Communities (NORCs), community centers and houses of worship that offer activities
geared toward older adults.
•	 Expand community-based reentry services to rural and suburban areas to meet the
increasing needs of older adults returning to traditionally under-resourced areas.
•	 Utilize the assets of older adults who want to work post-release, including allowing them to
provide care for others, removing restrictions for working in home health care, hospice and
other jobs for which there are typically blanket bans for individuals with felony records.

Recommendation Five:
Shift our response to violence by expanding the range of services offered to victims and
survivors of crime, and reducing excessively long sentences for all crimes of conviction
(including for violent crimes) that drive aging in prison.

Victims must be offered more than one way of seeking justice.
Our justice system should empower victims by providing them
with meaningful avenues to voice their needs. We must also invest
in other responses to violent crime besides long-term incarceration
that prioritize survivors’ well-being by promoting
true accountability and reducing recidivism.170
•	 Provide crime survivors with options beyond incarceration to hold those who committed
harm accountable, including alternatives to incarceration programs, shorter prison
sentences, restorative practices, and expanded prevention and rehabilitation services.171
•	 Create forums where policy makers and the public are presented with the latest research
about what the broad cross-section of crime victims and survivors are saying they want,
and ensure that these voices are informing policy development and criminal justice
responses, including ending the reliance on extreme sentences that fail to provide healing
and safety for victims while contributing to the growing crisis of those aging in prison.
While no single recommendation will serve as panacea to the challenges facing the aging prison
population, a shift to embrace any of the above recommendations will move the needle toward a
more compassionate, fair, and humane justice system. With support from key stakeholders, many
of these recommendations can be piloted or fully implemented within a realistic timeframe.

45

Conclusion: Toward a New Paradigm of Justice

Conclusion:
Toward a New Paradigm of Justice
The aging prison population is a logical conclusion of retributive criminal justice policies that
have led the United States to incarcerate more people than any country in the world. These
well-entrenched policies—the result of a confluence of attitudes, ideas, and events, and
grounded in the now bankrupt (though recently reinvigorated) “tough on crime” ideology—
have brought us to the precipice of an unmitigated human-made disaster.
The traditional criminal justice framework of the United States holds that punishment
serves four distinct functions: retribution, deterrence, rehabilitation, and incapacitation. As
this report and others have made clear, the perpetual incarceration of aging people does
not justifiably fulfill these purposes. Retribution—ensuring that the punishment fits the
crime—is glaringly undermined by the fact that many individuals have already served more
than their minimum sentences, often more than the sentencing judge would have imposed
were it not for stringent mandatory minimum guidelines. The use of long sentences as
effective deterrence is undermined by longstanding research showing that long sentences
do little, if anything, to deter crime.172 Furthermore, the older incarcerated person suffering
from dementia and chronic illness who cannot recall their crime has little to gain from
rehabilitative programming, and most other incarcerated elders have already completed
all available programming far before their minimum sentences expire. Finally, the physical
and mental impairments and deteriorating health that accompany old age (accelerated by
the years spent in prison and adverse living environments prior to incarceration) essentially
function as a debilitating force, rendering further incapacitation via continued incarceration
unnecessary and inhumane.
If the goal of the criminal justice system is public safety and the point of incarceration is
retribution, deterrence, rehabilitation, and incapacitation, then we gain little by keeping people
behind bars up until and through older age.
When this paper was first published in 2014, changes were on the horizon. Policy makers at all
levels of government were expressing the many shortcomings of existing criminal justice policy
and repeatedly advocating for significant reform for those with non-violent and drug-related
convictions. It is only more recently that calls for reform have pointed out that meaningful
reductions in incarceration require confronting the role violence plays, in regards to both
victims and those aging in prison, while serving lengthy sentences for violent crimes.
Clearly, aging people in prison experience greater hardships and worse health outcomes while
incarcerated, and have unique needs that place enormous strain on correctional institutions.
Older people comprise the most expensive cohort to incarcerate while posing the least danger to
public safety. While architectural and programmatic modifications within prisons are necessary
46

Conclusion: Toward a New Paradigm of Justice

components of meaningful change, merely making living conditions more amenable to the
needs of the infirm and frail is not a comprehensive nor cost-effective solution. At the same
time, releasing people en masse without a comprehensive plan for their reentry will simply
create a new humanitarian crisis.
The complexity of the crisis that surrounds currently and formerly incarcerated elders
requires a strategic response that is versatile and multifaceted, addressing the issue at
multiple points of intervention with involvement from diverse stakeholders. When the
Aging Reentry Task Force convened stakeholders in 2014, it demonstrated the importance
of the leadership of formerly incarcerated older people, as well as the involvement of the
criminal justice, corrections, health and mental health, aging, and philanthropy sectors. Such
expertise, leadership, and participation, of directly affected individuals was critical to the
Task Force’s success and to continued efforts to address what is least effective in our criminal
justice system.
Looking ahead, the fields of gerontology, philanthropy, health, workforce development, and
corrections are uniquely positioned and qualified to collectively inform and implement shortterm and long-term solutions to this issue. There are new opportunities to join forces with
those addressing the shifting demographics of the United States—every 8 seconds an American
turns 65 (almost 4 million per year)173—and the 215 communities, cities and counties across 41
states and Puerto Rico that are considering what it means to become “age-friendly.”174 Armed
with critical interdisciplinary/intersectoral knowledge and backed by investment from the
philanthropic community, collaborative partnerships possess unparalleled opportunity to make
lasting contributions to the policies and best practices affecting the aging prison population.
This joint stakeholder alliance is particularly well suited to enrich the reentry process, first by
identifying those factors that older, formerly incarcerated people require in order to thrive
upon their release to the community and, subsequently, by creating resources and pathways
for their success. The result will be tremendous cost savings, improved public health outcomes,
economic growth, a commitment to human rights and the vibrancy and valuable contributions
of older people, and the freedom for our elders to live the remainder of their lives in their
communities and to die with grace in the presence of friends and family.

