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Report of the Advisory Committee on Geriatric and Seriously Ill Inmates
Authorization: 2001 Senate Resolution 149, 2175

Senate Concurrent Resolution No. 149, Printer’s No. 2175, of 2002 directed the Joint State Government Commission to establish a bipartisan legislative task force and an advisory committee to study the geriatric and seriously ill inmate populations in Pennsylvania State correctional institutions and make recommendations to the General Assembly. Because the 46-member advisory committee could not reach consensus on recommendations for various issues, it decided to provide the legislative task force with a compilation of information, policy options and draft statutory language which may be reviewed should the General Assembly decide to address issues regarding geriatric and seriously ill inmates.

Tracking the language of the resolution, the advisory committee formed three subcommittees, which developed policy options in the following areas: health/hospice, mental health and geriatric/lifer. The committee also gathered information on victim wrap around programs.

The Commonwealth’s State correctional institutions (SCIs) provide health care for inmates, and several SCIs are capable of providing care for geriatric and seriously or terminally ill inmates, with SCI Laurel Highlands, in Somerset County, being the most notable. In addition to general population inmates, SCI Laurel Highlands houses long-term care, wheelchair, geriatric and seriously or terminally ill inmates. Among other things, the facility provides these special classes of inmates with medical care for long-term illness, life skills programs, individualized recreational activities and psychological assessment and treatment.

Because the Department of Corrections does provide for the care of seriously or terminally ill inmates, the release of such inmates would most often not be sought because of a lack of care but rather for humanitarian or economic reasons. In 2004, the average annual cost per inmate receiving long-term care at SCI Laurel Highlands was $63,500, while the average cost per patient in a publicly-funded county nursing home was $62,000. Cost would most likely be much less than that if the inmate could be released to a friend, family member or other individual, but not all inmates have family members or friends in the community, and not all family members or friends are willing or able to assume the responsibility of caring for the inmate. However, being paroled means the former inmate is entitled to Medicaid or Medicare benefits on the same basis as the rest of society, so federal funds that are unavailable to the incarcerated population might be available to help cover the cost of care for seriously or terminally ill inmates who are released on parole.

While cost savings or humanitarian goals would probably be realized with the release of a seriously or terminally ill inmate into society, very few community resources were found for former inmates. The now long-standing government policy of caring for individuals in the least restrictive setting possible, preferably in their homes, means that public nursing homes are not as available as resources as they once were. Private nursing homes often do not admit former inmates because of resistance from other patients and concern about behavioral problems the former inmate might have.

Policy Options
Draft legislation is provided in the report for the use of the members of the General Assembly should they wish to encourage the release of seriously or terminally ill inmates. The first draft allows for the medical release of an inmate through the trial court. This draft includes the repeal of the current Compassionate Release Act (the act of May 31, 1919 (P.L.356, No.170); 61 P.S. § 81), under which courts will not release an inmate unless that inmate can prove that he or she cannot get proper care in prison. The draft requires only that an inmate be seriously or terminally ill, as defined in the draft, and have a satisfactory risk assessment before a court could grant the petition for release. The second draft provides for expedited review by the Board of Probation and Parole of cases where the Department of Corrections has reported that an inmate is seriously or terminally ill and presents a minimal risk of reoffending.

A series of concepts regarding the establishment of an inter-agency committee on the medical release of inmates is also provided. Among other things, this committee would identify obstacles to the medical release of inmates and develop recommendations for overcoming the obstacles.

The Department of Corrections provides care and treatment for mentally ill inmates, who often have co-occurring problems with drug and alcohol abuse. However, there is a question regarding whether some mentally ill inmates should be in prison. A growing trend across the country has been to establish specialized courts addressing offenders with either drug and alcohol abuse problems or mental illness or both, in attempts to provide the offenders with treatment rather than incarceration. Treatment courts and mental health courts and programs have apparently been effective in Philadelphia, Chester County, Lackawanna County, Allegheny County and Erie County. Evaluations of mental health courts in Anchorage, Alaska and King County, Washington also appear to be positive.

