Older Adult Inmates:The Challenge for Social Work

Cindy Snyder, Katherine van Wormer, Janice Chadha, and Jeremiah W. Jaggers

Older adult inmates have grown both in proportion and in number due to the confluence of anumber of factors .This aging of the prison population has created a host of policy and practiceissues that encompass justice considerations, cost containment issues, and biopsychosocialcare needs. The older prisoner's physical, social, and psychological needs are complex andnecessitate gerontologically based service delivery systems.The intent of this article is to helpin the preparation ofsociai work practitioners who can engage in older adult prison advocacywork by familiarizing them with a review of pertinent lite rature. Topics discussed include thefollowing: the characteristics of older adult inmates, the special needs of older offenders andaccompanying service delivery issues, and the use of selective decarceration as one strategyfor addressing the problem of prison overcrowding.The authors conclude the article with asummary of key challenges social workers face in assisting this population.

KEY •S: criminal justice; j^erontoiogy; inmates; older adults; prison community

Truth-in-sentencing laws, mandatory mini-mums, and three-strikes-and-you're-outrules established over the past several de-

cades are keeping more offenders conhned in prisonfor longer periods of time (van Wormer & Bartollas,2()()7:Yorston & Taylor, 2006).These laws have cre-ated a"stacking ertect," whereby older adult inmateshave grown both in proportion and in number dueto sentencing statutes that hold inmates long intotheir geriatric years (Kerbs,20()t)b;U.S.Departnientofjustice, 2004).This trend has converged with thefact that, like other segments of the population, in-mates are hving longer. In addition, the number ofolder adults who are being prosecuted as first-timeoffenders is increasing {Kerbs, 2000a).

This aging of the prison population has createda host of policy and practice issues that encompassjustice considerations, cost-containment issues,and biopsycbosocial care needs {Mara, 2004; Yates&c Gillespie, 2000). The older prisoner's physical,social, and psychological needs are complex andnecessitate gerontologically based service deliverysystems {Kerbs, 2000b).

CHARACTERISTICS OF OLDERADULT INMATESNo clear consensus has arisen in terms of defin-ing an age beyond which one is considered oldin terms of criniinological research (U.S. Depart-ment ofjustice. 2004). Studies vary as to the age at

which researchers deem an inmate to be old. butfor many investigators the cutofFbegins at 55.Thislower bound age for defining an elderly offenderis considerably different than what is used in tbegeneral population. The main reasons for this arethe shorter life expectancy and lower health statusof criminal ofTenders (Auerhahn. 2002; Williams &Kikard,2(K)4).

In 2006, the adults age 55 and older comprised5.5 percent of the total U.S. male prison popula-tion and 3.5 percent of the total female population(Bureau ofjustice Statistics |IÎJS1, 2007). Althoughthe number of older female prisoners is increasing(vanWormer&Bartollas,2007;Wahidin,2()04;Wil-liams & Rikard, 2004),'Í2 percent of older prisonersare male (BJS, 2007). The majority of aging femaleinmates are serving fint-time, long-term sentencesfor nonviolent crimes that are drug- or property-related (Aday, 2003). Only about one-third of olderprisoners are married (Aday, 2O03).The majority ofolder imnates test at a sixth-grade level, and overone-third of the older female population tests at anIQ level below 70 (Aday, 2003). Few inmates havemarketable employment skills or sufficient literacyto maintain gainful employment upon release; one-third of all prisoners were unemployed at the timeof their most recent arrest (Petersilia, 2003).

