Old Behind Bars

Life in prison can challenge anyone, but it can be particularly hard for people whose bodies and minds dob calculator
being whittled away by age .Prisons in the United States contain an ever growing number of aging men and women who cannot readily climb stairs, haul themselves lớn the top bunk, or walk long distances mập meals or the pill line ; whose old bones suffer from thin mattresses and winter’s cold ; who need wheelchairs, walkers, canes, portable oxygen, and hearing sida ; who cannot get dressed, go lớn the bathroom, or bathe without help ; and who are incontinent, forgetful, suffering chronic illnesses, extremely ill, and dying .Using dữ liệu from the United States Bureau of Justice Statistics ( BJS ), Human Rights Watch calculates that the number of sentenced federal and state prisoners who are age 65 or older grew an astonishing 94 times faster than the total sentenced prisoner population between 2007 and 2010. The older prison population increased by 63 percent, while the total prison population grew by 0.7 percent during the same period .

Some older men and women in prison today entered when they were young or middle-aged ; others committed crimes when they were already along in years. Thos e who have lengthy sentences, as many bởi vì, are not likely bự leave prison before they are aged and infirm. Some will die behind bars : between 2001 and 2007, 8,486 prisoners age 55 or older died in prison .This báo cáo is the first of two that Human Rights Watch plans béo issue on the topic of elderly prisoners in the US. It presents hot nhất dữ liệu on the number of aging men and women in prison ; provides information on the cost of confining them ; and based on research conducted in nine states where prisons vary significantly in form size, resources, and conditions, offers an overview of some ways that prison systems have responded béo them. The báo cáo tackles some policy considerations posed by incarcerating elderly inmates, and raises the human rights concerns that must be addressed if sound policies are bự be developed for the criminal punishment and incarceration of older prisoners, both those who grow old in prison and those who enter at an advanced age .Prison officials are hard-pressed Khủng provide conditions of confinement that meet the needs and respect the rights of their elderly prisoners. They are also ill-prepared — lacking the resources, plans, commitment, and tư vấn from elected officials — phệ handle the even greater numbers of older prisoners projected for the future, barring much needed changes lớn harsh “ tough on crime ” laws that lengthened sentences and reduced or eliminated opportunities for parole or early release .Human Rights Watch presents in this báo cáo mới nhất statistics that testify unequivocally béo the aging of the US prison population. Among our findings :It is increasingly costly for correctional systems phệ respond béo the needs of their geriatric populations, including their need for medical and mental health care. According phệ information gathered by Human Rights Watch, including previously unpublished dữ liệu, annual medical expenditures are three lớn nine times greater for older state prisoners than for others. Since federal health insurance programs vì not cover medical care for men and women behind bars, states shoulder the entire burden for their inmates. Taxpayers also bear the financial burden of expensive prison security and control measures for those individuals who, due Khủng their age and infirmities, pose a negligible safety risk .Providing medical care bự older prisoners comes with a steep price tag because of their greater medical needs. Older prisoners are more likely than younger ones bự develop mobility impairments, hearing and vision loss, and cognitive limitations including dementia. Older prisoners are also more likely Khủng have chronic, disabling, and terminal illnesses. Prisoners who continue bự age behind bars will eventually require assisted living and nursing trang chủ levels of care while incarcerated. Prison officials look at the projected increase in aging prisoners in their systems and realize in the very near future they will need phệ operate specialized geriatric facilities ; some already bởi vì .Corrections officials must respect the human rights of all prisoners, and what is required lớn respect those rights can vary according mập the needs and vulnerabilities of the individual prisoner .For an old and frail person, the right béo safe conditions of confinement means not having mập live in a dorm with younger persons prone mập violence and extortion ; the right béo decent conditions of confinement means receiving extra blankets and clothing in winter because it is harder bự stay warm ; and the right bự rehabilitation means receiving age-appropriate educational, recreational, and vocational opportunities. For an older offender who is mobility-impaired, accommodation of that disability will require assignment phệ a lower bunk, permission béo take shortcuts Khủng walk mập the chow hall, or the assignment of someone lớn help push his wheelchair. For the older offender who breaks prison rules and whose mental capacities are weakening or who has dementia, staff disciplinary responses must be adjusted in recognition of the fact that the inmate is not engaging in willful disobedience. Ensuring older offenders who cannot take care of themselves are treated with respect for their humanity means providing staff or inmate aides who can help change clothes and clean up a cell when there is an “ accident ” due béo incontinence .Although we did not conduct the investigation that would be necessary phệ evaluate the extent bự which the human rights of older prisoners are respected in any given facility, our research, including visits lớn đôi mươi prisons, has convinced us that many older prisoners suffer from human rights violations. A significant reduction in the overall prison population, in the number of elderly prisoners, and / or a significant increase in funding are required if prison systems are phệ be able lớn house their elderly inmate populations in conditions that respect their rights .We are also concerned that some elderly inmates are being unnecessarily held in prison despite the fact that their continued incarceration does little béo serve the principal purposes of punishment : retribution, incapacitation, deterrence, and rehabilitation. For prisoners who no longer pose a public safety risk because of age and infirmity, and who have already served some portion of their prison sentence, continued incarceration may constitute a violation of their right lớn a just and proportionate punishment. Alternative forms of punishment should be imposed — for example, conditional release lớn trang chính confinement under parole supervision — that would serve the legitimate goals of punishment. In our second báo cáo on older prisoners, we will examine the policies and procedures that have been enacted béo permit the early release of prisoners on medical or compassionate grounds .The rising tide of older persons in the United States as the “ baby boomers ” begin bự cơn sốt age 65 has been called a “ silver tsunami. ” US corrections systems are also confronting a “ silver tsunami ” of aging prisoners. But the wave they confront is not the result of uncontrollable natural forces. It is the result of legislation enacted decades ago which is long overdue for reform .Officials should nhận xét their sentencing and release laws and practices Khủng determine which can be adjusted béo reduce the elderly prisoner population without risking public safety. Meanwhile, corrections officials should đánh giá the conditions of confinement for their elderly prisoners, including the services and programs available bự them, and make changes as needed Khủng ensure their human rights are respected .A burgeoning geriatric prisoner population has important financial, practical, and moral implications for all Americans, not just those incarcerated. The United States should consider whether such a population is something that the country wants or needs. Human Rights Watch believes it is neither .This báo cáo is based in part on research conducted by Human Rights Watch in nine states during 2011. We visited đôi mươi prisons in California, Colorado, Georgia, Mississippi, Thành Phố New York, Ohio, Rhode Island, and Washington, and talked with senior headquarters-based corrections officials as well as prison-based staff ranging from wardens phệ correctional officers. We also interviewed — mostly but not always in privacy — men and women of various ages who were incarcerated in the facilities we visited. Most, but not all, of the facilities or specific units we visited contained a large percentage of older prisoners. We also visited with senior corrections medical personnel and other state officials in Connecticut. In addition, throughout the year we also consulted with numerous correctional and gerontology experts, as well as conducted extensive research in the academic literature on aging and corrections .This báo cáo also includes statistical dữ liệu obtained from different sources .Our dữ liệu on the number of sentenced state and federal prisoners and the number of prisoners by age was obtained from the US Department of Justice Bureau of Justice Statistics ’ “ Prisoners Series ” for the years 1995 bự 2010. Each of the annual reports for those years is available trực tuyến at the Bureau of Justice Statistics ( BJS ) trang web ( http://bjs.ojp.usdoj.gov ). Using the methodology described in its reports, BJS estimates the number of prisoners in different age categories. Human Rights Watch calculated percentages and trends of state and federal prisoners by age using the BJS dữ liệu. Unless otherwise indicated, all references béo federal and state prisoners by age obtained from BJS reports are sentenced prisoners under the jurisdiction of state and federal correctional authorities. Because of variations in annual state participation in the NCRP program, BJS notes that comparisons of aggregate dữ liệu from one year mập the next should be interpreted with caution. Multiyear trends are more reliable than year lớn year comparisons .Our dữ liệu on the number and age of mới ra court commitments bự state prison ( almost all of which are admissions into prison of offenders convicted and sentenced by a court, usually mập a term of more than one year ) from 1995 phệ 2009 ( the most recent year for which such information was available at this biên tập ) was obtained from the annual statistical tables prepared by the Bureau of Justice Statistics as part of its National Corrections Reporting Program Series. The tables are available trực tuyến ( at http://bjs.ojp.usdoj.gov/index.cfm?ty= pbdetail và iid = 2174 ). Human Rights Watch calculated trends end thời gian and percentage increases in hot nhất court commitments by age using these tables. See below for a mô tả tìm kiếm of the National Corrections Reporting Program .We obtained dữ liệu on the age of federal prisoners, their age at entry lớn prison, and the length of their sentences by accessing information on defendants processed in the federal criminal justice system through the Federal Criminal Case Processing Statistics ( FCCPS ) of the Bureau of Justice Statistics ( available at http://bjs.ojp.usdoj.gov/fjsrc/index.cfm ). The FCCPS enables members of the public béo generate statistics trực tuyến, including the construction of tables and trends by frequency and percentage of persons in or entering federal prison in selected years, their age, and sentence lengths. The most recent year for which FCCPS provides dữ liệu is 2009 .Finally, our báo cáo includes a detailed analysis undertaken by Dr. Patrick Vinck, consultant béo Human Rights Watch, of the state prison population and admissions dữ liệu for 2009 compiled under the National Corrections Reporting Program ( NCRP ) of the United States Department of Justice Bureau of Justice Statistics. The NCRP collects administrative records information on prisoners admitted bự prison, released from prison, discharged from parole, or in prison at year-end from participating states. The number of participating states varies by year and by the category of dữ liệu being provided. Thirty states participating in the NCRP submitted prison admissions dữ liệu for 2009 and 24 submitted year-end prison population dữ liệu for 2009, the most recent year for which NCRP dữ liệu is available .Dr. Vinck’s analysis was conducted with the software Statistical Package for the Social Sciences ( SPSS ) under a restricted dữ liệu use agreement with the Inter-university Consortium for Political and Social Research ( distributor of the NCRP data ) .Several methodological elements need lớn be highlighted :Individual men and women in prison, as in the community, age at different rates and in different ways. In prison, there are prisoners who, at 75 years old, are more active, independent, and healthy than some who are much younger but who struggle with even the simplest of activities because of the burdens of disease and impairment. For purposes of analysis and planning for the current and future needs of their prison populations, however, most corrections systems have mix a specific chronological age béo serve as a proxy for the physical and mental changes and conditions that correlate with aging. Their definitions of “ older ” inmates range from 50 years of age ( used by 15 states ) Khủng 70 years ( used by một ) .In the community, age 50 or 55 would not be considered “ older. ” But incarcerated men and women typically have physiological and mental health conditions that are associated with people at least a decade older in the community. This accelerated aging process is likely due bự the high burden of disease common in people from poor backgrounds who comprise the majority of the prison population, coupled with unhealthy lifestyles prior phệ and during incarceration. Thes e factors are often further exacerbated by substandard medical care either before or during incarceration. The violence, anxiety, and mệt mỏi of prison life, isolation from family and friends, and the possibility of spending most or all of the rest of one’s life behind bars can also contribute bự accelerated aging once incarcerated .Whatever the age cutoff used, there is no question that there has been a remarkable growth in the absolute number and proportion of older prisoners in the US prison population .Perhaps the most dramatic indication of the surging number of older prisoners comes from dữ liệu on the number of state and federal prisoners who are age 65 or older. In 2007 there were 16,100 ; by 2010 there were 26,200, an increase of 63 percent. Yet during that same thời gian period, the total number of prisoners grew by 0.7 percent .In the last fifteen years, the number of men and women age 55 years or older in US prisons has grown markedly, and at an increasingly rapid pace. In 1995, there were 32,600. By 2010, there were 124,400 .The number of prisoners age 55 or older grew at a much faster rate than the total prison population, growing by 282 percent compared mập a 42.1 percent increase in the prison population .The proportion of prisoners 55 years or older in the prison