Several sociodemographic and legal trends have seen an unprecedented rise in the number of older people imprisoned in Australia. Most of these older adults will eventually be released into various systems of care in the community.
Whether this fact strikes intrigue, concern or no interest at all, it will be increasingly important for service providers to improve their awareness of this unique and growing group.
As a researcher interested in health equity for marginalised populations at UNSW Sydney, I’ve set out to understand this phenomenon better and to help direct policy and practice solutions.
I’ve spent the last few years exploring literature, conversing with academics in the United States and United Kingdom who lead the charge in this area, and engaging with stakeholders across corrective services, justice health, social services, aged care, advocacy and of course those with lived experience.
A detailed background to this issue is embodied in a paper I was involved in preparing for the Australian Association of Gerontology last year. Prepared in parallel was a set of recommendations for supporting “older people leaving prison to age adaptively and with dignity”.
Since these reports, I have spent more time engaging with individuals who have lived experience of leaving prison in older age and carers who have observed their experiences from a close distance. There is a high perceived level of challenge, and an associated lack of confidence when it comes to offering aged care and health services to this population.
Armed with the belief that this could be improved with a better understanding of what to expect with this population, I have distilled my thoughts into four key lessons that should help service providers more confidently open their doors to older adults leaving imprisonment.
Lesson one: Are they a risk?
Perhaps the biggest apprehension towards servicing this group lies in whether their history makes them a safety risk to staff or other care recipients. The prevailing argument in both research and theory is that the risk of reoffending decreases greatly with age, regardless of offence type. People are largely considered to have aged out of criminal behaviours by later adulthood.
The strong motive to desist, or rather the lack of a motive to reoffend, is often driven by a desire to stay out of prisons that are socially and physically challenging for older people. This is further encouraged by maturation in personality and behavioural domains, as well as gradual physical incapacitation in older age.
In my work, it is more commonly witnessed that the prospect of reoffending becomes attractive to an older person when they are unable to adjust to life in the community by being unable to access the care, support and stability needed after release. It is thus in everyone’s best interests they are provided with quality care in the community.
Lesson two: Mind the gap
Service providers should be aware of significant care and administrative gaps that must be reconciled as a person leaves custody. Whilst healthcare is provided in prison, it is by no means the priority, resulting in a high likelihood of unmet or inadequately managed needs for older people.
Care continuity for those leaving prison is mostly non-existent in policy
Service providers should consider under-detected conditions – especially cognitive decline – and review the appropriate diagnosis and management of known conditions.
Care continuity for those leaving prison is mostly non-existent in policy. Medicare is not available in prison, and the transfer of health and medical information between prisons and the community is a commonly voiced pain point that takes time and persistence to resolve.
In most cases, a person will not be equipped with their medical records nor be expected to recount details of their medications or assessment histories. A proactive approach to accessing this information, and addressing immediate needs for medication and health aids, will be a priority.
Lesson three: Leaving long-term institutionalisation
Older people leaving prison have often experienced lengthy and repeated periods of incarceration, disconnected from normal activities of daily living. Managing and adapting to newfound independence in an essentially foreign world is highly challenging.
These adults have often become accustomed to routines and a manual, supervised way of life. There are strengths to this, especially in adjusting to routine in aged care settings. However, it also means that independent management of a schedule or keeping up with appointments can be difficult. Moreover, not all activities or skills that other adults from the community are used to, will necessarily be familiar to this population.
Some common examples include using phones and the internet, preparing meals and navigating public transport. A person may also require support with basic literacy. Service providers should be cognisant of any assumptions they make regarding a person’s level of knowledge, competence or literacy in independent functioning, in a sensitive and respectful way.
Lesson four: Trust is the key to progress
An empathic understanding of their circumstances is the key to getting the best out of any older person. Care provision for this group must be informed by the possibility of a complex history of trauma and repeated institutionalisation, hyper-awareness and internalisation of stigma attached to their ‘offender’ status, and the turbulent anxiety of having to adjust to a new life in older age.
Whilst their needs are many, asking for help is often not a strength
A sense of trust and safety, built through rapport and familiarity, will be the key to progress, as relationships with support or authority figures often have been complex and fraught with distrust.
Unfortunately, many older people can become disconnected socially from friends and family during their imprisonment, so service providers will become a vital source of support. Whilst their needs are many, asking for help is often not a strength. This means fostering help-seeking through relationships of trust and safety is the most effective way of ensuring their needs are visible and cared for.
More to do
This work is ongoing. We are still a way off in understanding and adequately servicing older people leaving prison. There are plenty of attitudinal, structural, knowledge and funding barriers that must be overcome before we can improve services and outcomes for these individuals.
Despite seeming like a challenging group, there is great benefit and responsibility for service providers to improve awareness and provide quality care for older people leaving prison. As with all older adults, strengths-based approaches that work towards ‘ageing well’ in a holistic sense, will work toward the benefit of this growing population as well as wider society.
For now, I hope that equipping service providers with some well-informed familiarity regarding this population will help them open their doors when the time comes, or at least for now, leave them unlocked.
If you’d like to know more or receive updates on my work please email at Jane.hwang@unsw.edu.au. The AAG background paper Issues facing older people leaving prison and the accompanying recommendations are available for download here.
My other recently published papers on the topic include:
- Multi-sector stakeholder consensus on tackling the complex health and social needs of the growing population of people leaving prison in older age
- Population ageing, incarceration and the growing digital divide: Understanding the effects of digital literacy inequity experienced by older people leaving prison.
Dr Jane (Ye In) Hwang is a postdoctoral research fellow in the Justice Health Research Program at the School of Population Health at UNSW Sydney
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