The majority of offenders age 55 and over cur-rently housed in state and federal prisons are non-Hispanic white individuals. However, the older

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prisoner population includes a disproportionatenumber of African Americans (Kerbs. 20{)0b). Usingrecent incarceration tabular data from the BJS (20i}7),which provides a breakdown of numbers of prisonersby age, race.and gender, we have calculated that 53.1percent of male inmates over age 55 are white. 27,8percent are black, and 14.9 percent are Hispanic. Forolder female inmates, 59.5 percent are wbite, 21.6percent are black, and 13.5 percent are Hispanic.Furthermore, southern states typically incarceratea greater proportion of African Americans than dostates in other regions of the country. For example,of the 4,054 older prisoners incarcerated in Geoi^iaprisons, 51 percent are African American. 48 per-cent are white, and 1 percent are Native American(Georgia Department of Corrections, 2004).

Older inmates are a diverse group that might firstbe differentiated as geriatric and nongeriatnc. Geri-atric inmates include those with functional impair-ments who require assistance with activities of dailyliving (AÜL) such as eating, bathing, or using thetoilet; they are sometimes housed in separate units toaccommodate their extensive long-term care needs(U.S.Department ofJustice.2()04).A second groupof geriatric offenders is composed of inmates whoneed extra assistance but are not totally dependent.They may require environmental supports such asramps and elevators that will aid in their mobiUty.Nongeriatric offenders are older adults who mayhave health ailments and other special needs but arestill able to function independently; they are typicallyhoused with the general population.

SPECIAL NEEDS AND SERVICEDELIVERY ISSUES

HealthOn average, older adult offenders require more at-tention in the areas of chronic illness, nursing, diet,medication, and physical therapy than youngerinmates (Mara. 2OO2; U.S. Department of justice,2004). Having typically entered the prison environ-ment from a disadvantaged background, the onsetot serious health problems appears earlier amongolder adult inmates when they are compared withaging individuals in the general population (Yorston& Taylor. 2006). Such health problems often requirephysical therapy, skilled nursing care, special diets,and other supportive services (U.S. Department ofJustice, 2004), With an increase in the onset of thesetypes of health-related issues, correctional facihtieswill have to expend more fiscal resources as geriatric

inmates struj^le with decHning health, ADL, andimpending death.

Older inmates may have limited mobility andthus require special equipment, such as walkers,wheelchairs, prosthetic devices, and special shoes, tohelp overcome ambulatory impairments. Yet olderprisons were not structurally planned to meet theneeds oE aging inmates and typically present archi-tectural impediments such as narrow doorways thatdo not accommodate wheelchairs and an absence ofhandrails or grab bars (Mara. 2002), In addition, mostprisons are not constructed to permit barrier-freeaccess to bathrooms, minimize falls, and permit shortwalks to the dining hall (Kerbs, 2000b). Because ofgeriatric inmates'physical limitations, prison medi-cal facilities should be retrofitted to accommodatethem, or new long-term geriatric wings should beconstructed. Some prisons are attempting to containthe costs associated with these issues by outsourcinggeriatric inmates to other institutions, such as statenursing homes. Arguably, geriatric bealth care is ex-pensive in any setting,but its costs are compoundedin a prison that is incurring added expenditures suchas security (Yates & Gillespie, 2000),

As more aging offenders die in correctionalfacihties, it becomes a pressing priority to developeffective end-of-life care programs (Granse. 2003).Having suffered long-term isolation from the outsideworld, offenders often fear dying alone and experi-ence shame from dying as a prisoner (Wahidin.2004).Terminally il! inmates, typically,lack access to visitorsas well as estate planning, hospice, advance directives,and do-not-resuscitate orders (Yates & Gillespie,2000), C niy a tew prisons are experimenting withintroducing such end-of-life care programs forterminally ill inmates (Granse. 2003), Others makeuse of compassiotiale release programs, also referred toas medical parole, which allow an inmate to die in acommunity health care facility or home care setting(Yates & Gillespie, 200U).

