‘It’s Where We’re at Right Now’: US Prison System Struggling to Keep Up with Growing Need for Palliative Care

Individuals in prison environments often have limited access to palliative care services, making these patients among the hardest to reach for providers.

Labor pressures amid growing demand represent the largest barriers in terms of both limited staffing volumes and high workforce costs.

Many incarcerated seniors who could benefit from palliative care do not receive adequate access or referrals to these services, according to Katherine Supiano, associate professor in the College of Nursing at the University of Utah.

“We’re facing a backdrop in which a lot of people with serious illness are disproportionately represented in our jails and prisons,” Supiano told Palliative Care News. “And that is just unconscionable, but it’s where we are at right now. So many have a much higher risk of medical comorbidities and less access to health care.”

Swelling aging inmate populations are driving demand for palliative care in prison settings. Nearly one-third of the nation’s prison population will be 55 and older by 2030, according to research from the Prison Fellowship. Prison populations across the United States saw a 280% rise in incarcerated seniors in this age group from 1999 to 2016, the research found.

Seriously ill seniors in prison settings often do not receive the full interdisciplinary scope of palliative services, including limited nursing visits, according to David Gorlock, Pennsylvania’s state organizer for the advocacy group Straight Ahead.

“The population that is over 55 — considered geriatric inside prisons because people’s life spans are much shorter there — is nearly one-third of the prison population,” Gorlock told local news. “That is not because there is a crime wave by senior citizens. It is because of the amount of life without parole, life and lengthy sentences that are being handed out. The prison system was never designed to become a nursing home or hospice, but it has become one. They didn’t have a specific nurse for them. They might have received two or three more visits a week.”

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Clinical capacity limits are a large reason growing senior inmate populations lack access to palliative care services, according to researchers from Pennsylvania State University.

Prison health care staff can include various clinical disciplines, but often lack palliative-specific professionals. Fellow inmate caregivers provide much of the care and support that palliative care patients receive in prison settings, the Penn State researchers Susan Loeb and Rachel Wikon found in a data analysis report published in the American Journal of Nursing. The pair examined nearly 20 studies spanning serious illness and end-of-life care delivery among prisoners nationwide.

“The inmate caregivers, in particular, provided a wide array of services and were viewed positively by both patients and health care staff,” Loeb and Wikon stated. “There are insufficient data to characterize the patients’ and inmate caregivers’ perceptions of the care staff and the quality of care they provided. Inmates providing care viewed caregiving as a transformational experience.”

North Carolina is among the states that has launched legislation aimed at addressing some of the palliative access issues among inmates, including high staffing costs associated with palliative care delivery in prison settings.

A bill was approved in 2021 that issued $7.2 million of recurring funds towards the addition of 77 full-time employees to the state’s prison health care system. The funds were intended to establish a long-term care facility at Central Prison in North Carolina, a move to reduce the overall cost of health care for elderly incarcerated populations.

Two years later, only three of the positions have been filled, a number that trails behind demand, according to a report.

“Demand for long-term palliative care in our prisons has grown along with the aging offender population,” the report language stated. “The Department of Adult Correction (DAC) is still working through a minimum staffing threshold solution required to open a portion of the long-term care facility at Central Prison.”

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