States everywhere must deal with rising numbers of elderly inmates, but perhaps nowhere is the situation as pressing as in Florida. A favored destination for retirees, the state outranks all others in percentage of residents age 65 or older: 17.6% vs. 12.4% in the U.S. as a whole. It also has the nation’s top 12 counties with the highest percentages of citizens in this age group. Given that Florida ranks fourth in terms of total state correctional population, these percentages translate to some hefty numbers.

The striking statistics don’t stop there. While inmates age 50 or older make up about 8% of prison populations on average, in Florida the figure is 10% and is projected to reach 14% by 2009. Further, as overall prison populations have grown at the Florida Department of Corrections, likewise admissions of elderly inmates have trended steadily upwards in recent years. At present, about 7,700 DOC inmates are at least 50 years old.

This is straining the system, says Terre Marshall, MPH, CCHP-A, who’s with the DOC’s Office of Health Services and provided the statistics cited above. She adds that, on average, elderly inmates use more than three times as many health care resources than their counterparts under age 50. Further, the budget model used in Florida does not factor in the additional costs of providing health care to this contingent of older inmates.

With a crisis looming, the DOC administration decided to examine the data more closely, weigh possible solutions and devise a plan with input from health services, population management, classification and other key groups. In this they were aided by recommendations from the Florida Corrections Commission and the Correctional Medical Authority, which, at the direction of the state legislature, have for several years jointly issued an annual report on the aging prison population.

These agencies’ recommendations included studying this population’s needs and developing policies and procedures to standardize the approach to care. They also advised the use of current facilities to house elderly inmates who can live in general population and greater use of volunteer assistants, but also use of a separate facility for the elderly and infirm who require specialized care.

To date, five DOC prisons have designated units for the elderly, with about 2,000 beds total. No retrofitting for geriatric inmates has been necessary to date, but this living arrangement has greatly improved routine chronic care by consolidating visits, says Marshall. Also, inmate assistants are provided for those with mobility or other limitations.

For those with more serious needs, the Zephyrhills facility’s mental health building has a dorm that serves as a sheltered care environment for the aged and infirm. The “J Unit,” as it is called, is an open dorm designed for 100 beds in four pods. In the works is a fellowship program that will bring a geriatric specialist from Nova Southeastern University College of Osteopathic Medicine to practice at the unit.

The Wakulla Correctional Institution has an eight-bed unit in the infirmary to provide end-of-life palliative care to inmates, regardless of age, whose life expectancy is generally less than six months.

These steps to serve the growing geriatric population in Florida’s prisons are just the beginning of what’s being developed long-term, says Marshall, and many other projects and programs are being considered.

Housing for the elderly isn’t universally welcomed by the inmates placed there, some of whom have worked hard to get assigned to preferred facilities, such as those near family.

But elderly housing placements are based on clinical criteria, and from this perspective, the approach has been successful. “It’s too soon to tell if the steps we’ve taken will reduce costs in any way,” says Marshall, “but they do help us to better meet the needs of this population.”