In this blog, PRI’s Vicki Prais, looks at the challenges faced by elderly people in prison, sentenced to life imprisonment. Vicki notes that the ‘greying’ of the prison population has seen an upward trend and warrants attention as it is a group that will certainly grow given the rise in life sentences handed down globally. Between the years 2000 and 2014, there was an increase of almost 84 per cent in the number of those serving formal life sentences worldwide.
“My one big fear is dying in prison and all alone…I’ve never been inside before this conviction and I felt so cut off from my older wife and grandchildren. Because of my heart condition and the need for walking sticks to help me get around I can’t get to the library or education, so I have to stay in this unit all day long.”
A 2019 report by the Office of the Correctional Investigator in Canada, Aging and Dying in Prison: An Investigation into the Experiences of Older Individuals in Federal Custody has once again shone a light on the acute challenges faced by older people in prison. The report makes a number of recommendations to the Canadian Corrections Service (CSC) to improve the treatment and care of this group of prisoners and sets quite a clear tone at the outset of the report, ‘Prisons were never intended to be nursing homes, hospices or long-term care facilities’ The challenges faced by older people in prison have been well-documented by criminal justice experts, academics, civil society organisations and in previous blogs written for Penal Reform International.
The recent report of the UN Office of the High Commissioner on Human Rights (OHCHR), ‘Human Rights in the Administration of Justice: Violence, Death and Serious injury in situations of deprivation of liberty’ dedicates a section on the lack of adequate healthcare as a contributory factor to deaths in detention. The OHCHR notes, ‘…access to healthcare is often inexistent or inadequate and infringements to the right to health contributes to deaths in situations of deprivation of liberty.’ The High Commissioner on Human Rights has called for states to ‘guarantee access to healthcare this is tailored to the individual needs of detainees and ensure that the care available to them be at least equivalent to that available in the community’. The need for tailored medical care for older life-sentenced prisoners is vital to ensure that any detention is in line with international human rights standards.
The ‘greying’ of the prison population has seen an upward trend as documented by PRI in its latest Global Prison Trends Report 2019. Correctional facilities have traditionally categorised older prisoners as age 50 plus due in part to the phenomenon of “accelerated ageing” in prison. According to Global Prison Trends 2019, across the European region, the proportion of the prison population who are over the age of 50 is an average of 11.7 per cent, ranging from 44 per cent in Liechtenstein to three per cent in Russia. Further afield, the picture is equally concerning: in Japan, the number of prisoners aged 60 or older rose from seven per cent of the total prison population in 2008 to 19 per cent in 2016 and in Singapore, the number of prisoners over 60 doubled between 2012 and 2016. In Canada, elderly prisoners in federal custody (i.e. aged 50 or over) now account for 25 per cent of the federal prison population. And so the list continues.
Yet, buried deep within these statistics lies a sub-population of people in prison who face extremely challenging circumstances and who, it may be said, are something of a forgotten minority: older people in prison serving life or indeterminate sentences. As a wider group, life sentenced prisoners are a growing phenomenon within the criminal justice system as countries move towards the abolition of the death penalty. As of 2014, there were approximately 479,000 persons serving formal life sentences around the world. Life Imprisonment has, in many jurisdictions, become the de facto alternative. The definition of life imprisonment varies across jurisdictions, but PRI applies the following definition: Life imprisonment is a sentence following conviction, which gives the state the power to detain a person in prison for life, that is, until they die there. It is difficult to find figures for the number of older life-sentenced prisoners.
Rehabilitation: an ongoing challenge
For many older life sentenced prisoners the prospect of any type of life beyond the prison walls is a daunting and terrifying one. They are offered little, if any, rehabilitation opportunities by correctional authorities who prefer to place more focus and energy on ‘skilling up’ the younger prison community. In the European Court of Human Rights case of Vinter v UK, the Court spoke of “the right to hope” and stated that conditional release should be an option for all, including life-sentenced prisoners. Yet, these prisoners are simply left behind in terms of rehabilitation and reintegration and are not incentivized to think about release as a real prospect; they become, for want of a better word, ‘institutionalized’. This may be particularly acute for those prisoners sentenced to Life Without Parole or a long prison sentence at a young age. This malaise is palpable as one 68-year-old Canadian prisoner states, “I’m institutionalized. I’m bitter and I have been screwed over by the system so badly, I’ll never function on the outside.” Yet evidence proves the contrary: in 2013 in the U.S., 200 elderly life sentenced prisoners with an average age of 64 years old were released en masse from prison following a court ruling. These former prisoners collectively had a recidivism rate of just 3 per cent putting pay to any concerns around public safety.