47

Appendix A

Appendix A
Bibliography of Research on Currently and Formerly
Incarcerated Older People: Reports and Substantive Articles:
2014-2017
Reports:
Supporting America’s Aging Prison Population: Opportunities and Challenges for Area Agencies
on Aging. National Association of Area Agencies in Aging (February 2017). Available at:
https://www.n4a.org/Files/n4a_AgingPrisoners_23Feb2017REV (2).pdf
A Matter of Time: The Causes and Consequences of Rising Time Served in America’s Prison.
(2017). The Urban Institute. Available at: http://apps.urban.org/features/long-prison-terms/
reform.html. The online resource offers the latest data and impact on long and life sentences
in U.S. prisons, and includes how long sentences lead to aging in prison. The tool also offers
narratives from people who served long sentences, as well as policy recommendations.
New York State’s Aging Prison Population (2017). Office of the New York State Comptroller.
Available at: http://www.osc.state.ny.us/reports/aging-inmates.pdf. The report offers some of
the fiscal implications of having such a high number of older people in NYS prisons.
Caged In: Solitary Confinement’s Devastating Harm on Prisoners with Physical Disabilities
(2017). American Civil Liberties Union. Available at: https://www.aclu.org/sites/default/files/
field_document/010916-aclu-solitarydisabilityreport-single.pdf. The report offers national
data and information on people with disabilities in solitary, and incorporates the disability
difficulties that older people face leading up to, in, and after solitary.
Still Life: America’s Increasing Use of Life and Long-Term Sentences (2017). The Sentencing
Project. Available at: http://www.sentencingproject.org/publications/still-life-americasincreasing-use-life-long-term-sentences/. This report builds off of the Sentencing Project’s 2013
report, “Life Goes On: The Historic Rise of Life Sentences in America,” both of which provide
national data and analyses on the increase of life sentences in the U.S., and incorporate and cite
older people and aging as a direct result of the increase in sentences.
Aging in Prison: A Human Rights Problem We Must Fix (2017). American Friends Service
Committee. Available at: https://www.afsc.org/sites/afsc.civicactions.net/files/documents/
Aging%20in%20prison%20report%202017_new.pdf. The report briefly reviews the aging in
prison crisis by the numbers, and has a particular focus on the issue in New Jersey.
Aging of the State Prison Population, 1993-2013. (2016). Bureau of Justice Statistics. Available
at: https://www.bjs.gov/content/pub/pdf/aspp9313.pdf. The DOJ report outlines the increase
in older people in state prisons throughout the U.S. over a 20-year period. It provides data on
48

Appendix A:

by age, sentence, crime of conviction, race, and highlights some of the reasons for the large
increase in the older population.
The Impact of an Aging Inmate Population on the Federal Bureau of Prisons (2016). The Office of
the Inspector General. Available at: https://oig.justice.gov/reports/2015/e1505.pdf. The report
outlines the older prison population at the Federal level with an analysis of the difficulties the
BOP has had as a result. They also offer recommendations including in increase in the use of
compassionate release, oversight and training of the BOP, and the development of age-specific
programs.
Mortality in State Prisons, 2001-2014. (2016). Bureau of Justice Statistics. Available at: https://
www.bjs.gov/content/pub/pdf/msp0114st.pdf. The report provides statistics on data on death
and dying in State and Federal prisons between 2001 and 2014. It highlights older people as
the age demographic with the highest rates and whole numbers of deaths inside. The report
also highlights that older people deaths have exponentially increased over the last 13 years,
compared to overall decreases in deaths of all other age demographics.
False Hope: How Parole Systems Fail Youth Serving Extreme Sentences. (2016). American Civil
Liberties Union. Available at: https://www.aclu.org/report/report-false-hope-how-parolesystems-fail-youth-serving-extreme-sentences. The report takes an in-depth look into the U.S.
legacy and impact of Life and Life-Without Parole sentences on people convicted as juveniles,
and covers the impact of how these punitive sentences lead directly to people growing old in
prison.
Delaying a Second Chance: The Declining Prospects For Parole on Life Sentences (2016).
The Sentencing Project. Available at: http://www.sentencingproject.org/wp-content/
uploads/2017/01/Delaying-a-Second-Chance.pdf. The report documents the devastating impact
of increasingly punitive parole policy and practice for people with life sentences, and mentions
older people, with specific pullouts on New York and John MacKenzie.
Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety. (2015). The Center for
Justice at Columbia University. Available at: http://centerforjustice.columbia.edu/files/2015/10/
AgingInPrison_FINAL_web.pdf. The report outlines the topic, the work being done to combat
the issue, and recommendations for future work.
Aging Behind Bars: Trends and Implications of Graying Prisoners in the Federal Prison System.
(2014). The Urban Institute. Available at: http://www.urban.org/research/publication/agingbehind-bars-trends-and-implications-graying-prisoners-federal-prison-system/view/full_report.
The report offers data and trends of the increase of older people in prison in the Federal Prison
System and the implications of such trends. The report also offers recommendations including,
greater research and monitoring of the issue.

