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 or the Department of Management Services." The number of elderly inmates in the state prison system has increased steadily from 18,368 on June 30, 2012 to 22,458 on June 30, 2016; a 22.3% (4,090) increase over the last five years.
During FY 2015-16, there were 3,815 elderly inmates admitted to Florida prisons. The majority were admitted for property crimes (31.6%), followed by violent offenses (28.7%), and drug offenses (22.6%). The oldest male inmate admitted was 87 for other crimes and the oldest female was 73 years old for property crimes.
In September 2016, the Department’s Bureau of Research and Data Analysis developed a projection of the growth of the elderly inmate population, based on Criminal Justice Estimating Conference (CJEC) population estimates. Though the projection for growth of the total inmate population is relatively flat over the next six (6) years (a projected increase of only 1,417 inmates), the elderly population is expected to increase from 22.7% of the total population to 27.7% during that period. This represents an increase of 5,247 inmates, bringing the estimated total of elderly inmates to 27,743 by June 30, 2022.
There are numerous challenges inherent in providing health care services to inmates, specifically to those inmates age 50 and older:
Correctional Medical Authority
2014-2015 Annual Report and Report on Aging Inmates
“Florida’s elderly offender population is expected to continue to increase over the next decade. As the population grows, the demand of caring for inmates age 50 and older will continue to have a significant impact on FDC’s health care service delivery system and expenditures. Assessing the health care status of elderly offenders is essential because the information gathered provides policymakers with reliable information that can be used to help inform budgetary, policy, and programmatic decision making.”
The Pew Charitable Trusts
March 2016, Elderly Inmates Burden State Prisons
“Nearly every state is seeing that upward tick in elderly state prisoners. For state prisons, the consequence of that aging is money, more and more of it every year. Health care for aging prisoners costs far more than it does for younger ones, just as it does outside prison walls. Corrections departments across the country report that health care for older prisoners costs between four and eight times what it does for younger prisoners.”
February 15, 2015, Aging Inmates: A Prison Crisis (Valeriya Metla)
“It costs around $24,000 a year to house a young prisoner, but the expenses for an aging prisoner can be up to $72,000 per year. The reason for the jump, not surprisingly, is medical costs. As people grow older, they naturally have more health issues than their younger counterparts. Older prisoners with significant medical needs have to be housed in specific facilities that most prisons don’t have, or, if they do, cost them a fortune to maintain. Thus, prisons for aging populations increasingly resemble nursing homes more than correctional facilities.”
Elderly inmates are housed in most of the Department's major institutions consistent with their custody level and medical/mental health 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.
Currently, the Department contracts with two private correctional health care companies – Wexford Health Sources and Centurion of Florida, LLC. - to provide comprehensive health care services to more than 88,000 inmates statewide. Demand for bed space for elderly inmates with chronic medical needs is very high. Though Wexford and Centurion are providing care to all elderly inmates, the Department retained responsibility for assigning and transferring elderly inmates with chronic medical needs to the specialty beds outlined above. This ensures elderly inmates with the highest levels of acuity are placed in the most appropriate setting.
Recently, Florida TaxWatch and the Correctional Medical Authority (CMA) have made recommendations to the Department regarding elderly inmates.
Florida’s Aging Prison Problem (September 2014)
Report the Current Cost of Elderly Prison Health Care - Florida TaxWatch recommends that Florida collect and report the health care costs of the elderly prison population. Understanding the current costs for elderly heath care, the average cost per year to incarcerate an elderly prisoner, and the highest cost prisoners, are vital to the analysis and understanding of correction costs. Additionally, cost figures identifying current costs are necessary, so that cost projections can be determined and evaluated.
Report the Projected Growth of the Elderly Prison Population in Florida – “The data is available for the state to project the growth in elderly prison populations. FDOC reports elderly statistics for the overall prison population, and the age groups of new prison admissions each year. The FDOC offender database also permits searches of those currently incarcerated by age. This provides sufficient data to project elderly prison population growth. The state can use these projections, as it does to estimate future prison population totals, and make annual prison population projections for elderly prisoners. While prior year statistics show an elderly prison population which has grown from 5,605 in 2000, to 20,750 in 2014, the important information for decision-makers is if/when this growth will stop.”
