The state has been working to get people out of nursing homes, but officials are hoping that at least one facility will be open to taking a new group of residents — parolees and patients from state institutions.
Like many states, Connecticut has a growing population of older prisoners whose care, officials say, could be provided less expensively outside prison. The state already has legal mechanisms to parole inmates who are “physically incapable of presenting a danger to society,” but they’re rarely used, and Department of Correction staff often struggle to find nursing homes willing to take prisoners who could be paroled if suitable placements were available.
Many states facing budget woes have contemplated ways to parole inmates who need long-term or hospice care, but research suggests that few have been released.
“Given that many state policymakers have expressed an intention to permit the release of elderly inmates who are not a threat to public safety, it is remarkable that geriatric release policies have had little impact,” Tina Chiu, director of technical assistance for the New York-based Vera Institute of Justice, wrote in a 2010 report.
In seeking to contract with a nursing home for about 95 beds, Connecticut officials say they’re hoping to develop a workable pipeline when the number of people expected to use it is relatively small, rather than relying on case-by-case efforts to find beds for sick or disabled inmates when there are more in the system.
“Unless we try and deal with it now, it’ll be unmanageable, unaffordable 10 years from now,” said Michael Lawlor, undersecretary for criminal justice at the Office of Policy and Management, Gov. Dannel P. Malloy’s budget office.
Earlier this month, the state departments of correction, social services and mental health and addiction services issued a request for proposals for nursing homes willing to care for “clients under state care who are difficult to place,” which includes both paroled inmates and patients from Connecticut Valley Hospital, or CVH. In a nursing home, they would almost certainly qualify for Medicaid, allowing the state to receive federal reimbursement for about half the cost of their care. Medicaid doesn’t cover care delivered in prison or at CVH, where some patients who entered with behavioral health issues now have a primary diagnosis of dementia.
The proposal comes at a time when state policymakers are forecasting a drop in the need for nursing home beds even as the overall population ages, the result of efforts to expand the use of home and community-based long-term care. Malloy’s proposed budget adjustments for the coming fiscal year includes $13 million in bonding and operating dollars to help nursing homes “right-size” by modernizing, diversifying or downsizing, as well as $2.6 million to develop the capacity for nursing home care for the “difficult to place” state clients.
Is the timing right to get a nursing home interested in taking on patients the industry has traditionally shied away from?
“Some facilities have expressed an interest, but it would be wrong to characterize it as broad-based interest in the nursing home community to move into this line,” said Matthew Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes.
He added that there’s concern among facility operators that becoming known for serving inmates could make it hard to attract other residents.
Aging faster behind bars
In seeking placements for aging prisoners, state officials are trying to solve a problem that Lawlor said didn’t exist three decades ago, when the prison population was a third of its current size.
Aging prisoners represent a growing population across the country, presenting correctional systems with unique challenges that range from how to handle inmates who need special physical accommodations to the high cost of providing nursing home-level care in high-security settings.
There were 26,200 sentenced state and federal prisoners aged 65 and older in 2010, up 63 percent from 2007, according to an analysis by Human Rights Watch. In that time, the overall number of sentenced prisoners grew by less than 0.7 percent.
People in prison often exhibit signs of aging faster than the general population, experts say, the result of substance abuse, poor health or limited access to medical care before entering prison, as well as stresses that come with incarceration. Some states consider prisoners to be geriatric when they hit 50.
In Connecticut, the prison population has fluctuated over the past decade before declining in recent years. But the number of inmates over 60 has grown steadily, rising from 166 at the start of 2002 to 238 at the start of this year. In that time, the number of prisoners aged 46 to 60 rose from 1,511 to 2,844. The total prison population was 17,022 on Jan. 1, down from 17,999 a decade ago.
While the rise in the prison population was fueled in part by tougher sentencing policies, not all of the state’s older prisoners are serving long sentences. Department of Correction spokesman Brian Garnett said many enter in their 50s or 60s for a first-time offense.
