Steve Mellon, Post-Gazette Lori Will, a certified nurse assistant, feeds an inmate during lunch at SCI-Laurel Highlands near Somerset. This scene is growing more common as the 1.3 million people behind bars in America grows grayer each year. Click photo for larger image. Related story Proposal would let aged, ill out of jail

SOMERSET -- The State Correctional Institution Laurel Highlands has many of the usual "charms" of a penitentiary: coiled razor wire, steel security doors, guards and metal detectors.

But the inside of this complex in the rolling hills outside of town looks more like a nursing home than a prison.

Elderly men move about the clean hallways in wheelchairs.

In the medical unit, inmates lie hooked up to some of the 15 dialysis machines.

In his dorm-style room in A Unit, Cube 5, a man named Dale is lying in bed, watching Clint Eastwood in "Honkytonk Man," when he sits up to greet a visitor.

Prison policy prohibits him from being identified in the media. He's a sex offender, 62 years old, who came here two years ago from another prison after suffering a stroke that paralyzed his arm.

He spends his days watching TV, playing cards, getting his physical therapy.

So how's life here?

"I like it," he said with a shrug. "In a regular prison, if you get sick, they aren't equipped to handle it."

Dale uses a wheelchair, but he's a lot better off than the guy in the room across the hall -- a Fayette County murderer lying in bed with his mouth hanging open. John Wiser, the corrections officer in charge, nodded in his direction and said quietly, "He's just waiting to die."

Death isn't unusual here. SCI Laurel Highlands is a geriatric prison, one of the first in America when it was converted from a state mental hospital in 1996.

While most of the 900 prisoners are classified as general-population, about 250 are old or sick and housed according to need: geriatric, wheelchair users and long-term care. The waiting list to get in stands at 133, and a new $6 million medical wing is on the way.

"We hope to break ground in the spring," said Superintendent Fredric Rosemeyer, whose staff includes nurses, a health care coordinator and a full-time dentist. "The inmates like being here. The [British Broadcasting Corp.] called it a 'prison with compassion,' and that's pretty accurate."

'Population bulge'

Prisons like this one have become common as the 1.3 million people behind bars in America grow grayer each year.

In 1990, there were 33,499 prisoners in state and federal lockups who were 50 or older; by 2002, that number was about 125,000, according to "Aging Prisoners: Crisis in American Corrections," a 2003 book by Tennessee college professor Ronald Aday.

In Pennsylvania, the number of inmates 55 and older increased from 1,892 in September 2001 to 2,520 by last December.

Part of the jump is the natural result of the aging baby boom generation, those born between 1946 and 1964.

"That population bulge is a factor," said Alfred Blumstein, a nationally known criminology professor at Carnegie Mellon University. "It's just that there's more of them."

The other major cause, experts say, is the criminal justice system.

Starting in the 1980s, many states reacted to spikes in crime by abolishing parole and passing three-strikes laws. In the federal system, Congress imposed mandatory sentencing guidelines that sent inmates away for decades for such crimes as drug trafficking.

The pendulum may be swinging back the other way now. A recent Supreme Court decision, for example, has made the federal guidelines voluntary, giving judges more discretion in sentencing.

But in the meantime, inmates 50 and older are the fastest-growing segment of the U.S. prison population.

"The number of older offenders participating in the criminal justice system will continue to accelerate," Aday wrote, "as the baby boomer population marches toward old age."

Let them out?

As this trend builds momentum, so does the debate both inside the world of corrections and among lawmakers and academics about whether the country should continue to keep so many of its old prisoners locked up.

The cost of taking care of them is high and climbing.

At SCI Laurel Highlands, considered a model facility, the cost for one of the 111 inmates who need 24-hour nursing care is about $62,000 a year, nearly three times the cost for a regular prisoner.

All of which raises the question: Is it time to let at least some of these inmates go?

Many experts say yes.

"My take on it is that we have to have some balance," said Aday, who teaches at Middle Tennessee State University. "We need to use some common sense. How much punishment is enough?"

