The GRACE Project, coordinated by The Volunteers of America, is designed to achieve community hospice standards in end-of-life care for prisoners and to develop national guidelines for the care of prisoners at the ends of their lives. The project includes the comparative study of community and prison hospice, development of prison hospice guidelines, and the implementation of improved care strategies. Facilities in three states–New York, North Carolina and Oregon–will serve as demonstration sites. Collaborating organizations are the George Washington University Center to Improve Care of the Dying, The American Correctional Association, the National Prison Hospice Assoc-iation, the North American Association of Wardens and Superintendents, the Fordham University Third Age Center, the American Correctional Chaplains Association, and the American Correctional Health Services Association. The Robert Wood Johnson Foundation has funded the planning phase of the GRACE project through its Promoting Excellence in End-of-Life Care grant program.
Representatives from 15 state departments of corrections and the Federal Bureau of Prisons, as well as members of the GRACE advisory group, participated in the GRACE meeting. Each of the agencies represented is at some stage of developing prison hospice or palliative care programs.
Participants reviewed the National Hospice Organization’s standards of practice for hospices and discussed how they would need to be modified for prisons and jails. As elsewhere, prison hospices need to address spirituality, advance care planning, family services, and pain and symptom management. Of particular concern in a prison environment, however, are the physical plant, the correctional organization and structure, development and needs assessment, resources, training, costs, women’s programs, security, interdisciplinary teams, and inmate volunteers. The information collected at this meeting will serve as the basis for writing guidelines to be included in a handbook on end-of-life care in prisons and for planning demonstration projects.
The "Elderly Inmates" conference brought together corrections officials, legislators, criminal justice experts, geriatric health care professionals, and end-of-life care experts to explore the challenges presented by elderly inmates. Presenters addressed topics such as the number, type, and cost of elderly inmates; medical needs of the elderly; effects of incarceration on elderly inmates; programs for elderly inmates; hospice and palliative care programs; compassionate release or medical furlough programs, the transition of elderly inmates to the community; the effect of mandatory sentencing on prison populations; and future directions.
As the number of inmates with chronic and eventually fatal disease increases, corrections administrators must simultaneously address problems in managing the health needs of an aging population while side-stepping increased medical costs. In this regard, perhaps, prisons may not be that different from the rest of America.
For more information contact Felicia Cohn at ihofgc@gwumc.edu. See Exchange, April 1999, for a report on the hospice program at Louisiana’s state prison, Angola.
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