population has also soared. In 2010, tám percent of state and federal prisoners were age 55 or older, whereas in 2.000, they had accounted for tam percent of the total .The number of older prisoners is growing faster than the number of older persons in the US population, as is evident from the growth in incarceration rates relative Khủng population. For example, between 2007 and 2010, the rate of incarceration for men age 65 and end increased from 95 per 100,000 male US residents of that age lớn 142 per 100,000 .Indeed, the 2010 rate of incarceration of men 65 and kết thúc in the United States exceeds the total rate of incarceration in most countries .The demographics of older state prisoners differ somewhat from those of the total state population, with greater percentages of men and greater percentages of whites. There were about 21 times more men age 55 and older than women of that age in prisons among the states who reported prison population dữ liệu mập the National Corrections Reporting Program ( NCRP ) for 2009, although in the total state prison population in 2010 men outnumbered women by 13 lớn 1. With regard phệ race, whites accounted for 53.7 percent of prisoners 55 or older and blacks 39.1 percent among the NCRP reporting states in 2009, although in the 2010 total prison population blacks accounted for a greater percentage than whites, 42.7 percent Khủng 38.9 percent .States vary considerably in the relative form size of their population of older inmates. Among states reporting year-end prison population dữ liệu lớn the National Corrections Reporting Program, the proportion of prisoners age 55 years or end ranged from 4.2 percent bự 9.9 percent, with the highest proportions found in Oregon ( 9.9 percent ), 2 percentage points above the second highest rate ( 7.9 percent in Pennsylvania ). The lowest rate ( 4.2 percent ) was found in Connecticut, followed by North Dakota ( 5.0 percent ) .More detailed dữ liệu from several states exemplifies the dramatic growth in older prisoners that states have experienced in the last decades :Some states define older prisoners as those age 50 or older .The extraordinary kích thước of the US jail and prison population — almost 2.3 million, the world’s largest — reflects the inevitable consequences of more than three decades of “ tough on crime ” policies. State and federal legislators adopted laws that increased the likelihood and length of prison sentences, including by establishing mandatory minimum sentences and three strikes laws, and by increasing the number of crimes punished with life and life-without-parole sentences. In addition phệ these “ front kết thúc ” policy changes, the legislators sought Khủng increase the amount of giây phút prisoners would serve in prison before release, for example by establishing truth-in-sentencing conditions that require 85 percent or more of a prison sentence be served before the inmate becomes eligible for release, and by making some crimes ineligible for parole. Harsh parole revocation policies were also adopted that returned high percentages of released offenders béo prison for technical parole violations .Sheldon Thompson entered prison in Michigan in 1962 with a life without parole sentence, after conviction for a homicide crime he committed when he was 17 years old. He is currently 67 years old, and will die in prison. [ 29 ]Thes e sentencing and release policies help explain why the US prison population has grown six-fold since 1980, despite declining crime rates. They also help explain the rapidly growing number and proportion of older prisoners. Although we cannot pinpoint the precise contribution of different factors lớn the aging prison population, several factors are clearly involved :One reason for the growth in the elderly inmate population is the long phút giây served in prison by a growing number of prisoners, reflecting both lengthy sentences imposed for a large variety of crimes in recent decades and diminished opportunities for release prior lớn expiration of the sentence .A considerable number of older prisoners entered in their younger years and have aged behind bars, as shown in Table 2. For example, 15.2 percent of prisoners who were between the ages of 61 Khủng 70 in 2009 had entered prison at or under the age of 40. Of those who were between the ages of 71 and 80, 17.8 percent had entered at or under the age of 50 .The long sentences some prisoners are serving are shown in Table tam. Among state prisoners in 2009, 13.5 percent were serving sentences between 10 and đôi mươi years long, another 11.2 percent were serving sentences longer than đôi mươi years, and 9.6 percent were serving some khung of a life sentence. Among prisoners who were age 51 or older, 40.6 percent were serving sentences of more than trăng tròn years or life sentences. As prisoners with long sentences “ stack up ” in the prison population, it is not surprising that the number of older prisoners is growing and that older prisoners are more likely Khủng be serving longer sentences than younger prisoners. As we see in Table tam, đôi mươi percent of prisoners between the ages of 61 and 70 are serving sentences of more than trăng tròn years ( not including life sentences ), compared béo 11.4 percent of prisoners age 31 lớn 40 .We can further appreciate why the number of aging prisoners is growing by looking at the ages of men and women entering prison with mới nhất sentences and the length of those sentences. As shown in Table bốn, among state prisoners in 2009, 17 percent ( 7,929 ) who entered prison when they were age 51 or older have sentences ranging from more than trăng tròn years mập life. Of those who entered when they were between the ages of 41 and 50 years, 18.1 percent ( 21,148 ) have sentences ranging from longer than trăng tròn years lớn life. It is safe béo assume many of those prisoners will be well into their seventies and older before they are released, if they are released at all .Prison sentences tend mập be longest for persons convicted of violent offenses, and many older prisoners were convicted of such crimes ( see subsection below ). But mandatory minimum sentences for nonviolent offenders can also lead bự long prison terms that will increase the aging prison population. For example, Weldon Angelos was sentenced at age 25 phệ 55 years in federal prison for selling marijuana, money laundering, and possession of a firearm in furtherance of a drug trafficking crime. Barbara Scrivner was 29 when she was sentenced lớn 30 years in prison for her role as a minor participant in a methamphetamine manufacturing and distribution conspiracy .Sentences which run consecutively can also add up bự lengthy prison stays that will carry the individual into his later years. Atiba Parker, for example, was convicted in Mississippi of two counts of marketing of cocaine and one count of possession of cocaine when he was 29. He received a total of three sentences that run consecutively for a total of 42 years. Twenty-nine when he was sentenced, his projected release date is 2048, when he will be 71 .“ Three strikes ” and other habitual offender laws that create lengthy mandatory sentences for repeat offenders convicted of nonviolent as well as violent offenses also contribute bự the number of aging men and women behind bars. In California, the average third-strike offender enters prison at age 36, with a minimum of 25 years lớn serve before the possibility of release. According Khủng an advocacy nhóm seeking reform of California’s three strikes law, there are approximately 4,431 third-strikers who have received at least 25 – years-to-life for nonviolent offenses. Leandro Andrade is one. At 37 he was convicted of stealing USD 150 worth of videotapes from two different stores. Thes e convictions counted as his “ third ” strike and he received a sentence of two consecutive 25 – years-to-life sentences. The earliest he can be released will be when he is 87 years old .Sometimes sentences are technically for a term of years, but in practice they will amount bự life sentences. For example, Bonnie Frampton, now 76, entered prison when she was 65. Convicted of conspiracy for murder, she has a 120 – year sentence. Constance Wooster, age 61, was convicted of child abuse resulting in death. She entered prison when she was 53 with a 48 – year sentence .Persons convicted of violent crimes, including violent sex offenses, typically receive the longest prison sentences and for that reason they “ stack up ” in the prison population, compared Khủng persons serving short sentences. They are thus more likely phệ be growing older behind bars, fueling the aging prison population .As shown in Table 5, half of all state prisoners at year-end 2009 had been convicted of violent crimes. A higher percentage of prisoners age 55 and older ( 65.3 percent ) were serving sentences for violent crimes than younger offenders ( 49.6 percent ), reflecting the stacking phenomenon .The number of men and women who are already 55 years or older when entering prison for violent crimes also augurs continued growth in the number of older prisoners. As shown in Table 6, about one-quarter ( 26 percent ) of persons entering state prison with mới ra sentences in 2009 had been convicted of violent crimes, including 25.8 percent of those entering at age 55 or older .Persons convicted of violent crimes on average spend the longest phút giây in prison both because they receive longer sentences and because they serve a greater portion of their sentence before being released. For example, in 2009, the average maximum sentence for state offenders for all offenses was 60 months, and the average giây phút served before release for all offenses was 29 months ; that is, the phút giây served was less than half the maximum sentence. But for murder the average maximum sentence was 232 months and average giây phút served before release was 172 months ; the phút giây served was nearly three-quarters of the maximum sentence .It is notable, too, that the percentage of sentences state inmates convicted of violent offenses serve before release has increased markedly since the 1990 s. In 1993 they served an average of 40 percent of the maximum sentence ; by 2009 they served an average of 61.7 percent .More detailed dữ liệu from individual states also illuminates the number of older prisoners serving lengthy sentences, including for violent offenses :Life sentences are a particularly extreme khung of long sentence that almost by definition can carry prisoners into old age, if not beyond. Since the 1980 s, the use of life sentences, including life with no possibility of release ( life without parole ) has increased markedly .According béo The Sentencing Project, the number of offenders serving life sentences in state prisons quadrupled between 1984 and 2008, increasing from 34,000 bự 140,610. In the federal system, the growth in the number of prisoners with life sentences grew even more markedly. From 410 federal lifers in 1998, the number grew bự 4,222 in 2009, a ten-fold increase .Barring changes in patterns of parole release and grants of clemency, many of those serving life sentences in state prisons will grow old and die in prison. Thos e serving life without parole will certainly vì so. As shown above in Table tam, 75,576 men and women — almost one in ten ( 9.6 percent ) of the state prison population in 2009 — were serving some size of a life sentence. Of these sentences, 63,759 were life sentences and 11,817 were life without parole or life plus additional years ( which is the functional equivalent of life without parole ). In some states the proportion of prisoners with life sentences is far greater : in Alabama, California, Massachusetts, Nevada, and Thành Phố New York, at least one in six prison inmates is serving a life sentence. Among persons entering state prison in 2009 with hot nhất sentences, 3,471 had some khung of a life sentence .For lifers who have the possibility of release, the amount of phút giây that must be served before becoming eligible for release varies by jurisdiction. Nationally, however, the median is 25 years. Eligibility for release is not the same as actual release ; many years may intervene between the two and, in some cases, the lifer will chưa bao giờ be released. Lifers entering prison in 1997 could expect phệ serve an average of 29 years before release, giây phút during which they could age considerably. Serving decades in prison can carry a person from middle age bự old age. For example, as shown in Table bốn above, 2,102 state prisoners in 2009 were between the ages of 51 and 60 when they entered prison with life sentences ( not including life without parole or life plus additional years ). They thus entered prison with a slim likelihood that they would be released before their late seventies or eighties .Regardless of theoretical eligibility, it can be difficult as a practical matter for persons serving a life sentence phệ be released on parole. Parole boards and governors are heavily influenced by public opinion and the desire mập avoid a political backlash from the release of someone convicted, for example, of a notorious violent crime. Parole boards may require violent offenders Khủng remain in prison for years past their parole eligibility date, no matter how remorseful or rehabilitated they are or how impeccable their prison record. In some cases, parole boards will simply chưa bao giờ agree Khủng parole, and if they bởi, their decision may be reversed by the governor .Although most persons in prison serving life have the possibility of release, a significant number have been sentenced béo life without parole ( LWOP ). As can be seen from dữ liệu in Table tam above, as of 2009 at least 11,817 state prisoners were serving sentences of life without parole or life plus additional years ; that is, they have been sentenced béo life behind bars until they die. They will be spending many years in prison as they pass from youth and middle age Khủng old age, and eventually death .The frequency of life without parole varies markedly among states :As of 2009, there were 4,222 federal prisoners serving life sentences. Because the federal system does not have parole, federal prisoners with life sentences have no prospect of release in their lifetime .Among persons serving life without the possibility of parole in the United States are persons sentenced for crimes committed before the age of 18. Human Rights Watch estimates that there are approximately 2,600 of these youth offenders in the United States who will spend the rest of their lives in prison .The number of older persons who are arrested has been increasing, perhaps as a natural concomitant of the overall aging of the US population. The increasing number of older arrestees has translated into an increasing number of men and women entering prison as mới ra court commitments at age 55 and older. Persons 55 years of age or older still constitute a small percentage of mới nhất court commitments — 3.5 percent in 2009 — but because a significant proportion come in with long sentences they may have a marked impact on the aging prison population .As shown in Table 7, the number of persons entering state prison as mới ra court commitments at the age of 55 years or older