Pennsylvania has long recognized this problem.

In 2002, state lawmakers asked the Joint State Government Commission, a research agency for the General Assembly, to establish a task force to study the issue and come up with solutions.

"It was clear that we had a growing geriatric population in our prisons at a growing expense," said state Sen. Stewart Greenleaf, R-Montgomery County, chairman of the task force. "Some of these people are no longer a threat to society and maybe we could reduce these costs and find alternative settings for them."

A 47-person advisory committee hopes to have its final report ready by June.

But a draft recommends that the state set up a system to release some old prisoners through the courts or the parole system. Studies have shown that recidivism drops significantly with age, and many geriatric inmates at SCI Laurel Highlands can barely get out of bed, let alone harm anyone.

"Releasing such eligible inmates to private facilities or to the care of their families through a court-sanctioned medical release procedure would reflect both humanitarian and economic concerns," the report says.

There are three main proposals: allow judges the option of granting medical release, create mental health courts to place mentally ill inmates in outside institutions, and reinstate the possibility of parole for murderers serving life terms.

The committee is generally agreed on the first two, although the last has been a point of contention, said Karen Haley, assistant general counsel for the Joint State Government Commission.

"There has been some very strong opposition to that," she said, particularly from the state Office of the Victim Advocate and the angry families of murder victims who sent letters to the committee.

"I know that it is expensive to keep an inmate in prison for the rest of his or her natural life," wrote one family member. "However, has the advisory committee considered what the homicide has cost my family? Do you really think that we would feel compassion for the inmate who killed our son if he became terminally ill? He came very close to destroying our entire family!"

The costs of care

In practical terms, the biggest problem with housing older inmates is that they need a lot of medical care.

Prisoners at SCI Laurel Highlands, for instance, are considered geriatric at 55 because the average inmate that age has the health problems of someone 65 on the outside. Most are poor and didn't have access to health care when they were out. Many abused themselves with drugs and generally lived hard lives on the street.

"I've got some guys who are on 15, 16 different medications," said Rosemeyer, a member of the advisory committee. "A lot of these guys are going to be here until they die."

About 150 inmates at the prison have died since it opened.

Yet releasing prisoners in their final years is a much more complicated issue than it may seem.

For example, who will pay for their care on the outside and how much will it cost?

"Inmates who are released to family obviously are a cost savings," Haley said. "But for those released to public nursing homes, we don't know yet."

About three-quarters of geriatric inmates don't have families who can take them in or resources to pay for their own care. Most would end up in nursing or personal care homes with Medicaid footing the bill.

So while releasing geriatrics will free up prison space for more dangerous offenders and consequently relieve pressure on states to build more prisons, the cost would still be borne by taxpayers. The burden would merely shift from the state to the federal government.

The committee is still trying to collect figures on cost comparisons. But Haley said preliminary estimates indicated that releasing prisoners to other institutions would save only a few hundred dollars per inmate.

She couldn't provide any numbers, but the average Medicaid-eligible nursing home patient in America costs about $50,000 a year. The cost of caring for some geriatric inmates in prison is much higher than that, but for others, it is lower.

Further complicating the economic picture is the fact that SCI Laurel Highlands is becoming more efficient.

Costs have actually dropped over the years because of an economy of scale created by the influx of inmates of all ages being handled by the same-size staff. In 1996, when the prison had 155 inmates, the cost per day per inmate was about $300. Last year there were 882 inmates and the cost per day was down to $104.

In addition, the prison used to farm out dialysis patients to outside hospitals at a cost of $1,800 a week. But with its own dialysis unit, that cost has been slashed to $300.

'We don't get justice?'

Beyond the economics, early release is muddied by politics. No one ever won an election by letting killers and rapists go free.

"I do have the sense that everyone wants to avoid being the guy who makes the call," said Blumstein, who is on the advisory committee. "No one wants to take the rap for releasing these people."

There is also the question of a criminal's debt to society. Some experts, and certainly victims' families, aren't convinced that age or infirmity should be a get-out-of-jail pass.

