key: cord-294423-3458rek8 authors: Boucher, Nathan A.; Van Houtven, Courtney H.; Dawson, Walter D. title: Older Adults Post-Incarceration: Restructuring Long-Term Services and Supports in the Time of COVID-19 date: 2020-09-29 journal: J Am Med Dir Assoc DOI: 10.1016/j.jamda.2020.09.030 sha: doc_id: 294423 cord_uid: 3458rek8 Objectives To describe long-term care services and supports (LTSS) in the US, note their limitations in serving older adults post-incarceration, and offer potential solutions – with special consideration for the COVID-19 pandemic. Design Narrative review Setting and Participants: Long-term care services and supports for older adults post-incarceration Methods Literature review and policy analysis Results Skilled nursing facilities, nursing homes, assisted living, adult foster homes, and informal care from family and friends compose LTSS for older adults, but their utilization suffers from access and payment complexities, especially for older adults post-incarceration. A combination of public-private partnerships, utilization of health professional trainees, and unique approaches to informal caregiver support, including direct compensation to caregivers, could help older adults reentering our communities following prison. Conclusions and Implications Long-standing gaps in US LTSS are revealed by the coronavirus (SARS-CoV-2) pandemic. Older adults entering our communities from prison are particularly vulnerable and need unique solutions to aging care as they face stigma and access challenges not typically encountered by the general population. Our review and discussion offer guidance to systems, practitioners, and policy makers on how to improve the care of older adults post-incarceration. The United States (US) imprisons a larger proportion of its population than any other 27 country with 1,291,000 prisoners in state prisons, 631,000 in local jails, and 226,000 in federal Prison accelerates aging such that the prison population develops chronic illness 10-15 40 years earlier than community counterparts; incarcerated persons can be considered an 'older 41 adult' by 55. 5, 6 Contributing factors -largely predating sentencing in these disenfranchised 42 populations -are substance use, inadequate preventive care, mental illness, and the additional 43 stress of being incarcerated. 7 More than 600,000 individuals are released from state and federal 44 prisons each year and over 60,000 of them will be age 50 or above. These released older adults 45 leave prison in worse health than when they arrived and in worse health than community-46 J o u r n a l P r e -p r o o f dwelling persons of the same age. Despite the growing number of older incarcerated individuals 47 and their potential impact on the health of society, little has been done to research optimal 48 approaches to care once they are released. Firm data on the full extent of health status disparity is scarce, but one Texas study found 50 that incarcerated persons 55 years of age and older used an average of 7.3 prescription 51 medications, which is higher than for non-incarcerated Americans of the same age. 8 Inmates 52 often have their necessary medications stopped once out of the care of the prison system 53 including 25% of chronically ill state prisoners and over 36% of ill local jail inmates. 9 Regarding 54 neurocognitive disease (such as dementia), the Alzheimer's Association indicates dementia 55 prevalence in the general population will be increasing from 1.7% in 2009 to 1.9% in 2030 and 56 then 2.6% in 2050. 10 Based on this, inmates with dementia may increase to approximately 57 127,130 in 2050. 11 Furthermore, according to a recent systematic review, re-entry planning for 58 older incarcerated persons is "sparse and the outlook is grim, given that many are released to 59 urban communities characterized by health disparities and inadequate health care resources." 12 60 And yet, there is strong evidence that optimal utilization of health-related services is linked to 61 improved health outcomes, lower recidivism (re-incarceration), and improvements in housing, 62 employability, and support provided through families. 13,14 Recently released older adults, given high rates of health problems and chronic 64 conditions, may simultaneously face both a great need for access to routine and acute health care, 65 as well as an accelerated need for long-term services and supports (LTSS) for their age. 13 A lack 66 of insurance and potential discrimination may compound their difficulty in obtaining continuity 67 of care and medication upon release. 15 The challenges they face are further exacerbated by the 68 introduction of SARS-CoV-2 (or COVID-19) into prisons and the community alike -with 69 J o u r n a l P r e -p r o o f confined space and limited healthcare in the former, and little community support, stigma, and 70 high-risk due to age in the latter. We explore these emergent challenges and offer Early release is another approach to mitigate COVID-19 transmission but is controversial 99 due to real and perceived risks to communities such as recidivism or a perception of punishments the Affordable Care Act, 33 but again, processing these applications prior to release is critical for 127 older adults between age 55-65 years of age to allow a seamless transition to the community. With the enhanced access that insurance coverage assures, the released persons should then be newly released individual will obtain LTSS. While these individuals may also be Medicare 147 eligible due to age or disability status (so-called dual eligibles), Medicare coverage of LTSS is 148 limited to just 100 days of post-acute care (e.g., following a minimum three-day hospital stay). As such, Medicaid is the default option for ongoing LTSS. In many states, due to their Medicaid Better support of caregivers -who report financial, emotional and physical strain related 217 to their caregiving role 58,59 --can lead to improved home care for older adults, an increasing 218 concern for our aging population. Better care at home for older adults can avoid unnecessary or There is an interrelation of correctional-system health, public health, and long-term care 286 services and supports for older adults. 