By Richard Garden, MD, CCHP

Slowly and unavoidably our populations are aging, with the elderly making up a growing proportion of the American population. The Census Bureau projects that the percentage of the population over age 65 will reach 20% by 2040, compared to 12.5% in 1996. Though corrections does not exactly reflect the general population, we can assume that correctional demographics will experience the same relative increase.

In Utah, the percentage of elderly inmates, which we define as age 55 or older, has risen from 4.6% to 5.2% over the past five years. This represents a 30% increase in the absolute number of inmates in this age group.  Extrapolating based on Census Bureau estimates, the elderly may constitute nearly 7% of our prison population by 2040.

Inordinate Expense
The impact this demographic shift has upon health care is far-reaching. Already it taxes and strains our health care resources and, if projections hold true, enormous amounts of funding will be required to offset the elderly population increase expected over the next 35 years.

Intuitively this makes terrific sense. Older folks simply cost more. It is reasonable to assume that the elderly are seen more often in sick call, are prescribed medications more frequently and spend more time in the prison infirmary. Both directly and indirectly, this group requires more resources to meet their needs.

In Utah, while elderly inmates make up only 5% of the total prison population they account for 13% of all outside medical care costs. The per capita cost for outsourced care for this subset is nearly $7,500 per year, compared to a little more than $500 for those under age 55.

Despite consuming an increasing share of a finite budget, the true cost of care for Utah’s geriatric correctional population remains hidden and largely unrecognized by the state legislature and the Department of Corrections. It will remain so until we educate them about this stealthy expense and request adequate funding for our prison budgets.

Justifying Budget Increases
Many other states face the same crisis. It is crucial for correctional systems not only to identify current costs but also to predict future expenditures for their elderly populations. Such information can be used to lobby for more funds before the situation worsens.

Appealing to legislators is most successful if the plea for funding is based on specific cost increases rather than general inflationary increases. Therefore, it is helpful to dissect costs and identify specific reasons for the funding request. Besides, predicting costs down the line is always useful in budget management.

Utah has compiled data and is finalizing a paper that delves deeper into this topic. In short, we have devised an “O55” index to identify past costs and predict future values (cost increase divided by percentage increase in the elderly population).

It is our hope that other correctional systems use our index to quickly predict future costs as the proportion of elderly inmates increases in their own populations. This is proactive approach will help all systems to address this ravenous and growing consumer of our limited health care resources.