Prison Hospice ServicesMedical providers and social workers who use hos-pice services to provide compassion and comfort fortheir terminally ill patients often find themselves atodds with the rigid security concerns and proce-dures of the correctional institutions in which theywork (Aday, 2003). Social worker Barbara Granse(2003) described from firsthand experience thechallenges of end-of-iife care in a total institution.C'orrectionai officers, wary of dying patients' need

1H SocialWork VOLUME <;4, NÜMBKR i APRIL 1009

for pain medication, subjected sick inmates to con-stant, demeaning body cavity searches after a visitto the medical unit. The only amenities providedto the inmates served by the hospice agency forwhich Granse worked were basic nursing and medi-cal care. However, social work roles are crucial inproviding emotional care to terminally ill inmatesand building a situation of trust within a highlypunitive setting. Granse s recommendation was forcompassionate release into a home care setting orcommunity health care facility.

An excellent example of a model, patient-friendlyhospice program is found at the maximum-securityprison at the Louisiana State Penitentiary at An-gola. This hospice program serves about eight toto inmates at a time and gets enthusiastic reviewsfrom hospice experts (McMahon,2003). Consistentwith the hospice philosophy, nimates are trained asvolunteers. A significant,unanticipated consequenceofthe prison community care provided at Angolais that it has transformed the lives of many hospicevolunteers. Often, at the end of life, hospice socialworkers from outside the prison, and fellow inmates,help make up for the absence of family members,many of whom have died or long abandoned theterminally ill inmates.

Restricted Opportunities forSocial EngagementsHistorically, aging inmates held a higher status withiiithe prison liierarchy than they do now because oftheir experience with crime and advancing age(Kerbs, 20(l0b). But, over the past few decades, theproliferation of gangs has eroded the older adult in-mates" quality of life because ofthe perceived and realthreat of victimization by stronger, younger inmates(U.S.Department ofJustice,2()04).A primary factorthat disturbs the psychological health of inmates isfear of other prisoners (Krabill &Aday, 2005). Someolder inniates cope with their fear by avoiding theprison yard and restricting their participation inother activities. Thus, fear of victimization oftenreduces the older adult inmate's physical movement,thereby increasing feelings of isolation.

Over time, social isolation is compounded bythe fact that many ofthe older inmate's friends andfamily members typically cease being an outsidesource of support (Kerbs, 20()()b). Incarceration cre-ates tremendous strain on the family members leftbehind, and marital relationships frequently end indivorce during a prison term (Travis & Waul, 2003).

Issues that families commonly struggle with involvedealing with the shame and social stigma of a familymember being incarcerated, having fewer financialresources, and needing to realign the support net-work to handle child care responsibilities. Familiestypically need to travel long distances to reach thecorrectional facility; visiting hours are usually dur-ing the day, when spouses are working and childrenare in school; and the visiting procedures themselvesare often humiliating. Such obstacles make it dif-ficult for the offender to maintain fimily ties. Morethan half of all mothers and fathers never receive apersonal visit from their children while in prison(Travis, 2005). Some incarcerated parents do notwant their children to visit them, believing thatsuch visits will be too emotionally paintiil (Hairston.2003). Lynch and Sabol (2001 ) found that as prisonterms get longer, the frequency of family contactsof all kinds, such as visits, tetters, and phone calls.decreases.

Special Programming and Housing UnitsEducational, recreational, and reliahilitation pro-grams need to be designed to meet tbe needs oí olderadult inmates. It has been suggested that separatebasic education courses would allow for varying thepace and delivery of material in a way that wouldbetter accommodate older adult learners; this wouldalso help them deal with the embarrassment of notbeing able to keep up with their younger counter-parts (Formby & Abel, 1997). Also, the provisionof texts with larger print would help those withvision problems. Recreational programs shouldinvolve activities that take into account the physicalabilities and preferences of older adult inmates byoffering pursuits such as board games, movies, andmusic. Physical activities such as shuffleboard, walks.and horseshoes are popular among older adults andcan assist them in overcoming a sedentary lifestyle(Fromby & Abel, 1997).

