“Don’t let me die alone” the dying prisoner whispered as her reached for his caretakers hand. “I won’t” replied the younger man and true to his word he remained by the dying man’s side, helping him to sip water, wiping his face and holding his hand. When death came just after midnight, the younger man, also a prisoner, wiped a lone tear from his cheek. He had volunteered for this work, to care for ill and dying prisoners but had not foreseen the ways in which the experience would transform him.
Aging in Prison
For most people aging in place is a desired goal but it is the dreaded future for people who face declining health and eventual death in prison. Aging prisoners express their fear of being handcuffed to a hospital bed as they take their last breaths, of dying alone and abandoned
For taxpayers aging in prison means paying higher taxes. It costs over $150,000 a year to imprison people over the age of 55–more than twice the amount spent to imprison younger people. Costs rise as a result of increased costs of medical care inside and outside of prison. For example when prisoners are transported to outside hospitals they must be accompanied by two correctional officers who must remain with the prisoner through out the hospitalization. The officers generally receive overtime pay for this duty.
Prisons are not designed to house ill and cognitively impaired people. The impaired are not able to follow orders; the prison staff is not trained to assist those with impairments. There is no funding for ancillary services. Early onset dementia, including Alzheimer’s Disease, is difficult to detect in a population often accompanied with other mental illness and maladaptive social behaviors. According to the Alzheimer’s Association, Alzheimer’s Disease constitutes for nearly 80 percent of dementia cases. As the aging population continues to grow on the outside, the aging prison population parallels this not only in terms of lifers but newly incarcerated older adults.
Prisoner Initiated Solution
The needs of some of these prisoners have been met through two unique programs in which prisoners (working with pastoral and mental health staff) have received training to act as caregivers attending to patient needs. The prisoners are prepared to act as caregivers through intensive academic and clinical training to initiate the awareness, symptomology and recommendations for daily care of dementia clients, particularly Alzheimer’s Disease, behind bars. This is based on the Special Needs Program for Inmate-Patients with Dementia (SNPID) at the California Men’s Colony (CMC) in San Luis Obispo, California. As part of the SNPID, the Gold Coats program consists of healthy inmates specially trained to care for those with dementia and other cognitive impairments and are designated for the gold smocks they wear.
Former Prisoners Collaborate to Develop a Symposium
Women’s Council member Aileen Hongo met many of the caregivers as part of her “healing squad project” bringing art workshops to prisons through out the state. As Gold Coats were released some began to meet with Aileen on a regular basis. Together they developed the book The Gold Coats: An Exceptional Standard of Care: A Collaborative Guide to Caring for the Cognitively Impaired Behind Bars.”
Together they planned and implemented a meeting of local stakeholders who came together at USC on May 3, 2017 to participate in the Compassion in prison and Beyond Symposium. Participants learned about the Gold Coat vision, which would allow for compassionate release of ill and dying prisoners to a facility staffed by compassionate highly skilled Gold Coats.
The project addresses the social work grand challenge of successful decarceration in several ways. Releasing chronically and terminally ill prisoners to an outside treatment facility would significantly reduce tax payer costs, ensure adequate health care and reduce the prison population. The current wave of intent to release elderly inmates does not address the impact of how to care for this underserved population. Though the learned skills and work ethic have helped many former Gold Coats find employment outside caregiving after release, policies must change to allow formerly incarcerated individuals to utilize skills learned in prison that can improve the quality of life for those awaiting compassionate release.
Providing employment as caregivers for former prisoners would meet a labor market need for skilled caregivers and would provide meaningful employment for former prisoners with an expected reduction in recidivism. The experiences of former Gold Coats is a working rehabilitative program that provides skills for meaningful employment while caring for those who cannot help themselves. Many of the Gold Coats had dual roles and served as hospice caregivers assuring those that were dying they would not be alone or forgotten. Many, if not most, of their Alzeheimer’s clients who were not transferred or released ended up in hospice and again, in the care of the beloved Gold Coat that took care of them through the various stages of Alzheimer’s Disease.
The Gold Coat Vision
The vision of this group is to 1) develop a model home/facility with trained caregivers that would allow for compassionate release for those being held simply because there is no placement for them; 2) provide a continuum of care for those with dementia/cognitive impairments who would otherwise be turned away from assisted living/nursing homes due to criminal history and; 3) provide meaningful career opportunities as both caregivers and trainers for those with conviction histories and becoming mentors for those who otherwise have been deemed unlikely to succeed in society.
This model could be replicated throughout the country to reduce the prison population, provide humane care for the disabled and establish an effective, rehabilitative training program inside and outside prison walls. The outcome would address many of the current situations for aging prisoners such as a) increased cost of care and lack of preventative care; b) higher risk of accidents due to structural challenges and policies of prison environment and c) higher risk of homelessness post release.
Opportunities to Provide Assistance
As a result of the workshop strategies were developed to implement the Gold Coat vision, which include developing legislation to ensure licensing for caregivers and exploring options to create and fund a residential facility. Concerned allies are encouraged to attend Gold Coat meetings (usually on a Saturday over lunch near Union Station) to provide support and develop resources to advance the mission.
To contact the Gold Coats email email@example.com
The Women’s Council meets bimonthly and addresses a variety of practice issues and their ethical implications. The Council meets on Saturday mornings at various locations in the greater Los Angeles area. The next meeting is scheduled for Saturday June 24, 2017 in Redondo Beach. For further information contact firstname.lastname@example.org.