Adults aged 50 years or older constituted 10% of the US prison population in 2012 and 20% in 2017. Many factors have contributed to the aging of the prison population, including reduced judicial discretion (e.g., mandatory minimum sentences, “three strikes” legislation), indeterminate sentencing, and the reintroduction of life without parole. As many incarcerated older adults experience multiple physical and mental health conditions at higher rates than do nonincarcerated persons, prison yards are now peppered with walkers, wheelchairs, and other durable medical equipment. Incarcerated older adults are also vulnerable to predation and often live in environments not designed to meet their physical needs. As a result, older adults generate high costs for overcrowded correctional systems, many of which are ill suited to provide the complex medical care needed for patients of advanced age or approaching the end of life.
In response to the aging of the prison population, many jurisdictions have introduced or reinvigorated legal mechanisms to release or parole people with life-limiting illness early to their communities. Nearly all states have some form of early release policies, including medical parole, medical release, and “geriatric” parole, to name a few (all herein referred to as “compassionate release”). Such mechanisms are critical release valves for bloated US correctional facilities and can serve as supportive, human rights–oriented strategies for unifying families at the end of life and transferring persons to community-based health care systems that are better equipped to meet their complex health needs.
Despite the existence of compassionate release policies, a recent analysis paints a bleak portrait of their use. Only 4% of requests in the Federal Bureau of Prisons are granted, and anecdotal evidence points to similarly low rates among many state prison systems, indicating underuse of these mechanisms as an important approach to decarceration. The limited use of compassionate release is driven by numerous systemic barriers at the patient, professional, and policy levels. We describe these barriers and strategies to combat them and promote human dignity and decarceration among this medically vulnerable population.