Because older adult inmates comprise a smallerpercentage ofthe overall prison population, they areoften overlooked in terms of their special program-ming needs; activities are typically geared for themajority population, which is younger and moreable-bodied. For example, recreational activitiesfrequently involve physically taxing sports programsthat are most suitable for younger inmates (Kerbs.2000a). Similarly, counseling programs are mostfrequently targeted toward rehabilitating youngeroffenders rather than assisting older inmates who

SNYDER. VAN WORMKR. C H A D H A , AND JA(;GI-:RS / OUer Adult Inmates: The Challenge for Social Work 119

Although it is unsettling to hear that prison

programs typically have little relevance foraging offenders, it is even more disturbing to

hear that correctional staff frequently denies

them access to the programs that have beendesigned for younger inmates.

are dealing with difFerent life-span issues such asimpending death, chronic ilhicss, isolation, loss, de-pression, and institutional dependence (Aday, 2003;Kerbs, 2(X)0ii). At the same time, older inmates whocould benefit from typical program offerings areoften not encouraged to participate.

Althouj*h it is unsettling to hear that prisonprograms typically have little relevance for agingoffenders, it is even more disturbing to hear thatcorrectional staff frequently denies them access tothe programs that have been designed for youngerinmates (Kerbs, 2(H)()b}. According to both theRehabilitation Act of 1973 and the Americans with1 )isabilities Act of 1990 (ADA), older adult inmateshave the legal right to access programs, services, andother activities (Kerbs, 20()(lb).The ADA prohibitsdiscrimination against disabled inmates. Failure tocomply with this act can result in a wave of court-ordered decrees requiring services to inmates withspecial needs. Perhap.s because of this or becauseot greater awareness of the unique needs of theexpanding elderly inmate population, correctionalsystems increasingly are providing separate hvingfacilities for the elderly inmates.

For example, Ohio houses more than 3,000inmates who are 51) years of age or older in fivespecialized institutions (U.S. Department ofjustice,2004).The Hocking Correctional Facility is a me-dium-custody housing unit for older male inmates.A variety of special programs and services are of-fered, including chair aerobics, adult basic education,college-level courses, recreational program m ing, jobtraining, and GEI^ classes. One highly popular well-ness program is the Jogger/Walker Fitness Program.All residents have job assignments congruent withtheir capabilities. A case manager assists inmates withtasks such as applying for Social Security benefits,completing Medicaid and Medicare applications,and writing wills.

The Ohio Reformatory for Women is the onlyprison in the state that houses female ofFenders.

It has developed an assisted-living unit that offersrecreation activities.special programs,and a centrallylocated dining hall expressly for meeting the needsof geriatric inmates (Williams & Rikard, 2004).Those with severe medical problems are teamedwith an H.O.T. (Helping Others Together) partner.H.O.T partners are other inmates who serve in staffpositions and who perform any activity that assistswith the geriatric inmate's daily living needs. OlderResourceful Women (O.R.W.) provides the moreable-bodied residents with opportunities to makequilts and other craft projects to finance the unit'svarious programs. The Central Ohio Area Agency onAging sponsors a series of 14 educational programson a variety of topics relating to age. In addition,there is a five-day-a-week recreational programthat is designed specifically for the needs of all thefacility's aging inmates.

SELECTIVE DECARCERATION OF OLDERADULT INMATESWith the problem of prison overcrowding, it hasbeen noted that "it's no longer a question today ofwhether or not somebody is going to be released—the question is who" {Lundstrom, 1994, p. 158).Several states have enacted emergency release pio-gnims to deal with prison overcrowding,and there isa renewed mterest in using scarce and costly prisonspace for the high-risk offender—a practice knownas selccrii-e imarceralioit (Kerbs. 2000a). The reverseside of selective incarceration is selective dccarcera-tjon (Kerbs, 2000a)—the early release of inmatesconsidered to be of less risk to society. One suchgroup ot inmates consists of older adult offenders.On average, it costs three times more to maintainolder adult inmates compared with their youngercounterparts (Williams & Rikard 2004).These costsrelate to the complex, chronic, and serious natureof health problems that are often so debilitatingthat geriatric offenders are no longer considered asecurity risk. Thus, prison administrators are nowincreasingly considering transferring their low-riskolder adult inmates to less-expensive community-based programs, such as state nursing homes, grouphomes, or congregate care facilities.

