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Community Reentry and Older AdultOffenders: Redefining Social Work RolesDoreen Higgins a & Margaret E. Severson ba Social Work Professional Programs , University of Wisconsin–GreenBay , Green Bay, Wisconsin, USAb School of Social Welfare , University of Kansas , Lawrence, Kansas,USAPublished online: 14 Oct 2009.

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Journal of Gerontological Social Work, 52:784–802, 2009 Copyright © Taylor & Francis Group, LLC ISSN: 0163-4372 print/1540-4048 onlineDOI: 10.1080/01634370902888618

WGER0163-43721540-4048Journal of Gerontological Social Work, Vol. 52, No. 8, September 2009: pp. 0–0Journal of Gerontological Social Work

Community Reentry and Older Adult Offenders: Redefining Social Work Roles

Community Reentry and Older Adult OffendersD. Higgins and M. E. Severson

DOREEN HIGGINSSocial Work Professional Programs, University of Wisconsin–Green Bay,

Green Bay, Wisconsin, USA

MARGARET E. SEVERSONSchool of Social Welfare, University of Kansas, Lawrence, Kansas, USA

The number of older adults in US prisons continues to rise. In 2002,adults ages 50 and older made up 8% of the US prison population,up from 4% a decade prior. Many older offenders are released tocommunities that are poorly equipped to meet their special needs.and largely unprepared for the social and fiscal costs of their reentry.The focus of gerontological social work education on the returningolder adult offender has been limited. This article examines socialwork roles in the community reentry/reintegration of older adultoffenders. Best practices from the gerontological social work litera-ture are presented and implications for social work practice arediscussed.

KEYWORDS Older adult offender, community reentry, geriatricassessment, case management, geriatric social work

INTRODUCTION AND BACKGROUND: THE AGING OF AMERICA AND OF OLDER ADULT INMATES

The aging of America sets the stage for examination of a critical social workpractice issue. As of 2005, the US population of individuals age 65 and oldernumbered 36 million, or 12% of the population (US Department of Healthand Human Services, Administration on Aging [AOA], 2006). By 2030, this

Received 7 February 2008; accepted 2 March 2009.Address correspondence to Doreen Higgins, PhD, Social Work Professional Programs,

University of Wisconsin-Green Bay, 2420 Nicolet Drive, CL-710C, Green Bay, WI 54311.E-mail: [email protected]

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Community Reentry and Older Adult Offenders 785

number is expected to increase to approximately 70 million, or 20% of thepopulation (AOA, 2006).

Mirroring the trend in the population-at-large, there has been analarming increase in the number of older adults incarcerated in US pris-ons over the last 2 decades. Although definitions of what constitutes anolder adult vary, most studies use age 50 or 55 as the chronological ageat which one becomes an older adult offender (Aday, 2003; Rikard &Rosenberg, 2007). The National Institute of Corrections, an agency of theUS Department of Justice, recommends age 50 as the categorical age forolder offenders (US Senate Subcommittee on Aging and Long-Term Care,2003).

In 2002, approximately 125,000 individuals age 50 and older wereincarcerated in US prisons, or about 8% of the total US prison population—a figure nearly double that of the previous decade (Aday, 2003). Accordingto the US Department of Justice, from 1995 to 2003, inmates age 55 andolder made up the largest percentage of growth in prison inmates, increas-ing by an alarming 85% (Harrison & Beck, 2004). Some estimate that by2020, older inmates will make up 21% to 33% of the US prison population(Neeley, Addison, & Craig-Moreland, 1997).

In 2001, approximately 600,000 inmates were returned to the com-munity after serving time in prison—nearly 1,600 individuals per day(Petersilia, 2004). According to the US Bureau of Justice Statistics,between 1990 and 1999, the percentage of released prisoners age 55 andolder increased from 1.5% to 2.1% of the total US parolee population,from approximately 5,000 to 9,000 inmates annually (Williams &Abraldes, 2007). Many of these were released to underfunded probationand parole agencies that provided little oversight and service coordina-tion (Travis, 2000).

