In 2013, the number of state and federal prisoners 55 or older continued to grow rapidly, according to the Bureau of Justice Statistics. These inmates cost state prison health care systems, on average, at least two to three times that of other inmates. While correctional health care costs began declining in many states in 2010 and 2011, a steadily aging prison population could reverse this trend.
Older inmates, greater expense
A July 2014 report by the State Health Care Spending Project, a collaboration between The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, found that state spending on prisoner health care increased from fiscal 2007 to 2011, but it began trending downward from its peak in 2009—a positive development as long as it did not come at the expense of access to high-quality care. But states continue to face a variety of factors that threaten to drive costs back up. Chief among these is a steadily aging prison population.
New data from the Bureau of Justice Statistics suggests that this challenge became more acute in 2013. From 1999 to 2013, the number of state and federal prisoners 55 or older—a common definition of “older” prisoners—increased 234 percent, from 43,300 to 144,500. During the same period, the number of inmates younger than 55 grew much more slowly: up 9 percent, from 1.26 million to 1.37 million.1 (See Figure.) In 2013, the number of older inmates rose by 13,000, whereas the number of inmates younger than 55 fell by 8,700. The graying of U.S. prisons stems from an increase in admissions of older inmates to prison and policies that keep inmates behind bars for longer periods.2
As the number of inmates who have grown old behind bars increases, so do the health care costs for their treatment. Like senior citizens outside prison walls, older inmates are more susceptible to chronic medical conditions, including dementia, impaired mobility, and loss of hearing and vision. In prisons, these ailments necessitate increased staffing levels, more officer training, and special housing—all of which create additional health and nonhealth expenses. Medical experts say inmates typically experience the effects of age sooner than people outside prison because of such issues as substance use disorder, inadequate preventive and primary care before incarceration, and stress linked to the isolated and sometimes violent environment of prison life.3
The older inmate population has a substantial impact on prison budgets, but estimates of the increased cost vary. The National Institute of Corrections pegged the annual cost of incarcerating prisoners 55 and older with chronic and terminal illnesses at, on average, two to three times that of the expense for all other inmates, particularly younger ones.4 More recently, other researchers have found that the cost differential may be wider.5
At the state level, project researchers have found evidence of a relationship between the relative size of a state’s older inmate population and its spending per inmate. See here for inmate age and spending trends on a state-by-state level.
- Allen J. Beck, “Prisoners in 1999,” Bureau of Justice Statistics (August 2000), http://www.bjs.gov/content/pub/pdf/p99.pdf. Data for 2013 were generated using the Bureau of Justice Statistics’ Corrections Statistical Analysis Tool.
- Thomas P. Bonczar, “National Corrections Reporting Program: Most Serious Offense of State Prisoners, by Offense, Admission Type, Age, Sex, Race, and Hispanic Origin,” Bureau of Justice Statistics (May 2011), http://www.bjs.gov/index.cfm?ty=pbdetail&iid=2065; The Pew Charitable Trusts, Managing Prison Health Care Spending (October 2013), http://www.pewtrusts.org/en/research-and-analysis/reports/2014/05/15/managing-prison-health-care-spending; and The Pew Charitable Trusts, Time Served, (June 2012), http://www.pewtrusts.org/~/media/legacy/uploadedfiles/ pcs_assets/2012/PewTimeServedreportpdf.pdf.
- Tina Chiu, “It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release,” Vera Institute of Justice (April 2010), http://www.vera.org/sites/default/files/resources/downloads/Its-about-time-aging-prisoners-increasing-costs-and-geriatric-release.pdf.
- B. Jaye Anno et al., Correctional Health Care: Addressing the Needs of Elderly, Chronically Ill, and Terminally Ill Inmates, National Institute of Corrections (February 2004), http://static.nicic.gov/Library/018735.pdf.
- Cyrus Ahalt et al., “Paying the Price: The Pressing Need for Quality, Cost, and Outcomes Data to Improve Correctional Health Care for Older Prisoners,” Journal of the American Geriatrics Society 61, no. 11 (2013): 2013–9, doi:10.1111/jgs.12510.