Corrections_Today_July_August_2020_Vol.82_No.4

Office of Correctional Health

Correctional Health Perspectives

Management of chronic care in corrections

By Teresa I. Royer, MSN, RN and Harbans Deol, DO, Ph.D.

Over 2 million adults were estimated to be incarcerated in the United States in 2015, with an addi- tional 4.6 million people on parole or probation (Davis, Bello, & Rottnek, 2018). The U.S. pays more than $80 billion a year to fund health care in the correctional systems (Pew Chari- table Trusts, 2017). This was about 20% of the total amount spent for corrections in 2015. The Centers for Disease Control and Prevention (CDC) stated that nearly 75% of health care spending in the United States is for chronic medical conditions. It also lists that over two thirds of the deaths in this country are due to five chronic conditions: diabetes, heart disease, cancer, stroke, and chronic obstruc- tive pulmonary disease (CDC, 2019). The National Association of Chronic Disease Directors (2019) noted that if a patient has a chronic disease, the health care cost is about five times higher than someone without a chronic condition. As that person ages, he will have a good chance of developing another chronic condition. Geriatric patients tend to have more health problems than younger

persons. As a general rule, people in our society are considered to be elderly somewhere in their 60s. In the prison environment, inmates are considered elderly in their 50s. There are several factors that are thought to lead to this phenomenon, includ- ing leading unhealthy lifestyles and having inadequate healthcare (Skarupski, Gross, Schrack, Deal, & Eber, 2018). Skarupski, et al (2018) reported that 16% of the inmates in the U.S. are over 50 years old. They also noted that this percentage is expected to increase to 33% in the next 10 years.

People in the correctional settings tend to return to the same community and situations that they were living in before their incarceration, ie: family problems, unemployment, homeless- ness, and racial segregation. A study by Binswanger, Blatchford, Mueller, & Stern (2013) in the state of Wash- ington reported that during a nine-year period, 8.3% of the overdose deaths were of people who had been inmates. According to Davis, et al (2018) inmates transitioning back to the com- munity are 12 times more likely to die of any cause than those who have not been recently incarcerated.

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68 — July/August 2020 Corrections Today