Increasing numbers of Older Patients in Prison

Although the Mount, a Cat C training prison, has low numbers of the over 50s, they are increasing in all prisons.  If there is just one patient over 50/55 or a disabled patient, his needs must be addressed.  The Prison Service needs to follow the NSF for the Elderly which has the following headings:

• Standard One - Rooting out age discrimination
• Standard Two - Person-centred care
• Standard Three - Intermediate care
• Standard Four - General hospital care
• Standard Five - Stroke
• Standard Six - Falls
• Standard Seven - Mental health in older people
• Standard Eight - Promotion of health and Active

The Prison Service also needs to comply with The Disability Discrimination Act 1995-2005.  This affects both staff and prisoners in relation to buildings, such as access and toilet facilities.  The DDA also impacts on our attitudes towards those with disability.

It may seem reasonable that there should be a separate prison estate for the elderly.  I would rather not see that develop.  The Prison Service had a few general bedded units where complex problems were kept out of sight.  Such a policy would also discriminate.

In a prison healthcare setting, the difficulties of disabled people must be understood.  All members of the team should feel empowered to be responsible for care.  Compassion with confidence in aiding the disabled (e.g. pushing wheelchairs) may need staff training.  Prisoners also have a role in helping each other; that may require a more formalised system.  It could be part of care training for some prisoners, enhancing their life skills.  Healthcare should ensure, within Prison security limits, suitable supplies of aids for the disabled.  The primary care team has a duty to contact Adult Care Services [Social Services] for assessment of disabled patients’ needs.

For an incontinent patient we simply cannot simply supply the aids – as part of good medical practice we need to investigate and treat the cause.

In any disabled patient it is important not to assume that the condition is permanent. The team must encourage activity and rehabilitation. Healthcare must be on the lookout for further ailments. Older patients are not stable, and develop multiple problems.

Other issues in relation to the elderly:

• Prisoners seem to be older than their years in health terms as a whole
• Depression is more common in elderly prisoners and is often under-treated
• Defining disability needs special care in prisoners; but ensuring it is in line with the DDA
• Discharge planning is even more complex, with special medical and housing needs.
• Dementia can be missed in prisons, as such patients can function well in an institution; which increases their problems when they are released
• The Prison Service does not have a consistent policy on early release of the terminal patient.  Some patients may even wish to die in prison, with adequate services, or nearby at the new facilities of The Hospice of St. Francis.  Archway has visited there recently and we have discussed these issues with the Director, Dr Ros Taylor.
• Healthcare can engage the wings to identify these patients and to ensure patient-centred facilities are provided.  To that end, Social Service assessments can be arranged.
• Access to suitable aids for blind and deaf prisoners is required
• Clothing, bedding and other regime issues - are chits needed? 
• Adequate access for bathing arrangements and showers
• Prison Regime issues differentiating disabled patients
• There were also prison pay and retirement problems, with different practices in different prisons.