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End-of-life care varies for inmates at U.S. prisons

The aging population in prisons in the United States highlights the need for palliative care for inmates.

A new review of research articles suggests that while end-of-life care is often complicated, it can be especially challenging for those behind bars.

“The volume and quality of research about end-of-life care in prisons has increased, but research is still largely exploratory and descriptive,” says Susan J. Loeb, associate professor of nursing and medicine at Penn State. “We need to move toward more intervention research.”

In 15 years, from 1995 to 2010, the US prison population experienced a 282 percent increase in the number of inmates 55 and older. During that time, hospice care in prisons has increased, but the systems in place are not consistent across the country.

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Loeb and Rachel K. Wion, a nursing PhD student, analyzed 19 peer-reviewed research articles about end-of-life or palliative care for prisoners published between 2002 and 2014. All but one of those studies was conducted in the United States.

“It was surprising to find that family was clearly absent from these studies,” Loeb says. “There was mention of prisoners receiving family visits, but there was no family perspective on end-of-life care in prison.”

The number of designated hospice beds in prisons varied from as low as one bed to a high of “unlimited,” although nine available hospice beds was the average.

End-of-life care for prisoners is provided by a wide variety of people, including fellow inmates and professional healthcare workers, and the care itself ranges from addressing psychosocial and emotional needs to providing healthcare interventions.

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Attitudes toward hospice care for prisoners vary among prison staff, with corrections officers expressing the most resistance. Those corrections officers with substantial hospice exposure were more supportive than those with little or no exposure.

The status of inmate caregivers varied across the studies reviewed—some were paid, some were not; some worked one hour per week, while others worked 40 to 48 hours a week; some prisons trained the inmate caregivers for an hour, while others received four weeks of training.

“Hospice coordinators felt that end-of-life care had a positive impact on the general prison population as well as on dying prisoners because it promoted compassion and presented an alternative to the view of the prison system as entirely punitive—showing it to be more humane and caring, supportive of the dignity of the dying patient, and encouraging trust between prison staff and inmates,” write the researches in the study that is published in American Journal of Nursing.

Source: Penn State