A rarely discussed side-effect of “tough on crime” policies from the 1980’s and 1990’s is the number of felons now aging in federal and state prisons. At either state or federal level, our incarceration system is not equipped to manage the health needs of geriatric prisoners. There are very few nurses, no certified nurse aides, and nobody to handle the medication orders, administration and documentation. More and more states are evaluating this problem under the dual lenses of cost and 8th Amendment responsibilities. One solution that states are utilizing is the long-term care community. This may take the shape of medically releasing individuals or contracting with a SNF to solely take this population either under custody or under medical release. If you are considering either of these in your building, we urge you to consider the ramifications. The first option, where you take just a few ex-felons or one here and there under compassionate medical release asks you to think through the complications that may arise.
- How will you comply with the terms of the medical release?
- Who is responsible for sharing that information with third-party providers such as hospice and dialysis?
- Who do you communicate with as the medical and legal power of attorney?
Dependent on the type of crime committed, what risk factors do you need to address in your facility, for your residents and for your staff? Will you accept ex-felons who have committed a sexual assault crime and If you do, what adjustments to your center do you need to make? The second option, contracting with the corrections department, may sound more intimidating; but you eliminate the risk factor of mixing medically released ex-felons with a frail elderly population. This would also allow you to redesign your center and develop clinical protocols to meet the special needs of this population. You know your center, you manage change every day, if you are considering this opportunity, proceed with caution!