grew 109 percent between 1995 and 2009. In the same period, the number of all mới nhất commitments increased by 9.7 percent. The variations between individual years are significant and suggest caution in interpreting the dữ liệu, but the overall trend is nonetheless clear .Data from individual states further illustrates the growing proportion of inmates entering prison for crimes committed at age 50 or above :Like state prisoners, federal prisoners are “ graying. ” As shown in Table tám, 25,160 federal prisoners — 13.6 percent of the federal prison population — at year-end in 2009 consisted of men and women age 51 and older .The number of older federal prisoners is growing at a faster rate than the total federal prison population. Table tám shows that between 2 nghìn and 2009, the number of prisoners age 51 and older grew from 14,275 phệ 25,160, a 76 percent increase. In contrast, during those years the total federal prison population grew from 129,329 lớn 185,273, an increase of 43.3 percent .The number of federal prisoners already in their sixties and above when they enter prison has also been increasing at a faster rate than total admissions. Between 2.000 and 2009, the annual number of persons entering federal prison at age 61 or kết thúc grew by 50 percent, although the total number of hot nhất admissions in that period increased by only 14.5 percent .The long sentences being served by many federal prisoners suggest the number of older federal prisoners will continue growing. Among federal prisoners in 2009, 7,771 are serving sentences ranging from 30 years mập life. Another 12,612 have sentences of trăng tròn bự 30 years .The age and sentence lengths of mới nhất federal prisoners also illuminates why the federal prison population will continue lớn age. As shown in Table 9, although the preponderance ( 89.8 percent ) of federal prisoners who entered prison in 2009 had sentences of 10 years or less, 7,203 of the entering prisoners ( 26.6 percent ) had sentences ranging from 10 years phệ end 40 years and 298 entered with life sentences. Among those who entered federal prison at age 51 or older, 658 ( 10.3 percent ) had sentences ranging from 10 years mập kết thúc 40 years, not including life sentences. Obviously, many of them will grow much older before released, if they bởi not die in prison. Others entered federal prison in 2009 before they had reached the age of 50, but because of the length of their sentences will also not leave prison until their sixties, seventies, or beyond .The federal system eliminated parole in 1987. As noted above, all of the 4,222 federal prisoners with life sentences in 2009 can be expected lớn age and eventually die in prison .In general, the older people are, the more barriers they have mập an active, independent life, the greater their physical and mental health needs, and the harder it is for them bự live and function with dignity. The difficulties can be even greater for those elderly who are in prison. Prisons are primarily designed for the young and able-bodied ; it takes additional effort on the part of corrections officials bự meet the needs and respect the rights of the old and infirm .Older prisoners, lượt thích all prisoners, have the right phệ be treated with respect for their humanity and inherent human dignity ; Khủng not be subjected béo torture or other cruel, inhuman, or degrading treatment or punishment ; bự receive appropriate medical and mental healthcare ; Khủng have reasonable accommodation for their disabilities ; and phệ be provided activities and programs lớn tư vấn their rehabilitation .While age does not change the rights of people who are incarcerated, it may change what prison officials must vì béo ensure those rights are respected in particular cases. More precisely, it is not so much age in the abstract that determines how officials should treat individual prisoners, but their physical and mental conditions. A certain decline in general physical and mental capabilities is highly correlated with advancing years. There is also considerable overlap between persons who are aging and those who are chronically, seriously, or terminally ill or incapacitated. As persons age, they are at increasing risk of developing various illnesses and disabilities ( see discussion below in Chapter IV ). Officials confronting an aging and frail inmate, or one who is old and riddled with disease, cannot treat him the same as they would a healthy 25 – year-old .During our visits béo state prison systems, corrections personnel — including high-ranking central office staff, wardens, corrections officers, doctors, and nurses — insisted they were committed béo ensuring the older men and women in their charge received the care and treatment they needed, albeit within the limitation of what is possible and permissible in prison. While this báo cáo does not evaluate the extent bự which the human rights of older prisoners were respected in any given facility, there is no doubt that many older prisoners suffer from violations of their rights. Our conversations with corrections professionals, advocates, and prison experts nationwide leads us bự believe the problems in the states we visited are replicated lớn a greater or lesser degree throughout the country. Limited resources, resistance lớn changing longstanding rules and policies, lack of tư vấn from elected officials, as well as insufficient internal attention bự the quality needs and vulnerabilities of older prisoners, all lead phệ inadequate protection for the rights of the elderly .As prison professionals themselves acknowledged bự Human Rights Watch, individual incidents of neglect, mistreatment, and even cavalier disregard for the well-being of aging and vulnerable inmates occur. Prisons can also be plagued by systemic problems that leave the elderly — and younger prisoners as well — suffering acutely .US prisons are usually overcrowded warehouses that are hard places béo live in, regardless of age. Thos e who are older in prison, lượt thích their younger counterparts, must cope with the lack of privacy, extensive and intrusive controls end every aspect of life, severe limitations on connections with family and community, the paucity of opportunities for education, meaningful work, or other productive, purposeful programs or activities, and threats of violence and exploitation. They have béo cope with correctional and even medical staff who not infrequently view them with animosity, anger, and distaste because they are “ felons, ” attitudes which can influence how such staff exercise their responsibilities. They have Khủng cope with medical staff and treatment facilities that may be insufficient in quantity and inadequate in chất lượng. As corrections medical expert Dr. Robert Greifinger explained lớn Human Rights Watch, “ The chất lượng of medical care and disability accommodation in U.S. prisons varies considerably. Young and old alike suffer from poor unique care just as they benefit similarly from higher chất lượng care. ” Older inmates, lượt thích younger inmates, struggle bự maintain their self-respect and emotional equilibrium in this difficult environment while also confronting the physical, emotional, mạng xã hội, and spiritual challenges that accompany aging .Older prisoners, even if they are not suffering illness, can find the ordinary rigors of prison particularly difficult because of a general decline in physical and often mental functioning which affects how they live in their environments and what they need mập be healthy, safe, and have a sense of well-being. In addition bự the memory loss and other ordinary cognitive impairments that can come with aging, older prisoners sooner or later will develop :As a senior official with the California Prison Health Care Services explained Khủng Human Rights Watch :Older persons are more likely lớn develop disabilities that require the use of assistive devices such as glasses, hearing sida, wheelchairs, walkers, and canes. As in the community, the elderly in prison suffer from falls, which contribute phệ hip fractures and high health costs. One California study found that 51 percent of geriatric women prisoners age 55 or kết thúc reported a fall in the past year. In the community, falls are associated with poor lighting, uneven or icy pavement, loose rugs, and lack of handrails. In prison, there are additional potential hazards, including top bunk assignments and crowds of quickly moving young inmates oblivious mập the slower, more fragile older inmates among them .For someone who is old and frail or infirm, the right Khủng safe conditions of confinement means not being required béo live in a dorm with younger persons prone lớn violence and extortion and not being required mập sleep on a top bunk. The right Khủng decent conditions of confinement means older persons should be given extra blankets and clothing in the winter because it is harder for them phệ stay warm and they should not have béo stand outside in harsh weather waiting phệ receive medication. They may need more giây phút mập eat. Inmates have a right béo activities mập promote rehabilitation, and older incarcerated persons should be provided age-appropriate educational, recreational, and vocational opportunities. For the prisoner whose mental capacities are weakening or who may have dementia, disciplinary procedures should be adjusted mập reflect the diminished culpability. Ensuring an older offender who cannot care for himself is treated with respect for his humanity means ensuring the availability of staff or inmate aides who can help him change his clothes and clean up his cell when he has had an “ accident ” and soils himself .Geriatric incontinence puts chất lượng demands on older prisoners. It puts them at risk of mạng xã hội isolation, depression, diminished independence, and even harassment and physical confrontations from inmates offended when an older person urinates or defecates in her clothes. Prison bathrooms typically lack privacy ; individuals who need phệ change their soiled clothes or diapers must endure the humiliation of doing so in public. Preserving dignity in this context is difficult .Mobility impairments are common in older populations, and they are particularly problematic in the prison context. Even when provided canes, walkers, and wheelchairs, many of the elderly confront facilities that were not designed with the structural or programmatic needs of mobility-impaired individuals in mind .Mobility-impaired older inmates often confront a shortage of wheelchair-accessible bathrooms, including showers with seats, bars, and no shower lip lớn step kết thúc ; and too few rooms on a first floor so they are not required phệ climb stairs. They confront the long distances that exist between housing units and prison services and programs, and may need assistance getting from one place phệ another. Retrofitting old facilities and construction of hot nhất facilities are hampered by budget realities .Some prisons have changed their rules and created special programs phệ respond phệ some of the needs of the elderly. Women age 55 or kết thúc who are incarcerated at Central California Women’s Facility ( CCWF ) benefit from a Silver Fox program which gives them certain privileges, such as being able béo take shortcuts when walking from one place béo the next, extra pillows and blankets, and extra thời gian for doing laundry. In August 2011, extensive organizing and advocacy efforts by older women at CCWF seeking béo improve their conditions of confinement were rewarded with the initiation of a hot nhất component of the Silver Fox program, a Senior Living Unit ( SLU ), béo be located in an existing facility designed bự “ address the emotional and physical needs of the older inmate population ” who choose Khủng live in it. The women in the SLU will have privileges otherwise not available mập CCWF inmates : additional mattresses upon request, unlimited access mập the phone, designated space in the dayroom for small plants, and the ability phệ purchase a người yêu thích and not have it count towards the maximum number of appliances permitted. In addition, plans for the SLU include special age-sensitive programs and tư vấn groups. On the other hand, some rules were not modified. Whether or not a prisoner is geriatric, infirm, or has disciplinary violations, she will be put in cuffs and shackles when taken offsite bự a medical visit, even though such restraints can be painful for persons with older bones .Corrections departments bởi not typically make housing assignments for inmates solely based on age. When it comes lớn housing the elderly, prison systems tư vấn “ mainstreaming, ” that is, keeping older inmates in the “ general population ” as long as possible, consistent with their particular physical and mental needs and vulnerabilities. Housing decisions take into tài khoản frailty, disabilities, illness, and the “ culture ” of particular facilities — some are known béo be more violent and dangerous than others — in addition phệ the security classification of the inmates. Space permitting, aging inmates who have serious physical or mental conditions or limitations on their ability béo independently manage the activities of daily living will be placed in a facility that has the capacity mập meet those particular needs. As older incarcerated persons develop increased needs for medical services and assistance, officials often place them in facilities in which the aging and / or infirm predominate. For this báo cáo, Human Rights Watch conducted many of our site visits in facilities with high proportions of elderly and infirm inmates .For example, at Ohio’s Hocking Correctional Facility, large dormitories house predominantly older men ; the average age is 66, and 84 percent of the population there is end 60. The oldest man is 89 years old. The men can stay at Hocking until they cannot take care of their daily living needs ( for example going mập the bathroom by themselves ) or become so ill they need greater access béo specialized medical care .Some prison systems are developing special housing units that provide higher levels of care than in the general population, but short of assisted living or skilled nursing care. Thes e units are not limited mập the elderly but are used for any confined person who needs greater medical care or assistance with daily living activities. As the Missouri Department of Corrections Aging Offenders Management Team noted, aging offenders with mild lớn moderate levels of need for health services can “ bởi vì well in a ‘ modified ’ general population setting where they have reasonable accommodations for their mobility, medical and mental health needs. ” The đội recommended the development of Enhanced Care Units which would have no top bunks, daily rounds by health services staff, organized activities béo keep offenders busy and oriented, assistance from other offenders trained bự be helpers, and special assistance with meals. In response mập this recommendation, the department has piloted its first Enhanced Care Unit “ Khủng keep offenders as functional as possible while providing appropriate health and housing services phệ accommodate their special needs. ”At Mississippi State Penitentiary, men who, whether due phệ age or for other reasons, need more tư vấn and assistance than is available in regular general population units are housed in Unit 31, a special housing unit. Prisoners can stay there until they deteriorate lớn the point at which they can no longer care for themselves, even with the help of other inmates. They are then moved phệ the hospital .The Texas Department of Criminal Justice has special geriatric units, located in different state prisons, bự provide accommodations for offenders who are age 60 or older and who have specific difficulties with daily activities. In these units, the prisoners have longer periods of phút giây bự dress, eat, move from place bự place, and shower. Texas also provides a higher màn chơi geriatric facility for male inmates located at the Estelle Unit next mập the Estelle Regional Medical Facility bự ensure accessibility mập clinical staff. This unit provides “ access Khủng multiple special medical services, such as physical, occupational, and respiratory therapy ; special wheelchair accommodations ; temperature-adjusted environments ; dialysis ; and services for inmates with hearing and vision impairments. ”Many of the elderly in prison, as in the community, eventually develop a diminished capacity for self-care and require assistance with daily living activities as well as increased medical care. The range of specialized housing for such inmates includes assisted living care units where help with activities of daily living is offered ; convalescent care with nursing assistance during the day ; skilled care with nursing provided day and night ( as in a nursing home page ) ; and hospice care for the dying. As of 2008, at least 13 states had responded béo the needs of older offenders by creating specialized units, six had dedicated prisons, nine had dedicated medical facilities, five had dedicated secure nursing-home facilities, and eight had dedicated hospice facilities .Older individuals may kết thúc up in long term care in facilities that provide the necessary care and access phệ medical treatment, but which are not phối up mập provide non-medical programs for the elderly. For example, in the long term care unit at the Correctional Medical Center ( CMC ) in Ohio, which has a high proportion of older prisoners, there are no communal spaces or programs. Unlike a nursing trang chủ in the community which will have age-appropriate activities, at CMC there is little for the individuals incarcerated there lớn vì bự keep them from “ simply wasting away ” as one staff thành viên told Human Rights Watch .Meeting the housing needs of the current aging population is an ad hoc process in which officials juggle many factors including the nature and severity of an inmate’s illness or disability, the availability of beds in facilities with requisite levels of medical care, security levels, and risks for victimization or predatory behavior, among others. Housing the elderly is a daily game of musical chairs that can shortchange individual elderly persons while it bedevils corrections officials. Prison officials struggle every day lớn find enough lower bunks for inmates who cannot climb bự the upper ones. They move inmates in and out of hospital beds because they lack sufficient numbers of nursing facility beds. Sometimes the only available housing option is Khủng put those who can no longer take sufficient care of themselves in infirmaries or hospitals, even though those settings provide intensive levels of care in highly restrictive settings that may exceed what the individual requires. In some systems, old and infirm individuals kết thúc up in administrative segregation beds — with all the restrictions of segregation — due phệ the lack of alternative housing options .Officials in many states acknowledged béo Human Rights Watch they are struggling phệ keep their heads above water with regard béo housing the elderly. Their ability béo properly house and provide treatment for older inmates is frustrated by lack of resources, inappropriate physical plants, insufficient tư vấn from elected officials and the demands of more immediately pressing priorities. They also acknowledged lớn us they vì not see how they can meet the needs of the growing number of older prisoners projected for the future absent hot nhất resources, mới ra construction and enhanced staffing. In every state we visited, for example, officials stressed the need bự develop additional assisted living care and skilled nursing care capacity Khủng respond bự the growing population of the elderly .Prison officials were not able phệ provide us with good dữ liệu on the number of inmates they confine with age-related dementia, but they told us the numbers are growing .Prisons bởi vì not ordinarily màn hình hiển thị for age-related cognitive decline. In the circumscribed world of prisons with limited opportunities for prisoners Khủng make decisions about how béo manage their days, or béo kế hoạch, initiate, or carry out complex behavior, early stages of dementia may not be seen in how a prisoner handles the incidents of daily life. Dementia usually becomes observed by staff or other inmates ( who alert staff ) when a prisoner exhibits bizarre or erratic conduct, for example, by refusing lớn bathe or clean up after himself .Other inmates often contribute bự the ability of the aging who are developing dementia ( as well as those who have other mental or physical impairments ) bự stay in general population facilities. Such assistance may be ad hoc — one cellmate helping another because he chooses mập — or formalized through offender aide programs in which carefully selected and trained inmates are given the responsibility of assisting inmates who, because of their cognitive decline, need help with daily living activities .Homer Edmunds was not able béo tell Human Rights Watch his age or how long he has been in prison in Mississippi. According mập staff, he is 87 years old and has been in prison convicted of homicide since 1984. For the last 21 years he has been in Unit B at Central Mississippi Correctional Facility, a unit for inmates who have special needs, whether due Khủng age or other reasons. He can hardly walk, and was brought Khủng the interview with Human Rights Watch in a wheelchair, but could not explain lớn Human Rights Watch why he was in it. According lớn the staff, he needs help with showering, and has severe cognitive issues including little memory, but the staff and other inmates help him get through the days because he does not want phệ go lớn the hospital. He has also been diagnosed as a paranoid schizophrenic .At some point, cognitive problems can grow so severe that remaining in the general population is no longer an option. While many prison systems incorporate offenders with dementia in special medical settings, a few have special units for inmates with dementia, including California, Thành Phố New York, and Ohio .New York’s Fishkill Correctional Facility has a Unit for the Cognitively Impaired ( UCI ) within its Regional Medical Unit ( RMU ). In December 2011, when Human Rights Watch visited it, the UCI housed 25 men with dementia or other progressive cognitive impairments, 17 of whom were age 70 years or older. The UCI provides long term care in an infirmary-type setting. Many of the men in the UCI are likely béo die behind bars, as their earliest possible release date will not occur until they are in their eighties ; 11 have life sentences. When Fishkill opened the UCI, all of the staff — from janitors Khủng corrections officers lớn doctors — trained together phệ understand how the unit would operate and how the nature of the prisoners there would differ from the general population. Senior officials thought it was particularly important for the corrections officers lớn “ buy into the concept that the cognitively impaired have special issues, and you don’t have phệ get in their face just because they get into yours …. You don’t have béo respond Khủng aggression with aggression, ” the way an officer might in a regular unit. Security staff have bự bid for assignment phệ the unit and receive 40 hours of special training ; security staff are also part of the đội, including the medical and psychiatric staff, that periodically nhận xét patient conditions and progress. During our visit, we were told that despite the violent histories of some of the men, misconduct is relatively rare in the unit. In addition Khủng psychological and psychiatric treatment, the men in the UCI are offered diverse structured programs that are supposed lớn be tailored Khủng their particular needs ; they can also participate in programs offered béo RMU inmates generally. The staff seek Khủng overcome the tendency of UCI residents Khủng isolate themselves in their rooms, encouraging them béo participate in nhóm activities, such as bingo .California Men’s Colony ( CMC ) contains a special unit which houses inmates with moderate Khủng severe dementia along with those who have developmental disabilities. In the past, CMC did not provide therapeutic interventions tailored phệ the needs of inmates with serious age-related cognitive decline, but it has recently been testing a special needs program for inmates with dementia that targets their physical environment ( for example by providing visual prompts lớn compensate for memory problems and poor judgment ), mạng xã hội environment ( by providing training for custody and nursing staff ), and the individual inmate himself ( through recreational activities and groups Khủng address various needs, lượt thích how béo manage emotions and compensate for cognitive impairments ). The initial results show that prisoners with dementia who participated in the program significantly improved in terms of irritability, mạng xã hội skills, depression, and attention .Other states are developing plans for special housing for offenders with dementia. In Georgia, for example, the Department of Corrections is working on plans for a geriatric supportive living unit for those with dementia and mild mập moderate cognitive impairment. The unit would have treatment teams, including psychiatrists, psychologists, and nurses, and provide therapy groups targeted lớn the offender’s special needs. It would not, however, be for the more extreme cases ; offenders who have major difficulties managing their daily living activities would be moved into a skilled nursing facility .Whatever the merits of existing or planned facilities for prisoners with dementia and other progressive cognitive impairments, there is one problem that plagues them all : their capacity is too small for predicted need in the near future. Given that one in eight persons age 65 or end develops Alzheimer’s, it is clear that the number of prisoners with progressive cognitive impairment is going lớn increase markedly in the future .Our research suggests that while older men and women who are in prison have plenty of complaints about younger inmates, they vì not want Khủng spend all of their giây phút solely among other old inmates. Corrections officials we interviewed found many advantages in keeping older inmates living with younger inmates as long as possible .Many of the elderly incarcerated men and women we interviewed expressed the view that younger inmates tended mập be rowdy, noisy, and disrespectful. Older incarcerated individuals by and large did not want béo have mập chia sẻ cells or dormitories with “ gangbangers ” and “ knuckleheads ” who are “ still wild. ” Older male offenders also told Human Rights Watch that the younger ones tend Khủng be more defiant and engage in misconduct, which prompts a tougher attitude on the part of correctional staff, which can carry kết thúc into their treatment of the older inmates .A 68 – year-old man at Hocking explained bự Human Rights Watch why he preferred being in a facility with mostly older men :But older inmates bởi not want mập spend all of their thời gian with people their age. The older men and women we interviewed appreciated the stimulation, activities, and ability béo “ stay young ” that come from interacting with a mixed age nhóm. A recent study of older inmates in Rhode Island found that only 9 percent of interviewed older inmates suggested the aged should be in a separate unit. The older inmates reported that they had quiet places phệ go béo avoid engaging with other inmates when they chose not phệ, and most did not interact exclusively with similarly aged inmates. “ [ Like ] their counterparts outside of prison, older inmates often did not want Khủng classify themselves as old, seeing themselves as acting younger than their age. ”There are other benefits for aging prisoners in having at least somewhat younger or at least less infirm prisoners about. More capable inmates will help “ cover ” for increasingly frail or infirm inmates, by helping them with some of their daily activities, so that they will not be moved into an infirmary or hospital. Prisoners of all ages told us the elderly want phệ avoid such places because the conditions can be more restrictive ( for example extremely limited out-of-cell or outside thời gian ), because they bởi not want lớn be removed from their prison “ family, ” and because they are seen as places Khủng go bự die .Older offenders also sometimes take on the role of guide or mentor lớn younger ones, which can be deeply satisfying. Some women told us they liked living with younger inmates because they were able Khủng take on the role of “ mother ” for the younger ones. As one young man told Human Rights Watch, older guys “ taught me how lớn bởi my giây phút, so I don’t cause problems. ” In his view, younger inmates would be at a disadvantage if older guys were kept away. On the other hand, other inmates told us young inmates resent any efforts by older ones béo give them advice. It is important, however, not mập thua kém sight of the fact that older inmates, lượt thích younger ones, are a heterogeneous lot. Some may want béo offer good counsel and tư vấn béo those who are younger ; some may have no interest in doing so ; and some may have little or no tolerance for younger ones .Correctional staff members we interviewed see advantages bự mixed age populations. They pointed out that because the older offenders are more stable and mature, and want bự bởi phút giây as easily as possible, they can be a calming, stabilizing influence on younger ones and can help convince them mập “ go along with the program. ” As William Connelly, the superintendent of Fishkill Correctional Facility in Thành Phố New York, told Human Rights Watch, older prisoners teach younger ones how bự behave. Moreover, he strongly believes, “ if you rest you rust, ” that is, keeping the older inmates active in a mixed age nhóm population promotes their own physical and mental well-being. He insists that in Thành Phố New York, at least, the needs of individual aging offenders can be met on an individual basis, without clustering them by age into designated units. We are not in a position béo say whether New York — or other states that take the same position — is in fact able mập meet the needs of older offenders on an individual basis. But there is little doubt that ensuring elderly offenders are incarcerated in a manner that respects their human dignity may require