As the number of older adult prisoners released into the communitycontinues to rise, so, too, will the challenges facing correctional systems,social service agencies, health care providers, policymakers, and others whoare concerned with addressing the multiple needs of this particular group ofolder adults. The social work profession has a vital role to play in olderadult offenders’ transitions from prison settings to community living, yet hasseemingly lost its voice in the corrections system (Chaiklin, 2007; Reamer,2004). This article examines the role of social work in the community reen-try and reintegration of older adults, and argues that increased social workinvolvement with older adult offenders at the time of community reentry isnot only timely, but a professional responsibility, as well. In keeping with theobligation to serve those most vulnerable to discrimination and oppression,social workers should avail themselves of this opportunity to build on existinggerontological social work knowledge and guide community resources asthey are tapped to serve this marginalized and vulnerable subset of theolder adult population.

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786 D. Higgins and M. E. Severson

THE AGING INMATE POPULATION

Catalysts of Population Growth

In general, the older adult prison population consists of those with longcriminal histories, who have spent a substantial portion of their lives in thesystem, and those who become incarcerated for first offenses late in life(Ornduff, 1996; Yates & Gillespie, 2000).

Several factors are thought to have contributed to the rise in the olderadult prison population. Older people are sentenced to prison more now thanat times in the past and, at the same time, more punitive and restrictiveresponses to crime are used (Aday, 2003; AOA, 2007b; Rikard & Rosenberg,2007; Yates & Gillespie, 2000). Changes in criminal justice policies such asthose advanced in mandatory minimum sentencing, in two and three strikeslegislation, and in stricter parole eligibility policies and practices have resultedin the meting out and serving of longer sentences. The deinstitutionalizationand transinstitutionalization of persons with mental illness is also thought tohave played a role (AOA, 2006; Williams & Abraldes, 2007; Yates & Gillespie,2000), as has the dramatic growth in prison capacity over the past severaldecades (Roberts, 1983; Rikard & Rosenberg, 2007). Advances in medical tech-nology and increased life expectancy have also contributed to the increasednumber of older adult inmates (Rikard & Rosenberg, 2007). And the ability ofjudges and parole boards to consider mitigating factors, such as chronic healthconditions associated with old age, when determining offender’s sentences hasbeen diminished by many of these policies (Yates & Gillespie, 2000).

The Needs of Older Adult Inmates

The needs of older adults in the corrections system are significantly greaterthan those of other prisoners, and they tend to be sicker when they enterthe prison system (Chaiklin, 2007; Ornduff, 1996; Williams & Abraldes,2007). A significant number of older adults in prisons and in communitycorrections require specialized medical care for chronic health conditionssuch as degenerative arthritis, chronic respiratory ailments, cardiovasculardiseases, diabetes, and cancer (Aday, 2003; Williams & Abraldes, 2007).Cognitive and emotional disorders, such as depression, anxiety, and dementia,require a variety of health and social service interventions among the olderadult prison population (Aday, 2003; Yates & Gillespie, 2000). As with thepopulation in general, other conditions, such as vision and hearing impair-ment, risk of falls, urinary incontinence, and a general decline in functionalabilities, affect older adult prisoners as well (Williams & Abraldes, 2007).But, the average older adult prisoner is 7–10 years older physiologicallythan they are chronologically, due to histories of alcohol and drug abuse,insufficient medical care, poverty, harsh prison conditions, and other socialproblems (Rikard & Rosenberg, 2007).

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The cost of caring for older adult prisoners is nearly triple that of otherinmates, due largely to the expenses associated with their healthcare needs(AOA, 2006, Rikard & Rosenberg, 2007; Yates & Gillespie, 2000). A recentstudy by the Georgia Department of Corrections found that the meanannual cost of inmate incarceration for adults 50 and older was $69,000 perperson, compared with $22,000 for younger inmates (Rikard & Rosenberg,2007). Some contend that the costs of incarceration are high as a result ofinmates’ rights to care under the Eighth Amendment. The Supreme Courthas held that penal systems have an obligation to provide adequate medicalcare for those incarcerated, and that not doing so constitutes cruel andunusual punishment, contravening the principles of the Eighth Amendment(Estelle v. Gamble, 429, US 97, 1976). It has been suggested that the cost ofmaintaining older adults in prisons may outweigh the overall benefits tosociety because older adults are less likely to reoffend than those in otherage groups (Yates & Gillespie, 2000).

