The proportion of state and federal prisoners who are 55 or older is about five times what it was three decades ago. In 2022, that was more than 186,000 people. In Oklahoma, the geriatric population has quadrupled in the past two decades. In Virginia, a quarter of the state's prisoners will be geriatric by 2030. In Texas, geriatric inmates are the fastest-growing demographic in the system, NPR reports. Prison systems across the U.S. have a constitutional obligation to provide adequate health care, and they're racing to figure out how to care for the elderly in their custody and how to pay for it. "When you think about geriatric medical needs, many of the prisons across the United States are not equipped or weren't designed that way, and so the systems are grappling with how to retrofit or make do with the facilities that we have," says Nick Deml, commissioner of the Vermont Department of Corrections. "You see it visibly, but you see it in your health care budget and in your health care needs and your housing needs," says Bryan Collier, executive director of the Texas Department of Criminal Justice. "You don't usually build prisons with nursing home-type housing or geriatric housing or even wheelchair housing."
As that population grows, Collier says, prisons must adapt in all kinds of ways: making cells wheelchair accessible, accommodating prisoners who can no longer climb to an upper bunk, providing health care and food inside units when prisoners aren't mobile, installing more outlets for CPAP machines. Some states have opted to build entirely new facilities to house elderly or sick prisoners. Others have retrofitted existing units. At the state prison in Oak Park Heights, Minn., the Transitional Care Unit (TCU) has expanded twice in the past 20 years. Inside the 54-bed unit, there's a clinic on one end where prisoners can get dialysis and other medical treatments. Nursing care is available 24 hours a day. Dan Pfarr, CEO of a reentry nonprofit in Minnesota called 180 Degrees, says the older men he sees come out of prison are in rough shape. "They've gone so long with substandard health care or not the right types of health care," says Pfarr, whose organization has contracts with the state. "For men coming out of prison, 40 is the new 60, 60 is the new 80."