Substantive Articles:
Wheeler, L. (2017) Senator Push Federal Prisons to Expand Compassionate Release. The Hill.
Available at: http://thehill.com/regulation/345210-senators-push-federal-prisons-to-expandcompassionate-release

49

Introduction

Wisnieski, A. (2017). ‘Model’ Nursing Home for Paroled Inmates to Get Federal Funds.
Connecticut Health I-Team. Available at: http://c-hit.org/2017/04/25/model-nursing-home-forparoled-inmates-to-get-federal-funds/
NY Times Editorial Board (2017). Why Keep the Old and Sick Behind Bars? The New York Times.
Available at: https://www.nytimes.com/2017/01/03/opinion/why-keep-the-old-and-sickbehind-bars.html
Neumann, Ann. (2016). What Dying Looks Like in America’s Prisons. The Atlantic. Available at:
https://www.theatlantic.com/health/archive/2016/02/hospice-care-in-prison/462660/
Cohen, Andrew (2015). Older Prisoners, Higher Costs. The Marshall Project. Available at:
https://www.themarshallproject.org/2015/05/06/older-prisoners-higher-costs#.lDD4IXRnP
Lopez, German (2015). Why Keeping Elderly Criminals in Prison is a Waste of Your Money. Vox.
Available at: https://www.vox.com/2015/5/4/8545435/aging-prisoners-mass-incarceration
Horwitz, Sari (2015). The Painful Price of Aging in Prison: Even as Harsh Sentences are
Reconsidered, the financial-and human-tolls mount. The Washington Post. Available at:
http://www.washingtonpost.com/sf/national/2015/05/02/the-painful-price-of-aging-inprison/?utm_term=.9bcf92b64520
Fellner, Jamie (2015). Dispatches: Ever More US Prisoners Growing Old Behind Bars. Human
Rights Watch. Available at: https://www.hrw.org/news/2015/02/09/dispatches-ever-more-usprisoners-growing-old-behind-bars
Schwartzapfel, Beth (2015). Why it’s Hard to be a Lifer Who’s Getting Out of Prison. The
Marshall Project. Available at: https://www.themarshallproject.org/2015/12/04/why-it-s-hardto-be-a-lifer-who-s-getting-out-of-prison?utm_medium=social&utm_campaign=sprout&utm_
source=twitter#.Ui2YHRv5H
Chammah, Maurice (2015). Do You Age Faster in Prison? The Marshall Project. Available at:
https://www.themarshallproject.org/2015/08/24/do-you-age-faster-in-prison#.NvmtHHkZA
Trounstine, Jean (2015). A Moral Imperative: Release Aging and Long-Term Prisoners. Truthout.
Available at: http://www.truth-out.org/news/item/29028-a-moral-imperative-release-agingand-long-term-prisoners
Bedard, Rachel. (2015). When Dying Alone is Too Harsh a Sentence. The New York Times.
Available at: https://www.nytimes.com/2015/12/28/opinion/when-dying-alone-in-prison-istoo-harsh-a-sentence.html?_r=2
Law, Victoria (2014). You’re Old & Finally Out of Prison: What Happens Now?. The Gothamist.
Available at: http://gothamist.com/2014/09/18/elderly_ex_prisoners_nyc.php
Additional reports available at http://rappcampaign.com/reports/

50

Appendix B

Appendix B
Justice Department Inspector General’s 2016 recommendations
to address the impact of an aging incarcerated population within
Federal prison
(Available at: https://oig.justice.gov/reports/2015/e1505.pdf)

Recommendations
To ensure the BOP continues to provide safe, humane, and cost-efficient care within its
institutions and to further assist the BOP in managing its aging inmate population, reducing
overcrowding, and reducing incarceration costs, we recommend that the BOP:
1.	 Develop national guidelines for the availability and purpose of inmate companion programs.
2.	 Consider the feasibility of placing additional Social Workers in more institutions,
particularly those with larger populations of aging inmates.
3.	 Provide all staff training to identify signs of aging and assist in communicating with
aging inmates.
4.	 Reexamine the accessibility and the physical infrastructure of all of its institutions to
accommodate the large number of aging inmates with mobility needs.
5.	 Study the feasibility of creating units, institutions, or other structures specifically for
aging inmates in those institutions with high concentrations of aging inmates.
6.	 Systematically identify programming needs of aging inmates and develop programs and
activities to meet those needs.
7.	 Develop sections in release preparation courses that address the post-incarceration
medical care and retirement needs of aging inmates.
8.	 Consider revising its compassionate release policy to facilitate the release of appropriate
aging inmates, including by lowering the age requirement and eliminating the minimum
10 years served requirement.