It is well documented that poor prison living conditions, includingovercrowding and violence, inadequate mental health, and medical treat-ment, and prior life conditions that exacerbate existing health and mentalhealth conditions make older adult prisoners a unique special needs popu-lation that requires special prerelease considerations (AOA, 2007b; Ornduff,1996; Rikard & Rosenberg, 2007). Older adult prisoners also face the likeli-hood of having more chronic illnesses than nonimprisoned, similarly agedadults (Williams & Abraldes, 2007). Gerontologists have expressed concernabout the treatment, or lack thereof, provided to incarcerated older persons(Aday, 2003; Ornduff, 1996) and have proposed a number of solutionsincluding exploring alternatives to incarceration such as house arrest; estab-lishment of geriatric prisons; separating older prisoners; medical parole; andearly release of nonviolent, low-risk offenders (AOA, 2006; Williams &Abraldes, 2007). The Project for Older Prisoners (POPS) program is anexample of one reentry model that emphasizes the early release of olderinmates who have already served the average sentence for their offensesand who are deemed unlikely to repeat their crimes (Rikard & Rosenberg,2007; Yates & Gillespie, 2000). Another notable effort to integrate olderadult offenders into community settings is the Senior Ex-Offender Program(SEOP) sponsored through a San Francisco-based senior center (Bayview,2007). This innovative program uses federal Office on Aging funding toprovide needed medical, financial, social, mental health, and workopportunities to older exprisoners (Williams & Abraldes, 2007). Pettus andSeverson (2006) introduced the boundary spanner in one state’s reentryinitiative as an effective strategy to resolve the system-wide challenges tosecuring effective collaboration. Using a community-outreach approach,the boundary spanner’s role includes ensuring that there has been anassessment of criminologic risks and needs and that intensive case manage-ment services are provided to respond to those risks and needs, and then

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building the necessary community partnerships between corrections officialsand service providers.

Considerations of justice also must be weighed when discussing olderadult offenders and community reentry. Although the goals of imprison-ment, including the removal of the offender from society for a period ofcorrection, must be supported, the reality is that older adult offenders areless likely to reoffend than their younger counterparts (Aday, 2003). In practice,longer periods of incarceration to protect the public may work against boththe public and the older adult, resulting in significant fiscal costs to theformer (AOA, 2007b, Rikard & Rosenberg, 2007) and essentially becomelife sentences for the latter (Yates & Gillespie, 2000). Given these factors,the timing is right to consider how existing community networks of agingservice providers, probation and parole agencies, and the prison system cancome together to improve the transition of older adult offenders into com-munity life. Social work can serve as the catalyst to bring these groupstogether to maximize the independence and functioning of the older adultinmate, and promote the safety of the communities where they will ulti-mately reside.

SOCIAL WORK AND THE REINTEGRATION OF THE OLDER ADULT INMATE

Given the high fiscal and social costs of incarcerating older adults, the antic-ipated growth in the older inmate population, and the shrinking of federaland state budgets, efforts to address the special needs of older adultinmates in a manner that recognizes cost containment, quality of lifeissues, and justice considerations need to be explored. Traditional reentryapproaches managed by parole boards have struggled with the rising num-ber of prisoners under their supervision, and a loss of public confidence hasensued (Travis, 2000). Older prisoners who return to community living mustalso deal with adjustments to new living environments after years of adapta-tion to prison settings, and they are often released to unsafe neighborhoodsat a time when they are physically frail and, thus, particularly vulnerable(Williams & Abraldes, 2007). Many older adults who are released from prisonslack family support and have few financial resources, while at the sametime having to deal with multiple chronic health conditions, stigma, andend-of-life issues (Williams & Abraldes, 2007). Many may not be eligible forSocial Security and may even be prone to violating parole requirements ifcommunity supports are inadequate (Aday, 2003).

