What Will States Do With America's Aging Prison Population?

Longer life expectancies and a declining birth rate in the U.S. mean the American population is aging. The number of people aged 65 and older is expected to grow from 16.8% of the population in 2020 to 21.6% by 2040. The number of people aged 85 and older is projected to more than double from 6.6 million in 2019 to 14.4 million in 2040.

The U.S. also has the world’s highest incarceration rate, and it seems to be growing. The Bureau of Justice Statistics recently released a report showing data that the total prison population in the U.S. increased by 2% from 2021 to 2022. The majority (96%) of U.S. prisoners were serving sentences of more than 1 year. The report also noted that prison admissions exceeded releases, contributing to the population growth.

Statistics also show that our country’s prison population is aging rapidly. Inmates aged 55 and older have increased by 280% from 1999 to 2016, compared to a 3% increase in younger inmates. Going to prison also tends to age you faster than when you are in the outside world.

Prisoners experience accelerated aging due to the harsh conditions of incarceration and pre-existing health, social, and economic challenges. This leads to the earlier onset of geriatric conditions and increased medical costs. Older inmates face higher rates of cognitive impairment, dementia, and mental health issues than their community counterparts.

Prisoners' Right to Healthcare

Whether you’re in jail awaiting your trial or in prison serving your sentence, the U.S. Constitution gives you a right to adequate health care. This is true both in federal and state prisons. You’ve probably heard about the constitutional right to be free from “cruel and unusual punishment.” This is included in the Eighth Amendment, and goes far beyond just the obvious right not to be tortured. While the U.S. Constitution does not guarantee a right to health care, the right was read into the Constitution in a 1976 case called Estelle v. Gamble.

In Estelle, the Supreme Court established that if prison staff are “deliberately indifferent” to the “serious medical needs” of an inmate, that is a violation of the Eighth Amendment’s protection from cruel and unusual punishment. In that case, J.W. Gamble, a prisoner, sued after he received inadequate medical treatment for a back injury sustained during prison labor. He argued that this constituted cruel and unusual punishment under the Eighth Amendment, and SCOTUS agreed. This landmark decision established the standard that inmates must receive adequate medical care, shaping prisoners' rights by recognizing their entitlement to such care as a constitutional protection.

Problems Asserting the Right

While prisoners have this right, prisons often don’t have the resources to provide it. Gerontological nurses, with their expertise in caring for older adults and knowledge of health care systems, are positioned to play a crucial role in improving care for this vulnerable population. But correctional facilities often lack sufficient knowledgeable staff.  When these nurses have too high of a patient load, they may fail to recognize or manage aging-related health issues.

Additionally, what constitutes "deliberate indifference" and "serious medical need" for purposes of asserting your constitutional right is subject to judicial interpretation. As such, incarcerated individuals often face barriers to suing for inadequate medical care.

What Can You Do If Denied Right to Healthcare in Person?

What if your rights to adequate care as a prisoner have been violated? You may have a legal remedy and could go to a court to address the way you were or are being treated in prison. But many incarcerated individuals also struggle to access the legal system due to statutory barriers like the Prison Litigation Reform Act (PLRA). This law imposes restrictions on litigation, such as the need to prove physical injury for mental health claims, the requirement to exhaust administrative remedies, and financial burdens.

Before you can take a claim to court, you must show that you “exhausted” your remedies within the prison system by going through the procedures in place there for filing grievances. The judge will ask you how you tried to get access to medical care, and you will need to show evidence that you tried but your efforts were frustrated.

Thus, it is good to always document your complaints and requests for care, whether that be to prison staff or medical professionals. As soon as a medical need comes up, be sure to voice it. Seek the opinion of a doctor if you can. Showing that you complained to prison authorities and that you even got medical opinions on your needs will show that the powers responsible for providing you with adequate health care were aware of your needs. If you can show that your efforts to seek health care were ignored, you may have a viable claim of “deliberate indifference.”

A Flawed System

Unfortunately, even successful litigation often results in limited, piecemeal relief that fails to drive systemic change. Lots of cases have led to settlements benefiting only the plaintiffs or state residents, with limited broader impact. And then there’s the issue of funding prisoner health care. In most places, Medicaid has been barred from covering health care for prisoners. Instead, that falls to state and county funds. However, a recent amendment in California has finally allowed Medicaid to fund prison health care in that state only.

Many legal and policy experts have called for proactive reform, such as amended the PLRA, the establishment of uniform standards of care, penalties for noncompliance, and oversight by a regulatory body. They also propose that federal funds for medical services should be available to incarcerated persons to encourage compliance with health standards.

You can read more about the rights of prisoners in our legal resource pages. FindLaw also has Do-It-Yourself forms that can help you file a Complaint for Denial of Medical Care for a State Inmate. If you feel like you or someone you know has had their rights violated by the prison system, you should get in touch with a civil rights attorney in your area to see if you might have a good legal case.

Related Resources:

• How to Find Out If Someone You Know Has Been Arrested or Incarcerated (FindLaw's Law and Daily Life)
• Eighth Amendment Protection Against Cruel and Unusual Punishment (FindLaw's U.S. Constitution Pages)
• Types of Long-Term Health Care for Older Adults (FindLaw's Learn About the Law)