About five years ago, a group of healthcare experts applied to the federal government for funding to test a low-cost and widely lauded approach to caring for older people in prison.
The idea was to trial an initiative in the Northern Territory and New South Wales that would train healthy prisoners to assist aged inmates and monitor for symptoms of dementia. The Gold Coats program has been running in California since 2009, and has attracted acclaim as a world-leading strategy to help cope with a rapidly ageing prison population.
Nevertheless, the then Coalition government rejected the funding proposal. No such trial has taken place in Australia since.
This was one of many attempts by advocates, experts and researchers during the past decade to address a growing aged-care crisis in Australian prisons. And it’s one of many proposed solutions that have been rejected while the problem gets worse. For experts and advocates, it illustrates the unwillingness of authorities to act on an emergency that has long been foreseeable.
The aged-care royal commission has thrown a spotlight on the egregious state of aged care in Australia, and the disastrous impact of the pandemic. It’s been more than a year since the commission handed down its final report, revealing the neglect and shocking treatment of older Australians in facilities across the country. But the suffering of older people in prisons barely rates a mention.
Numerous experts and those with direct experience working in custodial facilities see difficulties in providing basic hygiene care to older people in prisons, let alone proper medication and treatment.
Ageing people in Australian society are often ignored, and even more so when they are incarcerated, says Dr Natasha Ginnivan, a research fellow with the UNSW Sydney School of Psychology and an associate investigator with the Ageing Futures Institute.
“The system is not set up at all for the ageing prisoner population,” Ginnivan tells The Saturday Paper. “Ageing generally is an afterthought in our culture, let alone in the prison system.”
Many studies classify “ageing prisoners” as those aged 45 and older, given the higher likelihood these people will have a range of health problems and the accelerated ageing that prison causes. This cohort has more than doubled during the past 20 years and accounted for nearly a quarter of the roughly 43,000 inmates in Australian prisons as of the end of last year. The increase is due to the ageing population in general, changes in laws to recognise more assaults, mandatory sentencing, more awareness and charges around sexual assaults and greater use of DNA evidence.
Despite this longstanding growth trend, little has been done to adequately prepare for having this number of older people behind bars. Prisons are inherently designed to house young men for short periods of time. From bunk beds, a lack of grip rails and narrow corridors, they are not made for ageing individuals dealing with health issues such as dementia.
“We saw this coming and we did nothing,” says one doctor who has worked at jails in NSW and Victoria that housed large numbers of older prisoners, and who asked for anonymity due to concerns about their employment. “We made a mistake and now we’ve got a mess we’ve got to get our way out of. It should never have been this way – it’s a miserable failure,” the doctor tells The Saturday Paper.
A key issue with aged care in prisons is the diagnosis and treatment of dementia. The structured, routine-based environment, along with a lack of proactive medical care, makes early diagnosis rare and difficult. People in prison are diagnosed with dementia far later than they would have been in the community, and then left to deteriorate in the hospital unit with little social contact.
“If symptoms aren’t identified, then they’re not given the opportunity for diagnosis early in the disease, and that deprives them of the opportunity to take the steps and to do the things that might slow the progression,” Dementia Australia executive director Leanne Emerson tells The Saturday Paper.
Dementia Australia has been active on this issue for more than a decade. In 2014 the organisation released a report with a number of recommendations for improving prison environments, including dementia-specific training for correctional staff, routine assessment for the disease and an expansion of specialised health services and support. Eight years since state and territory governments received this blueprint, it appears little action has been taken, and implementation of these recommendations is spotty at best.
It’s common to see inmates with dementia that has progressed too far to be treated effectively, says the prison doctor, who blames “systematic failures”.
“I have seen multiple examples of people that by the time I’ve seen them and they’ve been assessed by specialists, they’re simply not worth treating – they’re beyond the threshold for medication.
“Every bit of dementia is unrecoverable. It has to be picked up early from the very start, and the moment someone is worth treating, it should start. Every bit of time you lose is a deterioration you can’t get back.”
Many of the inmates the doctor has seen with dementia would have been diagnosed far earlier if they were in the general community, with a far better chance of being treated effectively. Moreover, people in prison also do not qualify for Medicare or the NDIS, and certain dementia medications are simply too expensive for many patients to take after they are released.
“I have to sit down and watch someone deteriorate, and I know what I need to do but I know that if I give them this medication, they’re never going to be able to afford it,” the doctor says.
Isolating people with dementia in a prison hospital unit without social contact can also make their condition worse.
“When you’ve got a security problem and the only way to contain them is to dump them in a hospital cell, it’s a substantial mistreatment of dementia – you’ve shortened their life,” the prison doctor says. “Because there’s no alternative, severely demented people are dying in hospital cells because there’s nowhere else to put them.”
The money required for programs and treatment for ageing prisoners is a drop in the ocean compared with what state and territory governments spend on the wider prison system.
The recent Victorian budget included $2.5 million to support aged care in the state’s prisons, including $1.8 million for personal care services and $638,000 for an in-prison aged-care consultant service and specialist aged-care transition service. This compares with the $1.5 billion the state allocated to run its prisons in 2022-23.
Nearly 10 years ago Ararat Rural City Council, in Victoria’s south-west, proposed a new aged-care prison in the town, which already has a jail that houses the vast majority of the state’s older prisoners. The proposal wasn’t adopted by the previous government and the Andrews government has shown no signs of backing it, despite spending billions of dollars on a program to expand the capacity of its existing prisons.
A spokesperson for the Victorian government said there are a “number of aged-care specific services and programs”, and existing programs have also been adapted for older prisoners.
The NSW and Victorian governments declined to say how many people in prisons in these states had been diagnosed with dementia, or if they have strategies in place to deal with them. A spokesperson for the NSW government said “multidisciplinary clinical teams”, including aged-care specialists, provide healthcare for older people in the state’s prisons.
“The network conducts aged-care assessments to inform care planning for frail and older inmates and provides advice to Corrective Services NSW on patient placement and access to additional living resources,” the spokesperson said.
The Long Bay Correctional Complex in NSW does have an inpatient ward for older prisoners, one of the few of its type in the country. This is a 15-bed, non-acute care and rehabilitation unit, but Natasha Ginnivan says it has been “overwhelmed” by the number of people eligible for its services.
A spokesperson for the NSW government said the facility has been “highly effective and responsive”.
The NSW Inspector of Custodial Services has conducted a number of inquiries into conditions for older prisoners. The Inspector says that the management of these people is an “ongoing challenge” and that more purpose-built, aged-care beds and services are needed across the entire network.
In the latest follow-ups to a 2015 report that offered a number of recommendations, the Inspector found that Corrective Services NSW has only met 11 of the 17 recommendations in full, as of June 2021.
Meanwhile, the Western Australian government is planning to open its own assisted-care unit for prisoners at the Casuarina Prison next year. This came after the state’s prison watchdog found no overarching strategic plan or framework to manage ageing prison populations, and also noted the government’s “limited focus”. While the watchdog welcomed the new facility, they said there was “almost no planning” for older women in the prison system.
“I don’t need a lot of money to look after these people,” the prison doctor says, adding that lower-cost treatments and better mobility aids would go a long way to addressing the problems.
“These are not high-price, big-ticket items – they’re basic and simple. I’m frustrated because I know what needs to happen, and it’s not rocket science.
“We could have had this all sorted years ago – we knew it was coming.”
This article was first published in the print edition of The Saturday Paper on June 18, 2022 as "The aged-care crisis in prisons".
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