The special needs of the older adult inmate population and the com-mensurate need for services at reentry, such as medical and health care,housing, employment, social, recreational, and other supportive services,necessitate that the social work profession play a larger role (Chaiklin,

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2007). According to Chaiklin, social workers should be the leaders in meetingthe unmet needs of offenders, especially at the time of prison release.“Reentry,” said Chaiklin (2007, p. 576), “is clearly an area that wouldemploy social workers if they were educated for this work.” However, lessthan 1% of social work graduate students list corrections as their primaryspecialty, and few see a career in the corrections system as a viable option(Chaiklin, 2007; McNeece & Roberts, 2001). Despite the mission of the pro-fession to maximize the dignity and worth of the individual, to foster clientself-determination, to advocate for clients, and to promote social justice(National Association of Social Worker’s [NASW], 1996), the profession islargely uninvolved in service delivery, policy and program development,and advocacy efforts (McNeece & Roberts, 2001; Reamer, 2004). McNeeceand Roberts noted that, although the NASW has adopted a policy statementon Correctional Social Work, no practice standards have been developed.

Reamer (2004), drawing on social work’s training and education inareas of clinical social work practice, administration, policy practice, super-vision, organizing, advocacy, and research and evaluation, noted that thechallenge to social work in corrections is significant, and that careful atten-tion must be paid to balancing public safety concerns with prevention andrehabilitation ideals. Social workers in criminal justice settings can fill anumber of roles, including as direct service providers, as advocates, asadministrators and supervision agents, and as research and program evaluators(Reamer, 2004). But, it is often the case that social work knowledge, values,and skills are often met with hostility, suspicion, or resistance by others incorrections settings (Reamer, 2004), and social workers are typically notvalued nor understood in the criminal justice system (Brownell & Roberts,2002). Bringing the principles of gerontological social work practice into thecorrections’ world may have a profound impact on how people age as theylive in and move from corrections’ systems into the community. Gerontologicalpractice may also significantly impact how social work contributions to thecorrections environment are perceived and valued.

GERONTOLOGICAL SOCIAL WORK AND REENTRY SERVICES

Much has been written in the criminal justice literature on various modelsand interventions for the community reentry of prison inmates. Here, thefocus shifts to a discussion of the models and interventions offered in thegerontological social work literature that have promise for older adults rein-tegrating into communities across the country. These interventions includegeriatric assessment, case management strategies, and end-of life care.Emphasis throughout this discussion will be given to the social work role inbuilding upon existing community networks of aging services, programs,and providers that serve the older adult population.

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Theoretical Framework

The person-in-environment perspective lends a useful framework withwhich to view the reintegration of the older adult offender into communitysettings. Using a biological metaphor of adaptation, this model focuses on thegoodness of fit between the individual and their environment, emphasizingthe reciprocal exchanges that take place between a person and their envi-ronment, which shape and influence each other throughout the individual’slife course (Germain & Gitterman, 1996). This model espouses that there isa good fit when there is a match between the individual’s needs, resources,and capacities, which, in turn, serves to “release human potential andgrowth, health, and satisfaction” (Germain & Gitterman, 1996, p. 8). Whenpersonal and environmental stressors exceed the resources available, anindividual may experience diminished ability to cope, poor health, andsocial isolation. Aday (2003, p. 149) noted, “If there is an imbalancebetween the person and environment, the situation may lead to variousdegrees of adaptive behavior, which often can have a negative effect on thepsychological well-being of the aging inmate.” Williams and Abraldes(2007) supported this contention in their discussion of the importance ofmatching environmental resources with the older prisoners’ capabilities.Given the range and severity of challenges facing older adult offenders,attention to the multiplicity and interplay of factors that influence the well-being of returning older adults is paramount.

Geriatric Assessment

Assessment is an important component of work with older adults, andgeriatric assessment is a core social work practice competency (Geron,2006; Naito-Chan, Damron-Rodriguez, & Simmons, 2004). Morano andMorano (2006) suggested that geriatric assessment focus on client strengths,functional assessments to understand how medical conditions impact theolder adult; and the examination of cognitive functioning, psychiatric status,and family care giving. Kane (2006) urged social work practitioners to care-fully examine the quality of assessment tools used in practice, and presentsa review of many standardized assessment instruments including those thatassess quality of life, religion and spirituality, and emotional and mentalwell-being.

It is vitally important in geriatric social work assessment that olderadults be carefully assessed in terms of their cognitive status. Ageist assump-tions in society that equate incompetence with aging are common, and thereturning older adult offender may be more susceptible to societal judgmentson perceived competence than are their age-matched community cohorts. Awide range of geriatric assessment tools is available; they are designed tohelp social work professionals understand the challenges and needs of

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older adults (Geron, 2006; Kane, 2006). Table 1 presents a list of commongeriatric assessment instruments available to gerontological social workpractitioners.

