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 17,492 on June 30, 2011 to 21,620 on June 30, 2015; a 23.6% (4,128) increase over the last five years.
During FY 2014-15, there were 3,739 elderly inmates admitted to Florida prisons. The majority were admitted for violent offenses (30.5%), followed by property crimes (30.0%), and drug offenses (24.5%). The oldest male inmate admitted was 89 for murder/manslaughter and oldest female was 78 years old for property crimes.
In August 2015, 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 1,080 inmates), the elderly population is expected to increase from 21.6% of the total population to 26.5% during that period. This represents an increase of 4,860 inmates, bringing the estimated total of elderly inmates to 26,703 by June 30, 2021.
There are numerous challenges inherent in providing health care services to inmates, specifically to those inmates age 50 and older:
Correctional Medical Authority
2013-2014 Annual Report and Report on Aging Inmates
“The CMA’s report on the status of elderly offenders continues to show that older inmates have more health problems and generally consume more health care services than younger inmates. The demands of caring for the elderly continue to have an impact on corrections’ health care costs. According to the National Institute of Corrections, the overall cost of incarceration for inmates over 50 is as much as three times higher than for the younger population mostly due to the difference in health care costs.”
September 2014, Florida’s Aging Prisoner Problem
“The rising cost of health care for elderly prisoners is a national dilemma, creating budgetary headaches for the federal government and most states. Nowhere is this looming crisis more acute than in Florida. Florida’s elderly prisoner population is now over 20,000, and on its way to 30,000 by 2018. By 2020, one out of every three prisoners in Florida will be elderly. This rate will be double the 16 percent national average, and impose huge and unsustainable fiscal burdens on Florida taxpayers.”
June 29, 2013
“State and federal prisons spend an estimated $1.6 billion taxpayer dollars a year keeping elderly convicts…Nearly a quarter of that price tag – roughly $3 billion taxpayer dollars annually – is devoted to providing health care to sick or dying prisoners.”
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 Corizon, LLC. - to provide comprehensive health care services to more than 100,000 inmates statewide. Demand for bed space for elderly inmates with chronic medical needs is very high. Though Wexford and Corizon 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
2013-14 Annual Report
“It is recommended that DOC continue to examine and consider the needs of inmates over 50 when establishing standards of care criteria for the private health care providers. Additionally, reporting of detailed health care costs for aging inmates would be beneficial for analysis of projected needs to adequately care for the elderly population in the coming years.”
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 2016; 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.
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, 2006 to June 30, 2015, the elderly inmate population in Florida increased by 93.4% (from 11,178 to 21,620 inmates). Based on the projections outlined in this report, this rate of growth is expected to increase by 4,860 inmates by June 30, 2021.
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. Identifying additional bed space appropriate for inmates with dementia is a high priority.
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 Assistant Secretary of Health Services, the Director of Medical Services, or the appropriate discipline director (mental health, dental, nursing, or pharmacy). 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.
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.