Doing Time, Standing in Line: Elder Prisoner Healthcare from the Inside

Abstract

Purpose:

It is critical to understand the importance and meaning of health in the older prisoner's life. The health of this population not only affects the individual - but the prison system, the family, the institutional caregivers and the larger community. Aday (2003) notes there are over 150,000 elder prisoners in state and federal correctional facilities. In Alabama alone, there has been an increase from 1925 inmates in 2001 to over 3167 inmates in 2006. Adults over the age of fifty now represent 11.3% of the total prison population in the state (Aday, 2003). While the older inmate population continues to grow, changes in the system (funding, resources, support) have not kept pace at the same level. Over one half of these prisoners report their health as poor, there is a prevalence of chronic health concerns in this population: hypertension, diabetes, arthritis, cancer, heart problems and sensory losses. This study provides a unique opportunity to explore the experience of the older inmate placed in a southern prison that has provided care specifically for aged and infirm prisoners since the mid 1980s.

Method:

Qualitative data were collected via semi-structured, in-depth interviews with four older male prisoners (60 and up), and 10 participants, who worked in various positions in the healthcare system of a southern prison. Individual cases were designed around each inmate's healthcare story. Prominent themes across cases were derived using a constant comparative approach. Interviews were transcribed and Nvivo 7 was used for coding and data analysis.

The analysis provided descriptive cases about how healthcare is managed and received in a prison specifically housing older male inmates. Specific exploration of key themes included: healthcare challenges; description of the healthcare process; family support; health communication; challenges and obstacles concerning policy issues; and community education to increase awareness of issues faced by inmates in the prison system. Each case provided a multi-faceted view of the healthcare process from each key participant involved. Prisoners and healthcare providers expressed both feelings of frustration and satisfaction with components of the current system

Conclusions and Implications:

There are direct implications at both the practice and policy level for social workers in the prison system and in the “free world”. Interviews reveal critical needs and challenges faced by older male inmates related to their healthcare. Some participants ignored health problems until they became health crises. The healthcare process routinely involved much time standing in line waiting, sometimes not to be seen by the “doctor”. Similarly, the healthcare providers face challenges in providing quality care in a heavily monitored, secure environment. Does prisoner status trump healthcare needs? Can appropriate care for chronic medical conditions be provided within the limits of a prison budget? These questions create potential areas for program design and expansion. On a larger level, policy issues need to be addressed at the state level to provide avenues for change in the prison healthcare system and how the outside community views this marginalized group in society.