Correctional Medical Authority
2014-15 Annual Report
“If FDC’s elderly offender population continues to grow at the same rate it has during the past 10 years, it is projected that over the next five years, inmates age 50 and older will account for 27 percent of Florida’s inmate population. It is a generally recognized fact that elderly offenders disproportionately impact correctional health care systems. They have complex needs that often require ongoing and extensive treatment and care. As Florida’s elderly offender population continues to grow, FDC will be faced with operational and fiscal challenges as the agency works to meet the demands of caring for this population. To meet those demands, FDC must be proactive and identify fiscal, programmatic, system, and policy solutions that can alleviate the burden of providing care to a growing 50 and over inmate population.”
The Department has begun the process of re-bidding health care services through a series of Invitations To Negotiate (ITNs). Requirements for contractors to track detailed health care costs for inmates age 50 and over will be included in these ITNs. It is anticipated that contracts from these ITNs will be awarded in 2018; data will be available after health care service provision has begun. It should be noted that an electronic health record would help facilitate the collection of this data.
One of the biggest challenges for the Department is ensuring we have the appropriate health care workforce to serve the growing elderly population. To this end, the Department will place greater emphasis on requiring the contractors to hire health care workers for specialty care units who are familiar with the specific requirements of geriatric care. In addition, the Department will review training courses on geriatrics that could be added to the standard training package for all health services staff.
In addition, the Department’s Bureau of Research and Data Analysis has made a projection for the growth of the elderly inmate population through June 30, 2021, consistent with Criminal Justice Estimating Conference (CJEC) prison projections. This projection is included in the “Background and Statistics” section of this report, and it will be updated annually. The Department does not recommend making projections beyond the standard CJEC estimates.
From June 30, 2007 to June 30, 2016, the elderly inmate population in Florida increased by 77.4% (from 12,658 to 22,458 inmates). Based on the projections outlined in this report, this rate of growth is expected to increase by 5,247 inmates by June 30, 2022.
Each year, the Department assesses the growing need for appropriate bed space for elderly inmates, especially those with complex medical and/or mental health needs. In December 2010, the Department opened the renovated F-dorm at SFRC, which added 84 beds to the statewide inventory of bed space specifically geared to this population. The Department is currently examining other options to increase bed space to accommodate the expected increase in demand for specialty beds for elderly inmates.
As part of this effort, the Department has submitted a Legislative Budget Request in the amount of $16.3 million for FY 2017-18, to create a 598-bed Residential Mental Health Continuum of Care (RMHCC) program at Wakulla Correctional Institution. The RMHCC is an innovative initiative that uses specialized residential mental health units to improve treatment outcomes, promote safety and reduce costs. These specialized units provide protective housing and augmented treatment for inmates whose serious mental illness makes it difficult for them to adjust to the prison environment. The RMCCC uses specialized mental health units for diversion, stabilization, habilitation and rehabilitation, creating an inter-connected continuum of care at a singular location.
Though there may be challenges associated with bed space, the Department has a comprehensive system for ensuring elderly inmates receive appropriate medical, mental health, and dental services. Health care procedures and health services bulletins are reviewed annually to ensure they reflect the latest standards of care, and that appropriate services are provided in accordance with acuity level, age and other factors. The Department has a grievance appeal process established in Rule that allows inmates to submit appeals directly to Central Office. The health care grievance appeals that are received from inmates are screened by a registered nurse and personally reviewed by the Health Services Director and the appropriate discipline director(s) for Medical Services, Mental Health Services, Dental Services, Pharmaceutical Services and/or Nursing Services. This process includes a review of the inmate’s health care record, to ascertain if appropriate care has been provided. Finally, as mentioned above, the Department has a process for reviewing service plans of impaired elderly inmates quarterly, at a minimum.