Given the increased likelihood of developing a cognitive disorder withaging, and given the multiple ways in which cognitive disorders maymanifest behaviorally, Williams and Abraldes (2007) suggested that newapproaches must be developed to deal with this phenomenon among agingoffenders. Because older offenders may have served long sentences thatremoved them from the pressure to cognitively absorb the rapid societalchanges that have occurred, it is important that existing assessment tools bemodified (and validated) to appropriately evaluate an older inmate’s expo-sure to daily living skills enjoyed by their free and younger counterparts.

Case Management and Older Adult Reentry

Case management is a long-standing social work practice model and animportant method for work with older adults (Robinson, 2000). It is particu-larly well-suited to address the complexity of social, psychological, medical,economic, and legal issues facing older adult offenders. The NASW (1992)defined social work case management as “a method of providing serviceswhereby a professional social worker assesses the needs of the client andthe client’s family, when appropriate, and arranges, coordinates, monitors,evaluates, and advocates for a package of multiple services to meet the spe-cific client’s complex needs” (p. 5). This definition encompasses the mostcommon functions associated with social work case management: intake/

TABLE 1 Geriatric Assessment Tools

Assessment Instrument Purpose Source

Beck Anxiety Inventory Discriminates depression from anxiety

Beck, A., and Steer, A. (1990).

Geriatric Depression Scale Screening for depression in older adults

Sheikh, J. I., and Yesavage, J. A. (1986).

Index of Independence in Activities of Daily Living

Assesses performance of self-care measures

Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B.A., and Jaffe, M.W. (1970).

Lawton Instrumental Activities of Daily Living

Assesses functional status Lawton M. P., and Brody, E.M. (1986).

Life Satisfaction Index-A Assesses well-being in later life

Neugarten, B., Havighurst, R., and Tobin, S. (1961).

Spiritual Strategies Scale Assessment of use of spiritual coping strategies in older adults

Nelson-Becker, H. B., (2005).

Short Portable Mental Status Questionnaire

Screening for presence and degree of cognitive impairment

Pfeiffer, E. (1975).

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screening, assessment, development of a service/care plan, coordination ofneeded services, follow-up and monitoring of services, and reassessment(Naleppa, 2006; Robinson, 2000).

As a specialty, geriatric case management recognizes the necessity ofproviding a range of service options, linking clients to resources, and pro-viding advocacy for challenging system barriers (Robinson, 2000). Moranoand Morano (2006) suggested that geriatric case management should empha-size the relationship between the client system and the case manager, theactive involvement of informal and formal helping networks, and the maxi-mizing of client self-determination. The empirical literature supports theapplication of case management methods in offender community reentry(Seiter & Kadela, 2003), although available data on case management witholder adult returning offenders is minimal. Programs like the POPS, whichtargets older inmates who do not pose a threat to society for early release,employ case management strategies to support community living, includ-ing helping clients access Social Security benefits or find housing and jobs(Ornduff, 1996; Yates & Gillespie, 2000). The Michigan Prisoner ReentryInitiative Model, a pilot demonstration reentry project, provides case man-agement as a key feature of transitioning from prison to community-living,and uses probation and parole and human service providers at various junc-tures throughout the process (Michigan, 2007). The Access, Plan, Identifyand Coordinate model of reentry, sponsored by the Center for MentalHealth Services and Center for Substance Abuse Treatment, is heavily case-management oriented in its efforts to assist individuals with mental illness toreintegrate into community settings (US Department of Health and HumanService, Substance Abuse and Mental Health Services Administration, 2002).Finally, Williams and Abraldes (2007) suggested that intensive case manage-ment can be helpful in promoting a smoother community transition for theolder adult prisoner.

