"In here, time stands still": Rights, Needs and Experiences of Older People in Prison

29th September 2016

The number of older people in Irish prisons has increased considerably in recent years and this group now represents a substantial minority within the Irish prison system. Latest figures indicate that almost 10% of people in prison custody today are over the age of 50.

This new report from IPRT examines the rights, needs and experiences of this vulnerable group within the prison system, and makes key recommendations as to how the Irish Prison Service can meet these needs. The recommendations contained in the report are based on best practice examples set out in the research literature and on the recommendations of the research participants and professional stakeholders. If acted upon, these recommendations will greatly improve the lives of older people in the Irish prison system. 

Encouragingly, the Irish Prison Service Strategic Plan 2016–2018 includes a commitment to finalise and implement an Older Prisoner Strategy. 

Download the report here.

“I wouldn’t like to die in prison, that’s kind of a big thing for us. I’d like [at least] a day free. I think it’s a common [fear] among older people, it’s a terrible place to die.” (61-year-old man)

Background of the research: 

This report is based on research commissioned by IPRT and conducted by Joanna Joyce and Dr Tina Maschi. The research was conducted in three stages: (i) desk-based review of local and international literature; (ii) semi-structured interviews with older people in prison and professional stakeholders; and (iii) the completion of a questionnaire by participants and professional stakeholders. The research was supported by the St Stephen's Green Trust.

“That stairs is a real difficulty for a lot of older men...They try to accommodate the older men on the ground floor...because there’s people with crutches or difficulties with mobility or dizziness or things like that, but the medics are up there [on a higher landing].” (56-yr-old man)

Key findings:

Older people in prison face a wide range of issues which are different from those faced by the general prison population. These issues fall into six main themes: 

• physical and mental health needs,
• mobility and the physical environment, 
• social care needs,
• bullying and victimisation, 
• participation in prison programmes,
• release planning and resettlement.

Many participants spoke positively about several aspects of prison life, including the physical and mental health services provided, their relationship with younger people and prison staff, and access to education and work. However, a number of issues arose which are a cause of serious concern. These include:

• the detention of older people living with dementia and other serious conditions,
• the fact that some older people are confined to their cell or are bed-bound, and 
• the fact that in some instances personal care, including intimate care such as the changing of incontinence pads, is being provided by other prisoners.

“There’s people in here who have horrendous illnesses up to and including cancer, you know a lot of heart conditions, I could go on and on. They should not be here. Certainly they should be perhaps segregated, but in a prison system it’s not right, it can’t be right.” (59-yr-old man)

Recommendations:

RECOMMENDATION 1: A Comprehensive Strategy for the Management of Older Persons in Prison

• The Irish Prison Service should build on the existing Strategy for the Management of Older Persons to create a comprehensive strategy that considers the rights and needs of older people in relation to physical and mental health needs, mobility and the physical environment, social care needs, bullying and victimisation, participation in prison programmes and release planning and resettlement. The commitment to finalise and implement an Older Prisoner Strategy in the Irish Prison Service Strategic Plan 2016–2018 is welcome and it is vital that this strategy is fully implemented.
• In developing this strategy, there should be a wider debate about the appropriateness of detaining old and seriously ill people in a prison environment, particularly those living with dementia or other terminal illnesses. This debate should consider the significant practical and ethical challenges the continued detention of these people presents for prison staff and for other prisoners.

RECOMMENDATION 2: Physical and Mental Health Needs

• Physical and mental health services which are dedicated to the needs of older people should be made available throughout the Irish prison system. This should include the introduction of an over-50s health clinic in each prison.
• All prisons should have an identified, trained and supported lead staff member for older people in the health care unit.
• Prisons housing women should address their gender-related health issues, ensuring that they continue to receive mammograms, cervical cytology screenings and support for age-related issues including the menopause.
• Older people with significant medical problems whose care cannot be adequately catered for in prison should be released on health grounds.
• The decision to grant Temporary Release on health grounds should be based on the particular circumstances of each case and should not be influenced by policies regarding the nature of the offence committed.
• When an older person is reaching the end of his/her life, a case conference involving a palliative care team should be convened to formulate a care plan.
• All prison staff should receive dementia awareness training, allowing them to identify symptoms of Alzheimer’s and other forms of dementia, and providing them with the skills necessary to support people living with dementia.
• Older people should be given regular access to specialist health services including a dentist, chiropodist and optician.
• The Prison Service should support older people to maintain a healthy diet. As a person ages, they should be given access to a special diet which contains less processed food. Staff members should be trained to monitor the eating habits of older people and any concerns about a person’s diet should be reported to prison health staff.