Yet it has been observed that community-basedprograms are often unwilling to accept older mul-tiproblem inmates with health-related limitations(Curran,2000).This situation requires trained socialworkers who can broker the needed resources andplacements for decarcerated older adult inmates.

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Nuiiieroiis legislative acts, such as the Older Ameri-cans Act of 1965. can be used by social workers todismantle discriminatory procedures and policiesthat create barriers that prevent decarcerated olderadults from receiving community services.

THE CHALLENGE FOR SOCIAL WORKSocial workers should be prepared to work at manysystem levels and fill an array of roles as they assistolder .ldult inmates.At the legislative level,they willbe required to advocate for the development andimplementation of policies that will enable themto develop the special programs that members ofthis vulnerable population require to meet theirmany needs. They must also be prepared to offerservices that help prisoners and their families stayconnected. Social workers can play an integralrole in providing both prerelease rehabilitativeprogramming, including discharge plans to theconununity, and foUow-up services after the olderadult inmate's release. Similarly, social workers canhelp in the discharge planning and coordination ofneeded community services for inmates who arebeing released on medical parole. In addition, socialworkers can advocate for the creation of specialdiversion programs that serve as an alternative toincarceration for older adults, particularly thosewho are first-time otTenders.

A key difference between older adults in prisonand those in the outside world is that there are fewadvocacy groups lobbying for the formers specialneeds. Social workers can help to bridge this gap byraising public awareness that, as a society, we haveboth an ethical and a legal responsibility to providethis most vulnerable population with essential care.In the ADA. prisons now have a legal mandate toacconmiodate the needs of disabled and elderlyinmates (Yates & Gillespie, 2000). In addition, inEstelle i>. Gamhk (1976), the U.S. Supreme Courtruled that prisons are required not to act in "de-hberate indifTerence" to prisoners' medical needs.And recent lower court rulings indicate that federalcourts are prepared to make prisons take steps toensure that offenders have a proper environment foraccommodating their medical needs.

As older adult inmates increase in number, theirspecial needs will become increasingly difficult toignore; social workers can use this demographicimperative and the aforementioned legal mandatesas an opportunity to intensiiy the implementationof specialized programs to meet those needs. These

needs are considerable, encompassing such areasas the following: mental, physical, and preventivehealth care; educational, recreational, and voca-tional activities; physical exercise and rehabilitationprogramming; dietary care; and long-term geriatricnursing. Prison staff will require training programsto learn how to address these areas (Cianciolo &Zupan. 2(K)4). In addition, prison staff should befamiliarized with the normal process of aging; theycan begin to establish empathy in training sessionsthat make use of glasses that blur the vision, wheel-chairs, bandages, and other props that simulate thephysical disabihties older adult inmates experience.Staff feelings about the aging process and personalfears about growing older also need to be addressed(Curran, 2000). Training modules should includeinstruction in the communication skills needed witholder adult inmates as the process of aging can aftectboth the clarity and the speed of speech as well asthought processes.

Social workers should play a role in helpingsociety mindfully assess its policy of increasing thenumber of geriatric inmates by its implementation otharsh and inflexible sentencing laws (Mauer. 2002);our society's current penchant for long incarcera-tions ultimately restricts the public funds that couldbe used for other social programs. Social workerscan also help build public awareness that we are ata period in history wherein prison overcrowding isforcing the early release of inmates.This overcrowd-ing typically has resulted in the release of violentyoung offenders who are far more likely to harm so-ciety' upon discharge than their elderly counterparts(Yates Gillespie.2t)(K)}. Only recently have prisonofficials begun to recognize that older offendersmight be better candidates for early release becauseof their low recidivism rates. But it has been notedthat correctional personnel often find it frustratingto make arrangements for older inmates who arereentering the community, particularly if an inmatehas no community ties (Huggins, Hunter. & Moore.1992). It is during the prerelease planning phase thatcorrectional facilities need to intensively networkwith available community resources that providesupportive programs and services for older adultinmates as they transitioîi out of prison.

