May 28, 2007

FISHKILL, N.Y. (AP) — Past a metal gate, near a board listing names and inmate numbers, white-haired men in robes watch "The Price is Right" in the day room. Out on the balcony, another patient looks through the bars as he fidgets from side to side.

Units catering to patients with dementia-related conditions like Alzheimer's disease are common. But they're not like the one here in Fishkill state prison.
In years past, men here were convicted crimes like of murder, robbery and rape. Now they are the first group of patients in Fishkill's "unit for cognitively impaired inmates," a therapeutic center created by New York prison officials faced with an aging inmate population.

"Some of them don't even remember their crimes," said Dr. Edward Sottile, medical director for the Hudson Valley prison. 

The unit — 30 beds on the third floor of the prison's medical center — is a first for New York and possibly the nation, through experts say it likely won't be the last as more people grow old behind bars.

The average age of New York's prisoners is climbing. Inmates 50 and over accounted 3 percent of the prison population two decades ago, compared to 11 percent last year.

Like society as a whole, inmates are getting older as health care improves and baby boomers hit retirement age. But researchers also note that inmates are staying behind bars longer thanks to "three strikes" and other tough-on-crime laws. Nationwide, the number of prisoners over age 50 in state and federal prisons is rising at about 8 percent a year, said sociologist Ronald Aday, author of "Aging Prisoners: Crisis in American Corrections."

"This group is going to mirror what's going on in our nursing homes. You have the terminally ill, you have people who have strokes in this population, you have people who have dementia," said Aday, of Middle Tennessee State University.
Fishkill is a 1,700-inmate, medium-security prison some 70 miles north of New York City that serves as a regional medical hub for the system. Inmates can get everything from throat cultures to long-term nursing care at the modern medical center built inside the prison's accordian-wired perimeter.

The unit opened in October on the center's third floor and is still getting up to speed. Twenty inmates from state prisons around the state — Attica, Midstate, Coxsackie, Orleans — are now patients.

But for the prison bars, the unit has the clean-white-wall feel of a nursing home. A marker board in the day room includes a picture of a sun with a smiley face and a reminder to "Have a great day." The activity calendar lists puppies on Thursday and bingo on Friday. As long as they behave, patients can wander from their rooms to the day room.

"They're still in prison," said Fishkill superintendent William Connolly. "This is just a unique environment within a prison environment."

The average age of patients here is 62, or 26 years above the systemwide average. All have been diagnosed with some level of dementia, which in the case of some patients is related to Alzheimer's or AIDS. One has Parkinson's disease and another has Huntington's disease. Some have additional psychiatric or medical disorders.

Connolly said the men's crimes are not considered in the screening process, though their prison record matters. The idea is to provide proper care and a safe environment. 

"A lot of guys, when they were confined to the general population, they stayed in their rooms, they wouldn't come out," said nursing director Angela Maume. "They were in a cocoon."

Prisons have been dealing with the special needs of older prisoners for years. Long-term care units or special buildings for geriatric care are common in U.S. prisons. Still, neither the American Correctional Association nor several experts in prison geriatrics were aware of any other special prison units for inmates with dementia. Prison health care consultant Dr. Robert Greifinger said the idea makes sense because staff can be trained to deal with the special cases.

All workers on the Fishkill unit — nurses, corrections officers, housekeepers — go through a 40-hour training course to learn how to work with the cognitively impaired.

The job can be especially tricky for corrections officers, who usually must fill out a report every time they touch an inmate. Here, contact comes with the territory. One officer said she had to help an inmate into bed recently. Officers are trained to know that, on this ward, an outburst by an inmate could be a symptom of a troubled mind instead of a hostile act.

"A lot of times it would be construed as bad behavior," Sottile said, "but they have no idea what they're doing."