The rapidly aging of the U.S. population presents significant challenges for healthcare systems, with prisons serving as a microcosm of these broader trends. Between 1999 and 2016, the number of incarcerated individuals aged 55 and older increased by 280%, compared to a mere 3% increase in younger adults. By 2030, seniors are expected to comprise one-third of the total prison population.
This demographic shift places considerable strain on correctional facilities, which often lack the infrastructure, staff, and resources needed to address the complex health needs of aging individuals. Older incarcerated individuals face heightened risks of chronic illnesses, dementia, and comorbid mental and physical health conditions. Despite the constitutional right to adequate healthcare, many prisons struggle to meet these demands in large part because of increasing costs. According to the U.S. Government Accountability Office, the Federal Bureau of Prisons allocated over $9 billion to healthcare expenses between 2009 and 2016, with the aging prison population identified as a significant driver of expenditures.
Existing models, such as hospice units and prison nursing homes, provide vital care but are limited in scope. For example, the California Medical Facility’s 17-bed program serves about 70 patients per year in a system with over 100,000 incarcerated people. This reflects a nationwide gap in capacity despite increased healthcare spending. Fewer than 80 of the 1,800 US prisons (4%) have prison hospice programs.
Peer caregiving offers a promising, cost-effective solution to this crisis. The Humane Prison Hospice Project (Humane) trains incarcerated individuals to provide hospice and palliative care to their peers, creating a compassionate, scalable model for addressing the needs of aging populations. This approach builds on existing community structures within prisons, fostering trust and reducing the burden on overextended medical staff. Peer caregivers complete a rigorous 15-module training curriculum and work as part of multidisciplinary teams to advocate for and support care recipients.
Humane is an awardee of the Hillman Emergent Innovation: Serious Illness and End of Life (HSEI) program, a philanthropic initiative jointly supported by AVDF and the Rita and Alex Hillman Foundation. The HSEI program awards grants to support innovative, nurse-led solutions in the early stages of development, designed to enhance the lives of marginalized populations facing serious illness. In 2023, Humane received a $100,000 grant through the program for their peer caregiving initiative.
By integrating peer caregiving programs, prisons can cultivate environments of empathy and respect, benefiting caregivers, care recipients, and institutional culture.
“Even small acts of compassion build up over time and can help build more of a culture of empathy and respect,” said Laura Musselman, Director of Communications at Humane, in a Forbes article. “The hope is that [this program] has the potential to influence attitudes and behaviors and health outcomes institution wide.”
The Humane model has successfully trained 118 peer caregivers across five California prisons and continues to expand its reach. For example, the California Department of Corrections and Rehabilitation (CDCR) is working to expand hospice and palliative care support, including launching the first prison hospice program for incarcerated women in California. CDCR invited Humane to collaborate on the creation of a new curriculum to expand the use of peer workers in other California prisons.
Establishing such programs requires collaboration with local organizations, community members, and prison administrators. Humane recommends starting by researching existing resources, engaging with prison communities through volunteer work, and partnering with hospice organizations to design tailored programs.
The growing healthcare crisis for older adults in prisons demands innovative, human-centered solutions. Peer caregiving not only addresses gaps in care for incarcerated individuals but also provides a model for improving end-of-life or serious illness care in broader community settings. By investing in these programs, healthcare professionals, policymakers, and foundations can help ensure that aging individuals—both within and beyond prison walls—receive the compassionate care they deserve.
To learn more, click here for an article about caregiving in prisons published in Forbes or visit humaneprisonhospiceproject.org.
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