The Older Americans Act: Connecting Reentering Older Adults to Community Resources

Providing linkages to appropriate community resources is a critical aspect ofsocial work assessment and case management, and is of primary importancein sustaining older adult offenders in community settings. One potentialway to enhance social work services for older adult offenders within com-munities relates to the service provisions of the federal Older Americans Act(OAA). Enacted in 1965, this landmark legislation has changed the face ofprograms and services for older people in the United States. The OAA estab-lished the US Administration on Aging (AOA), which authorized grants tostates for aging-related community-based programs, research, demonstration,and training projects, and called for the development of State Units onAging (Carbonell & Povlinka, 2003). Consequently, a network of federal,

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state, and local agencies linked together to focus on social services andother programs targeted to community-based older adults. This network,widely known as the aging network or aging services network (Carbonell &Povlinka, 2003; Stevenson, 2007) consists of 56 state units on aging and 655area agencies on aging across the nation, representing thousands of non-profit, in-home, and community-based residential service providers andadvocacy groups (Carbonnell & Polivka, 2003).

Aging network program and service agencies provide OAA-funded pro-grams in all 50 states via their state units on aging, enabling older adults tolive independently in their homes and communities. Some of the servicesprovided include congregate nutrition services and home-delivered meals;information and assistance about local services for older adults; case man-agement; benefits-related services to assist with questions regarding pro-grams such as Medicaid, Medicare, or food stamps; referral to legal services;transportation assistance; volunteer services and friendly visiting services;telephone reassurance programs; homemaker and chore services; senior cen-ter programs; adult day services; energy assistance programs; and informationand support such as respite care for family caregivers under the NationalFamily Caregiver Support Program (AOA, 2007a). The OAA also providesspecial programs for Native American elders, other low-income minorities,and older individuals living in rural areas (AOA, 2007a; Takamura, 1999).

The OAA services provided via the aging network are valuableresources for returning older adult offenders for enhancing their physical,social, psychological, and economic well-being. However, little is knownabout if, or how, OAA services are accessed or utilized by this population.We were unable to locate published material that specifically links OAAprograms and services to the community reentry of older adult inmates—but the need for the linkage is made clear, for example, by the statement ofone state Department of Corrections:

The Kansas Department of Corrections releases about 5,800 offenderseach year from prison. A significant number of them do not have reliableor any transportation. We transport the offenders to the county ofrelease, after which time they are responsible for obtaining their owntransportation within the community. Lack of transportation hampers theirability to find and keep employment, attend meetings with parole officers,participate in treatment, access necessary services, and otherwise success-fully function in the community. While there are many significant barriersthat face returning offenders, transportation adds to the mix. [KansasUniversity Transportation Center, 2005].

Figure 1 provides a visual representation of the interface of prison offi-cials, community-based social workers and aging service providers, andprobation and parole professionals. Ideally, prior to the release of the older

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adult offender, local community aging network social service providersshould be contacted directly by the parole officer or reentry case managerto facilitate referral and assessment to community-based networks of agingservices. Referrals can be made directly to the area agencies on aging or thelocal senior centers. A recent conversation with a local community areaagency on aging service agency practitioner revealed that referrals fromlocal prisons for community services for older adults to their agency wasminimal, and that if at all, referrals for state-mandated area agency on agingassessments were made upon discharge from the prison to ensure admittanceto nursing home care (R. VanDyke, personal communication, December 10,2007). Probation and parole providers should be encouraged to attend localcommunity activities related to aging service provision and become part ofthe aging network. Many communities provide venues for regular interdisci-plinary meetings of aging network service providers, which can be accessed

FIGURE 1 Service integration for the older adult: Prison, parole agencies, and communityaging services.

Prison ProvidersP re-re lease p lann ing & coord ina tion

Probation and Parole Providers M onito ring & superv is ionC oord ina tion w ith serv ice p roviders

Social work and Community-basedAging ServiceProvidersC ase m anagem entC ounse lingC ris is In te rven tionC om m unity R eferra l& C oord ina tionThe A g ing N etwork

Service Integration for the Older Adult: Prison, Parole Agencies, and

Community Aging Services

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by community corrections professionals. To facilitate this process, socialworkers can call upon their knowledge and skills in relationship-building,what Sheafor and Horejski (2008) called the social worker’s “fundamental tool”(p. 35), to bring corrections officials into the community aging network.