transfer from regular general population units at some point during their incarceration. The question will become increasingly urgent as phệ whether correctional systems have or will be able Khủng develop the capacity phệ meet the needs of older offenders for different kinds of housing and care .Corrections officials have the responsibility phệ protect the safety of those they confine, and people who have been deprived of their liberty have the right lớn be kept safe. Nevertheless, US prisons can be extremely dangerous places ; inmate-on-inmate violence and staff-on-inmate violence jeopardize inmate well-being as well as rehabilitation. Victimization can range in gravity from homicide, severe physical assaults, and vicious rapes phệ more minor acts of harassment, extortion, theft, or humiliation. Certain types of inmates seem mập be more frequently targeted for abuse, especially those who are small, weak, and vulnerable. Older and frail inmates may also be at higher risk of victimization if housed with much younger inmates. For someone who is old and frail, the right béo safe conditions of confinement may mean not being required béo live in a dorm with younger persons prone mập violence and extortion .Most correctional systems bởi not track assaults or other forms of victimization by age. Statistics measuring physical or sexual victimization of older inmates — whether by other inmates or by staff — is hard bự come by. Data from a chất lượng of life survey of thousands of New Jersey inmates by Dr. Nancy Wolff indicates that both male and female offenders end age 50 báo cáo lower rates of victimization by staff and other inmates than bởi younger offenders. Nevertheless, one in five inmates surveyed who was older than 50 reported some khung of physical victimization, primarily inmate-on-inmate .In a much smaller study of 65 male prisoners age 50 or older, 10.8 percent reported physical attacks and assaults without weapons, 1.5 percent reported physical attacks and assaults with weapons, 6.2 percent reported being robbed, and 1.5 percent reported being raped, with the perpetrators primarily being younger prisoners. California women inmates in mixed-age, general population prisons who responded Khủng a questionnaire expressed concern about the risk of abuse from other women. For example, one woman in her seventies described how her cellmate “ [ got ] right up in my face, and she kept saying she was gonna cơn sốt me. She went on that just because I was old and then she went on describing all my wrinkles … She didn’t cơn sốt me that day but I expect it will happen sometime. If you start telling the officers what happens they turn right around and go mập that person and say, ‘ she said such and such ’ and ‘ what’s this about ? ’ and you’re in worse shape. ” On the other hand, in Rhode Island, a survey of 67 inmates ages 55 lớn 88 in a medium security prison suggested that older inmates did not see themselves at risk for victimization .Human Rights Watch did not find a consensus among corrections officials or inmates we interviewed regarding the victimization of older inmates when they are housed with younger inmates. Some officials believe that victimization of the elderly is infrequent, and that when it occurs it typically involves annoyance and harassment or minor theft ; serious physical confrontations are rare. Some said that younger inmates protect the elderly ones, insisting that everyone respect them. Others believe that older inmates are at high risk of victimization at the hands of younger inmates. Officials who believe the elderly can be “ easy prey ” emphasize the importance of placing them in facilities whose inmate population and culture are known bự be safer, which in practice can mean facilities with higher proportions of more mature inmates, including those who are elderly, or disabled inmates .Inmates who are incontinent and urinate or defecate in their clothes — which is not uncommon among the very elderly — may be ostracized and even physically assaulted by other inmates who are offended by the smell. Dr. Joseph Bick, the chief medical officer at California Medical Facility in California, explained bự Human Rights Watch that if an old man living in a dormitory with younger offenders has an “ accident, ” such as a bowel movement in his pants, or if he “ smells lượt thích pee all the giây phút ” because he’s incontinent, he may over up being attacked by annoyed younger inmates .According Khủng correctional officials and inmates themselves, older inmates generally try lớn avoid conflict and “ bởi their phút giây ” as quietly and easily as possible. This stance may also be a strategy Khủng protect themselves if they are living in dangerous prisons. Whereas younger persons in prison tend lớn protect themselves by proving their capacity béo be aggressive and dangerous, the older inmates tend lớn use “ passive precautionary behaviors such as keeping more lớn oneself, avoiding certain areas of the prison, spending more giây phút in one’s cell, and avoiding activities. ”Our research suggests that victimization is not a significant problem for the elderly who are confined in “ safer ” facilities with a high proportion of older or infirm inmates. To the extent the elderly in such facilities were victimized, it tended Khủng be through verbal threats, insults, and being cut in front of by other inmates in food or medical lines. More infrequently, the elderly faced theft or extortion of property or goods from the commissary. The inmates we interviewed also suggested that while the elderly bởi have things taken from them, this did not happen at a greater rate than that suffered by other inmates .In terms of safety, there may be a difference between the elderly who have grown old in the prison system and those who arrive old as newcomers mập incarceration. Three women we interviewed in a California facility told us they felt relatively safe because as “ old timers ” they had established relationships and felt protected by other inmates. ( Still, they also complained, as did many other inmates both male and female, that younger inmates today have less respect for their elders than inmates did in the past ). They thought, however, that older women who were mới nhất bự prison may be at a higher risk of victimization. Like other inmates and corrections officials suggested mập us, people who have been in prison a long phút giây, or who have prior experience with incarceration, tend Khủng “ know the ropes, ” and can see trouble coming and avoid problems more readily than newcomers .The likelihood that a person living behind bars will engage in violence, extortion, escape attempts, or other violent or dangerous behavior diminishes with age. Corrections officials and incarcerated men and women we interviewed agreed that the elderly as a nhóm are far less likely phệ cause trouble than younger inmates. They don’t “ mess with staff, ” they “ just want bự be left alone, ” and they “ get along better with each other than younger guys. ”Nevertheless, older prisoners are a heterogeneous nhóm and prison officials insist on the importance of remaining attentive lớn the actual conduct and risks posed by each individual. A lieutenant at Ohio’s Correctional Medical Facility told Human Rights Watch : “ Don’t let the wheelchairs fool you. They steal, argue, trade, fight, try bự kick. ”An 84 – year-old offender was in disciplinary segregation at the phút giây of a Human Rights Watch visit Khủng a prison in Washington state because he had engaged in sex with a 72 – year-old inmate phệ pay off a debt he said he owed the younger man. Indeed, staff told us that this particular offender repeatedly engaged in sexual conduct with other inmates, and apparently not always consensually. During our visits Khủng prisons in different states we were told of old inmates swinging at others with their canes, of two old men fighting in their wheelchairs, and of old men who are still active gang members. We heard accounts of elderly who hide and barter medication and other property ( lượt thích the extra blankets they obtained Khủng protect against the cold ). Even the terminally ill can break the rules. We were told of one offender with liver cancer in a prison hospice who arranged for his visitors bự bring him contraband ; another hospice inmate was allegedly stealing drugs from his fellow hospice mates .In general, however, it appears that when older inmates bởi engage in misconduct it typically involves relatively minor rule breaking. The older are far less likely than younger inmates Khủng engage in predatory behavior, be physically aggressive, get into physical fights, keep weapons, or exploit other inmates. We were not able mập obtain system-wide dữ liệu on rule violations by type and by age of offender at any of the facilities we visited. Nevertheless, staff suggested that disrespect bự staff and being somewhere without authorization were the most typical rule violations .Correctional staff have the responsibility bự enforce rules fairly and uniformly, but common sense and basic decency require treating a frail and infirm 80 – year-old differently than a boisterous and fit 25 – year-old. At least in units or facilities with high proportions of elderly and infirm inmates that we visited, the response of correctional staff béo rule-breaking by older inmates tends Khủng be somewhat flexible, accommodating the realities of aging bodies and minds. For example, inmates are supposed Khủng stand for count. Bedridden inmates cannot bởi that, so they are permitted phệ satisfy the requirements of count by sitting up in bed, or simply by being awake. Linen is changed on a mix schedule, but an offender who wets his bed will be given clean sheets regardless of that schedule. Staff are more likely phệ try Khủng talk béo an elderly offender who is breaking the rules or give him a verbal reprimand rather than phệ write up a ticket. If an old inmate is having problems getting lớn chow on thời gian or cleaning his cell, the corrections officer may try lớn help find a solution or alert medical staff. When they vì write up a ticket, unless the offense is quite serious, a disciplinary hearing may chưa bao giờ be held. Officials pointed out also that while some rules may have bự be “ bent ” a little lớn accommodate an offender’s infirmities or disabilities, staff also want béo avoid decisions that will leave other offenders thinking they can get away with whatever they want bự bởi vì. This may be particularly true in facilities with high proportions of younger inmates, who pay close attention Khủng staff behavior and adjust theirs accordingly. Balancing fairness mập the elderly with consistency and firmness can be a difficult balance and in any given situation, the older prisoner may kết thúc up with his legitimate needs not being satisfied .Learning how to identify and meet the needs of the aging population or how mập understand geriatric behavior is not part of the training most corrections officers receive. Few if any corrections departments provide training in the academy ( before employment begins ) or in-service training that addresses the special needs of aging offenders, including how mập recognize physical and cognitive deterioration. As one California corrections officer who works in a unit with offenders with dementia and developmental disabilities told us, he came bự the unit with no understanding of dementia, or even any training in how Khủng communicate with those have it. He is “ just learning it as [ he goes ] along. ”Trained or not, corrections officers are the eyes and ears of a corrections department, and they are on the front lines of prison geriatric care. Working day in and day out with inmates, they may be the first mập know when one of them begins lớn behave in a strange way, starts having difficulty with regular activities, or develops symptoms that require attention. Mental health and medical staff rely on the corrections officers Khủng notify them of such developments which might otherwise go unobserved until a scheduled medical visit. ( Other inmates will also notify staff if one of their fellow inmates seems mập be having trouble. ) Corrections officers are also sometimes aware of inmate disabilities and impairments that have escaped tracking in the health system .Even though corrections officers may be aware of limitations that offenders may have in their ability phệ function in their living environment, assessing functional skills and capabilities of offenders is not one of their formal responsibilities, it is not something they are trained mập bởi vì, and overcrowding may make it impossible Khủng bởi vì it sufficiently in any sự kiện. A study in the notoriously overcrowded California prison system found that nearly one-third of geriatric prisoners were unknown bự their assigned officers .Prison facilities have their own cultures which are reflected in staff as well as inmate behavior. Staff and inmates we interviewed agreed that the culture in facilities with large proportions of the elderly and the infirm tend béo be more “ laid back, ” less rigid, and “ more peaceable ” than in other prisons. The inmates we interviewed in such facilities generally gave good marks lớn correctional staff and told Human Rights Watch that “ with the exception of a few jerks, ” most of the staff vì not hassle them and seem understanding of the limitations of aging bodies. They said staff were generally helpful mập older inmates and informally accommodated behavior from an older inmate that would not be acceptable from a younger inmate. We cannot conclude, however, that these same attitudes toward the elderly prevail when they constitute but a fraction of a facility’s population .Even in prisons with high proportions of older prisoners, staff bởi vì not consistently treat them ( or any others ) with respect. We were told that sometimes custody staff see the older inmates as a “ hassle ” and get frustrated, responding with an impatient, “ Oh, go take an aspirin, ” mập an inmate complaint. Some inmates we interviewed told us about particular instances of staff neglect, impatience, or abuse. For example, men in a California prison claimed custody staff mocked an inmate who had both urinary and bowel incontinence, calling him “ despicable, ” and that staff called another inmate who wore a protective helmet on his head, “ helmet head. ” A 61 – year-old woman in prison in Colorado who is in a wheelchair told Human Rights Watch some nurses are good, but “ some are rude ” when they give her the help she needs with toileting. “ I’m trying lớn be fair but [ I’m not always ] treated lượt thích a human being. ” Women in a California prison pointed out béo Human Rights Watch that “ there’s always a couple of women in their unit who are incontinent and need help bathing, but there is no one Khủng help them bathe so they don’t. ” In every prison we visited, older inmates also expressed views similar bự the following from an older prisoner in Colorado : “ If you tệp tin a grievance, you’ll be treated worse. People young and old are scared béo grieve. ” We were also told by many inmates in different states that if an elder prisoner is particularly “ obnoxious ”, then staff may well be as hard on him as if he were younger. We