Delaware Prison Health Care: A Costly Proposition

Joseph Bostic is blind, wheelchair-bound, and mumbles like a man 25 years older than his 56 years. The former truck driver’s mind seems sharp enough as he recounts 27 years of deterioration in prison: diabetic comas, kidneys lost, bleeding ulcers, heart surgery. But he’s fuzzy at best about less concrete subjects, like whether “20 years mandatory” means he can be paroled someday or die in prison.

In the outside world, professional long-term care for men like Bostic with chronic conditions and cognitive changes happens in nursing homes, which deliver more specialized care than hospitals and cost far less. However, none of Delaware’s four prisons have assisted living units, so Bostic has been in the infirmary at James T. Vaughn Correctional Center in Smyrna for nine years.

That approach may have made some sense for a small state like Delaware when the geriatric prison population numbered a few hundred. After all, for efficiency and cost, the state already combines its prisons and municipal jails.

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But in keeping with a national trend, Delaware’s over-50 prison population has nearly quadrupled from 254 in 1999 to 945 in 2012, while the state’s overall population has dropped almost 20 percent in eight years (6,627 in 2003 to 5,452 in 2011). If the trend continues, the elderly could make up more than a third of Delaware’s prison population by 2020. Experts predict it will—the consequence of “tough on crime” policies of the 1980s playing out in longer sentences and less parole, compounded by an aging generation of baby boomers. 

If so, it’s going to be costly for Delawareans: As the proportion of elderly inmates rises, the cost of prison health care rises more steeply.

The Delaware Department of Correction doesn’t track medical expenses by age, but “Aging Behind Walls,” a 2003 Delaware Criminal Justice Council report, estimates the price tag is three to five times higher for older inmates than it is for the general prison population. Medical costs are already among the largest items in the $259 million DOC budget. For 2012, $46.5 million was ticketed for medical costs, more than double that of a decade ago ($16.5 million). And because inmates are not eligible for Medicare or Medicaid (except when hospitalized outside prison), Delaware taxpayers shoulder the bill.