End of Life Care

The number of older people dying while incarcerated has increased overthe last 15 years (Linder, Enders, Craig, Richard, & Meyers, 2002; Williams &Abraldes, 2007). Of the 3,008 inmates in US prisons who died in 2001, themajority (2,514) died from cancer, AIDS, other extended and chronic illnesses,and old age (Wright & Bronstein, 2007). This represents an increase ofnearly 50% from a decade earlier (Yampolskaya & Winston, 2003). Dyinginmates have raised serious concerns for the corrections system and societyin the areas of security, costs of care, legal issues, public safety, and human-itarian concerns (Aday, 2003; Yampolskaya & Winston, 2003).

Since the 1980s, many prisons have adopted formal hospice programsto provide palliative care to manage pain, provide compassionate care, andpromote dying with dignity. Rapidly becoming a preferred mode of treatmentfor terminally ill inmates, hospice programs emphasize quality of life, andprovide an array of services, including spiritual and psychosocial support andbereavement counseling (US Department of Justice [DOJ], 1998). Underhospice programs, specialized services and treatment are available to termi-nally ill individuals who have been certified by a physician as having a lifeexpectancy of less than 6 months. For their hospice programs, correctionssystems often ease restrictions on visiting hours, honor requests for foodchoices, provide different clothing, and make exceptions for the inmate’spossession of physical effects (Aday, 2003).

The GRACE Project (which stands for the Guiding Responsible Actionfor Corrections at End-of-Life), sponsored by the Robert Wood JohnsonFoundation, has played a primary role in the development of hospice carein US prisons through the collaborative efforts of corrections staff, hospiceorganizations, and trained volunteers (Ratcliffe & Craig, 2004). The US DOJreported that in 1997 there were approximately 12 hospice programs inplace in US prisons, with 8 under development (US Department of Justice,1998). Aday (2003) noted that about one-third of state corrections depart-ments provided some type of hospice care in 1997. The majority of healthcare and other services to inmates at the end of their lives, however, areprovided via regular correction venues. A major challenge in the provisionof end-of-life care is balancing the needs for compassionate medical careagainst the necessary constraints of the prison system (Aday, 2003).

Social workers have long been involved in the provision of services inend-of-life care, and can play significant roles in helping older adult offenderscope and manage issues related to terminal illness and dying. At no time is

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it more important to attend to the mental, spiritual, and psychosocial needsof inmates than during the process of dying (Aday, 2003). Although littleresearch has been conducted related to the inmate experience at the end oflife, it is commonly thought that alienation from family members due tolong periods of incarceration, fear of dying alone, feelings of worthlessnessand despair, needs for atonement, and spiritual care are significant factors(Aday, 2003; Lindner et al., 2002).

As people age, they tend to move toward more self-reflection, seekingmeaning and purpose that transcend their present circumstance (Nelson-Becker, Nakashima, & Canda, 2006). Older adults who have been incarceratedmay be especially reflective about finding a sense of meaning and purposefor their lives. Returning to community living as an exoffender brings a hostof challenges, not the least of which is related to personal identity and meaning.As holistic practitioners, social workers can help these older adults draw upontheir spiritual beliefs to cope with the stress of reintegration, stress often aggra-vated by chronic illness, disability, or impending death, and connect them toresources to enhance their spiritual growth and development.

Whitehead and Braswell (2002) suggested that spiritual dimensionsshould be applied to probationers to enhance their lives, and that spiritualityshould also be incorporated into probation practices in hopes of helpingoffenders “find hope and meaning in their lives” (p. 226). Social workassessments of spirituality with older adult offenders should reflect the per-spectives of the older individual, and practitioners should take caution tonot impose their beliefs on the client. Nelson-Becker and colleagues (2006)advanced a client-centered approach to spiritual assessment with olderadults and encouraged social workers to inquire about the importance ofmeaning and purpose in clients’ lives; the role of spirituality, religion, andfaith; and how the client prefers to express these, as well as whether or notthe client wants to incorporate aspects of these into the work with the socialworker.