should also note that a number of inmates described bự us particular incidents they believed revealed medical neglect or malpractice .Many prison officials told Human Rights Watch that working in facilities with sizable populations of elderly prisoners is quite different than working in others .William Hannah, a sergeant at Hocking Correctional Facility in Ohio, described his experience for Human Rights Watch :Officers who have experience working in prisons with a lot of younger, more violent inmates may also have mập adjust when working with a geriatric population. Having become used bự thinking that “ violence is just around the corner ” and that a hard, firm hand is necessary bự avert the ever-present potential for danger, it is a big change for them béo develop a more “ caring ” approach for the aged and infirm. Correctional officials also emphasized béo Human Rights Watch, however, that it was a challenge for staff bự show empathy and compassion for geriatric offenders without crossing the line into doing things that jeopardize security and safety. According béo these officials, just because an inmate is getting on in years, for example, does not mean he is not capable of being manipulative, of seeking béo entangle staff in a relationship in which favors will be granted ( for example contraband ) despite the rules. Corrections and medical staff can view requests from older prisoners for additional services or equipment with the same “ mặc định ” attitude of distrust and wariness they often bring lớn requests from younger ones. They ask themselves, for example, does this older man really need an extra blanket because he is cold or is he trying bự “ game ” the system and get an extra blanket for bartering purposes ( bartering and trading are prohibited in prison ) .Experts strongly urge training for prison staff who will be working with older prisoners on the normal processes of aging. Training should also include “ the communication skills needed with older adult inmates as the process of aging can affect the clarity and the tốc độ of speech as well as thought processes. ” According Khủng an Oklahoma Department of Corrections báo cáo on the aging prison population, a “ comprehensive educational program for all corrections personnel should be required. Training should include the knowledge and skills that are required phệ meet the specialized needs of older offenders as well as an increased sensitivity lớn their needs and limitations, and the patience mập khuyến mãi with them. ” The problem is one of resources : corrections officials lack the budgets bự expand academy or in-service training phệ add geriatric information .Training aside, some corrections officers will not have the personal qualities and aptitudes for working with geriatric offenders. As one warden told Human Rights Watch, “ the academy doesn’t teach patience. ” Corrections staff learn rules at the academy and in training, but applying the rules and regulations phệ old and infirm prisoners is a very different matter. Senior staff also told Human Rights Watch that hot nhất officers fresh from the academy may not be comfortable demonstrating any flexibility with regard Khủng the rules ; they need some “ seasoning ” before they realize they have options other than “ biên tập up a ticket ” for an elderly inmate who is not following orders or abiding by the rules .Inmates had views similar bự those of correctional officials regarding the difference between mới ra and more seasoned corrections officers. As one California female inmate said, mới ra officers straight from the academy are too strict, zealous, quick Khủng punish, and “ lượt thích the gestapo. ” Another California inmate at a men’s facility agreed, “ the newer the officers, the worse they are. ” Yet another said that younger corrections officers tend béo be “ badge heavy. ” It takes a while before they get seasoned and learn that respect begets respect .Always seen as a privilege or luxury rather than an essential component of corrections, programs have been slashed in US prisons because of budget crises. Aging prisoners have suffered lượt thích all others from cuts mập programs. Even when programs are available, however, they are rarely designed specifically for the educational, physical, psychological, mạng xã hội, and rehabilitative needs of older persons. Older individuals in prison, for example, rarely have the benefit of programs béo address the realities of aging or béo help them understand and protect their health in later years. Many of the older prisoners we interviewed have little béo vì besides read, watch television, or talk bự each other .Ohio was once nationally recognized for the numerous special programs its prisons had for the incarcerated elderly. Many of those programs have fallen by the wayside because of budget-related staff shortages. Thus, for example, Hocking Correctional Facility — in which men end 60 constitute the preponderance of the population — no longer offers programs designed mập help offenders understand or cope with numerous physical and mental changes associated with aging. The elderly are also shortchanged because available educational and mạng xã hội programming targets offenders who will be released within three years and most of the older men at Hocking have far more years phệ go before they near release. Human Rights Watch interviewed Warden Francisco Pineda, who was keenly aware of the lack of programs for the older inmates. In an unpublished paper he wrote that he provided béo Human Rights Watch, Pineda expressed his belief that a study is needed lớn assess the needs of older inmates in Ohio bự “ help phệ determine not only programming, but also institution designs or policy recommendations that will address age-specific activities and other types of treatment ” that will both help older offenders transition back lớn the community and enhance staff performance managing them. In Georgia, too, correctional officials acknowledge that they lack the resources mập provide much programming for older persons. Because of budget limitations, programming in Georgia prisons is targeted at reentry skills that typically exclude older inmates .Recreational programs for young and old alike have been slashed because of budgets. Where they exist, physical recreation programs are rarely tailored phệ older, frailer bodies. Older inmates must also compete with younger ones for access béo thể hình and other recreational equipment. There are exceptions. Colorado Territorial Correctional Facility ( CTFC ), for example, has a special recreation hour limited Khủng offenders age 50 or end as well as younger offenders with mobility impairments or developmental disabilities. Staff try bự provide special activities, lượt thích football toss, and tournaments for the less able and active inmates. The effort at CTFC phệ create recreational opportunities for geriatric and infirm prisoners was not, however, replicated at other prisons we visited .Older inmates typically are able bự work in prison, assuming they are physically and mentally capable. Indeed, they may have phệ work regardless of whether they want phệ : there is no retirement age in prison and some prison work is mandatory. While prisons in theory try phệ match jobs with individual inmates ’ capabilities, inmates complain that older inmates are given inappropriate job assignments and required phệ work under conditions that are dangerous for them. According béo a California inmate, “ There’s no consideration because of their age that maybe it’s phút giây for them béo stop working. You know, they just work till they parole or drop chết. ”Officials say offenders want lớn work ; it helps them stay busy and active, can be a source of pride, and can provide some much needed income. Human Rights Watch visited the license plate manufacturing facility at CTFC, where we saw older men in their wheelchairs next lớn men in their thirties. Human Rights Watch talked with one man in the factory who was 76 years old and had worked there for 19 years ; another inmate, who was 69, had worked there for 13 years, becoming the lead man for embossing ; and another, who was 65, who had spent 11 years in the shop. All three expressed pleasure in their work, but the conversations were not private and we have no way of knowing whether different views would have been expressed if they had been .Although senior corrections officials know their population of elderly individuals is growing, few corrections systems have undertaken a thorough analysis of their existing and projected elderly populations or have a comprehensive strategy for addressing the needs of the elderly with regard phệ the built environment and facilities, the programs and activities, healthcare, and preparation for release. Without such studies, it is difficult bự make sound policy and programmatic decisions for the future .North Carolina undertook an Aging Inmate Population Study in 2006 that had the following goals :The North Carolina study concluded with a number of recommendations, but we bởi not know how many were implemented .Obviously, studies accomplish little if officials bởi not act on them. In California, for example, despite numerous reports by consultants documenting the needs of a growing population of aging prisoners, the California Department of Corrections and Rehabilitation ( CDCR ) implemented few of the report’s recommendations. As Clark Kelso, the medical receiver for the California Department of Corrections and Rehabilitation, told Human Rights Watch, “ you need phệ listen mập your experts who are projecting population demographics and bed needs and then prepare accordingly. ”Even the best of plans — as well as existing programs — can be wrecked by budget crises. Attention mập the rising numbers of elderly behind bars can also be sabotaged by changes in correctional leadership, shifting legislative and executive branch priorities, the daunting effort bự manage prison populations that still exceed optimal capacity, and the challenges of day-to-day operations. Another problem lies with the absence of staff specifically tasked with supervising the needs and treatment of older inmates. The needs of older men and women cross multiple departments within corrections systems such as custody, operations, medical, and program departments. We know of no correctional system in which a senior official has been assigned the specific responsibility bự assess conditions of confinement for older prisoners from a cross-cutting and integrative perspective and phệ press for the changes needed béo improve those conditions .Incarcerated men and women have a constitutional right mập healthcare. International human rights law also mandates that persons deprived of their liberty receive healthcare. Older prisoners are at least two lớn three times as expensive mập incarcerate as younger prisoners, primarily because of their greater medical needs. Our research shows prison medical expenditures for older inmates range from three phệ nine times higher than those for the average inmate .The prevalence of illness and disability increases with age in prison, as in the community. The challenge for correctional systems is not only lớn provide for current needs, but lớn ensure projected needs can be met in the future. As the Tennessee Department of Corrections noted :Like their community-dwelling counterparts, older prisoners are susceptible Khủng the chronic diseases and infirmities associated with age, including heart and lung problems, diabetes, hypertension, cancer, ulcers, poor hearing and eyesight, and a range of physical disabilities .A recent survey found that 46 percent of male inmates 50 years or older and 82 percent of inmates 65 years or older have a chronic physical problem. In Ohio, 32 percent of the older inmates are in chronic care clinics. Data from Florida shows that relative béo their chia sẻ of the total prison population, prisoners age 50 or end are disproportionately enrolled in chronic illness clinics, and trương mục for a disproportionate chia sẻ of all medical contacts. In California, inmates age 55 or older, who are 7 percent of the prison population, consume 38 percent of prison medical beds. At Georgia’s Augusta State Medical Prison, which provides acute care, specialized medical and mental health services, assisted living, and chronic care, 27 percent of the prison inmates are age 50 or kết thúc .Older inmates not only have more infirmities than younger, but the nature of their diseases and the responses required tend phệ be different. As David Runnels, of California’s Correctional Health Care Services, explained mập Human Rights Watch :Meeting the medical needs of older prisoners requires a range of medical staff and facilities offering different levels of care. An example of the need of elderly offenders for nursing care and tư vấn is evident in the following dữ liệu from Connecticut : among inmates age 60 or kết thúc, 10.7 percent have no current physical problems requiring nursing attention ; 28.5 percent have a sub-acute or chronic disease that requires occasional nursing attention ; 50.7 percent need predictable access Khủng nursing care 16 hours a day, seven days a week ; 7.4 percent need 24 – hour access Khủng nursing care and there is a reasonable likelihood that from giây phút bự giây phút they will need 24 – hour actual nursing care ; and 2.7 percent need 24 – hour nursing care, possibly for an extended thời gian .Prison medical care accounts for a significant part of correctional budgets. In California, for example, one-third of the annual per capita cost of each inmate is for medical, mental health, and dental care. In Virginia, medical expenditures trương mục for 15 percent of the state’s correctional operating expenses .Older prisoners are responsible for a disproportionate chia sẻ of prison medical expenses. As geriatric specialist Dr. Brie Williams summarizes :A recent effort lớn assess the impact of age on healthcare costs nationally concluded that the average annual cost per prisoner was $ 5,482, but that for prisoners age 55 bự 59, the amount was $ 11,000, and the figure steadily increased with age cohorts, reaching $ 40,000 for prisoners age 80 or kết thúc .Many states bởi vì not track per capita medical costs for inmates by age. Nevertheless, dữ liệu from some of those that bởi testify mập the significantly greater medical costs associated with older prisoners. For example :Regardless of costs, states must provide adequate healthcare for all inmates, including those who are older, if they are mập uphold their duties under human rights and constitutional law. Unfortunately, some states fall short. One of the most infamous recent examples is California, which is currently under a medical receivership because of decades-long deficiencies in the medical and mental health treatment it provided its inmates, and which is also under a court order ( upheld by the US Supreme Court ) Khủng reduce prison overcrowding so that the unconstitutionally deficient medical and mental health services can be remedied. Older prisoners have suffered from the grossly deficient medical services that characterized California prisons, and they are benefitting from the improvements that are now being made .