76 Yet, there is a major knowledge gap about older adults 287 who are decarcerated due to a lack of data --including on rates of informal care and LTSS 288 utilization after release. We must first fill this knowledge gap to serve this population better. Between these LTSS components, and along the continuum from prison to community, there are Mass Incarceration: The Whole Pie Medical problems of state and federal prisoners and jail 297 inmates Aging Prison Populations Drive Up Costs Kaiser Family Foundation Since you asked: How many people aged 55 or older are in 306 prison Incarceration nation Medication prescribing practices for older 311 prisoners in the Texas prison system The Health and Health Care of US Prisoners: Results of 313 a Nationwide Survey Alzheimer's Association. ALZHEIMER'S DISEASE FACTS AND FIGURES The Looming Challenge of Dementia in Corrections. Correct Care The Health of America's Aging 320 Prison Population Health and prisoner reentry: How physical, mental, and substance 322 abuse conditions shape the process of reintegration Health coverage and care for the adult criminal justice-involved 325 population. Menlo Park: The Henry J Kaiser Family Foundation. 2014. 326 15. US Department of Health and Human Services Incarceration & social inequality Disparities in the Population at Risk of Severe Illness From COVID-19 by 331 Deliberate Indifference: Inadequate Health Care in U.S. Prisons. Ann Intern 333 Med Are Our Prisons and Jails Ready for COVID-19? The guidelines on infection control in prisons need revising Federal inmates to be confined to cells for two weeks amid coronavirus outbreak Infection Control in Jails and Prisons Flattening the Curve for Incarcerated Populations -Covid-344 19 in Jails and Prisons Flattening the curve for incarcerated populations-Covid-19 349 in jails and prisons Large scale releases and public safety Virus-wracked federal prisons again expand release criteria US Congress. COVID-19 Correctional Facility Emergency Response Act Bureau of Prisons. COMPASSIONATE RELEASE CRITERIA FOR ELDERLY INMATES WITH MEDICAL 359 CONDITIONS The Marshall Project. Too old to commit Understanding Violent-Crime Recidivism Using Jail to Enroll Low-Income Men in Medicaid Engaging individuals recently 371 released from prison into primary care: a randomized trial A systematic review of randomized controlled trials 374 of interventions to improve the health of persons during imprisonment and in the year after 375 release Medicaid Expenditures for Long-Term Services and Supports (LTSS) in 379 FY 2015. Truven Health Analytics Inc;2017. 380 38. Medicaid.gov. Home & Community Based Services Final Regulation The Place of Assisted Living in Long-Term Care and Related Service 384 Systems. The Gerontologist Department of Health and Human Services Community-Based Care Resident and Community 388 Assistant Secretary for Planning and Evaluation, 392 Department of Health and Human Services Disparities in Assisted Living: Does It Meet the HCBS Test Annual Costs of Care Survey Nowhere to go: Homelessness among formerly incarcerated people. Prison Policy 403 Initiative Securing private housing with a criminal record Aging with Serious Mental Illness: One State's Response Where Does Adult Foster Care Fit In The Long-Term Care Continuum Medical foster homes: Can the adult foster care model substitute for 412 nursing home care Telehealth grew wildly popular amid Covid-19. Now visits are plunging, forcing providers 414 to recalibrate Older adults' acceptance of a 417 community-based telehealth wellness system. Informatics for Health and Social Care Factors Associated With Receipt of Training Among 421 Caregivers of Older Adults Informal and Formal Home Care Both Increased 423 Between Life Interrupted: Caregiving of Justice-Involved Older Adults Center for Health Care Strategies. Restoring Health and Humanity to the Recently Incarcerated Objective burden, resources, and other stressors among 434 informal cancer caregivers: a hidden quality issue? Better access, quality, and 436 cost for clinically complex veterans with home-based primary care States Leverage Medicaid to Provide Nursing Homes a Lifeline through COVID-19 North Carolina Department of Health and Human Services Medicaid Temporarily Increasing Flexibility and Reimbursement Rates for Primary and Specialty 443 America's health care safety net: intact but endangered The necessity of 448 social medicine in medical education The UCSD student-run free clinic project: Transdisciplinary health professional 450 education Predictors of caregiver and family functioning following 452 traumatic brain injury: Social support moderates caregiver distress Factors Associated With Receipt of Training Among Caregivers of 455 Older Adults Using care navigation to address caregiver burden in 457 dementia: A qualitative case study analysis Family caregiver use and value of support services 461 in the VA Program of comprehensive assistance for family caregivers Medicaid and CHIP Payment and Access Commission Federal Medical Assistance Percentages and Enhanced Federal Medical Assistance Percentages 475 by State, FYs COVID-19 and the correctional environment: 479 the American prison as a focal point for public health