51

Endnotes

Endnotes
1	

The Sentencing Project (September 12, 2017), Black disparities in youth incarceration. Washington DC.
Available at: https://goo.gl/GrHyqA

2	

Center for American Progress (2015). 8 Facts You Should Know About the Criminal Justice System and People of Color.
Available at: https://goo.gl/5axNKK

3	

Vera Institute of Justice (2016). Overlooked: Women and Jails in an Era of Reform. NYC. https://goo.gl/dmMDbZ

4	

NAACP (2016). Criminal Justice Fact Sheet. Available at: https://goo.gl/xQ6RYP

5	

FBI Uniform Crime reports (September, 2016). Crime in the United States, 2015. Available at: https://goo.gl/uW275C

6	

Friedman, M., Grawert, A., and Cullen, J. (2017). Crime Trends: 1990-2016. Brennan Center for Justice.
Available at: https://goo.gl/1ByRQ8

7	

Gelb, A. and Denney, J. (January 16, 2018). “National Prison Rate Continues to Decline Amid Sentencing, Reentry Reforms.” Public
Safety Performance Project, Pew Charitable Trusts. Available at: https://goo.gl/eFKihM

8	

Chettiar, I., Bunting, W. & Schotter, G. (2012). At America’s Expense: The Mass Incarceration of the Elderly. American Civil Liberties
Union. Available at: https://goo.gl/QLVP7K

9	

Center for Justice at Columbia University (2015). Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety.
Available at: https://goo.gl/dkp7MJ

10	 Williams, B. et al. Aging (2012). Aging in Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care. Framing Health
Matters. American Journal of Public Heath. Available at: https://goo.gl/KpKJMb
11	 National Prison Rate Continues to Decline Amid Sentencing, Reentry Reforms (January 16, 2018). Available at: https://goo.gl/eFKihM
12	 New York State Department of Corrections and Community Supervision (April 2016). Under Custody Report: Profile of Under Custody
Population as of January 1, 2016. Available at: https://goo.gl/NJCRCW
13	 E. Ann Carson & W. J. Sabol. (2016). Aging of the State Prison Population, 1993-2013. Bureau of Justice Statistics.
Available at: https://goo.gl/WQ5kGv
14	 Id., p.26
15	 ACLU (June 2012). At America’s Expense: The Mass Incarceration of the Elderly. p.i. Available at: https://goo.gl/RBxBCt
16	 Highest to Lowest Prison Population Total (2016). World Prison Brief. Available at: https://goo.gl/X1SERc
17	 Id.
18	 Email communication with NYS DOCCS Program Planning, Research, and Evaluation Division (November 16, 2017). As of end
November 2017, those over age 50 made up 20.8% of New York State’s prison population.
19	 California Department of Corrections and Rehabilitation (2014). Prison Census Data as of December 31, 2013.
Available at: https://goo.gl/Bb8TGf; Pennsylvania Department of Corrections Annual Statistics Report (2015).
Georgia Department of Corrections Inmate Statistical Profile (2016). Available at https://goo.gl/vnAwMT; Illinois Department of
Corrections Fiscal Year Annual Report (2015). Michigan Department of Corrections Annual Statistical Report (2016). Available at:
https://goo.gl/eeSvCT; Texas Department of Criminal Justice Statistical Report (2015). Available at: https://goo.gl/Lesups; Ohio
Department of Rehabilitation and Correction Census of Institutional Population (2016). Available at: https://goo.gl/EMK12f; Florida
Department of Corrections Annual Report (2015). Available at: https://goo.gl/q67Pqp
20	 Id.
21	 American Civil Liberties Union (2016). American Civil Liberties Union. False Hope: How Parole Systems Fail Youth Serving Extreme
Sentences. Available at: https://goo.gl/VJppFt
22	 Pew Center on the States. (2011). State of Recidivism: The Revolving Door of America’s Prisons. Washington, DC: The Pew Charitable
Trusts.
23	 American Civil Liberties Union (June 2012). At America’s Expense: The Mass Incarceration of the Elderly.
Available at: https://goo.gl/Ko2RfM
24	 NYS DOCCS (December 2016), 2012 Inmate Releases: Three Year Post-Release Follow-Up. Available at: https://goo.gl/J9x9vV
25	 Id.
26	 Ghandnoosh, N. et al. (2016). Delaying a Second Chance: The Declining Prospects For Parole on Life Sentences. The Sentencing Project.
Available at: https://goo.gl/zeHJJv
27	 Nellis, A. et al. (2013) Life Goes On: The Historic Rise in Life Sentences in America. The Sentencing Project.
Available at: https://goo.gl/oRqkdk
28	 Id. p. 13