Social workers could play a key role in provid-ing prerelease rehabilitative programming as well asdischarge plans to the community and tollow-upservices after the older adult inmate's release. Follow-up services are critical, because even those agencies

SNYDER. VAN WORMF-B, C H A D H A , AND jAr.GKR.s / Older Adult Inmates: The Challenge for Soeiat Work 121

designed expressly for working with ex-convictsoften work ineffectively with older adults becausetheir services are geared toward assisting youngeroffenders who typically have more living family andfriends, a shorter history with the criminal justicesystem, and the physical health to pursue employ-ment opportun i ties.The Project for Older Prisoners(POPS) is one of the most prominent programsseeking the early release and social réintégration ofolder offenders (Aday, 2003). POPS identifies olderadults who are no longer deemed to be a threatto society and helps them transition back to thecommunity by brokering needed resources. POPSremains a fîedgiing program that is not adequatelyfunded and not available in many states.

Social workers help in the discharge planningand coordination of needed community services forinmates who are being released on medical parole.For both practical and humanitarian reasons, manystates have created statutory provisions for parolefor the terminally ill inmate—commonly known asmedical par(.)le or compassionate release. In addition,social workers can advocate for the creation of specialdiversion programs for older adults, particularly thosewho are first-time offenders, lí^ather than remand-ing the older adult to the correctional systetn, suchprograms seek to divert elderly offenders back intosociety af'ter they are arrested and have appeared incourt for sentencing.

Numerous studies have found that recidivism ratesare lower among prisoners who maintain family tiesduring imprisonment when compared with thosewho do not (Visher & Travis. 2003). Families playa powerful role in serving as a buffer against themany challenges newly released inmates encounter.But there are several barriers to maintaining fam-ily relationships during incarceration, sucb as longtravel times to the facility, inconvenient visitinghours, the high expense of collect phone calls, andhumiliating security procedures within the prisoncomplex. These are all challenges that can straineven the strongest family relationships (Travis &Waul. 2003). Given that we live in an era whereinthe Internet and teleconference hookups can beused to maintain communication across geographicbarriers, such technology can be harnessed to helpmaintain prisoners' familial relationships (Travis,2005). Social workers can play a key role in lobby-ing the public and elected officials to acknowledgethat correctional facilities bear a responsibility forproviding programming that helps bridge the divide

that incarceration erects between inmates and theirfamilies.

In addition to fulfilling these many roles, socialworkers need to be skilled in working with diversegroups of older adult inmates. One group of pris-oners is first-time offenders who were incarceratedduring older adulthood—they constitute about 50percent of the older adult inmates in prison, anda majority were older than 60 when incarcerated(Smyer, Gragert, & LaMere, 1997). Because thisgroup's family and community ties are more likelyto have remained intact, members of the group havea better chance of placement in prison prereleaseor community release programs. Another group ofoffenders includes those who have aged in prisonbecause of lengthy sentences for serious offenses.Much of their time may have been served in max-imum-security institutions that provided minimalopportunities for socialization (Smyer et al., 1997).The final group comprises repeat offenders whoreturn to prison in later adulthood; they typicallyhave been in prison sporadically across the life span.These later two groups pose a problem for releaseas their ties to family and community are oftentenuous or severed (Kerbs. 200()b). Furthermore.the skills these groups have used to survive in prisonenvironments are frequently antithetical to thoserequired for successful adaptation in the outsideworld (Smyer et al.,19V7).

