Initiatives to Increase the Quality of Care in Correctional Facilities

Nearly 2.3 million people are imprisoned in the United States’ criminal justice system, which consists of 1,833 state prisons, 110 federal prisons, 1,772 juvenile correctional facilities, 3,134 local jails, 218 immigration detention facilities, and 80 Indian Country jails, in addition to military prisons, civil commitment centers, state psychiatric hospitals, and prisons in US territories. Prisons and jails are critical for the protection of society. However, the Constitution’s Eighth Amendment guarantees those convicted the right to adequate medical care. The Americans with Disabilities Act (ADA) is a federal law that requires inmates with disabilities, such as diabetes, to have equal access to services, programs, and activities. Over 95% of incarcerated individuals eventually reintegrate into the general population, bringing their health conditions with them, and 80% of reintegrated individuals lack health insurance. Proper care enables those who have been incarcerated to reintegrate into society and engage in productive activities without becoming a burden on others.

 

Correctional facilities have seen an increase in chronic disease cases, such as wound chronicity, heart disease, diabetes, cancer, hypertension, and asthma, as well as increased health care costs and COVID-19 infection rates. Around 44% of people who are incarcerated have a chronic illness, compared to 31% of the general population. Numerous chronic conditions are associated with the reasons people who are incarcerated become incarcerated in the first place. According to the Centers for Disease Control and Prevention (CDC), the population is overrepresented by people who are incarcerated for drug and alcohol addictions, mental health issues, or homelessness.

 

Facilities must consider whether to provide inmates with the option of moving to dedicated facilities with nursing care or making changes to existing living arrangements if they are physically fragile or their cognitive function is failing. Because community-based nursing institutions are typically unwilling to take prisoners, and few jails provide on-site long-term care facilities, moving can be difficult. Even when amenities are provided, senior inmates who change institutions lose their social network and are more likely to become depressed.

 

Inmates with dementia may find relocating to be very difficult. Furthermore, the presence of senior inmates can act as a social stabilizing influence for their fellow inmates; thus, relocating them to a separate facility with higher nursing care may cause a cellblock to be disrupted. It is possible to improve accessibility by retrofitting existing facilities, but it is expensive. Wheelchairs cannot readily pass through tiny doorways and washroom stalls in jails and prisons. Bunkbeds must be replaced with floor-level beds. Nonslip flooring and handrails are more practical accommodations for preventing falls.

 

It is estimated that over 80,000 jailed inmates have diabetes, resulting in a 4.8 percent diabetes prevalence rate and a greater rate of amputations in the prison population. As a result of their imprisonment, a significant number of these individuals are diagnosed with diabetes for the first time. According to the American Diabetes Association (ADA) Standards of Care, all jailed adults with a diabetes diagnosis should undergo routine screening for diabetes-related complications. The use of periodic chronic disease clinics to monitor patients with diabetes for the development of diabetes-related problems is a successful strategy. In addition to enabling on-demand referrals to consulting specialists, it also permits interval laboratory tests to be performed. Patients with diabetes are frequently examined and maintained using a combination of medications, nutritional control, glucose monitoring, foot care, treatment from an optometrist or ophthalmologist, and education.

 

Withholding health care during jail violates the Eighth Amendment’s prohibition on cruel and unusual punishment. A prison or jail sentence should imply the forfeiture of liberty but not of health or dignity. Senior convicts (whether recently condemned at an advanced age or serving an extended or life sentence) have a plethora of health concerns that require daily treatment. While there are some promising programs for addressing the health needs of elderly convicts, they are not universally available. Coordination between correctional health systems and primary care clinics has been related to a reduction in emergency department visits following release from prison. A microsimulation study reveals that opting out of hepatitis C screening, which is highly prevalent among jailed older persons, could result in increased early diagnosis and prevent disease-related fatalities. Selected jails now feature hospice and palliative care programs for convicts with life-limiting diseases, some of which are staffed by peer volunteers who provide one-on-one care to dying inmates.

Telemedicine and Telehealth Advantages

Scheduling medical appointments is a significant barrier to care within the jail or prison systems. All movement within correctional facilities must be monitored and controlled for security reasons. According to a CDC survey, telemedicine was used in at least 30 of the 45 states surveyed for at least one type of specialty or diagnostic treatment. Patients treated via telemedicine in prison also report a higher level of perceived satisfaction with the treatment. Utilizing telemedicine or telehealth for wound, ostomy, and continence care can enhance overall outcomes. The first step toward closing care gaps is to gain a better understanding of your patients. Additionally, clinicians and correctional nurses fear for their safety, and those who have been incarcerated may be hesitant to speak up to their nurse or provider in the presence of a correctional officer. While significant progress has been made over the last decade, there is still room for improvement, and it is critical to maintaining services comparable to those provided in the community, particularly in the area of wound care.

References

United States Bureau of Justice Statistics. Census of state and federal adult correctional facilities, 2012. Inter-university Consortium for Political and Social Research [distributor], 2020-09-15. Accessed December 29, 2021. https://doi.org/10.3886/ICPSR37294.v2

Wagner, Wendy Sawyer and Peter. “Mass Incarceration: The Whole Pie 2020” Mass Incarceration: The Whole Pie 2020 | Prison Policy Initiative, www..prisonpolicy.org/reports/pie/2020.html.

Mateo M, Álvarez R, Cobo C, Pallas JR, López AM, Gaite L. Telemedicine: contributions, difficulties and key factors for implementation in the prison setting. Rev Esp Sanid Penit. 2019;21(2):95-105.

Garrido M, Frakt AB. Challenges of Aging Population Are Intensified in Prison. JAMA Health Forum. 2020;1(2):e200170. doi:10.1001/jamahealthforum.2020.0170

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