52

Endnotes
29	 Carson, A.E., and Sabol, W.J. (May 19, 2016). Aging of the State Prison Population: 1993-2013. Bureau of Justice Statistics, Office of
Justice Programs. p. 5. Available at: https://goo.gl/V8tJGf
30	 There is a significant body of research on “aging out of crime.” See: https://goo.gl/ZhRAQb and the National Institute of Justice’s
https://goo.gl/4mbjwH among many sources.
31	 The Sentencing Project (January 2017), Delaying a Second Chance: Declining Prospects for Parole on Life Sentences.
Available at: https://goo.gl/mq8bm6
32	 Schwartzapfel, B. (2017). Life Without Parole. The Marshall Project. Available at https://goo.gl/xj3bbM
33	 A recent survey conducted by the Robina Institute found that Parole Boards nationwide consider, by varying degrees, some number of
17 factors by which they determine whether or not to grant an individual parole. Ruhland, E.L., Rhine, E.E., Robey, J.P., and Mitchell, K.L.
(2016). The Continuing Leverage of Releasing Authorities: Findings from a National Survey. Robina Institute of Criminal Law and Criminal
Justice. Available at: https://goo.gl/qaNE2z
34	 Id. p. 27
35	 The Sentencing Project (January 2017), Delaying a Second Chance: Declining Prospects for Parole on Life Sentences.p.14.
Available at: https://goo.gl/mq8bm6
36	 Rounded up from 20.6%. Citation: DOCCS report (2015)“Medical Parole, 2014.” p. 3 available at: https://goo.gl/vGXbhw
37	 Id. p.3.
38	 Schwartz, J. (October 4, 2013). Herman Wallace, Freed After 41 Years in Solitary, Dies at 71. New York Times.
Available at https://goo.gl/ZhRAQb
39	 Democracy Now! (2016). Longtime Prisoner Mohaman Koti Dies at 89 2 Months After Release. Available at: https://goo.gl/cHfevM
40	 Office of the Inspector General U.S. Department of Justice(2016). The Impact of an Aging Inmate Population on the Federal Bureau of
Prisons. Available at: https://goo.gl/aX6SY1
41	 Wheeler, L. (2017) Senator Push Federal Prisons to Expand Compassionate Release. The Hill. Available at: https://goo.gl/2pR8xK
42	 Chiu, T. (2010). It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release. Vera Institute of Justice. Available at
https://www.vera.org/publications/its-about-time-aging-prisoners-increasing-costs-and-geriatric-release
43	 Id.
44	 Maschi, T., Viola, D. & Sun, F. (2012). “The High Cost of the International Aging Prisoner Crisis: Well-Being as the Common Denominator
for Action.” The Gerontologist, Oct 4 2012, 1-12.
45	 Center for Justice at Columbia University (Nov. 2015). Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety. p. .3.
46	 There are many examples of this, among them: https://goo.gl/PW7XX8
47	 Associated Press (October 13, 2015). “Prosecutors, sheriffs oppose parole changes in Mich. Bill.” Corrections One. https://goo.gl/KtKZBF
48	 Pishko, J. (October 18, 2017). Prosecutors are banding together to prevent criminal justice reform. The Nation.
Available at: https://goo.gl/1qv7bx
49	 Tatum, Sophie (November 8, 2017). Progressive Civil Rights Lawyer to be the Next Philadelphia District Attorney.
Available at: https://goo.gl/jsTgqw
50	 The Sentencing Project (January 2017), Delaying a Second Chance: Declining Prospects for Parole on Life Sentences. p.11.
Available at: https://goo.gl/W6SFgM
51	 Schwartzapfel, B. (July 11, 2015). “How Parole Boards Keep Prisoners in the Dark and Behind Bars.” The Washington Post.
Available at: https://goo.gl/ESqVQZ
52	 Durose, M. Cooper, A.D., and Snyder, H. N. (April 22, 2014). Recidivism of Prisoners Released in 30 States in 2005: Patterns from 2005 to
2010. Bureau of Justice Statistics, Office of Justice Programs. Available at: https://goo.gl/mUU8HF
See also: www.cdcr.ca.gov/BOPH/docs/.../Recidivism_Rates_Long_Term_Offenders.pdf
53	 Sered, D. (2017) Accounting for Violence: How to Increase Safety and Break Our Failed Reliance on Mass Incarceration. Vera Institute of
Justice. Available at: https://goo.gl/7V5i42
54	 Gilligan, J. (1996). Violence: Our Deadly Epidemic and Its Causes. Putnam Publishing Group.
55	 Borum, R. (2000). Assessing Violence Risk Among Youth. Journal of Clinical Psychology.
56	 Alliance for Safety and Justice Press Release (October 2017). “Michigan launches first trauma recovery center in Flint for victims of
violent crime.” Available at: https://goo.gl/ZXL4wS
57	 Id.
58	 Sered, D. (2017) Accounting for Violence: How to Increase Safety and Break Our Failed Reliance on Mass Incarceration. Vera Institute of
Justice. p.4. Available at: https://goo.gl/7V5i42
59	 Hanson Treen, B. (August 23, 2017), A Former Parole Commissioner on Aging & Changing. Available at: https://goo.gl/NiGP9A
60	 The Alliance for Safety and Justice (2016). Crime Survivors Speak: The First-Ever National Survey of Victims’ Views on Safety and Justice.
(2016). Available at: https://goo.gl/C4LPfE
61	 Id. p. 5

