Ageing prisoners are challenging the system inside and out
PHIL Goulding stopped talking. It was only for a few moments, but the silence was noticeable. Up until then our conversation had been flowing freely.
You see, we were talking about the face of ageing prisoners in Australia and it was quickly evident there is a lot of sensitivity around the subject.
Mr Goulding is the deputy general manager of operations at Melbourne's Wintringham, a specialist aged care provider for the homeless and disadvantaged. He is a member of a growing cohort of professionals across Australia gradually peeling back the layers to reveal the challenges for ageing prisoners who are in custody, rehabilitation or on release from prison, and for the corrective and justice health care workers managing these people.
The professionals are focused on people aged 50 and over; in the prison system they are considered 'ageing'.
Many of them have entered the system with chronic health issues brought on by drug and alcohol use, poor nutrition, lack of medical care and, for some, after spending a lot of their life in both prison and juvenile detention.
All of this escalates age-related illnesses.
Australian Institute of Criminology (AIC) researcher Matthew Willis said these factors often resulted in high levels of physical, mental health and cognitive impairment, and higher vulnerability to victimisation within the general prison population.
These ageing prisoners fall loosely into four categories - recidivists, first-time prisoners incarcerated at an older age, inmates who are growing old in prison due to long sentences, and those who commit crime as a result of cognitive damage or decline.
The number of senior prisioners is increasing and so too is the cost of providing appropriate aged care health support and facilities which they have a right to access as stipulated under the UN Human Rights Committee in its International Covenant on Civil and Political Rights . In particular, this states the right of a prisoner to be treated with humanity, dignity and respect while in detention.
At June 30, 2018 there were 5,554 prisoners aged 50 years and over - 94.3 per cent male and 5.7 per cent female - adding to Australia's burgeoning prison population.
This is an increase of 81.6 per cent between 2001 and 2010, and another increase of 67 per cent from 2010 to 2018.
At the same June date there were 1,156 prisoners aged 65 years and over - 97.2 per cent male and 2.7 per cent female.
Between 2001 and 2010 there was an increase of about 128 per cent, and a further increase of 119.4 per cent during the years to 2018.
The ABS in its Prisoners in Australia Report 2018 noted 62 per cent of the prisoners aged 65 and over have a "serious offence/charge of sexual assault and related offences".
The increase in numbers isn't due solely to an ageing Australian population.
"Another part of it is some of the changes we have had to sentencing laws and parole laws," Mr Willis said.
Parole is now harder to get, which can result in people staying in prison for longer.
There has also been improvements in DNA technology, investigative techniques and information handling which have all impacted on prosecuting old offences, including sex offences which can carry long life sentences.
The consequence of the growth in older prisoners is an increase in remand costs due to specialist service delivery and facilities, changes to prison activities and upskilling correction and health services staff to cater for this cohort.
In 2013-14 it was costing about $292 per prisoner per day according to the Report on Government Services 2015.
The 1999 AIC report Elderly inmates: issues for Australia calculated that cost increases three-fold for ageing prisoners.
Who's in charge
Currently eight jurisdictions look after prisoner welfare in Australia, each with its own ageing prisoner management approach.
UNSW Kirby Institute researcher Dr Natasha Ginnivan suggests it's time for a national policy approach to deal with accelerated ageing.
"Because there isn't a management plan in place for dementia, cognitive impairment or frailty, or pre-frailty which is a measure that has been used in population ageing, we don't know the prevalence of some of the muscular-skeletal and mild cognitive concerns within this population," Dr Ginnivan said.
"We know that when they get to a certain stage it becomes very expensive to house them when they are frail, not withstanding the human rights issues around providing appropriate care."
NSW, then Queensland and Victoria have the greatest number of ageing prisoners.
In NSW, a Correction Services spokesperson reports most of the state's older inmates are in mainstream facilities and their medical or disability concerns are considered, including placement in bottom bunks or ground floor placement.
"The infrastructure at some facilities has also been modified with hand-rails above beds and in bathrooms, easy-to-use taps and ramps in yards," the spokesperson said.
Elderly and frail inmates are located in the Long Bay Aged Care Rehabilitation Unit and the Kevin Waller Unit.
Old-age and neuro psychiatrist Dr Sharon Reutens said NSW had speciality psychiatrists and geriatricians, and speciality units to address the problems around dementia in ageing prisoners.
Corrections Victoria (CV) developed a framework for 2015-2020 which identifies actions around designing and managing its correction services to meet the needs of its ageing prisoners. Subsequently, CV last month entered a contract with Wintringham.
Mr Goulding said: "We've been asked to provide advice on older prisoners and assessing them for their care needs."
"It's a really positive step. It's the first time there is an acknowledgement that there is a gap."
Over the next three years they will look at two prisons to identify aged care needs, including where some prisoners won't admit their needs as they don't want to be transferred.
"At the end of the project, then further planning will be done."
Many of Victoria's ageing prisoners are in a handful of centres such as Port Phillip Prison and the Hopkins Correctional Centre, which has recently been refurbished specifically to cater for prisoners needing aged care support.
The Queensland Corrective Services (QCS) spokesperson said "while prison can be a challenging environment for older prisoners, every reasonable effort is made to support them while in our custody".
In most states correctional facilities are cognisant of, or acting on, providing some facilities for ageing prisoners.
But Dr Reutens questions how will justice health not only identify, but also cater for the complexities of dementia.
"We need a societal discussion about it," she said.
"I think it has to stem from what is the purpose of prison and does incarcerating cognitively impaired people fulfil the purpose of the prison which is to deter and rehabilitate.
"Can that be adequately addressed by imprisonment in a culturally impaired population?
"It's really hard in prison because everything is done for you.
"You don't make your breakfast, you have no household chores; all your activities for living are taken over so it can be really hard to identify. Someone can slip under the radar until they are quite demented."
When it comes to leaving prison at the end of a sentence or when parole is available, the options are limited if the person has aged care needs.
"Where do you put a sex offender?" Mr Goulding asked.
"In a good world, once you have done your time, everything is fine."
Mr Willis said: "In the case of older people, you are potentially releasing people who have completed their sentence at quite an advanced age and needing specialist care and specialist type of accommodation, and in a lot of cases not having family and people who can provide that kind of support for them."
Under 65 the choice is NDIS. Over 65, it's My Aged Care.
But the wait times can be up to two years.
"There can be a hiatus on release for some older prisoners and then they will probably end up with a GP or in a hospital and the system will pick them up," Mr Willis said. Or homeless.
The QCS said on release it connects eligible prisoners to the NDIS and aged care services.
In Melbourne, Wintringham has an accommodation facility.
In Sydney there is a new HammondCare venue. Residential care general manager Angela Raguz said."HammondCare does not discriminate based on the criminal history of any potential residents," residential care general manager Angela Raguz said.
"When the Darlinghurst aged care venue for homelessness people is open, entry will be based on several factors including the physical, psychological and social needs of potential residents, as well as the safety of staff and other residents."
There is the opportunity for the issues around the health and wellbeing of ageing prisoners, which currently seems to be bubbling away under the surface of the community, to be addressed through the Aged Care Royal Commission.
A spokesperson for the Commission said it may accept submissions on prison aged care and other services offered in prisons, and how prisoners can transition from prison care to the public aged care system.