California’s oldest prison, the San Quentin Rehabilitation Center, was built in 1852. It is not technically a medical facility, but you wouldn’t know it by the number of bright yellow mobility and hearing impaired vests work and the dozens of slow moving people hunched over with canes. Some people are so far gone and heavily medicated, that it can look more like a nursing home or psychiatric facility than a prison.
I have been in prison for 30 years. I’m no spring chicken. I don’t have the shock absorbers to jump up and down out of top bunks like I used to. When I navigate the five concrete and steel tiers to my cell in the north block housing unit, I find younger people blowing their imaginary horn at me, as they gallop two or three steps at a time. After living in an artificial dungeon with poor lighting and watching bright TV screens in the dark for decades, I now need assistive eye wear to read. Sometimes I find myself forgetting where my glasses are only to discover them five minutes later sitting on top of my head. I’m no longer in a hurry. Aging, physical, and cognitive impairment is slowly beginning to catch up with me. And I’m not alone.
Prisons originally designed for young, able-bodied adults are increasingly unable to meet the medical and accessibility needs of elderly residents.
Older people make up five times as much of the prison population as they did three decades ago, according to an August 2023 report from the Prison Policy Initiative: “From 1991 to 2021, the percentage of the state and federal prison population nationwide aged 55 or older swelled from 3% to a whopping 15%.” The report found that prison takes two years off of life expectancy and that, between 2001 and 2018, 30,500 people aged 55 or older died in prison.
In California, approximately 20% of the nearly 90,000 incarcerated people are age 55 or older, up from about seven percent in 2010. The aging of California’s prison population is requiring the state to provide services that extend far beyond traditional corrections.
The California Department of Corrections and Rehabilitation’s (CDCR) has put out two proposals this year to address these rising challenges. In March, CDCR released “Alternatives to Incarceration,” which identified a “focus population” of 9,283 incarcerated individuals who could potentially be released. Seventy-seven percent of them are over 65 years old and 60%, or 5,531 people, are serving indeterminate sentences and have been incarcerated for more than 20 years.
According to the report, incarcerated people are experiencing mental and physical decline approximately ten years earlier than people living in the community. People in their 50’s are requiring the types of medical care that are more commonly associated with people in their 60s and 70s. Conditions such as dementia, Alzheimer’s disease, Parkinson’s disease, and other age-related illnesses are becoming increasingly common behind prison walls.
Older incarcerated people typically require more frequent hospitalizations, chronic disease management, mobility accommodations, specialized medical equipment, and around-the-clock care. This comes with a steep financial price tag for taxpayers. The average per capita cost of incarceration in California is $138,000; 40% goes toward health care.
In May, CDCR published the “Infrastructure Master Plan,” requesting $73 billion for new infrastructure upgrades to existing facilities to specifically address the aging prison population. The plan includes new geriatric housing units, assisted living facilities, dementia care units, hospice programs, and other specialized medical housing intended to care for incarcerated people through the final stages of their life.
Without decarceration, there is essentially no way around the astronomical cost of caring for an aging prison population. California has a constitutional obligation to provide adequate medical care to everyone in its custody per the Eighth Amendment to the United States Constitution and the federal three-judge panel decisions in Plata v. Newsom and Coleman v. Newsom. These decisions resulted in mandatory medical and mental health receivership and a complete takeover of California prison health care facilities by the federal courts.
Social justice groups, including Initiate Justice and the Ella Baker Center for Human Rights, argue that CDCR’s expensive infrastructure plan does not address the underlying problem. Rather than spending billions to build what some describe as “nursing homes behind bars,” these organizations argue that California should expand opportunities for compassionate release, medical parole, elderly parole, and resentencing for people who no longer present a significant public safety risk.
Many aging incarcerated people have served decades in prison and have among the lowest rates of recidivism rates of any age group, according to CDCR’s own Alternative to Incarceration report: “Incarcerated individuals released through elderly parole have a reconviction rate of 1.8 percent, consistent with long-standing trends of low recidivism among older age groups.”
But the statutes designed to release the elderly are being underutilized. These include elderly parole laws established through Plata v. Newsom and Coleman v. Newsom, Penal Code Section 3055, medical parole laws established in 2011 by Penal Code Section 3550, and Compassionate release laws established through Penal Code Section 1172.2.
Equally problematic is that, when they are released, elderly people often face challenges securing stable housing and adequate health care upon reentry to society. They have are facing cognitive decline, have poor support networks due to criminal stigma and loss of family and friends.
Many of these elderly individuals have already engaged in costly programs to transform their lives, from rehabilitative treatment to educational and vocational programming. California should not be preparing to care for thousands of people as they die in prison, stakeholders argue. Instead, it should be examining how to safely return people who have been rehabilitated to their families and communities.
The purpose of prison is to rehabilitate people who represent a threat and to return them to society. Turning prisons into nursing homes ultimately raises serious questions about justice, public safety, fiscal responsibility and human dignity. The state has a choice to make: build more specialized prison housing or create broader pathways for elderly release. The decision about where to put public resources will define justice for an aging generation of incarcerated people and for local communities that stand to gain or lose resources.
This is a critical moment for the future of incarceration in California. Pouring resources into upgrading prisons to accommodate old people with weak bones is fundamentally at odds with the true purpose of public safety. Many people who have been incarcerated for decades are no longer dangers to society. Some are mobility impaired and can barely hear or see. There are almost 10,000 people aged 65-80 sitting in prison, forgetting where they are while playing checkers and eating jello pudding. That’s not the type of lifestyle prisons were designed to accommodate.