RECOMMENDATION 3: Mobility and the Physical Environment

• Single cell accommodation should be the norm across the prison estate for all prisoners; as a minimum, cell and bed allocation policies should take account of age and disability.
• Older people should have the option of being housed in a separate unit or wing, while still having an opportunity to mix with younger people in prison.
• Any older person’s unit or wing should incorporate age-friendly design, and all prisons should provide mobility aids to allow older people with mobility problems to remain active.
• The future design of prisons should include an appropriate number of cells capable of accommodating wheelchairs, hospital beds and relevant paraphernalia necessary to the needs of older people with serious physical health needs.
• A peer support programme should be rolled out across all prisons (see 4.1). Through this optional programme, prisoners may be trained to support older people with mobility issues by bringing them their meals, collecting their laundry and helping them to clean their cells.

RECOMMENDATION 4:  Social Care

• Consideration should be given to an optional and strictly monitored scheme whereby prisoners are trained to provide some limited social care to older people through a peer support programme and may gain accreditation and privileges for so providing. However, any care provided through this scheme should not extend to personal care such as washing and dressing, which should properly remain the responsibility of prison medical staff and professional care assistants.
• The Irish Prison Service should set out the minimum standard of social care that it expects and consider the possibility of placing social workers in prisons to support older people.
• Policy guidelines should be agreed between prison management and social work agencies, and time and resources should be allocated so that staff can undertake specific social work tasks required when working with older people.
• Prison staff should receive specific training regarding the social and emotional needs of older people.
• Joint health and social care assessments should be undertaken routinely for older people with social care needs.
• Family contact should be encouraged through the use of extended visits for people who cannot visit often and grandparents’ visits days. Where older family members are unable to visit due to mobility or other issues, family contact should be facilitated through Skype and/or longer phone calls.
• Visitor areas should be accessible and have appropriate facilities for older and disabled visitors.
• Information materials about the prison regime should be dementia-friendly and approved by National Adult Literacy Agency (NALA). These materials should be disseminated and discussed with older people to ensure they are aware of their rights.

RECOMMENDATION 5: Bullying and Victimisation

• All prison staff should receive training on how to recognise and manage bullying.
• All allegations of bullying of older people should be responded to quickly and effectively.
• Older people should be accommodated in single cells to provide them with more personal security and reduce the risk of bullying and victimisation.
• The Strategy for the Management of Older Persons in Prison should consider and address the threat of elder abuse in a prison environment.
• Prison staff should receive training on how to foster positive communication and relationships between prisoners and on how to deal with traumatic situations.

RECOMMENDATION 6: Participation in Prison Programmes

• Older people should be given access to physical exercise regimes that are appropriate to their age and ability, and appropriate programmes should be made available in locations that are physically accessible to older people with mobility issues.
• The diversity of older people should be recognised and given special consideration in prison programming.
• The Irish Prison Service should consult older people about what courses and recreational activities would be most appropriate.
• Specialist services for older people, such as low impact gym sessions and designated library sessions, should be implemented in all prisons using existing resources.

RECOMMENDATION 7: Release Planning and Resettlement

• All available information regarding an older person’s release, including accommodation options, employment opportunities, and supports in the community, should be provided to the person well ahead of his/her release date.
• A resettlement strategy should take into account the health and welfare needs of an older person and appropriate accommodation should be in place before an older person is released from prison.
• Older people should be given additional support to find employment as this is an area of particular concern for people over the age of 50.
• The rules regarding Temporary Release should be made clear to all older people, and they should be supported to access Temporary Release, particularly towards the end of their sentence.
• An open prison and/or training unit should be created for women to provide them with the same opportunities for resettlement.
• Older people released from prison should have access to adequate medical care in the community, including a medical card if necessary.
• The Irish Prison Service should continue to engage with the HSE to develop collaborative programmes which will ensure a seamless transition when an older person is released.
• The Irish Prison Service should consider the implications of the Assisted Decision-Making (Capacity) Act 2015 for older people, particularly those living with dementia. A revised Strategy for the Management of Older Persons should set out how the prison service will support those whose capacity is in question to engage in decisions about their welfare.

Download the report here.