End-of-life (EOL) care for prison inmates is in need of greater attention, research, and regulation, as the general age of the prison population is rapidly increasing, according to nursing researchers at Penn State.
In the years between 1995 and 2010, the U.S. prison population experienced a 282 percent increase in the number of inmates aged 55 and older. While hospice care in prisons has become more common, the systems in place are not consistent across the country.
For the study, Susan J. Loeb, Ph.D., associate professor of nursing and medicine, and Rachel K. Wion, a nursing Ph.D. student, analyzed 19 peer-reviewed research articles about EOL or palliative care for prisoners published between 2002 and 2014. All but one of these studies were conducted in the U.S.
They found that EOL care for prisoners is provided by a wide variety of people, from fellow inmates to professional healthcare workers. The care itself ranged from addressing psychosocial and emotional needs to providing healthcare interventions.
“Hospice coordinators felt that EOL 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,” wrote the authors.
The researchers found that attitudes toward hospice care for prisoners varied among prison staff, with corrections officers expressing the strongest resistance. However, corrections officers who had substantial hospice exposure were more supportive than those with little or no exposure.
The study also looked at the role of inmate caregivers. Some prisons trained the inmate caregivers for an hour, while others received four weeks of training. Some were paid, while others were not; some worked one hour per week, while others worked 40 to 48 hours a week.
“It was surprising to find that family was clearly absent from these studies,” said Loeb, also director of the Ph.D. program in nursing. “There was mention of prisoners receiving family visits, but there was no family perspective on end-of-life care in prison.”
The researchers also found that the number of designated hospice beds in prisons was extremely variable, with some prisons having only one available bed while others had “unlimited” beds. Nine available hospice beds was the average.
The authors say that more research is needed to better understand how healthcare providers’ approach EOL care and to determine how patients, prison administrators and external hospice providers view the quality of EOL care delivered by healthcare professionals in prisons. The researchers also note that studying EOL care in non-American prisons is important, as very little research has been done in prisons elsewhere in the world.
“The volume and quality of research about end-of-life care in prisons has increased, but research is still largely exploratory and descriptive,” said Loeb. “We need to move toward more intervention research.”
The findings are published in the American Journal of Nursing.