53

Endnotes
62	 Spectrum News Capital Region: Capital Tonight (2017). Proposed Changes to the Parole System.
Retrieved from http://www.twcnews.com/nys/capital-region/capital-tonight-interviews/2017/05/9/parole-panel-050917.html
63	 Id.
64	 Id. p. 5
65	 Maschi, T (2012). Aging in the Criminal Justice System Webinar: Part I. National Organization of Forensic Social Work.
Retrieved from https://goo.gl/gcMCyR
66	 Linder, J and Meyers, F. (2009). Palliative and End-of-Life Care in Correctional Settings. Journal of Social Work in End-of-Life & Palliative
Care, 5, 7-33.
67	 Aday R. (2003). Aging Prisoners: Crisis in American Corrections. Westport, CT: Praeger Publishers.
68	 Dawes, J. (2009). Aging prisoners: Issues for social work. Australian Social Work, 62, 258 – 271.
69	 Id.
70	 Jaye Anno, B. et al (2004). Correctional Health Care: Addressing the Needs of Elderly, Chronically Ill, and Terminally Ill Inmates. U.S.
Department of Justice National Institute of Corrections. Available at https://info.nicic.gov/nicrp/node/244
71	 Reimer, G. (2008). The graying of the U.S. prisoner population. Journal of Correctional Health Care, 14, 202–208.
72	 American Civil Liberties Union (2017). Caged In: Solitary Confinement’s Devastating Harm on Prisoners with Physical Disabilities.
Available at: https://goo.gl/9YAd1n
73	 National Institute of Aging recommends four types of exercise as important for healthy aging: endurance, strength, balance, and
flexibility. National Institute on Aging: https://goo.gl/yKtHmt
74	 Urban Institute (2017). A Matter of Time: The Causes and Consequences of Rising Time Served in America’s Prisons.
Available at: https://goo.gl/dkSbDV
75	 Caverly S. (2006). Older mentally ill inmates: A descriptive study. Journal of Correctional Health Care, 12, 262– 268.
76	 Williams, B., Baillargeon, J., Lindquist, K. et al. (2009). Medication prescribing practices for older prisoners in the Texas prison system.
American Journal of Public Health, 100, 756–761.
77	 Koenig, H.G., Johnson, S., Bellard, J., Denker, M., & Fenlon, R. (1995). Depression and anxiety disorder among older male inmates at a
federal correctional facility. Psychiatric Services, 46, 399–401.
78	 Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older adults. The Gerontologist, 44, 615–623.
79	 Loeb, S.J., Abudagga, A. (2006). Health-related research on older inmates: An integrative review. Research in Nursing & Health, 29, 556–565.
80	 Freudenberg, N. (2001). Jails, prisons, and the health of urban populations: A review of the impact of the correctional system on
community health. Journal of Urban Health, 78, 214–235.
81	 James, D. and Glaze, L. (2006). Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates. U.S.
Department of Justice, Office of Justice Programs.
82	 Williams, B., Baillargeon, J., Lindquist, K. et al. (2009). Medication prescribing practices for older prisoners in the Texas prison system.
American Journal of Public Health, 100, 756–761.
83	 Haney, C. (2001). The psychological impact of incarceration: implications for post-prison adjustment. Prepared for the “From Prison to
Home” Conference (January 30-31, 2002). Accessible at: https://goo.gl/kVmUsj
84	 Fazel, S., McMillan, J., & O’Donnell, I. (2002). Dementia in prison: Ethical and legal implications. Journal of Medical Ethics, 28,156–159.
85	 Pew Charitable Trusts. (2010). Collateral Costs: Incarceration’s Effect on Economic Mobility. Washington, DC: The Pew Charitable Trusts.
86	 “With few exceptions, inmates are required to work if cleared by medical professionals at the prison. Punishments for refusing to do
so include solitary confinement, loss of earned good time, and revocation of family visitation.” https://goo.gl/1UTboM
87	 This is the range for non-industry jobs. “Industry jobs” (jobs in state-owned businesses) on average pay about $1.41 per hour.
https://goo.gl/9YJzYF
88	 See Brown v. Plata, United States Supreme Court, 131 S. Ct 1910 (2011).
89	 “Using the middle estimate [$68,270 per year for an older person which is twice that of a younger incarcerated person], it costs
taxpayers $16 billion every year to incarcerate the 246,600 prisoners age 50 and older—a relatively low-risk population.” (p.28)
Chettiar,I., Bunting, W., and Schotter, G. (June 2012). At America’s Expense; the Mass Incarceration of the Elderly. ACLU.
90	 Pew Charitable Trusts (October 2017), Prison Healthcare: Costs and Quality. p.27
91	 Ollove, M. (March 17, 2016). Elderly Inmates Burden State Prisons. Pew Charitable Trusts. Available at: https://goo.gl/grW4gc
92	 Office of the New York State Comptroller (2017). New York State’s Aging Prison Population.p.2. Available at: https://goo.gl/Gtigo4
93	 Id. p. 5
94	 Exact figures are not available but increased cost estimates for older people range from 2 to 9 times more expensive. We used the
figure of 4 times more expensive and an annual incarceration cost per person of $60,000 to arrive at $240,000. Two-to-three times
more can be found at ACLU (2012), p.28 (see Note 8); 2-5 times more expensive can be found at Columbia Center for Justice (2015),
p.ix (see Note 9); and the up to 9 times more expensive figure can be found at Human Rights Watch (2012, Old Behind Bars: The Aging
Prison Population in the United States), p.73. New York is not one of the 7 states who tracked healthcare costs by age of the incarcerated (Ahalt,C. et al (2014). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984258/).

