Can the Early Release of California’s Terminally Ill In-mates Work?
By Rev. Amy Ziettlow
The short answer to this question is yes, but that yes depends greatly on one factor that I haven’t found mentioned in discussions concerning California’s SB 1462, which would allow early release for inmates with a prognosis of 6 months or less: Hospice. Studies show that the highest quality and lowest cost care we can offer those at the end of life remains the interdisciplinary, home-based model of care provided by hospices, and thus if California releases any terminally patients, the only wise way to do so would be into the care of a hospice team.
As someone who has served in hospice care in Louisiana, a state that not only boasts the highest number of incarcerated in the country but also boasts ground-breaking prison hospice programs, I have seen first-hand how the success of compassionate release programs for inmates depends greatly on the quality of relationship between the releasing prison or jail system and the local hospice community. Several factors would be wise to explore:
1) The tax-status of the local hospices. Today, hospices can be both for-profit and non-profit entities, and I will admit that I am a strong proponent for the non-profit hospice world, and in terms of caring for released offenders, my passion for the vision and mission of non-profit hospices only grows stronger. Why? Because what the articles relating to the passage of SB 1462 fail to ask is WHO is going to pay for the care of these sick and dying released individuals?
They will not have nor be eligible for Medicare or Medicaid and their families may be reticent to accept financial responsibility for these individuals with whom they may have a contentious relationship history. So, the cost and burden of their care will fall upon the charitable dollars of our communities. Our hospice made a conscious choice to use charitable dollars to support released inmates and their families, admitting them as non-funded patients, believing that we cannot discriminate among the vulnerable people who need our services. Local hospice boards might want to have this discussion concerning their mission and the use of charitable dollars prior to accepting released inmates.
2) The social work and nursing staff of the local prison or jail. Our hospice team of physicians, nurses, social workers, chaplains, and volunteers worked closely with prison staff in the days, even weeks, prior to a release. Countless details need to be addressed in the plan of care from deciding who will be accountable for medications, determining how day to day care will be provided, ordering and delivering the needed medical equipment to assessing the family dynamics, discussing funeral plans, and establishing long term goals for the patient and his or her family and friends. Our staff often went to the prison setting prior to release so that the transition could be made as smoothly as possible. The process of entering a jail or prison can be arduous so setting up a system prior to a dying patient needing care would be wise.
3) The ethos of the hospice team. As hospice staff and professionals we provided released inmates with the same quality care that we provide any other patient. But among ourselves we agonized. Some asked, should the fact that you made a criminal choice earlier in life negate any choice you might want to make at the end of life? Does every person have the right to die "free"? I struggled, too, because I have lost a loved one to violent crime. Each time I signed the paper to admit a dying prisoner to our hospice program, I thought of Juli. My dear friend, a fellow ballet dancer, 21 years old and a senior in college, Juli was raped and murdered. For me, it was the first time death, violence, and evil intent collided with my sheltered world. The grief of her friends and especially her family is beyond words.
Juli’s convicted killer is now one of our nation’s prison inmates. He may one day need hospice care. I was forced to consider how I would handle caring for Juli’s killer? What would I do?
I came to several conclusions. I would be honest with our hospice team about my conflicts and make clear that I should be the last team member to serve him, and only if absolutely necessary. I would pray for him and his loved ones as well as our hospice team who serves him. And I would write a letter to Juli’s parents, who are far more gracious and compassionate people than I can ever hope to be, and express that even though this man chose not to treat their daughter and my friend with anything close to the dignity she deserved, he has been treated with the dignity that all human beings deserve. His terrible wrong has not been forgotten nor negated; rather, it is simply not being held against him by caregivers as he dies. He has died a man and not a prisoner.
In the coming months, wardens will be wise to begin fostering good relationships with their local non-profit hospice organizations. A trusting relationship between these care providers can help ensure that these released individuals not only receive high quality, dignified care during their final days but also enter a local community that has begun to buy-in to this shift in how we care for and see those incarcerated in our midst simply because they trust the reputation and history of the local hospice who will be coordinating and responsible for their care.
In the end, SB 1462 may become more than simply a cost savings for the state, but an opportunity to restore dignity to all at the end of life. Every inmate convicted of a violent crime carries with him the precious memory of those he has hurt, people like my friend Juli. But if in our freedom we choose to treat prisoners with care and dignity, we are not imprisoned by the memories of what they have done.
Amy Ziettlow is an affiliate scholar at the Institute for American Values in New York City and co-investigator of a three-year study funded by the Lilly Endowment titled Homeward Bound: How We Live When Our Parents Die. For over a decade, Amy Ziettlow has been actively involved in hospice care, most recently as Chief Operating Officer for The Hospice of Baton Rouge, as well as serving as a chaplain visiting dying patients and their families and coordinating and training hospice volunteers.