The state of California had followed a national trend toward more prisoners, and older prisoners. Nationwide, state and federal prisons in 2010 held over 1.5 million men and women. Of those, some 125,000 were over age 55—and the numbers were growing. In California, as of June 30, 2011, its 33 state prisons held 162,368 inmates. Those aged 55+ stood at 14,098, a 500 percent increase since 1990, compared to overall prison population growth of 85 percent. ^[2]

Click here for a map of the California state prison system.

Not surprisingly, California’s incarceration costs had risen sharply. One of the prime drivers was healthcare. For one thing, prisoners were not a healthy group to start with. Officials estimated prisoners’ physical age at 10-15 years older than their chronological age, not just because of the stress of prison life but also due to substance abuse, poverty, poor healthcare before prison, and lack of health insurance. Inmates suffering from mental illness fared even worse, with a physical age some 15-20 years older.

Prisoners were not eligible for the federal Medicare or Medicaid health insurance programs. So the state paid all prisoner medical, dental, and mental health costs. In 2011, one-third of California’s prison funding went to healthcare, including mental health and dental care. That translated into some $14,000 of the average annual $48,536 it cost to maintain a prisoner. ^[3] Of the $14,000, some $10,000 went to medical care, including infrastructure investment and administrative costs; the balance was for dental and mental healthcare.

For elderly inmates, those prices skyrocketed. Prisoners over 55 constituted only seven percent of inmates, but in 2011 they occupied fully 38 percent of the available “medical beds”—spaces in prison reserved for those who needed assistance with daily activities. ^[4] The most expensive inmate-patients were those who needed regular hospitalization or medical visits outside prison walls.

CDCR regulations required that an inmate leaving prison for dialysis, or a doctor’s appointment, or to go into hospital, be accompanied at all times by custody officers—the number depended on the severity of the inmate’s crime and the security risk s/he posed. It was not uncommon to see three officers for one criminal: one to sit outside the hospital room door and two to stand at the foot of the bed. This applied equally to prisoners in a coma or otherwise immobilized. After adding personnel costs, ambulance transportation, hospital board, doctor’s fees and tests or treatment, the tab could run as high as $2 million a year. ^[5] By comparison, nursing homes cost an average $73,000. ^[6]