54

Endnotes
95	 Ewing, M. (August 17, 2015). When Prisons Need to be More like Nursing Homes. The Marshall Project. https://goo.gl/wXD5hS
96	 Id. p.10
97	 Schaenman, P. et al. (2013). Opportunities for Cost Savings in Corrections Without Sacrificing Service Quality: Inmate Health Care. The
Urban Institute. Available at: https://goo.gl/v3T9No
98	 Williams, B. and Abraldes, R. (2007). Growing Older: Challenges of Prison and Reentry for the Aging Population. In Greifinger, R. (Ed.),
Public Health Behind Bars (56-72). New York, NY: Springer.
99	 Commissioner Fischer as quoted in: Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety (2015). Center for Justice
at Columbia University. Available at: https://goo.gl/x8jc9x
100	 See Note 26.
101	 Id. p.19
102	 State of New York Department of Corrections and Community Supervision (2013). Inmate Mortality Report: 2009-2012.
Available at: https://goo.gl/5ds6qG
103	 Death Penalty Information Center (2017). Number of Executions Since 1976. Available at: https://goo.gl/TWGRH7
104	 Noonan, M.E. (December 2016). Mortality in State Prisons, 2001-2014. Bureau of Justice Statistics. Available at: https://goo.gl/bi58sj
105	 Id. p. 6
106	 Benzing, J. (June 10, 2015). Prison Releases Rarely an Option for Dying State Inmates. PublicSource. Available at: https://goo.gl/oR36Nq
107	 Melamed, S. (September 27, 2017). “More people than ever are dying in prison. Their caregivers? Other inmates.” The Inquirer, Philly.com.
Available at: https://goo.gl/PF5eZL
108	 Id.
109	 Bedard, R. (2015). When Dying Alone is Too Harsh a Sentence. New York Times. Available at: https://goo.gl/Uijy2G
110	 Belluck, P. (February 25, 2012). Life, With Dementia. New York Times. Retrieved July 9, 2013 at https://goo.gl/VEpmLz
111	 Hill, M. (2007). New York Prison Creates Dementia Unit. The Associated Press. Available at: https://goo.gl/3fx34W
112	 Law, V. (2016). Suicide of 70-Year-Old John Mackenzie After Tenth Parole Denial Illustrates Broken System. The Village Voice.
Available at: https://goo.gl/W1N9Zv
113	 Id.
114	 Wegman, J. (2016). False Hope and a Needless Death Behind Bars. NY Times. Available at: https://goo.gl/td7Cba
115	 Democracy Now!(2016). After Being Denied Parole 10 Times, Elderly Prisoner Allegedly Commits Suicide at Fishkill Prison.
Available at: https://goo.gl/htHM8Y
116	 Center for Justice at Columbia University (2015). Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety.
Available at: https://goo.gl/GEd3CD
117	 Binswanger, I., Stern, M., Deyo, R. et al. (2007) Release from prison—a high risk of death for former inmates. New England Journal of
Medicine, 356, 157–165.
118	 Crawley, E. and Sparks, R. (2006). Is there life after imprisonment? How elderly men talk about imprisonment and release. Criminology
and Criminal Justice, 6(1), 63-82.
119	 Mesurier, N. (2011). Supporting older people in prison: Ideas for practice. United Kingdom: Age UK.
Retrieved from https://goo.gl/XqF22T
120	 New York State Department of Correction and Community Supervision (2017). Homelessness Among People Aged 50 and Older
Released from a New York State Prison: 2014-2016. Data send to RAPP as a result of a FOIL request. Contact RAPP for more information:
rappcampaign.com
121	 Id.
122	 See Note 119
123	 County of conviction is used as a proxy for where incarcerated individuals come from. See DOCCS Offender Population Report (2016)
for demographics of NY’s state prison population. Data on the number and percentage of older people returning to NYC were provided
by the NYS DOCCS Program Planning, Research, and Evaluation Division (via email communication on November 16, 2017).
124	 Lowe, N. and Cobb, K. (2016). The Long Road Home in Rural America: Challenges & Strategies for Rural Reentry Supervision. Capitol
Ideas Magazine. Available at: https://goo.gl/JpxDuZ
125	 Human Rights Watch (2012). Old Behind Bars: The Aging Prison Population in the United States. Available at: https://goo.gl/Ei4LXb
126	 Barker, K. (2015). A Choice for Recovering Addicts: Relapse or Homelessness. The New York Times. Available at: https://goo.gl/XqW2aQ
127	 Ahalt, C., Binswanger, I., Steinman, M. et al. (2012). Confined to ignorance: The absence of prisoner information from nationally
representative health data sets. Journal of General Internal Medicine, 27, 160–166.
128	 Wakeman, S.E., McKinney, M.E., & Rich, J.D. (2009). Filling the gap: The importance of Medicaid continuity for former inmates. Journal of
General Internal Medicine, 24(7), 860-862.
129	 Alarid, L.F. (2013). Community-Based Corrections (10th ed.). Belmont, CA: Cengage Learning. 251.

