The U.S. prison population is graying fast. Prisons aren't ready By one measure, about a third of all prisoners will be considered geriatric by 2030. Prison systems are grappling with how to care for their elderly prisoners — and how to pay for it.

The U.S. prison population is rapidly graying. Prisons aren't built for what's coming

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The U.S. has more people in prison than any other country, and that population is rapidly graying. By one measure, about a third of them will be considered geriatric by 2030, and state prison systems are trying to figure out how to care for them. Here's NPR's Meg Anderson.

MEG ANDERSON, BYLINE: Andre Gay went to state prison in Pennsylvania in 1972. He was sentenced to life for robbery and murder. At the time, he was 16 years old.

ANDRE GAY: I was a kid when I came to jail, so I was basically a blank slate.

ANDERSON: He learned from the older men there, who he called his elders. Then he became an elder himself - and with that, all the things that come with age.

GAY: Sciatica, arthritis - as you get older, you don't have the strength that you used to have. You don't have the stamina. Prison is not good for anybody. A lot of times, the elderlies have it the worst.

ANDERSON: For years, Gay only saw his reflection in a scratched-up metal mirror. But decades into his prison term, he caught a glimpse of himself in a real mirror as clear as day.

GAY: I literally did not recognize who I was looking at. I had changed so much. It was so disconcerting that it stayed in my head all this time.

ANDERSON: He hadn't realized just how much he'd aged. Prison is a hard place, and people behind bars tend to age faster than people on the outside. So geriatric in prison can mean someone as young as 50. And today that's a big group. The country's geriatric prison population is about five times what it was 30 years ago.

KEVIN KEMPF: It is a problem, and it's a growing problem.

ANDERSON: Kevin Kempf is the executive director of the Correctional Leaders Association.

KEMPF: We actually saw it coming. We knew from a lot of the decisions that were made, you know, in the late '80s, early '90s, that were contributing to mass incarceration. And here we are today.

ANDERSON: He says tough-on-crime policies like mandatory minimums and three-strikes laws are a big reason why many people who went to prison decades ago are still there today. And now prisons are racing to figure out how to care for their elderly and how to pay for it. The first people to tell you that are the ones running state prison systems, like Nick Deml in Vermont...

NICK DEML: When you think about geriatric medical needs, many of the prisons across the United States are not equipped or weren't designed that way.

ANDERSON: ...And Bryan Collier in Texas...

BRYAN COLLIER: And you have to adapt cells. You have to go into an existing cell and basically make it wheelchair compatible.

DEML: And so the systems are grappling with how to retrofit or make do with the facilities that we have.

ANDERSON: ...And Heidi Washington in Michigan.

HEIDI WASHINGTON: They may have a need for a bottom bunk or for certain kinds of diets.

ANDERSON: The list goes on.

COLLIER: Being able to do oxygen in there.

WASHINGTON: More specialized staff.

COLLIER: More plugs for CPAP machines - little things you don't think about.

ANDERSON: Right now, many states are using their medical wards as a place to also care for aging prisoners who need long-term care. Some states are building entirely new facilities devoted at least partly to geriatric care. Others have retrofitted their prison units.


UNIDENTIFIED GUARD: It'll be just a minute.

JOAN WOLFF: OK, thank you.

ANDERSON: That's what they did with the unit at the state prison in Oak Park Heights, Minn.

WOLFF: And what we're going to be walking into is called a sally port, which means that one door can only be open at a time.

ANDERSON: Joan Wolff is the associate director of nursing at the state's department of corrections. She says this unit serves both the sick and the elderly. It has about four dozen beds and has expanded twice in the last two decades. There's a medical clinic on one end where prisoners are getting dialysis, and then a row of prison cells, each one with a hospital bed, a nurse call button and a glass door.

WOLFF: That way, we can visualize what is happening with the patient as we walk by the door. And you're also going to note that the doorways are substantially wider to allow for wheelchairs.

ANDERSON: Oak Park Heights is one of two specialized units like this in Minnesota's prison system. Together, they can house around 150 people. But the state's prisons have 1,400 people over the age of 50. Of course, not all older prisoners need this level of care, but even those who aren't in sick wards might need more attention than they're getting now. That's according to Andre Gay in Pennsylvania.

GAY: This is common throughout all prisons that I've been in. I have seen a lot of bad things - a lot of dudes just getting old.

ANDERSON: Some prisoners end up having to help each other. Gay remembers a young man who would care for an elderly man who was blind.

GAY: He used to always come to his cell and take him to the yard, to the kitchen, wherever he needed to go.

ANDERSON: Gay says you can't just tweak the prison system to make it better. And Marta Nelson, the director of sentencing reform at the Vera Institute of Justice, agrees. She says prisons are not going to be able to build their way out of this.

MARTA NELSON: It becomes quite expensive to do that. There are more people in prison now serving a life sentence than there were people in prison at all in 1970.

ANDERSON: It is expensive. Kentucky, for instance, is spending more than $200 million to build a new prison medical facility with a nursing-home unit, and that doesn't include the cost of hiring staff or providing health care. Nelson says states need to think much more seriously about releasing elderly prisoners, but she acknowledges that's complicated for all kinds of reasons.

NELSON: You have somebody who is in prison for, say, murder. Well, OK, this person literally couldn't hurt a fly. And yet at one point in time, they created a great deal of harm. So how can we release them?

ANDERSON: Andre Gay did get released in 2022, avoiding a future where he grew sick and died in prison.

GAY: I was in prison for 50 years, three months, two weeks and three days.

ANDERSON: He's 68 now. He's got gray hair and gray beard stubble and wears glasses. These days, he helps get other prisoners released.

GAY: It's what gives me what I need to keep on going.

ANDERSON: Gay flips through his phone to a photo of himself with a frail older man, a friend from the inside with cancer.

GAY: Believe it or not, we got him out.

ANDERSON: That man was able to die surrounded by his loved ones. Many won't have that chance, and it'll be up to the states to find a way to take care of them.

Meg Anderson, NPR News.


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