'They really struggle': As inmates grow old, Kansas prisons plan for geriatric care

Feb. 2--TOPEKA -- Cody Carter, who leads a non-denominational Christian ministry at Lansing Correctional Facility, sees first-hand what happens as inmates age behind bars.

"I do have guys in my program that have like a colostomy bag or are wheelchair bound or have seizure problems -- a number of issues that make it really tough to navigate," Carter said.

It's a scene likely to become increasingly common as Kansas prepares for a rising tide of hundreds of aging inmates who will require expensive, specialized care as they approach the end of their lives.

Gov. Laura Kelly plans to retrofit an unused building near a prison in Winfield, south of Wichita, for a growing population of elderly inmates. The unit would accommodate those struggling with some of the most difficult challenges associated with aging, including dementia.

Aging prisoners are a critical challenge for a system in chronic crisis from overcrowding and staff shortages. To stabilize and improve prisons, officials are pursuing almost contradictory goals.

A sweeping criminal justice overhaul to substantially cut the prison population could take years, prompting Kansas to take interim steps to improve the system as a bigger debate over reform plays out.

While the long term goal remains a smaller population, the state plans to spend heavily in the short term: on new space to reduce overcrowding, expensive services to house elderly inmates and rehabilitation for those with substance abuse issues.

The expansion for older inmates is part of a larger proposal by Kelly to add space for hundreds of additional inmates at a time when the state's prisons are stretched to their limit. The request, outlined in her budget, would cost more than $13.5 million over two years and require more than 160 additional staff. Lawmakers will need to authorize funding for the project to move forward.

Kansas prisons have been under stress for years, with the largest facilities struggling from staffing shortages that have prompted pay raises for frontline workers. Episodes of violence and unrest have revealed the stress facing the system as it operates at or above capacity. Last year, the state paid private prison operator CoreCivic to begin housing 120 inmates in Arizona.

Kelly's plan represents an acknowledgment by the Democratic governor that Kansas needs more prison space, at least in the short term. The inmate population of roughly 10,000 is expected to grow by more than 1,000 within five or six years, according to state projections.

The governor's plan is likely to fuel conversations surrounding criminal justice reform in Kansas. Kelly is a vocal proponent of sentencing changes that would help keep non-violent drug offenders out of prison and some lawmakers appear eager to debate the issue.

Her administration hopes the expansion, which will also include space for inmates with substance abuse issues, may ultimately help keep people out of prison by reducing recidivism.

"By expanding and innovating our capacity for substance abuse treatment and mental health treatment, we can bend the curve on our prison population long-term, improve public safety and strengthen Kansas communities," Kelly said in her State of the State address.

As for older inmates, the numbers tell the story of the looming need for intense care. Nearly 1,500 inmates are older than 50, accounting for about 20 percent of the total population. More than 300 are over 65.

"Dementia, Alzheimers, cognitive care issues, and then just that aging process where they're not ambulatory -- they really struggle," Corrections Secretary Jeff Zmuda told lawmakers at a briefing this month. "And when they're out in a general population bed, they're more at risk."

Over the years, lawmakers have raised penalties for some crimes, especially sex offenses, leading to "stacking" within the prison system, said Rep. Russ Jennings, a Lakin Republican who chairs the House Corrections and Juvenile Justice Committee.

"So now you end up with more that are there longer," Jennings said. "And they reach an age where they, like people in the free world, have health challenges."

Prison's toll on aging inmates

Old age exacts its emotional and physical toll on everyone. Growing old in prison only compounds those challenges.

Carter, the director of Relentless Prison Ministry, said for many older inmates, most if not all of their family has cut them off, leaving them without visits and outside support.

"There's a significant lack of privacy in prison, but it can feel very detached from meaningful relationships sometimes and so there can be a strong sense of hopelessness or loneliness that happens, particularly with the older guys," Carter said.

Carter said he spent about two hours during a recent morning just listening to an older prisoner.

"He doesn't have very many people that will sit and talk to him and listen to him," Carter said. "That is something that a lot of them are starved for, is sort of meaningful connection."

The American Civil Liberties Union of Kansas praised the state for taking steps to support the incarcerated who are elderly and infirm. But the organization emphasized that Kansas already has procedures in place, called "compassionate clemency," to release inmates who would be housed in the proposed beds.

"As officials and organizations across the state work to address the need for criminal justice reform, we would urge use of compassionate clemency to assess the possibility of release for these inmates for whom incarceration no longer makes sense from a community safety or financial perspective," ACLU of Kansas director Nadine Johnson said.

