The case for transitional services and programs for older adults reentering society: a narrative review of US departments of correction and recommendations

• DOI: https://doi.org/10.1108/IJPH-08-2021-0073
• Published date: 13 February 2023
• Date: 13 February 2023
• Pages: 4-19
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Rose Onyeali,Benjamin A. Howell,D. Keith McInnes,Amanda Emerson,Monica E. Williams

The case for transitional services and

programs for older adults reentering society:

a narrative review of US departments of

correction and recommendations

Rose Onyeali, Benjamin A. Howell, D. Keith McInnes, Amanda Emerson and

Monica E. Williams

Abstract

Purpose –Older adults who areor have been incarcerated constitute a growingpopulation in the USA.

The complex health needs of this group are often inadequately addressed during incarceration and

equally so whentransitioning back to the community. The purposeof this paper is to discuss the literature

on challenges olderadults (age 50 and over) face in maintaining health and accessingsocial services to

supporthealth after an incarceration and to outline recommendationsto address the most urgent of these

needs.

Design/methodology/approach –This study conducted a narrative literature review to identify the

complex healthconditions and health services needs of incarceratedolder adults in the USA and outline

three primarybarriers they face in accessing healthcare and social services during reentry.

Findings –Challenges to healthy reentry of older adults include continuity of health care; housing availability;

and access to health insurance, disability and other support. The authors recommend policy changes to

improve uniformity of care, development of support networks and increased funding to ensure that older

adults reentering communities have access to resources necessary to safeguard their health and safety.

Originality/value –This review presents a broad perspective of the current literature on barriers to

healthy reentry for older adults in the USA and offers valuable system, program and policy

recommendationsto address those barriers.

Keywords Older adults,Health care, Reentry, Prison programs,Prison policies, Transitionalhealthcare,

Aging inmates,Incarceration, Medicalservices, Graying

Paper type Literature review

Background

In 2019, over 1.2 million persons were incarcerated in the US prisons and another 600,000

detained in jails on any givenday (Sawyer and Wagner, 2020). An increasing proportion are

older adults, defined by the National Commission on Correctional Healthcare as people

aged 55 or older (Anno et al., 2004) and by others as 50 or older (Chiu, 2010;DiTomas

et al.,2022

). Between 1993 and 2013, the older adult population in state prisons increased

400% nationwide, with 131,500 persons over age 55 held in the state prison systems alone

in 2013 (Bronson and Carson, 2019;Hawks et al., 2020). Incarcerated older adults

represented 30% of the overall prison population (National Corrections Reporting Program,

2000–2012, 2014), similar to their overall percentage in the US population in 2013. The

growth in the proportion of imprisoned older adults reflects increases in age of individuals

already incarcerated, increasing rates in the incarceration of older persons and longer

(Informationabout the

authorscan be found at the

end of this article.)

Received 25 August 2021

Revised 25 February 2022

16 May 2022

Accepted 26 May 2022

©Rose Onyeali, Benjamin A.

Howell, D. Keith McInnes,

Amanda Emerson and Monica

E. Williams. Publishedby

Emerald Publishing Limited. This

article is published under the

Creative Commons Attribution

(CC BY 4.0) licence. Anyone

may reproduce, distribute,

translate and create derivative

works of this article (for both

commercial and non-commercial

purposes), subject to full

attribution to the original

publication and authors. The full

terms of this licence may be

seen at http://creativecommons.

org/licences/by/4.0/legalcode

Research reported in this

publication was supported by a

subaward of the Aging in

Criminal Justice & Health

(ARCH) Network, funded by the

National Institute on Aging in

the National Institutes of Health

under award number

R24AG065175. The content is

solely the responsibilityof the

authors and does not necessarily

represent the official views of

theNIH.

PAGE 4 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 19 NO. 1 2023, pp. 4-19, EmeraldPublishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-08-2021-0073

sentences (Rikard and Rosenberg, 2007;Williams and Rikard, 2004). People over 55 years

constitute approximately 12% of people sentenced to more than one year in prison

(Bronson and Carson, 2019).

In this article, we describe the literature on the complex health needs of incarcerated older

adults and the reentry barriers that confront them as they return to their families and

communities following incarceration. While reentry after a jail admission mightpresent many

of the same barriers –and some amplified ones –we concentrate on the transition from

longer term sentences of a prison incarceration. We focus on older adults’ needs during

reentry in discharge planning, health-care access, housing, health insurance and Social

Security income. In addition, we suggest areas for future research and policy interventions

to improve the health outcomes of olderadults during reentry.

Method

This general review was based on informal surveys of the literature and our pooled

expertise as clinicians and researchers who regularly work with older adults who are or

have been incarcerated. As a group, we identified key categories of focus in ongoing

scholarly and policy conversationsat the nexus of aging and health care, incarceration and

reentry. We divided the topic areas and consulted work we had on hand along with

independently conducted literature searches in PubMed, Scopus and Ebsco databases to

identify current emphases in research and policy. We conducted searches of the literature

based on key terms reflective of each subtopic area. General or narrative reviews of a topic

may be systematic or non-systematic, the latter involvingcomparatively informal methods of

search and selection, in keeping with the form’s emphasis on broad topic overview rather

than a systematic evaluation of all available literature to answer a specific question (Ferrari,

2015). Narrative reviews are appropriate for describing general debates and multiple,

interrelated questions related to a topic and to speculate on future needs, as was our intent

here. In weekly meetings over six months, we discussed our findings, shared sources and

gave feedback. The resultingoverview addressed:

䊏the complexity of health and social services needs of older adults while incarcerated

and during reentry;

䊏the challenge of finding housing during reentry; and

䊏the barriers faced by re-entering older adults in obtaining health insurance and other

support to pay for health-care post incarceration.

We defined each area, discussed the literature and identified gaps and opportunities for

additional investigationor action.

Findings

Health care for older adults during incarceration

Older incarcerated adults face health challenges arising from processes, policies and an

environment not designed to meet the needs of persons while aging (DiTomas et al., 2022;

Hill, Williams et al., 2006;Zeng and Minton, 2021). Adults with criminal-legal involvement

report high rates of chronic disease, including cardiovascular disease, metabolic disease,

cancer and chronic obstructive pulmonary disease (Colsher et al.,1992;Binswanger et al.,

2009;Maruschak et al., 2015;Wilper et al.,2009;Williams et al.,2012). Of imprisoned

adults aged 55 and older, 46.7% report three or more chronic illnesses requiring

pharmacological treatment with an average of 7.3 different classes of medication (Williams

et al.,2012

). Incarcerated adults also report more infectious diseases than community

samples, including tuberculosis, human immunodeficiency virus (HIV) and hepatitis

(Binswanger et al.,2009;Wilper et al.,2009). Chronic diseases are related to functional

VOL. 19 NO. 1 2023 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 5