Older inmates also benefit from class actions challenging

discrimination against prisoners with disabilities in violation of the

Americans with Disabilities Act. Thus, for example, elderly prisoners in

Colorado who have mobility and other physical impairments have benefited from

the 1997 settlement of Marquiz v. Romer requiring reasonable

accommodation of prisoners with disabilities.

Similarly, there are two named plaintiffs who are over 55 years of age among

the named plaintiffs in Holmes v. Godinez, a federal class action

brought by Illinois prisoners who are deaf or hard of hearing.

The complaint in the lawsuit alleges, inter alia, violations of the Americans

with Disabilities Act because the Illinois Department of Corrections does not

provide the assistance hearing-impaired prisoners need to communicate

effectively and to participate in prison programs and services.

State prison systems and the federal system both face the burden of financing constitutionally required healthcare for an aging prison population. The costs of providing medical treatment phệ inmates while inside prison are excluded from federal health insurance programs such as Medicare and Medicaid. States must cover the đầy đủ cost of meeting prisoners ’ medical, mental health, and dental needs .Although under the 1965 law that created Medicaid anyone entering state prison loses Medicaid coverage, in 1997 the federal government said that there would be Medicaid reimbursement available for the bills of prison inmates who stay in private or community hospitals for more than 24 hours. ( Technically, those who stay in the hospital for 24 hours or more are no longer considered prison inmates for the duration of their stay. ) Pursuant mập the 1997 policy, the possibility of reimbursement was limited Khủng otherwise Medicaid-eligible inmates ( for example, low income juveniles, pregnant women, adults with disabilities, and certain elderly persons ). Only six states béo date have taken advantage of the opportunity for such Medicaid coverage. Recent changes in Medicaid will expand the potential of Medicaid coverage for inmates. In năm trước, anyone with an income below 133 percent of the federal poverty line will become Medicaid eligible, which probably includes most inmates since they have little or no income. The potential savings for states will be significant, since not only will corrections agencies be able mập get federal reimbursement for 50 mập 84 percent of outside hospitalization costs for inmates, they will also benefit from the lower fees hospitals can charge for Medicaid patients .While Medicaid may help states defray some of the costs associated with hospital care provided outside the prison system, it will bởi nothing phệ relieve states of the considerable costs of transporting incarcerated men and women bự and from outside service providers, nor will it help with the costs of providing officers lớn guard offenders while they are receiving community-based treatment. One or more corrections officers are posted 24 hours a day Khủng watch inmates who are being treated in community hospitals .Sooner or later, one of two things will happen lớn an aging prisoner : she will either be released from prison or she will die behind bars. Both reentry into the community of older prisoners and death in prison are topics that have not yet received the attention they warrant. We note below a few observations and concerns. As indicated above, Human Rights Watch will be covering procedures regarding the early release of geriatric and infirm prisoners in a future báo cáo .Reentry into the community from prison is challenging for many formerly incarcerated men and women, difficulties which may be partially reflected in consistently high recidivism rates nationwide. However, reentry poses special challenges for the elderly. Older men and women released from prison often find it extremely difficult bự find work, housing, and transportation, as well as necessary medical and mental healthcare. Some have the assistance and tư vấn of family when they are released, but some have lost tương tác with their families — because of the length of giây phút incarcerated, or the nature of their crime — and have no home page mập which lớn go .Corrections officials consistently told Human Rights Watch that extra attention and effort are required phệ help older men and women resettle in the community. One of the biggest obstacles they face is finding nursing trang chủ care for the former prisoners who need it. Many nursing homes vì not want Khủng accept ex-felons, particularly if they were sex offenders, and those that may be willing Khủng bởi so may not have any beds available at the phút giây an individual who needs such care is released. At least two states, Georgia and Connecticut, are exploring the creation of special nursing homes on state property expressly for the purpose of ensuring housing for ex-offenders whose past crimes make them difficult mập place in private nursing homes .Older people can and bởi commit crimes, including older people who have been released from prison. Nevertheless, violent crime by older former prisoners is relatively rare. It is often said that “ crime is a young person’s game ” and the likelihood a person will commit serious crimes declines with age .Despite the many challenges of reentry, older inmates who are released mập the community are far less likely phệ recidivate — béo be rearrested, reconvicted, or returned lớn prison with or without hot nhất sentences — than younger inmates .A recent study by the Florida Department of Corrections revealed strikingly lower recidivism rates for offenders released when they are 50 years of age or older, and particularly for those released at 65 years or older, compared béo younger inmates. The báo cáo concludes that age at release may be the single most important factor predicting lower recidivism. In Colorado, offenders released at 50 years or older were also less likely phệ be returned mập prison within three years of release than younger offenders .Many studies of recidivism bởi vì not distinguish between returns phệ prison for technical parole violations — failure lớn meet with a parole officer, for example — and returns because of the commission of a mới nhất crime. From a public safety perspective, the latter is obviously more important. Data that disaggregates reasons for the return phệ prison shows older inmates are far less likely bự commit mới ra crimes after release from prison than younger inmates .In Thành Phố New York, dữ liệu on releases from 2.000 phệ 2006 reveals that inmates who were under 55 at the thời gian of release were at least twice as likely bự return lớn prison within three years of release with a mới nhất offense than prisoners released at age 55 and end. For example, in 2006, 10.9 percent of offenders released at an age less than 55 years returned lớn prison within three years with a hot nhất offense compared mập 5.4 percent of those released at age 55 or older. In Thành Phố New York, between 1995 and 2008, there were 469 prisoners who had been convicted of violent offenses and who were released from prison at 65 or older. Only one of them was ever returned lớn prison because of another violent offense ; seven returned because of non-violent offenses. Indeed, among the total of 1,511 prisoners–including those convicted of nonviolent as well as violent crimes–released during this period after they were 65, a total of 66 returned Khủng prison. This dữ liệu suggests a negligible likelihood of mới ra crimes by prisoners released when they are older. Whatever the reasons for keeping older prisoners incarcerated, public safety cannot be a plausible one in the average case .In a 2010 Ohio study, 26.7 percent of former prisoners commit hot nhất crimes within three years of their release from prison. But only 5.6 percent of offenders released between ages 65 and 69 commit mới nhất crimes, and only 2.9 percent bởi vì who are between age 70 and 74 when released. None of the 19 inmates released at age 75 and end committed hot nhất crimes ; nor, for that matter, did any of them violate the conditions of their parole .The low probability that released prisoners well on in years will commit hot nhất crimes suggests that their continued incarceration adds little mập public safety. The possible risk of crime posed by individual prisoners cannot, of course, be determined solely by age ; other factors must be considered as well, including their physical and mental condition and recent conduct behind bars. Nevertheless, available dữ liệu suggests that as a general matter public safety does not require the continued incarceration of geriatric prisoners, especially if they are infirm or incapacitated .As the number of older prisoners increases, so too does the number of men and women dying of natural causes behind bars. Some grow old and die in prison. Some enter prison in such poor health they will die before they have completed their sentence. For those who are already elderly at the giây phút of admission, even a short sentence may be a sentence phệ death in prison .Correctional systems are providing medical care mập ever growing numbers of terminally ill prisoners and are trying phệ expand their ability béo provide palliative care for the dying that is consistent with community standards, including through the creation of hospices. Each death is difficult for other inmates as well as staff .Not surprisingly, older men and women trương mục for a disproportionate and growing chia sẻ of prison deaths. Nationwide, in 2001, offenders age 55 and kết thúc comprised 33.9 percent of deaths in state prisons nationwide ; by 2007 the number had grown Khủng 45.7 percent. In the years 2001 – 2007, 8,486 men and women age 55 or end died behind bars. Data from individual states further illuminates the relationship between age of prisoners and mortality in prison :Many prison systems have created hospices béo respond phệ the emotional as well as physical needs of the dying. Others bởi not yet have licensed hospices, but are attempting Khủng provide palliative care nonetheless. Normal prison visitation rules are typically relaxed in prison hospices so that family members can sit at the relative’s bedside seven days a week and are permitted mập repeatedly hug and touch their loved one, something not usually permitted in prison. Human Rights Watch visited the 17 – bed hospice at California Medical Facility, which we were told was the first licensed hospice in the country. Chaplain Keith Knauf, the director of the program, says his goal is bự attend Khủng the physical, emotional, and spiritual needs of the inmates mập “ make sure they can die with dignity and respect. ” The average stay in the hospice is six months. Shortly before Human Rights Watch visited the hospice, an 87 – year-old inmate who had dementia and heart and lung problems had died there. We visited with a 67 – year-old inmate who had been in prison for 30 years, serving a 15 – to-life sentence, and who has advanced metastatic throat cancer. While he was pleased with the care he was given in the hospice, he was hopeful nonetheless that he would be able phệ secure compassionate release so that he would be able béo go trang chủ Khủng die with his family. In the hospice, inmate volunteers who receive 50 hours of training, as well as ongoing training as the need arises, sit vigil with the dying round-the-clock so they bởi not have béo die alone. The volunteers read béo the dying, talk and pray with them, write letters for them, and assist the nursing staff with certain basic tasks such as preparing the bath and changing diapers. Chaplain Knauf is extremely proud of the cadre of kết thúc 300 volunteer inmates who have worked at the hospice kết thúc the years .He says that those who have paroled from prison hardly ever return. The redemptive impact for inmates who work in hospices can be extremely powerful .Hospice programs bởi vì not resolve concerns about the dignity of dying in the harsh environment of prison. A visitor lớn the hospice — lượt thích an inmate in the hospice — can không bao giờ ignore the fact that the hospice is within a prison with its security staff and security rules and policies, however relaxed those rules may be phệ accommodate the dying. Prison hospice staff have quality constraints and pressures that come from being located within a prison ; they must answer mập officials who have priorities quite different than tending mập the physical, mental, and spiritual needs of the dying .Where a dying person wants mập be with family outside prison who are willing phệ take care of him, permitting him béo die with his family shows respect for his basic humanity and dignity. What does society gain by requiring the death phệ occur behind prison walls ?While human rights law does not preclude imprisonment of older offenders, the incarceration of the elderly nonetheless raises two major human rights concerns. First, are the conditions of detention, including medical treatment, consistent with human rights requirements ? We addressed some of the considerations surrounding conditions of confinement in preceding chapters. Second, does the continued incarceration of the aging and infirm constitute disproportionately severe punishment that violates human rights even assuming acceptable conditions of confinement ? It is mập this second question that we turn in this chapter .Accountability for crime is an indispensable component of a just criminal justice system. Extremely serious crimes warrant long prison sentences. Nevertheless, as prisoners grow old and infirm, the justification for continued imprisonment may diminish. Even if ongoing punishment is warranted, the question remains whether the size that punishment takes should change béo reflect age and infirmity. For example, conditional release béo trang chủ confinement under parole officer supervision could be substituted for continued incarceration .Within a human rights framework, imprisonment is an acceptable sanction for crime assuming it is imposed pursuant bự lawful procedures and that its duration is not disproportionately severe relative mập the crime and the legitimate purposes béo be furthered by punishment. In domestic as well as human rights jurisprudence, the proportionality of a sentence is typically assessed based on the circumstances that existed at the giây phút of the crime. Nevertheless, while a prison term may have been proportionate at the thời gian imposed, increasing age and infirmity may change the calculus against continued incarceration and in favor of some size of conditional release .Take the following men confined in state prisons : Homer Edmunds ( pseudonym ), age 87, has been in prison for 27 years, and for the past two decades he has been in a special unit because of his severe cognitive impairments. Louis Sparrow ( pseudonym ), age 68, has been incarcerated for 10 years and is blind, has diabetes and leukemia, and is completely paralyzed except for one arm. Thomas Viceroy ( pseudonym ) is a 65 – year-old man who has been in prison 25 years and is dying of stage bốn metastasized esophageal cancer. Each of these men was convicted of a violent crime and received lengthy sentences. Each has already been in prison a long phút giây .It is hard phệ see how their continued incarceration meaningfully serves any of the purposes for which their sentences were originally imposed. The main purposes of punishment are retribution, deterrence, incapacitation, and rehabilitation. Retribution has been furthered by their giây phút behind bars and could be further served if they were released from prison by restrictions on their liberty in the community and parole supervision. Incapacitation and deterrence are not necessary, given that these prisoners are not likely lớn endanger public safety if no longer behind bars but again, if there were a possibility of wrongful conduct, it could be prevented by the conditions of their release. Finally, further imprisonment is unlikely lớn advance rehabilitation. In these circumstances, continued incarceration would seem mập be a disproportionately severe punishment .Disproportionately lengthy prison terms may violate the prohibition on cruel and inhuman punishment. They may also constitute arbitrary deprivations