Older people in prison face chronic medical conditions including hypertension, diabetes, pulmonary disease, strokes, arthritis, asthma, depression, cognitive impairment and ongoing health issues which will require enhanced medical attention. In addition, life-sentenced prisoners face a very real prospect of dying in prison which brings with it challenges for healthcare professionals in terms of end-of-life care and gives rise to a phenomenon of ‘death anxiety’ among life-sentenced prisoners. There are relatively few medical studies focusing on health impacts for older life-sentenced prisoners; one UK research study of 121 prisoners over the age of 55 serving life or indeterminate sentences found that 48% of prisoners had mild depression and 3% had severe depression. The same report also found that depression in this group of prisoners was related to ‘the burden of chronic ill health’ as opposed to the specific effects of imprisonment.
Older people in prison: time for a geriatric informed policy?
The “ageing crisis” within criminal justice systems will invariably require States to adapt and adjust their practices, policies and planning to accommodate this ever-expanding prison population. Correctional authorities globally will need to future-proof their prisons for this community. The International Committee of the Red Cross has suggested that corrections services “geratricize” clinical spaces in correctional facilities and establish a geriatric healthcare policy agenda. This may include adaptations to the physical prison infrastructure for example sound proofing or adapted lighting. These adaptations are particularly important for life sentenced prisoners who may be spending many years in prison and may live out their natural life there. In addition, the training of criminal justice professionals including lawyers, judges, correctional staff and probation officers in geriatric care should be explored to ensure that the system treats older people in prison in line with human rights standards and provide the appropriate medical care. In some institutions, specialist staff have been hired with expertise in gerontology and aged care.
People in prison do not lose their right to dignity simply by virtue of being detained and for many older people their time in prison can be a humiliating and degrading experience. In many cases a prison sentence is not always the best option. Governments should rethink their policy and look to alternatives to detention for older life-sentenced prisoners such as electronic tagging, diversion to nursing homes, hospices or house arrest. Such practices are happening on the ground. In Connecticut, US a system called “nursing home parole” allows individuals who do not pose a risk to the community to be housed in privately-owned nursing homes contracted out by the state.
Moreover, older life sentenced prisoners are strong candidates for benevolent release policies such as geriatric release (age dependent) or compassionate release (based on ill health). In some countries for example in Russia, Ukraine and Romania, the authorities limit the imposition of life imprisonment on individuals over a certain age (65 years old). In other jurisdictions, such as Spain and France, the authorities ensure that elderly life-sentenced prisoners have the possibility of leaving prison by making them eligible for parole when they reach a certain age – in both cases 70 years old. And in some quarters, notably in the US, there are discussions around ‘second look sentencing’ which would give life-sentenced prisoners the opportunity to have their sentence reviewed through a more compassionate and rehabilitation-focused lens. Compassionate release mechanisms however are generally underused with restrictive eligibility criteria acting as a serious bar. In one case in Wisconsin, US, a blind quadriplegic was ineligible to apply for early release.
Nor does it make financial sense to keep older people in prison given their associated healthcare costs. The figures speak for themselves: according to a 2012 report by the American Civil Liberties Union, care of older people in state and federal prisons is in the region of $16 billion a year; approximately $3 billion is spent on health care for sick or dying prisoners. Research in both Australia and the US found that the cost of accommodating older prisoners is approximately three times greater than for younger people in prison. Data is difficult to find on the costs of detaining older life-sentenced prisoners. The economic imperative to detain older people in prison is simply not sustainable.
The treatment of older life-sentenced prisoners requires a careful calibration on the part of criminal justice authorities. Policies should be evidence-based to better understand their experiences and needs in prison yet there is a glaring lack of academic research in this area. Perhaps it is now the right time to explore this area further and create humane and human rights-based policy for this group of vulnerable prisoners.
Office of the Correctional Investigator, Aging and Dying in Prison: An Investigation into the Experience of Older Individuals in Federal Custody
PRI Blog, Old age behind bars: how can prisons adapt to the needs of increasingly elderly populations, Bridget Sleap, 25 September 2014
PRI and the University of Nottingham, Policy Briefing – Life Imprisonment, April 2019
The Philadelphia Inquirer, 200 elderly lifers got out of prison en masse. Here’s what happened next, 12 December 2018
Ageing and Imprisonment, Workshop on ageing and imprisonment: identifying and meeting the needs of older prisoners, International Committee of the Red Cross – June 2018
Second look sentencing, Diane Diamond, 14 July 2018
Depression in elderly life sentence prisoners – Murdoch, Morris and Holmes, International Journal of Geriatric Psychiatry – April 2008
American Civil Liberties Union, At America’s Expense: The Mass Incarceration of the Elderly – June 2012
The Osborne Association, The High Costs of Low Risk: The Crisis of America’s Aging Prison Population, May 2018
The author is very grateful to Ben Jarman, PhD researcher at Cambridge University for his input and advice on this blog. See: https://changinginside.co.uk/ and to Aldyen Krieger, PRI Policy and Programme intern for desk-based research.
 ‘Doing Time’: the experiences and needs of older people in prison, Prison Reform Trust briefing, 2008