Prisoners are released when their sentences have been served; this istrue for the healthy, as well as for the dying. Social work’s unique trainingin the person-in-environment perspective lends itself well to taking a holisticview of the older adult at the end of life, and thus social workers can servemultiple roles as they work to enhance the quality of life for reenteringoffenders. Advocating for the promotion of quality care at the end of life,educating patients and their families about available resources, providingadvanced care planning to ensure the individual’s needs and wishes arehonored at the end of life, facilitating communication between prison healthcare and community health care providers, and linking individuals toneeded financial and other resources are just a few of the traditional socialwork roles useful in working with this population. Competent social workersin end-of-life care understand the process of dying, biopsychosocial issuesrelated to illness, the importance of adequate pain management, as well as

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the range of services and settings that provide end-of-life care (Gutheil &Souza, 2006).

Social workers are instrumental in facilitating appropriate placement forthe terminally ill individual, especially for older adult offenders who havereintegrated into the community. In this capacity, the social worker mayseek formalized hospice services, engage home healthcare teams, or coordinateplacements with skilled nursing facilities.

Finally, grief counseling, listening, and validating the individual’s feelingsand concerns about the dying process requires a highly individualized focus,where the social worker recognizes various aspects of the grief process andidentifies the cultural and spiritual resources that may impact the individualat the end of life (Gutheil & Souza, 2006; Howe & Daratsos, 2006). They canalso assist family members of offenders to help them prepare for the emo-tional, technical, and legal aspects of death.

CONCLUSION

The anticipated surge in the older adult population has received muchattention across multiple disciplines over the past several years, focusing onsuch issues as retirement and financial planning, and various aspects oflong-term care (Carbonell & Polivka, 2003; Chapin, Baca, Landry, Rachlin &Wedel, 2006). The social work profession has been an active part of thenational discourse on how to best prepare for social work practice with theincreasing numbers of older adults who will require social work services.The NASW, the Council on Social Work Education (CSWE), and New YorkAcademy of Medicine/Social Work Leadership Institute have been involvedin numerous research, education, and policy efforts in this regard (CSWE,2001; Damron-Rodriguez, 2006; Hooyman, 2006). At a time when thegrowth in numbers of older adult inmates is accelerating, and when therelated policy and program issues are at the doorstep (Aday, 2003), theseorganizations must play a broader role in promoting social work practice inthe field of corrections as a whole, and specifically with older adult offend-ers as they return to the community. With the support of larger social workorganizations like the NASW, services for the older adult offender populationcan be offered under the auspices of aging and community social serviceprovider networks already in existence.

Programs such as those supported by the John A. Hartford Foundation thathave been successful in promoting aging and social work education across thecountry serve as exemplars for preparing competent prisoner reentry-focusedgerontological practitioners. The Hartford Foundation’s Geriatric Social WorkInitiative to improve the health and well being of older Americans and theirfamilies through enhanced social work knowledge and services provides anexcellent foundation for reentry work with this population (Hooyman, 2006).

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Recently, the NASW has made efforts to bring corrections back into thesocial work landscape, hosting a national conference on offender reentry.According to the NASW Workforce Development Center, the associationrecognizes social work involvement in corrections and community reentryas being vital to public safety, and notes that the association anticipates thedevelopment of a position statement on criminal justice in the near future(M. Wilson, personal communication, December 10, 2007).

In sum, efforts to enhance social work education and practice witholder adults and their families are well-underway. In keeping with its mis-sion to serve those most vulnerable in our society, gerontological socialwork professionals have a timely and critical opportunity to revisit socialwork’s role in corrections and to serve a particularly vulnerable segment ofthe corrections population—the older adult offender. To do so, the profession“must exert genuine and sustained leadership” (Reamer, 2004, p. 228).

Sustaining social work involvement with older adult offenders dependson an increased availability of trained gerontological social workers that willassist returning adult offenders in accessing service options in a way thatrespects the dignity and rights of the individual and balances the public’sneed for safety. As a nation, the United States has invested billions of dollarsinto locking up offenders. Policies around reentry have become increasinglyfocused on the avoidance of risk and as a result, create a revolving door ofoffenders who will be committed to prison again and again as they fail inthe community. Although this revolving door is perhaps a failure of reentrypolicies (Seiter & Kadela, 2003) it is also the opportunity for a redesign ofservices. President Bush, in his 2004 State of the Union Address, remarkedabout prisoner reentry: “America is the land of second chance, and whenthe gates of the prison open, the path ahead should lead to a better life”(White House, 2007). Beginning with the older offender, social workershave the opportunity and professional obligation to help returning offenderstraverse that path.

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