55

Endnotes
130	 Refer to the Electronic Code of Federal Regulations, 42 CFR §411.4(b), “Special conditions for services furnished to individuals in custody
of penal authorities.”
131	 Mallik-Kane, K. &Visher, C. (2008). Health and Prisoner Reentry: How Physical, Mental, and Substance Abuse Conditions Shape the Process
of Reintegration. Washington: Urban Institute.
132	 Boffetta, E. and Belhumeur, J. (2016). My Life After 44 Years in Prison: One Man’s Story of Reintegration with the Modern World. Al
Jazeera. Available at: https://goo.gl/XBmE1x
133	 Urban Institute (2017). A Matter of Time: The Causes and Consequences of Rising Time Served in America’s Prisons.
Available at: https://goo.gl/YWfT9g
134	 Pager, D. (2009). Marked: Race, Crime, and Finding Work in an Era of Mass Incarceration. The University of Chicago Press. See also:
Research on Reentry and Employment, National Institute of Justice available at: https://goo.gl/3apv7i among many other sources on
this topic.
135	 The Leadership Conference (March 2017). Barriers to Successful Re-Entry of Formerly Incarcerated People.
Available at: https://goo.gl/QFxh96
136	 Urban Institute (2017). A Matter of Time: The Causes and Consequences of Rising Time Served in America’s Prisons.
Available at: https://goo.gl/YmP6Pi
137	 Thivierge-Rikard, V., & Thompson, M. S. (2007). The association between aging inmate housing management models and non-geriatric
health services in state correctional institutions. Journal of Aging and Social Policy, 19, 39–56.
138	 Neumann, A. (2016). What Dying Looks Like in America’s Prisons. The Atlantic. Available at: https://goo.gl/JgZ5KP
139	 Diaz, R. (March 2014). Working with the Dying in California Prisons. Available at: https://goo.gl/hPSrEE
140	 Belluck, P (2012). Life, With Dementia. The New York Times. Available at: https://goo.gl/VvorKH
141	 Senior Ex-Offender Program (SEOP). Retrieved from: https://goo.gl/YGjfFw
142	 Ohio Department of Rehabilitation and Correction (March 2018), Fact Sheet. (obtained via email from the Communications Office of
the ODRC, May 11, 2018). And, Rotuno-Johnson, Michelle (January 3, 2018). “Ohio closing Hocking Correctional Unit, which houses 430
inmates, to save money.” NBC4i.com. Available at: https://goo.gl/mMPsjn
143	 AAA8 Partners with Hocking Correctional Facility to Offer Disease Management Programs. (2012, February 7). Area Agency on Aging 8.
Retrieved July 9, 2013 from https://goo.gl/6mPb23
144	 Id.
145	 Harrison, M. and Benedetti, J. (2009). Comprehensive Geriatric Programs in a Time of Shrinking Resources: “True Grit” Revisited.
Corrections Today, 71(5), 44-47.
146	 McCarthy, K. (2013). State Initiatives to Address Aging Prisoners. Connecticut General Assembly Office of Legislative Research, 2013-R0166. Retrieved July 9, 2013 from https://goo.gl/VwCVdT.
147	 Chang, C. (May 15, 2012). Angola inmates are taught life skills, then spend their lives behind bars. The Times- Picayune. Retrieved July
30, 2013 from https://goo.gl/TXi5Nf.
148	 Id.
149	 “This dormitory will operate under a therapeutic community model for senior living with programs focused on life skills, technology
use, family unification, and health and wellness. Individuals placed in the dormitory will benefit from the age appropriate
environment to better prepare them to return to their neighborhoods.” Available at: https://goo.gl/ygeFBr
150	 Release Aging People in Prison (RAPP) Campaign. From: rappcampaign.com
151	 Tulane Project for Older Prisoners (POPS) from: https://goo.gl/zW9us4
152	 The Osborne Association’s Elder Reentry Initiative (ERI). From: http://www.osborneny.org/programs.cfm?programID=56
153	 Wisnieski, A. (2017). ‘Model’ Nursing Home for Paroled Inmates to Get Federal Funds. Connecticut Health I-Team.
Available at: https://goo.gl/EFfknY
154	 Senior Community Service Employment Program (SCSEP). from: https://goo.gl/u1QGNb
155	 Cook, R (2016). Nursing Home for Prison Inmates Opening in Millegdeville. The Atlanta Journal-Constitution.
Available at https://goo.gl/z6T8wL; and Morris, L (2016). First-of-its-Kind Nursing Home to Open in Georgia. The Telegraph.
Available at: https://goo.gl/nLek5e
156	 Resettlement and Care for Older Ex-Offenders and Prisoners (RECOOP). https://goo.gl/Hei4TN
157	 Maschi, T., Viola, D. & Sun, F. (2012). The High Cost of the International Aging Prisoner Crisis: Well-Being as the Common Denominator for
Action. The Gerontologist, Oct 4 2012, 1-12.
158	 As described on their website, “Developed by leading experts in the fields of health, law and corrections, the Standards are our
recommendations for managing the delivery of medical and mental health care in correctional systems. These essential resources
have guided the field toward continual improvement of care for the incarcerated, strengthening organizational effectiveness and
reducing the risk of adverse legal judgments. The Standards are also the foundation of NCCHC’s accreditation program.” National
Commission on Correctional Healthcare Standards: https://goo.gl/xLfdzy

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Endnotes
159	 The eight domains recommended for cities and communities to better adapt their structures and services to the needs of older people
are: the built environment, transport, housing, social participation, respect and social inclusion, civic participation and employment,
communication, and community support and health services. Available at: https://goo.gl/MJciE5
160	 See Note 91.
161	 Policy Research Associates. (August 2012). Responding to the Needs of an Aging Prison Population.
162	 Williams, B. et al. (2012). Addressing the Aging Crisis in U.S. Criminal Justice Health Care. American Geriatrics Society, 60.6, 1150-1156.
163	 Williams, B., Lindquist, K., Sudore, R. et al. (2006). Being old and doing time: Functional impairment and adverse experiences of geriatric
female prisoners. Journal of the American Geriatrics Society, 54, 702–707.
164	 Thivierge-Rikard, V., & Thompson, M. S. (2007). The association between aging inmate housing management models and non-geriatric
health services in state correctional institutions. Journal of Aging and Social Policy, 19, 39–56.
165	 Id. p.39-56
166	 Williams, B., Lindquist, K., Hill, T. et al. (2009). Caregiving behind bars: Correctional officer reports of disability in geriatric prisoners.
Journal of the American Geriatrics Society, 57, 1286–1292.
167	 Center for Justice at Columbia University (2015). Aging in Prison: Reducing Elder Incarceration and Promoting Public Safety.
Available https://goo.gl/GEd3CD
168	 See Note 155.
169	 See Williams & Abraldes, 2007; Aday, 2003; and Crawley & Sparks, 2006.
170	 Urban Institute (2017). A Matter of Time: The Causes and Consequences of Rising Time Served in America’s Prisons.
Available at: https://goo.gl/nZDDH5
171	 Id.
172	 See footnote 219 in Human Rights Watch (2012). Old Behind Bars: The Aging Prison Population in the United States.
Available at: https://goo.gl/BmYBT1
173	 Poo, A. (2015). The Age of Dignity: Preparing for the Elder Boom in a Changing America. New York: The New Press.
174	 AARP Network of Age-Friendly States and Communities. (updated May 7, 2018) Available at: https://goo.gl/ZpYCcV

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