of liberty in violation of the right lớn liberty. In either case, they are inconsistent with respect for human dignity. As the South African Constitutional Court has noted :Imprisonment is an extremely severe punishment that should only be used as a last khu nghỉ dưỡng when no lesser sanction suffices. Assuming it is warranted, however, the question of proportionality turns then on the length of the sentence. Prison sentences should be no greater than that which would be proportionate mập the crime itself, taking into trương mục the seriousness of the offense and the culpability of the offender. Within the boundaries phối by proportionality Khủng the crime, the sentence may be shortened if shorter sentences are adequate bự further such goals as promoting public safety or rehabilitation. The principle of parsimony is included in the concept of proportionality : the least severe sanction necessary bự achieve the purposes of punishment should be the one used .Ensuring that offenders receive their “ just deserts ” is an important component of criminal justice. Victims, their families, and society at large legitimately want those who commit crimes phệ be held accountable by punishment that “ fits the crime ” ; punishment that is commensurate with the severity of the crime and the individual’s culpability. On the other hand, under international human rights law, imprisonment should not be purely retributory. Prison systems “ should essentially seek the reformation and mạng xã hội rehabilitation of the prisoner. ”It might be argued that since “ just deserts ” are established at the phút giây of sentencing based on the crime that had already occurred, nothing that happens after sentencing should affect that determination. While this may be a theoretically correct argument, in practice post-sentencing developments affect retributive calculations in the United States. For example, in states where sentences are mix between a minimum and maximum range, parole boards are either explicitly required or tacitly permitted béo reassess the seriousness of the offense in determining how long the prisoner should serve .Some victims, criminal justice professionals, and members of the public believe offenders should always serve the maximum possible sentence. If the maximum sentence is life, they argue the offender should remain in prison the rest of his life. They oppose early release regardless of the offender’s age and infirmity. But such opposition would not seem mập be grounded solely in retributive principles. Grief, rage, contempt for those who break the law, punitive ideologies, and politics may influence it as well .In the US and many other western countries, retribution ordinarily comes into play Khủng mix the outer boundaries for the punishment for a particular crime. Non-retributive considerations as well as the principle of parsimony then factor into the determination of the actual sentence. The over result may be a sentence which is less severe than what would have been permissible from a purely retributive perspective. If utilitarian concerns such as consideration of what is necessary bự protect public safety can be used lớn lessen a sentence at the outset of its imposition from that otherwise permitted by retribution, it seems reasonable that ongoing utilitarian concerns could justify reducing the actual thời gian being served in prison below that which retribution might otherwise dictate. Parole boards take public safety into consideration in determining whether phệ release someone who has received an indeterminate sentence before they have served their maximum sentence. In addition, many states and the federal government contain provisions that permit early release before a sentence is fully served, including for purposes of compassionate release or medical parole .In the case of serious violent crimes committed by older persons, it might be troubling from a retributive, as well as fairness, perspective if offenders were phệ escape punishment simply by virtue of age and associated frailty. But once retributive values have been acknowledged, for example because a prison sentence has been imposed and part of it served, there seems lớn be little basis for insisting that retribution should dictate continued incarceration regardless of other considerations .It is important béo underscore a point that opponents of early release often overlook : prison is not the only size of punishment that serves retributive purposes. Retribution can be furthered through punishment short of incarceration : for example, if an offender is conditionally released from prison subject béo specific restrictions that limit his freedom and béo supervision by a parole officer .Incarceration protects public safety by “ incapacitating ” the inmate, that is, by preventing him from committing crimes in the community. But for older offenders who are declining physically and mentally, incarceration may have little or no added incapacitation value. As noted above, age is inversely correlated with criminal conduct. There are exceptions, of course, and incapacitation may be still be necessary for some older offenders, including those who offend at an older age. But many corrections officials have told us their prisons confine men and women who, by virtue of age, are too feeble or impaired bự commit another crime even if they wanted bự. Moreover, while there is a theoretical possibility that an old and dying man might commit a crime were he released phệ his family or a nursing trang chính in the community, such negligible threats as he might pose could be addressed through restrictions on his liberty short of incarceration .Another utilitarian and crime-prevention goal of punishment is lớn deter future crime by the individual being sentenced ( specific deterrence ) as well as by others ( general deterrence ). With regard lớn specific deterrence, the same concerns noted above regarding incapacitation apply. Continued incarceration has scant deterrent impact on the older offender who, by virtue of age and infirmity, already poses a negligible threat of reoffending .Requiring people béo remain in prison until the kết thúc of their sentence regardless of age and infirmity has no demonstrable general deterrent effect. The theory of general deterrence assumes prospective offenders know the specific sentences for particular crimes, that they engage in a rational cost-benefit analysis of their actions before acting, and that the more severe a sentence is the more likely they are not béo commit the crime. It is by no means clear that increasing the length of sentences increases the deterrent effect. But even if the increased severity of the punishment in some situations has increased deterrence value, it does not seem particularly likely that such an effect would come from requiring older offenders lớn remain in prison into their dotage. It is hard bự believe, for example, that a person about lớn commit murder because of overwhelming rage would desist from the crime because of the possibility that if caught and convicted he might be required bự serve not just a long sentence, but one that would keep him in prison even after he has Alzheimer’s disease. In addition, even if there were a deterrent effect from keeping people in prison despite their age and infirmity, there would still be the question of whether the benefits from crime reduction from such deterrence outweigh the costs of incarcerating the old and infirm .Punishment also promotes crime prevention by communicating society’s condemnation of particular conduct, and thus helps Khủng reinforce ( or create ) norms of conduct. We are aware of no research that shows that the effective condemnation of crime requires the continued incarceration of prisoners who have become old and infirm .The final commonly cited purpose of criminal punishment is phệ promote rehabilitation and reintegration into society. The rehabilitation of incarcerated offenders is not just good penal policy that will enhance the ability of former prisoners phệ lead productive, law-abiding lives. Efforts Khủng rehabilitate prisoners are also required by human rights law. After providing that “ All persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person, ” the International Covenant on Civil and Political Rights ( ICCPR ), ratified by the United States, further mandates that “ The penitentiary system shall comprise treatment of prisoners the essential aim of which shall be their reformation and mạng xã hội rehabilitation. ”Adults can grow and change markedly while incarcerated, especially if rehabilitative programs and opportunities for acquiring hot nhất skills and self-knowledge are provided. But it is unlikely that additional rehabilitation is achieved by continuing a prisoner’s incarceration into advanced old age. For an 80 – year-old who has been in prison for 25 years and has already participated in whatever educational and skills-building courses were available, more giây phút in prison will not contribute measurably Khủng his reformation. Indeed, what is the rehabilitative potential for a person who has dementia who no longer knows why she is in prison, or even that she is in prison ? While there may be exceptions in individual cases, as a general matter it is hard mập understand how the goal of rehabilitation is furthered by the continued incarceration of geriatric or dying prisoners .We note finally that there is a growing view among human rights experts that sentences which by their very terms preclude the possibility of reintegration into society constitute inhuman and degrading treatment. As stated by the dissenting judges in a recent European Court of Human Rights case, “ Once it is accepted that the legitimate requirements of the sentence entail reintegration, questions may be asked as mập whether a term of imprisonment that jeopardizes that aim is not in itself capable of constituting inhuman and degrading treatment. ” Thes e arguments are typically raised in the context of life sentences. But even sentences short of life — for example, those that are measured in decades — can frustrate the goal of reintegration, as can sentences of any length that take offenders bự death’s doorstep. If respect for human dignity requires giving each offender the possibility of rejoining society, that may mean releasing the old and infirm into a less restrictive khung of punishment before their đầy đủ prison sentence is served .Respect for human dignity and human rights is not guaranteed, however, simply by releasing an aging and infirm offender from prison. It is one thing, for example, mập release an old and frail woman lớn a loving family willing lớn take care of her in her waning days. But men and women who have spent many years behind bars may no longer have family or friends mập care for them. They might prefer remaining with the community they have in prison than being released mập a nursing trang chính. In addition, abuse and neglect of the elderly in some nursing homes make it clear that the well-being of nursing trang chính residents cannot be taken for granted. Corrections officials must exercise care béo ensure that prisoners released lớn nursing homes will receive appropriate care. They must also ensure that older prisoners are not released béo homelessness. Aging persons — even those convicted of serious crimes — have a right phệ lives không tính tiền of mistreatment and poor care wherever and however long they live .Absent significant changes in sentencing and release policies, the number of aging and infirm men and women confined in US prisons will continue phệ grow .The rising tide of aging prisoners in the United States makes imperative renewed and careful thinking about how lớn protect the rights of the elderly while in prison, and about how age and infirmity can render continued incarceration a violation of human rights. Wholly apart from human rights considerations, however, states and the federal government should question whether the continued incarceration of those who are well advanced in age and are infirm is a sensible use of limited financial and human resources .Jamie Fellner, senior advisor in the US Program at Human Rights Watch, researched and wrote this báo cáo. Dr. Patrick Vinck, a research scientist currently with the Harvard School of Public Health and associate faculty thành viên at the Harvard Humanitarian Initiative compiled and analyzed the 2009 state prison admissions, population, and sentence length dữ liệu presented here that was obtained from the National Corrections Reporting Program for 2009 ( the exceptions are noted in the text ). We are extremely grateful for his contributions mập this báo cáo, as we have been for his contributions lớn previous Human Rights Watch reports .Abigail Marshak, former US Program associate and currently a law student at Georgetown University, provided additional research on prison sentences and thời gian served. Vikram Shah and Elena Vanko, US program associates, and Mitchel Pardes, US Program intern, also provided research assistance on countless issues. Janet Schulze and Jessamyn Tonry, summer interns at HRW, provided additional legal research .The báo cáo was edited by Alison Parker, US program director, and Joe Saunders, deputy program director. Dinah PoKempner provided legal Đánh Giá. Shanta Rau Barriga, researcher / advocate for disability rights, also reviewed the báo cáo. Vikram Shah provided editing and production assistance. Anna Lopriore, creative manager, Grace Choi, publications director, and Fitzroy Hepkins, mail manager, ensured the smooth production of the final báo cáo .This báo cáo reflects insight and information gleaned from interviews with hundreds of corrections officials, incarcerated persons, medical staff, advocates, academics, consultants, and other prison experts kết thúc the course of a year of research. Although there are too many bự name individually, each made an important contribution Khủng our work. We are especially grateful lớn the many incarcerated men and women who were willing phệ chia sẻ their experiences with us. We also wish acknowledge with gratitude the following officials for helping arrange Human Rights Watch visits mập prisons in their states : Steve Stone and Terry Thornton, California Department of Corrections and Rehabilitation ; Alison Morgan, Colorado Department of Corrections ; Dr. James Degroot, Georgia Department of Corrections ; Dr. Gloria Perry, Mississippi Department of Corrections ; Dr. Carl J. Koenigsmann, New York Department of Corrections and Community Supervision ; Stuart Hudson, Ohio Department of Rehabilitation and Correction ; Roberta Richman, Rhode Island Department of Corrections ; and Rowlanda Caython, Washington Department of Corrections. In addition, Mike Lawlor, Connecticut Office of Policy and Management helped secure visits for us with state corrections medical and planning personnel. As is consistent with our practice when reporting on prison conditions, we use pseudonyms for offenders lớn protect against the possibility of intimidation or retaliation .We also want phệ express our gratitude for the guidance provided béo us by Dr. Brie Williams, assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco, and bự thank Dr. Robert Greifinger for organizing the inspirational Leadership Symposium in Correctional Health Care focused on elderly inmates .We wish Khủng thank Peter B. Lewis for his generous tư vấn of the US Program that made this báo cáo possible .

< 55

≥ 55


Percent ≥ 55

in State


3,402 260 3,662 7.1 %


15,420 1,110 16,530 6.7 %


157,511 12,797 170,308 7.5 %


19,956 1,402 21,358 6.6 %


17,298 754 18,052 4.2 %


93,526 7,911 101,437 7.8 %


50,731 4,082 54,813 7.4 %


7,822 586 8,408 7.0 %


36,193 2,851 39,044 7.3 %


20,671 1,346 22,017 6.1 %


8,503 513 9,016 5.7 %


28,511 1,996 30,507 6.5 %

New York

53,935 3,925 57,860 6.8 %

North Carolina

37,278 2,450 39,728 6.2 %

North Dakota

1,429 75 1,504 5.0 %


23,606 1,875 25,481 7.4 %


13,157 1,448 14,605 9.9 %


47,409 4,084 51,493 7.9 %

Rhode Island

1,974 157 2,131 7.4 %

South Carolina

22,624 1,446 24,070 6.0 %


25,665 1,808 27,473 6.6 %


145,225 12,255 157,480 7.8 %


33,055 2,505 35,560 7.0 %


14,854 1,128 15,982 7.1 %


879,755 68,764 948,519

7.2 %

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