Inside the 60 West nursing home in Rocky Hill, two residents played solitaire to the sound of soul music. Others sat in wheelchairs beneath a simulation of rolling clouds, while one got a haircut in a barbershop decorated with Red Sox posters.
From the outside, the 95-bed, single-story facility set back from the road looks like any other nursing home. But many of the elderly and ill residents are actually paroled prisoners, and the home is being watched nationally as a potential game-changer for states grappling for ways to care for their aging inmate populations.
60 West is the first facility in the country to win approval from the Centers for Medicare & Medicaid Services (CMS) for federal nursing home funding—a designation that has national significance, experts say, because it’s a new option for cash-strapped states looking for ways to care for growing populations of older and sicker inmates.
“Connecticut has tried to be innovative in our criminal justice reforms. This is one of them,” said Michael Lawlor, the state’s undersecretary for criminal justice policy and planning. “What we are doing is being copied in other parts of the country. It’s this kind of innovation that helps reform the criminal justice system nationwide.”
Tina Maschi, a Fordham University professor and former prison social worker who studies aging prisoners, said that the state “responded to a difficult problem of caring for seriously, terminally ill prisoners, and [its approach] managed to survive, despite community pushback. This program is a role model.”
In December, 60 West, a privately-owned facility under contract with the state, was notified that CMS had reversed its 2015 rejection for federal certification and granted the facility the same status as thousands of other nursing homes across the country, making it eligible for federal funds—a development first reported by the website the Crime Report. CMS previously had ruled that paroled inmates did not meet federal guidelines.
Ailing inmates who qualify for nursing home-level care and who the state deems are not public safety risks are referred to 60 West. Medicaid covers half the cost of their care, which will save the state about $5 million annually.
Lawlor said that federal approval is a boon to Connecticut, where the over-60 population increased by more than 40 percent from 2010 to 2016.
“There is a need for this type of facility in every state in the country,” Lawlor said. “It’s way more expensive to provide this care in the context of a prison. … If they are in a real nursing home, you get 50 percent [funding] from the feds; in prison, you get zero percent.”
In addition to funding concerns, caring for the growing population of elderly prisoners is difficult because “prison infirmaries were not designed to serve chronically ill people or people who need hospice care,” said Judith Dowd, director of health and human services for the state’s Office of Policy and Management.
While Connecticut’s total prison population decreased by more than 3,000 inmates between 2010 and 2016, the over-60 population increased from 301 inmates to 426, according to December population counts posted on the state Department of Correction (DOC) website. In 2010, inmates ages 46 to 60 made up just 16 percent of the state prison population; that percentage inched up steadily to 19 percent last year.
As the number of elderly and sick prisoners rises, so, too, does the cost of their care. The annual price of care for an inmate increased from $4,814 in fiscal year 2010 to $5,201 in 2015, as more inmates required regular health care. In 2016, 27 percent of the prison population required health care, up from 20 percent in 2011. And most Connecticut’s prisoners are on some form of medication: 56 percent in 2016 up from 40 to 45 percent between 2008 and 2010.
Connecticut is not alone in dealing with growing numbers of elderly prisoners. Due largely to the “tough on crime” laws of the 1980s and 1990s and strict release policies, the percentage of older prisoners behind bars nationally has exploded in the past decade, experts say. The crisis has states scrambling to come up with ideas to lower costs.
The success of Connecticut’s community-based approach is a signal to other states that they can secure federal funding to help care for ill, aging prisoners, which until recently was viewed as impossible, prisoner advocates said.
“It’s pretty exciting,” said Maschi. “I do think that the idea will spread. It is inspirational, and people are taking notice.”
At least three states—Kentucky, Michigan and Wisconsin—have explored creating facilities like 60 West. But some have been waiting to see how the CMS approval would play out.
Al Pscholka, a former Republican state representative from Michigan, introduced a bill last year that would have permitted medically frail inmates to be cared for in licensed health care facilities rather than prisons. The bill passed the House, but did not make it through the Senate because of funding concerns.
The federal approval “is great news and should help efforts in Michigan,” said Pscholka, who is now the state’s budget director. “I believe this is a cost-effective and compassionate way to deal with terminal prisoners.”
Other states are taking different approaches. Missouri is modifying prison housing units to accommodate disabled inmates. Virginia has a designated assisted-living unit inside a prison to care for infirm and geriatric inmates. New York has a prison unit for the cognitively impaired. Iowa opened a prison hospice unit. Nevada has a preventative health program called True Grit for inmates over 55.
“States are using a variety of strategies,” said Maria Schiff, director of state and local fiscal health for the Pew Charitable Trusts. “They are trying to accommodate both sides: to treat these individuals as they need to, but to try to contain some of the costs.”
60 West is not the first Connecticut innovation to address the aging prison population. The state is one of a few with a prison hospice program in which fellow inmates care for dying prisoners.
The program started in 2001 at the MacDougall-Walker Correctional Institution in Suffield and was expanded to Connecticut’s only prison for women, York Correctional Institution in Niantic, in 2003 and to a second men’s facility, Osborn Correctional Institution in Somers, in 2007.
Most states also now have compassionate release parole, which lets dying inmates out of prison at the very end of their lives. Connecticut began releasing such prisoners in 2012, and the federal government started a similar policy in 2013. But compassionate release and medical parole, another form of relief for sick prisoners, are rarely used, records show. In 2016, Connecticut’s Board of Pardons and Parole granted one compassionate parole and two medical paroles; in 2015, there were three compassionate paroles and one medical parole.
“It’s so bureaucratic that by the time [the prisoners] get considered, they die,” said Maschi. “There’s a fear about letting people out, especially about how the public would react to letting them out.”
Many of the 60 West residents are on nursing-home-release parole, a form of parole the state legislature created in 2013. To qualify, the DOC must determine that inmates are “suffering from a terminal condition, disease or syndrome” and “be physically incapable of presenting a danger to society.”
These “offenders are so medically compromised, they don’t have the physical ability to commit a crime,” said Dr. Kathleen Maurer, DOC’s director of health services.
‘We’ll Take Care Of Them’
The idea for a facility like 60 West began under former Gov. Jodi Rell. Inmates eligible for release often languished in prison, as nursing homes refused referrals from DOC and the Department of Mental Health and Addiction Services (DMHAS), according to Lawlor.
In 2011, the Malloy administration sought a facility operator for 60 West, and SecureCare Options LLC submitted the winning bid. The facility started accepting paroled inmates in 2013.
But the process of gaining acceptance was anything but smooth.
Some neighbors opposed the facility, and the town of Rocky Hill filed a lawsuit against SecureCare, arguing that the nursing home violated local zoning regulations. The state Supreme Court tossed out that lawsuit, but others are still pending. The town of Rocky Hill filed a second lawsuit alleging a separate zoning violation, and two neighbors have a pending lawsuit alleging the facility has decreased their property values.
In the 3½ years since 60 West opened, state officials say, no criminal incidents have been reported. “There hasn’t even been a workers’ comp claim,” Lawlor said.
Currently 72 residents live at 60 West: 45 were referred from DMHAS, which includes referrals from inpatient psychiatric units; 19 residents were referred from DOC; and eight are from the community.
Diagnoses vary, and include dementia, brain injuries, HIV, cancer, Huntington’s disease and psychiatric conditions, such as schizophrenia, depression, personality disorders and anxiety, said Diana Lejardi, a spokesperson for DMHAS.
Jessica DeRing, the administrator of 60 West, said staff members know where the residents come from, so that they can accommodate their needs, but “they don’t necessarily know their histories.”
“From our end, these are nursing home residents,” she said. “And they are here and we’ll take care of them.”