Older prisoners are more likely to need higher-cost medical care, and some states have looked to save money through policies allowing the release of those who are not considered a threat. In 2009, 15 states and Washington, D.C., had provisions for releasing geriatric inmates, according Chiu’s Vera Institute report.
But Chiu found that those provisions were rarely used.
Maryland and Oklahoma had not released anyone under their geriatric release laws as of 2009, and several states released only a handful. As barriers, Chiu cited the way application processes for some release programs worked, as well as politics and public sentiment.
“A commonly cited reservation is that offenders placed in nursing homes may prey upon an already vulnerable population,” she wrote.
‘Incarcerated for a reason’
Connecticut Department of Correction staff members have faced similar concerns when they’ve tried to place potential parolees in nursing homes.
“There are legitimate concerns, but at the same time, we have a responsibility to provide appropriate medical care for that offender, and finding that sort of placement in the community is extremely difficult,” Garnett said.
In seeking a more formalized arrangement, the departments involved have been clear that they would not discharge anyone they’re concerned about, said Judith Dowd, section director in the budget division overseeing health and human services issues. It’s in their interest to have the program work, she noted; if there’s ever a bad incident, the effort wouldn’t succeed.
The program would start up mid-year with fewer beds to assure that the system works before ramping up to 95 or so beds.
The request for proposals appears to seek out a nursing home operator with a facility that could serve only those leaving prisons or institutions, rather than mingling them with other residents; a minimum qualification includes owning and operating a nursing facility with a capacity of about 95 beds.
Sen. John Kissel, R-Enfield, said the proposal raises several concerns and questions, including about whether the beds would be in a stand-alone facility or a wing of a larger facility with other patients.
“What if it was your mom or dad or grandparents in this nursing facility and one whole wing is dedicated towards prisoners?” he said, adding that the types of crimes they were convicted of would make a difference. If there were 25 convicted murderers in a facility, he said, “I don’t care how old they are, I would not feel good about it.”
Kissel said having a separate facility dedicated to parolees would cause fewer concerns, although he said 95 beds is a lot and could raise questions about location, staffing and security.
“I don’t care if they’re 80 years old,” he said. “They’re incarcerated for a reason.”
Rep. Craig Miner, R-Litchfield, said it could make fiscal sense to have people with significant health issues receive care in lower-cost settings. The state currently spends just under $100 million on health care for prisoners, a figure that’s drawn scrutiny from lawmakers.
But Miner said it will be critical for the plans to be clearly disclosed and explained so people understand what’s happening in their communities.
“I try not to be an alarmist, but I do think there are a lot of reasons for concern and a lot of hope that if done the right way, it can save the state some money, allow us to, as Secretary [Benjamin] Barnes said, rebalance this asset of a nursing home in some other productive way, and not upset the community in which they exist,” he said.
Miner likened the situation to group homes opening in communities. In some cases, it worked well, with no tension, while in other cases, it didn’t go as well, the result, Miner said, of not having the communication to make neighbors understand what was happening.
Growing need
The state’s inmate population is down more than 13 percent from its peak in February 2008, and Lawlor expects it will continue to fall. But if it were to remain steady, he said, in 20 years, the system could require 500 nursing home beds.
Massachusetts is already facing similar projections. Unlike Connecticut, the Commonwealth does not have any “compassionate release” provisions, and a recent master plan for the state’s corrections system recommended building three facilities for patients who need long-term care. By 2020, the plan authors estimated, 900 of about 27,000 inmates could have medical needs serious enough to require a separate living environment.
Connecticut’s Department of Correction has a hospice unit and infirmaries that serve inmates with dementia, and Lawlor said the system will always need that level of care for people whose sentences make them ineligible for parole, or who aren’t suitable for release.
The people who could be released if a nursing home agrees to take them are people who are already eligible to be out of prison. If a person doesn’t know what day it is, can’t get out of a wheelchair and is close to death, Lawlor added, why spend twice the money of a nursing home caring for him in prison?