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Dementia and Prison

Image courtesy franky242 @ http://freedigitalphotos.netThe other day, I ran across an old re-run of the TV show, “Law and Order,” in which a man was being tried for the brutal  murder of his wife.  One of the major underlying themes of the story was that the man had advanced dementia, and his daughter (and others) attempted to beg for leniency in his sentencing on those grounds.  One of the show’s lawyers reported on her visit to the prison ward where persons with dementia were housed, and the substandard conditions they were subjected to.

I was reminded of this yesterday, when I was cruising around the web and found a very thought-provoking story in the New York Times entitled, “Life, With Dementia.”  It’s amazing how one little comma can place a whole different context on things.  And this story focused not just on the lives of persons who have dementia, but specifically on those who are in our prison system, serving life sentences, who also have dementia.  When one considers the growing number of criminals who have been sentenced to life behind bars, and who subsequently develop dementia, the question arises,  “What do we do with these people?”

Consider, first of all, the statistics showing that the numbers of people in the general population with dementia are growing by leaps and bounds.  Plug into this the fact that the prison population is aging significantly, and is apt to develop the same age-related health concerns as the rest of us.  Actually, it can be said that these imprisoned persons are more vulnerable to such conditions than others, due to factors such as head injuries incurred in fights, health concerns related to drug use and other poor lifestyle choices, and finally the effects of health problems long ignored or poorly-treated.  Of the approximately 1.6 million inmates of our Federal prisons, 10 percent are serving life sentences, with another 11 percent sentenced to over 20 years.  More older persons are being sent to prison, too, with more than twice as many persons over the age of 55 sentenced in 2010 than in 1995.

Different states are taking varying approaches to dealing with this problem of aging prisoners.  California and Louisiana have selected inmates serve as caregivers for others who have dementia.  They help their charges with the most basic of functions at times — bathing, dressing, and even toileting.  New York, on the other hand, has taken the approach of establishing special units for these prisoners.  Professional caregivers are utilized at the cost of about $93,000 per year each.  (As compared to the approximately $41,000 required to care for prisoners in the general population.)  Some other states, including Pennsylvania, are offering mental health workers special training.

At the California Mens Colony, men who care for their fellow inmates are called Gold Coats, because of the color of the jackets they wear to differentiate them from other prisoners.  They are given special training provided by the Alzheimer’s Association, and receive a small monetary reward for their efforts.  They participate in weekly support meetings with a psychologist, where they share observations they have made about their charges and discuss strategies that might prove helpful.

Gold Coats often also act as buffers between their charges and other prisoners and prison staff.  For instance, when a prisoner with dementia began showing problem behaviors during a random search of his person, his caregiver was able to explain that he needed additional time to process commands.  Gold Coats can also sometimes serve to protect their charges from other prisoners who might want to take advantage of them.  It is reasoned that the impaired prisoners will have a greater trust of other prisoners than they might a stranger or someone who could be seen as an authority figure.

There are currently 6 Gold Coats for approximately 40 inmates with dementia.  Before the program started, in 2009, inmates with dementia frequently started, or were the cause of, fights.  And, the Gold Coats themselves are at times the victims of personal attacks.  They get a certain amount of harrassment from the general population — seen as snitches because of the special privileges they receive, and their relationship with prison staffers.

California’s prison system currently holds 55,000 inmates who are 55 years or older.  It was recognized, early on, that identifying which of these inmates had dementia would be difficult.  The fact that routine is such a vital part of prison life is a boon to those with dementia, and yet also a complicating factor.  Too, prison staff lack the training or the time to differentiate problem behaviors due to illness, or just plain bad behavior.  Psychologist Bettina Hodel approached Sara Bartlett, the director of the local Alzheimer’s Association chapter, who initially expressed some skepticism that such a program would be successful.

However, program director Arlene Stepputat found that inmates were easier to work with than she had expected.  They lacked the emotional ties that family caregivers would bring to the scenario, and they were actually flattered that they were thought capable of such interaction.  More than one Gold Coat has reported that participation in the program allows him to feel a sense of humanity again.  Those chosen for the program must have maintained a clean record for several years, and only one of them has had to be removed due to problems.

The Gold Coats not only provide personal care for their charges.  They also run exercise classes and meetings to stimulate memory and orientation.  They escort inmates to doctors, and to various places around the prison.  There are some limits to what they are able to do, and they tend to learn a sense of empathy that comes from assisting their charges with basic functions such as cleaning up bodily fluids.

Two of the Gold Coats have been able to earn parole, at least partly due to their efforts.  Family members have also been approached about granting parole to prisoners with dementia, however many have replied that they could not provide better care than what they receive behind bars.


  1. June 16, 2014 at 11:05 AM

    I had not heard about this Gold Coats program, thanks for sharing. It sounds like it has been a successful program, hopefully it will expand. Not only is it cost-effective but prisoners learn new skills that will be in high demand if they do get released from prison. They also learn compassion, which I’m guessing is not something one experiences much in prison life.

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