For example,because prisons are inherently dan-gerous places, inmates learn to continually monitorthe environment for signs of risk to their personalsafety (Haney, 2003).Some inmates attempt to createsafe physical and psychological havens by becomingas inconspicuous as po.ssible as they disconnect fromthe people and events around them—withdrawingdeeply into themselves. Furthermore,signs of weak-ness or vulnerability are discouraged in the prisonculture; men's prisons in particular tend to promotea type of hypermasculinity in which dominance andviolence may be glorified as essential componentsof status and self-respect (Haney,2OO3). People whointernalize too many of these types of prison valuesmay find themselves seriously handicapped whentrying to forge or reestablish personal relation-ships upon release. In addition, prisoners servinglengthy sentences frequently become dependenton the constraints of prison to provide them witha sense direction and balance—a process known asprisonization (Aday,2(iO6). Once the external struc-ture is removed upon release, severely prisonized

122 SocialWork VOLUME 54, NUMBER 2 APRIL 1009

inmates may find that they no longer know howto cope with the outside world because they havebecome excessively dependent on the institution'srigid routines to regulate their behavior. Hence,the psychological effects of an inmate's attempts toadapt to prison life may raise significant barriers topostprison adjustment.

To counter the adverse psychological effects ofprison, social workers must work at many systemlevels.They must address prison policies and condi-tions of confinement tbat lead to prisonization byproviding pockets of freedom that give inmates op-portunities to exercise real autonomy and personalinitiative (Haney. 2003). Prison environment safetymust be ensured, thereby removing the need forpervasive hypervigilance and distrust. An emphasison maximizing visitation and fostering contactwith the outside world needs to be promoted todiscourage social withdrawal. Gounseling services forex-convicts and their famihes should be made avail-able. Most important, the reentry process must beginwell in advance of a prisoner's release as postreleasesuccess often depends heavily on the quahty andnature of services available within the communityro which the inmate is being returned.

CONCLUSIONOlder adult inmates bave grown both in propor-tion and in number because of the proliferation ofharsh sentencing statutes that hold young inmateslong into their geriatric years. Meeting the specialneeds of this growing prison population is expen-sive, and it requires the delivery of gerontologicallyinformed services. The revision of current, harshsentencing laws that have led to an increase inthe proportion of older adult inmates is one wayto address cost-containment issues. Reducing theactual number of older adults currently in prisonis another means of containing these costs. Prisonadministrators currently have several options foraccomplishing this goal: the use of special diversionprograms for first-time elderly offenders, the use ofmedical pamle to outsource the high cost of carerequired by extremely sick and terminally ill olderadult inmates, and the engagement of early releaseprograms that seek to free older adult inmates nolonger considered a threat to society. Social workerscan become key players in tbe provision and evalu-ation of services for each of these program options.Social workers should also help society mindfullyassess its implementation of harsh and inflexible

sentencing laws, which have contributed to anincrease in tbe proportion of geriatric inmates andthe overcrowding of prisons. B53

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Cindy Snyder, PhD, MA, Af5Wf « assistant professor, De-

partmcni of Social Work. Western Kentucky Vniversiiy, 1906

Collej^e Hai¡lus Bmtla'drd. BoivUu^ Creen. KV42101-10.^9;

e-mail:cindy.snydcr(a)M-ku.eí¡u. Katherine van Wormer, PhD,M55HÍ' is profhsin. Department of Social Work, Unii'mity of

Northern ¡omj.Janice Chadha,PhD,MSUÇisassistantprojh-

.ior, Department of Social Work, Western Kentucky Unit'ersity.

Bowlin_^ Green. Jeremiah i^Jag^ers, MSH{^^raditated from

Westerti Keittucky I .htii'ersity, Bowlittf' (irceiLAn earlier version

of this article was presented at the Association of Baccalatmate

Directors Conférence. March 2008. San Destin. PL.

Original manuscript received July 11, 2007Final revision received April 8, 2008Accepted May 21. 200B

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124 SocialWork VOLUME S4, NtJMBER z APRIL 2009