The first time I visited a prison was memorable; I only conducted a single qualitative interview, but it has stayed with me for years. Despite my prior experience researching incarceration and health from afar, I was struck by so many details: the tense stillness in the waiting room, the colorful murals painted on cement walls, and the diversity of the faces that I passed while walking through the prison yard.
It’s easy to form stereotypes about incarceration in our country. Turn to any form of media and the “typical” inmate is likely depicted as young, male, and dark-skinned. Though certain groups are undeniably overrepresented in the criminal justice system, individuals who enter and exit prisons and jails do not fit neatly within a single demographic—and age is one form of diversity within this population. Individuals 50 years and older make up the fastest growing segment of state and federal prison populations—projected to reach 30 percent by 2030—yet are often excluded from research and policy. For me, this exclusion hit home during an interview with a case worker who supports elderly “reentrants” (those exiting prison or jail) in the San Francisco Bay Area. When asked to describe her clients, she did not hesitate: “These are the most invisible people.”
The story of reentry after incarceration is too often a story of limited visibility. Individuals with criminal justice involvement (as well as their families) face marginalization, stigmatization, and fragmented support, and this is especially true for those age 50 and older. We know that older individuals have particularly high health needs and costs, yet there is little evidence of the specific challenges they face during reentry or how to best support them.
My colleagues and I recently examined barriers to and strategies for connecting older reentrants to health coverage and health care upon their release. This connection is critical, as older reentrants have higher rates of infectious diseases, chronic conditions, disabilities, and cognitive impairments compared to both their non-incarcerated peers and their younger, incarcerated counterparts. Aging exacerbates these issues in both expected and unexpected ways. For example, a case worker described aging as a potential trigger for substance abuse relapse. Incarceration itself can compound age-related health concerns due to factors such as stress and inadequate health care.
Upon returning to the community, older reentrants face a variety of barriers to health coverage and care, including challenges with documentation of disability needed for Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI); lack of sufficient qualifying work history for Medicare Part A (which covers hospital costs) and SSDI; limited pathways to Medicaid eligibility for non-disabled individuals in states that have not expanded coverage under the Affordable Care Act; and challenges presented by unstable housing, lack of transportation, functional and cognitive impairment, low literacy and social capital, and distrust of institutions and government. Many of these challenges are not unique to older reentrants. However, according to experts we interviewed, age amplifies existing challenges and presents new ones, such as difficulty walking to the Social Security office.
Our work highlights the important role of targeted enrollment strategies to both address barriers to reentry and promote linkage to health coverage and care. Promising strategies include the following:
- Individualized assistance with the SSI/SSDI application process (for more information, see the case study)
- Use of community health workers and peer navigators of a similar age
- Communication and data sharing between correctional and public benefits systems
- Training of prison and jail staff to support public benefit applications
- Targeted approaches for key subpopulations of elderly reentrants such as veterans.
Although these approaches hold promise, there is significant need for more research on support for older reentrants. Without targeted evidence, it is extremely difficult for researchers and policymakers to make actionable programmatic and policy recommendations on connecting older reentrants to care. We see a particular need for estimation of potential eligibility among these reentrants for Medicaid, Medicare, and other relevant health coverage sources (e.g., TRICARE) and identification of qualitative and quantitative factors that influence their health outcomes.
Much has been written about ageism in our culture and the “invisibility” of older Americans. For those with a history of criminal justice involvement, the stigma and barriers associated with getting older can be even greater. Collectively, older reentrants are a complex, vulnerable, and often-overlooked group that challenges the stereotypical “young, male, minority” narrative of incarceration and reentry. As older individuals continue to grow as a percentage of the incarcerated population, and as public systems grapple with the associated challenges, needs, and costs, there is an opportunity for research and innovation that brings these invisible experiences to light and charts a course for meaningful and humane support.