End-of-Life Care Strategies Examined in Pennsylvania Prisons

January 20, 2010

Penn State researchers are working with employees from six Pennsylvania prisons and the Pennsylvania Department of Corrections to refine the delivery of end-of-life (EOL) care in a new study. The researchers are developing an intervention toolkit to improve EOL care that can be used by staff at any prison across the country. The project is funded by a $1.27-million grant from the National Institute of Nursing Research.

End-of-life care, which is an attempt to optimize the quality of life through dying and until death, includes both hospice and palliative care, with a focus on alleviating symptoms and suffering during advanced chronic illness.

Following the “participatory action research” model, prison workers, including health care professionals, chaplaincy, prison society volunteers, and corrections officers, will provide information on current limitations and strengths they see, existing perceptions of EOL care among prison stakeholders, and areas of EOL care that can be improved. Using those data, researchers will create a set of educational strategies that will be used internally by prison staff, which can be tailored to fit an individual prison’s needs.

Researchers selected prisons that represent the diversity of prisons in the country. They include varying levels of racial/ethnic concentrations and security (from minimum to maximum), and they house both male and female inmates. Additionally, the study includes a prison with an oncology unit, a prison that holds a primarily geriatric population, two prisons that house inmates facing death penalties, and a prison that has a mental health unit.

“The older population of inmates is increasing by leaps and bounds,” says Dr. Susan Loeb, assistant professor of nursing (principal investigator). “In addition, with three strikes laws, we are seeing more inmates  ‘aging in place’ [spending much of their lives aging in prison]. We’re also seeing more chronic illnesses that are outcomes of insufficient health care, substance abuse, and environmental stressors prior to incarceration. Studying the delivery of end-of-life care in prisons will provide great insights into not only the delivery of health care in a large, complex organization, but to end-of-life care in general.”

Studying the delivery of EOL care in the prison system is appropriate because, on average, incarcerated people face health issues associated with non-incarcerated people 10 to 15 years older.

“In the past few decades we’ve seen major advances in understanding EOL care, but the application of that knowledge has been fragmented,” says Dr. Janice Penrod, associate professor of nursing, also a principal investigator on the study. This study could rectify that disjoint between theory and application by finding new approaches that make a difference in the health care system.

Health care in prisons operates on a fixed budget, where care is paid for through internal funds  instead of insurance plans—a major contrast to the reimbursement system used by most health care users outside of prison in the United States. One goal of the study is to examine the feasibility of different EOL care measures on that fixed budget.

“The biggest challenge in terms of health care costs in prisons is that they are rising.  Since most prison health care is contracted to outside parties, costs to prisons have risen along with the rest of society,” says Dr. Christopher Hollenbeak, associate professor of surgery and health evaluation sciences, the third principal investigator on the study. “Prison medical costs are increasing at a rate of around 21 percent each year. This has put tremendous strain on prison health care budgets.  With fixed budgets this forces prisons to have to make hard choices about what sort of care to provide, and, perhaps more importantly, not to provide.”

 “Using the participatory action model in correctional settings is an important innovation that holds promise to promote humane EOL care for inmates with advanced chronic health conditions; greater satisfaction for prison staff caring for inmates at the end of life; and more cost-effective care for the institution, the broader system, and ultimately society,” says Loeb.

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Editors: Susan Loeb can be contacted at svl100@psu.edu. For additional information, please contact the College of Health and Human Development Office of College Relations at 814-865-3831 or healthhd@psu.edu.