For mentally ill offenders who are in prison, re-entry into society upon release is a major concern. Having public benefits, such as Medicare, Medicaid and Supplemental Security Income, and treatment resources available upon release would greatly improve the situation of most mentally ill offenders re-entering society. Community-based re-entry programs may also be designed to help smooth the offender’s transition from incarceration to living in the community. Notable re-entry initiatives across the Commonwealth include the Forensic Re-Entry Development program at SCI Muncy, Community Re-Integration of Offenders with Mental Illness and Substance Abuse programs (specialized Community Corrections Centers) in the Pittsburgh and Erie areas and the Cameron/Elk County Forensic Mental Health Program.

Policy Options
Draft legislation is included in the report for the use of the members of the General Assembly should they wish to encourage the establishment of mental health courts in the judicial districts of the Commonwealth. The draft lists the goals of mental health courts, which include reducing stress on the correctional system by utilizing an alternative to incarceration for mentally ill offenders when appropriate, improving the assessment of mentally ill offenders, improving access for mentally ill offenders to services and treatment in the community, ensuring compliance with individualized treatment plans and training law enforcement and judicial personnel to identify and address the needs of mentally ill offenders. The report also includes concepts regarding the establishment of a multi-agency committee to strengthen communication between communities and prisons and between various agencies to ensure continuity of care for mentally ill offenders as they re-enter society.

The number of inmates 50 years of age or older serving life sentences in Pennsylvania’s State correctional institutions has grown from 795 in 2001 to 1,077 in 2004. Because inmates serving life sentences (lifers) grow old and often become seriously or terminally ill in prison, requiring costly care, they contribute to the growing cost of the Commonwealth’s corrections system. Because lifers are not eligible for parole in Pennsylvania, a lifer may see the possibility of release from prison only if his application for commutation of sentence is recommended by the members of the Board of Pardons and approved by the Governor. The chances of that happening were already declining (e.g., 251 life sentences were commuted from 1971 through 1979, while 27 were commuted from 1987 through 1995) when the Commonwealth’s Constitution was amended in 1997 to require the unanimous recommendation of the Board of Pardons before an application for commutation could proceed to the Governor. From 1995 to the present, only one life sentence has been commuted.

Adding to the Commonwealth’s sentencing statutes the option of sentencing an individual to life in prison with the possibility of parole for first degree murder where the prosecution is not seeking the death penalty and for second degree murder might help reduce the costly geriatric and seriously or terminally ill inmate population. It would also give lifers hope that release might be possible, making them more manageable for the Department of Corrections.

Little recidivism data is available regarding inmates who were incarcerated for at least 25 years and released at the age of 50 or older. Ohio provided data showing that, of 21 offenders in that category who were released in 2000, none had committed a new crime during the following three years. The Pennsylvania Board of Probation and Parole provided data showing that, since the inception of parole in the Commonwealth, 99 commuted lifers have been released on parole at the age of 50 years or older, one of whom was recommitted to prison for a new crime. This individual was a sex offender with mental health issues whose new criminal conviction resulted from his falsification of his criminal record on a job application to obtain a job as a custodian in a private school with minor female students.

Policy Options
Draft legislation is included in the report for the use of the members of the General Assembly should they wish to consider adding a sentence of life with the possibility of parole to the Commonwealth’s sentencing statutes. The draft legislation provides for the prospective option of parole eligibility for lifers who reach the age of 50 (or 45 for offenders who committed their crime before the age of 21) and serve at least 25 years of their sentence in prison.

Should the General Assembly enact such legislation, the Board of Pardons might rely upon the policy behind the enactment to once again provide current lifers with some hope that they might have their sentence commuted and eventually be released from prison.

The main function of a victim wrap around program is offering confidential services to support the victim at the time of the offender’s re-entry into the community. Victim wrap around services may include developing a safety plan for the victim and community and providing assistance to link the victim to other necessary services.

Information on existing programs in Washington state (where the first program began), Iowa, Ohio and Vermont is included in the appendices of the report for the use of the members of the General Assembly should they wish to encourage the development of victim wrap around programs in the Commonwealth.