This report is provided in accordance with requirements outlined in Section 944.8041, Florida Statutes.
Elderly inmates are defined by Florida Statute 944.02 as "prisoners age 50 or older in a state correctional institution or facility operated by the Department of Corrections." The number of elderly inmates in the state prison system has increased steadily from 11,178 on June 30, 2006 to 20,753 on June 30, 2014, and this particular population is expected to continue to increase over the next decade.
Policy makers and independent auditing bodies that review the Department’s health services operations have consistently noted the challenges inherent in providing health care services to inmates, specifically to those inmates age 50 and older:
Correctional Medical Authority
2012-2013 Annual Report and Report on Aging Inmates
“It is evident from the data presented here and in the professional literature, that older inmates have more health problems and generally consume more health care services than younger inmates. Older inmates may also place a greater fiscal strain on correctional systems as they may require additional housing and management needs in a prison setting, secondary to their generalized vulnerability and medical conditions. Many of them will never leave prison because of the length of their sentences. Older prisoners will continue to increase in numbers and in the overall percentage of prisoners, and thus, will continue to consume a disproportionate share of an already limited number of resources available for health care and programmatic enhancements within the correctional setting.”
Florida’s Aging Prisoner Problem, September 2014
“The FDOC budget has grown by $560 million (35 percent) from 2000-2012. Health care costs have grown by $176 million, or 76 percent, in that same period. Health care costs are growing at more than twice the rate of overall corrections spending.”
“Extrapolating the cost of elderly health care from published FDOC information is possible. FDOC reports that elderly patients accounted for 49 percent of all hospital days in 2012. Assuming hospitalization days are representative of overall prison health care costs, the elderly prison population was responsible for approximately half of the $408 million prisoner healthcare costs in 2012, which averages to $11,000 per year solely for the health care of elderly prisoners. The remaining 82,209 prison population is under the age of 50, and their health care costs average approximately $2,500 per prisoner.”
“This rough analysis indicates that elderly prisoners cost four times as much as non-elderly prisoners. Furthermore, this estimate is very likely a conservative one, as a “hospital day” for an elderly patient likely requires more doctor and nurse supervision, more drugs, more physical therapy, and more tests than younger prisoners.”
“These estimates are congruent with medical costs estimates from prison studies conducted around the country, and from medical experts regarding prison healthcare costs for the elderly. These experts report elderly prisoners create cost multipliers of 2-8 times that of prisoners below 50 years of age.”
The Pew Center on Research has estimated that the cost of managing an elderly prisoner is approximately $70,000 annually. This yields a per diem of $192, compared with the Department’s average healthcare cost of $10.96 per inmate per day for all facilities during Fiscal Year 2013-14. Pew further notes that; “Health care is consuming a growing share of state budgets, and corrections departments are not immune to this trend,” said Maria Schiff, director of the State Health Care Spending Project, an initiative of Pew and the John D. and Catherine T. MacArthur Foundation.
The Department does not house or treat inmates based solely on age. Elderly inmates are housed in most of the Department's major institutions consistent with their custody level and medical status.
Currently, the facilities listed below serve relatively large populations of elderly inmates. Housing these inmates separate from the general population reduces the potential for predatory and abusive behavior by younger, more aggressive inmates and promotes efficient use of medical resources.
In 2013, the Department began implementing a statewide health care outsourcing project. The Department contracted with two private correctional health care companies to provide comprehensive onsite and offsite medical, mental health, dental, pharmacy management, utilization management, claims, quality management, risk management, and other services to more than 90,000 inmates statewide. Wexford Health Sources provides services at nine institutions in South Florida, and Corizon, Inc. covers the other 41 institutions in North and Central Florida.
Demand for bed space for elderly inmates with chronic medical needs is very high. Therefore, though Wexford and Corizon are providing care to all elderly inmates, the Department has retained responsibility for assigning and transferring elderly inmates with chronic medical needs to specialty beds at CFRC South Unit, Reception and Medical Center, Zephyrhills J-Dorm, and SFRC F-Dorm. This ensures elderly inmates with the highest levels of acuity will be placed in the most appropriate setting.
The elderly inmate population in Florida has increased by 86% since 2006 (from 11,178 to 20,753 inmates). This rapid rate of growth is expected to continue through the peak of the national aging boom (2020-30). Although Florida does not track inmate health care costs by age, utilization data shows that elderly inmates account for a disproportionate share of hospital services. In FY2013-14, elderly inmates accounted for 51.3% of all episodes of care and 63.40% of all hospital days although they only represented 20.6% of the total prison population.