From 1995 to 2010, U.S. prisons saw a 282% rise in the number of older inmates (ages 55 and older), and between 2001 and 2007, nearly 8,500 prisoners ages 55 and older died while incarcerated.
According to Penrod and colleagues, the availability of hospice services varied across prisons within the same state, with variations attributed to perceived need (a considerably larger number of older inmates or prisoners with life sentences, for example); attitudes held by “security personnel, health care staff, other prison staff, and the public,” which influenced prioritization; and “prison culture” (That is, how prison leadership sees an institution’s mission).
The numbers of designated hospice beds in prisons varied from a low of one to three beds to a high cited by nine programs of “unlimited” beds, though most facilities can care for no more than nine hospice patients at any given time, and a significant number can house no more than one, two, or three hospice patients simultaneously.
Criteria for receiving end of life services: The patient must be terminally ill. According to Centers for Medicare and Medicaid Services, nonincarcerated Medicare enrollees are eligible for hospice if thy have a terminal illness with a life expectancy of six month or less, pursue palliative or supportive care rather than curative treatment, and sign a treatment acknowledging that they choose to receive hospice care rather than other treatment covered by Medicare.
Hoffman and Dickinson reported that most of the 43 prison hospice programs they surveyed offered sustained-release opioid pain medications; about 18% used patient controlled analgesia pumps, and about a quarter used short-acting pain medications or behavioral management interventions.
The screening process for potential inmate caregivers varied among the programs, but eligibility relied heavily on inmate behavior and past offenses, typically requiring that inmate caregivers, have no sex offenses and no rules infractions over the past one or two years. After initial screening, potential inmate caregivers were interviewed and selected by the hospice team, including current inmate caregivers, and prison officials. Training was usually overseen by members of the hospice team. Depending on the specific program, social workers, chaplains, nurses, health administrators, or corrections officers monitored and coordinated the end of life program; supervision of inmate caregivers tended to fall to the nurses.
The two key contributions of inmate caregivers were assistance with activities of daily living, such as bathing and toileting, and support with instrumental activities of daily living, such as letter writing and transport of patients within the prison. Inmate caregivers described hospice care as a moral and social responsibility. Inmate caregivers cited many motivations for their role. A common theme was redemption–providing a way to give back and right past wrongs. Some inmate caregivers viewed providing end of life care to dying peers as transformative.
In Correctional Nursing: Scope and Standards of Practice, the American Nurses Association specifies that an RN’s “primary duties in the correctional setting are the prevention of illness, health promotion, health education, and restoration and maintenance of the health of patients in a spirit of compassion, concern, and professionalism.”
Wion, R. K. & Loeb, S. J. (2016). End-of-life care behind bars: A systematic review among the caregiver groups studied, inmates are starting to assume a central role. AJN, 116(3), 24-36. Retrieved from https://nursing.ceconnection.com/public/modules/7131