Kansas law allows the secretary of corrections to release inmates if they have a terminal medical condition and will likely die within 30 days. The state has released only one inmate under those conditions since 2013.

On Monday, lawmakers will hold a hearing on a bill that would extend the timeframe to 90 days.

Rep. Boog Highberger, a Lawrence Democrat, said lawmakers should look at approving a policy comparable to a provision in the First Step Act, approved by Congress and signed by President Donald Trump in 2018. It gives inmates the right to go to court to seek compassionate release if their application is denied by the Bureau of Federal Prisons.

Cost of elderly care

Prisons across the country are grappling with an elderly population that continues to grow even as the overall number of incarcerated shrinks. The proportion of inmates 55 and older grew by 280 percent between 1999 and 2016, according to an analysis of Bureau of Justice Statistics by the Pew Charitable Trusts.

Kansas had the 13th highest percentage of aging inmates in 2015, Pew said in a 2018 report.

While older prisoners suffer from the same conditions that afflict senior citizens everywhere, the costs of these issues only increases in a correctional setting. Elder care becomes a logistical challenge in prison, complicated by security concerns.

An elderly inmate costs state taxpayers between $60,000 and $70,000 each year, compared with about $27,000 for the general population, according to data in a 2004 National Institute of Corrections report. More than a decade later, those figures are undoubtedly higher.

"It would be nearsighted for any state or county not to be planning for an aging prison population," said Marc Stern, a prison health care consultant who is a professor at the University of Washington and University of Albany.

Under Kelly's plan, two vacant buildings near Winfield Correctional Facility will be repurposed for a prison environment. The Kansas Veterans' Home has used the buildings, Tripplet and Funston, in the past but they currently sit empty.

Funston, originally built as a skilled-nursing facility, will provide acute medical care for aging inmates, according to Rebecca White, a spokeswoman for the Kansas Department of Corrections. Tripplet will house general population inmates but will be geared toward the aging as well as those requiring substance abuse help.

The renovation will add 241 beds to the state's capacity at a cost over two years of $9.7 million. The expansion will require about 120 new employees and cost $8.3 million a year to operate, White said in an emailed response to questions.

Although the state's largest prisons -- in Lansing and El Dorado -- have struggled to attract and retain employees, White said the agency is confident it can hire the workers necessary.

"The Winfield Correctional Facility has historically been very successful with recruitment and retention," White wrote, adding that as of Jan. 27, every security position at the prison was filled.

The renovations of the Winfield buildings represent only half of Kelly's proposed expansion of prison space. The governor also wants to overhaul a closed unit at Lansing to add 200 beds at a cost of $3.5 million. About 43 additional workers would be needed.

The Lansing unit would be dedicated to providing substance abuse treatment. Together with Winfield, the expansion would provide hundreds of additional beds focused on treating inmates for problems with drugs and alcohol.

In her State of the State address, Kelly said the Kansas Department of Corrections is shifting from an approach "that's purely punitive to one that emphasizes rehabilitation and workforce training."

The ability to work with more inmates to address substance abuse problems could help keep inmates out of prison once their sentences are over. It's one way state officials hope an expansion of prison space now will ultimately contribute to a shrinking prison population in the long term.

Additionally, large sections of Lansing have been rebuilt over the past couple years. The prison's new minimum security site opened in December and a new medium and maximum security site is expected to open in March.

Zmuda told lawmakers he's confident that all of the construction -- the proposed Winfield and Lansing renovations and completion of reconstruction at Lansing -- will meet the state's short-term needs. He suggested the March reopening at Lansing will allow the 120 inmates at a CoreCivic prison in Arizona to be brought home.

"The plan is to get them back... as soon as we can," Zmuda said.

'A turning point'

A Department of Corrections memo to legislative leaders last year outlined several possible plans to address its multiple problems, but all would take months or years to have an effect. The department suggested changing guidelines for sentencing offenders as well as expanding the credit inmates can earn toward good behavior. But both would take legislative action.

The memo estimated that building a new prison to house 1,200 inmates would cost between $135 million and $145 million, but wouldn't be operational for three or four years.

The Kansas Criminal Justice Reform Commission, which lawmakers established in 2019, has issued several preliminary recommendations, including sentencing and penalty changes. But in its November report it also recommended adding hundreds of prison beds for aging inmates and those with substance abuse issues -- a suggestion that largely aligns with Kelly's proposal.

"We are at a turning point. We will have a choice here," Jennings, the Lakin Republican, said. "We will either come up with ways to go ahead and provide opportunities for effective treatment and reduce the number of people going into prison" or the additional beds for specialized care "will be the tip of the iceberg."

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