Swelling incarcerated aging populations with unmet end-of-life care needs are straining prison systems worldwide. Recent research has uncovered some of the common strategies to address the issue that are being employed across the globe.
More countries have adopted peer caregiving as a way to provide improved support for terminally ill incarcerated individuals, according to researcher Barry Ashpole. Ashpole has been an educator and communication consultant in hospice and palliative care since the 1980s. He previously served as a board member for the International Association of Hospice & Palliative Care (IAHPC), compiling its monthly Literature Search journal.
Hospice communities have increasingly forged collaborations to provide caregiving training programs in prison systems throughout the United States, United Kingdom, New Zealand and Germany, among others, according to a recent report dubbed as End-of-Life Care in the Prison Environment. The report examined global trends around end-of-life care delivery among incarcerated populations.
“One of the main, universal issues prisons are having to deal with is overcrowding, and a huge problem has been the aging population. This isn’t exclusive to one country or another,” Ashpole told Hospice News. “It presents real challenges for underresourced health care services and prison staff who are not trained to address end-of-life care needs. A concept that’s taken root with demonstrated effectiveness is inmates being trained as hospice volunteers, which plays into overall quality of life for the ill and opportunities for self-improvement.”
Through the caregiving programs, hospice volunteers are trained to address some of the physical, emotional and spiritual needs of incarcerated individuals with a terminal diagnosis. The peer support caregiving has provided incarcerated individuals with a chance to have a meaningful purpose, with some programs geared toward rehabilitation opportunities, according to the report.
These programs allow an opportunity to assess whether individuals could qualify for compassionate release and receive community-based care outside of a prison setting. But the terms for compassionate release vastly vary from country to country, which can compound overcrowding issues, said Ashpole.
Korea, Africa and the United States are some of the countries with the most pressing prison capacity issues, the End-of-Life Care report found. Among the common challenges in prison systems across the globe is having insufficient operational infrastructure to address the needs of dying inmates, as well as the ethical and humane treatment considerations of a prison environment for a terminally ill individual, according to the research.
Gender differences also exist, with incarcerated women often receiving less end-of-life support compared to men, the report found.
Aging incarcerated populations are in “urgent” need for integrated reforms that promote dignified deaths, according to recent IAHPC research. The research identified several ethnic, racial and sexist discrimination practices taking place in prison systems in countries such as Portugal, Canada and Africa.
Socioeconomic discrepancies also contributed to inequitable access to end-of-life support in incarcerated settings in several countries, the IAHPC research found.
The concept of hospice in prison systems worldwide is a “mixed bag” of end-of-life care delivery, Ashpole indicated. Large gaps of unmet spiritual, emotional and bereavement needs exist, an issue that hospice providers can help to address with further development of volunteer training programs, he stated.
Hospice providers need a firm understanding of the common challenges that prison systems are facing and learn the key strategies that are moving the needle toward more equitable, humane treatment, according to Ashpole.
“There is not a lot of sympathy for the incarcerated chronically ill, but they have families and loved ones, and are a vulnerable population,” Ashpole said. “Community hospices have the skills that prisons could really benefit from in helping to sensitize prison staff and helping to train volunteers in grief counseling and caregiving. There are huge gaps of psychosocial and spiritual needs uncovered in global literature, with mental health a universal issue in prison systems. It’s being cognizant of the challenges and taking mixed responsibility with the health care teams to see what bridges could be built.”