inmates’ medical needs. As a result, aging inmates experience delays in
receiving medical care. In addition, the needs of aging inmates differ from
their younger counterparts, including the need for increased assistance with
activities of daily living. According to BOP staff, however, staff is not
responsible for ensuring inmates can accomplish these activities. We found
that, instead, institutions rely on local inmate companion programs in which
healthy inmates provide assistance for aging or disabled inmates. Further,
aging inmates, specifically those with unique medical needs, also require
advanced release preparation. We found that Social Workers are uniquely
qualified and trained to address these needs, yet few institutions have them.
Finally, we found that institution staff has limited training to identify signs of
aging in inmate conduct, which can be mistakenly viewed as reflecting
disciplinary issues rather than signs that the inmate needs medical or mental
health care.
Understaffed health services units limit access to medical care and contribute
to delays for aging inmates
Aging inmates have an increased need for health services; but,
according to BOP officials, staff, and inmates, institutions lack adequate
health services staff to address these needs.
28
For example, the Clinical
Director of a medical center told us that only 80 percent of that institution’s
health services positions are staffed and that the vacancies limit the number
of inmates, including aging inmates, the institution can treat.
29
A Case
Manager at a nonmedical institution told us that the institution was “over a
thousand inmates behind” in servicing those enrolled in chronic care clinics.
An aging inmate told us that the health services staff at his institution is
“inundated” with requests for care and that, while they work hard, they can
only do so much. Aging inmates at numerous institutions also told us that
limited health services staff sometimes resulted in long waiting periods for
care.
30
For example, an aging inmate told us that he requested dentures in
28
BOP officials told us that hiring health service staff is difficult. According to the
Assistant Director for Human Resources, it is difficult to hire medical staff in urban areas
because the BOP cannot offer doctors and nurses salaries and benefits that are comparable to
those offered by private employers. Although the salaries and benefits are more competitive
in rural areas, the BOP is challenged with finding medical staff willing to live in remote areas.
The BOP uses some incentives such as periodically increasing employee pay, paying relocation
expenses, and offering to a pay a portion of student loans. Nevertheless, as of August 2014,
only 84 percent of the BOP’s medical doctor positions were filled, which is below the BOP’s
goal of 90 percent.
29
This medical center had two physician vacancies, two mid-level practitioner
vacancies, and several nurse vacancies open at the time of our fieldwork.
30
The BOP’s Assistant Director for Health Services and Medical Director told us that in
November 2014 the BOP launched a survey of inmates in all BOP institutions to assess
inmates’ access to healthcare. He told us that once the survey is complete, the Health
Services Division will analyze the results by institution. For institutions where inmates report
delays in receiving care, the BOP will try to determine the underlying causes of delay at each
institution in order to develop potential responses.
17