"Say I do a horrendous crime, maybe rape someone's daughter, and I'm incarcerated, and five years later I develop some terminal illness," said Louis Garzarelli, a former U.S. Bureau of Prisons intelligence officer who teaches criminology at Mount Aloysius College. "Should I be let out? Just because a guy's old, we don't get justice?"

Finding a place to put former inmates is yet another complication.

The task force study says there is a shortage of community care options. Public nursing homes and skilled-care centers, it says, aren't as available as they once were because of the shift in recent years toward "community care" for sick or old patients.

A handful of inmates, for example, have been sent from SCI Laurel Highlands to South Mountain Restoration Center in South Mountain, Franklin County, a skilled-care facility run by the Department of Public Welfare.

But the committee report says there isn't enough staff there to accommodate more inmates, and that the cost is high.

Private nursing homes probably aren't an option, either. The committee report says private homes often can't admit ex-cons because of "resistance" from families of residents who aren't criminals.

Garzarelli said he understood that attitude.

"My father was in a home for three years, God rest his soul," he said. "Now [consider], here come five or six convicted felons into my father's home. If I knew that was happening to my father, I would move him out."

What's more, he says, finding out about inmates in nursing homes would be difficult because of confidentiality laws. Who would know, then, if Mom or Dad is living next to a rapist, child molester or triple-murderer in the old folks' home?

"All these liberal people [advocating release] who might have relatives in a home have to realize that once these inmates are in there, their records are confidential," Garzarelli said. "They don't have a right to know. They give that right up."

But others discount such concerns. Blumstein, who has studied recidivism rates, said he would have no problem with old felons moving in next to a loved one or next to him.

"We can never be sure they won't commit another crime," he said. "But I would take that risk."

'A good experience'

While this debate goes on, life for older men behind bars has never been better.

"Very often in a general prison population, the geriatric inmate becomes a victim," said Rosemeyer, who worked his way up through the ranks at several state prisons and, most recently, oversaw the Allegheny County Jail after the departure of former Warden Calvin Lightfoot. "He lives with his peers here. It's a safer environment for him. It's a morale issue."

Adding to the high morale is the fact that medical care in prisons is generally good, often better than on the outside, because federal courts have forced states to provide it on constitutional grounds.

The U.S. Bureau of Prisons, in particular, is known for exceptional care, including such high-cost procedures as open-heart surgery.

"There are some [federal] facilities that would make your head spin," Garzarelli said. "These inmates aren't taking the bus to go to the hospital. They're not waiting in line at a clinic. They have unequivocal coverage every day."

In some cases, the care is so good that Blumstein joked, "I will confess that my plan for my dotage is to commit a felony."

The high standard of care, he said, is one of the factors driving up the costs and another reason to let some inmates go. "Why should these people be treated better than people on the outside?"

In some instances, older inmates don't even want to leave the lockup. They have no one on the outside, no ability to cope with the world after so many years behind bars, and all their medical needs are covered under one roof.

"I had a guy not too long ago who said, 'I don't want parole,' " Rosemeyer said. " 'I want to max out. Where am I going to go?' "

Charles, of Philadelphia, who describes himself as a "chronic burglar" who was more a "nuisance" than a thief, certainly wants out. But he said he'd rather be at SCI Laurel Highlands than any other prison.

He looks fairly strong at 66, but he has trouble walking long distances and suffers from hypertension and hepatitis C. He came to Laurel Highlands two years ago from SCI Graterford, a much tougher environment; he knows he's pretty well off in Somerset.

He's served six years on his nine- to 20-year term and hopes never to return to Graterford or any other facility.

"There's no way I would put myself in that position," he said. "It's still prison [here]. It has its ups and downs, but this has been a really good experience. You couldn't ask for anything else."

Well, you could.

Such as?

He said with a laugh, "A furlough every now and then."

	Steve Mellon, Post-Gazette An inmate at SCI Laurel Highlands near Somerset heads back to his pod after lunch. The prison is set up to house geriatric and sick prisoners. Click photo for larger image.