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Background There are roughly 6,000 individuals incarcerated in the Massachusetts Department of Corrections (MADOC), and in 2025, 32% of these individuals were age 50 and older. Older incarcerated individuals have a higher burden of chronic disease, and caring for them is associated with higher healthcare costs. In 2018, Massachusetts passed legislation enabling medical parole, a process by which an individual can be released due to terminal illness or permanent incapacitation. Existing literature suggests medical parole is underutilized. The aim of this study was to characterize the cause of death of individuals in MADOC custody to determine potential medical parole eligibility and gaps in referrals. Methods We conducted a retrospective analysis of deaths of individuals in MADOC custody between 2021 and 2023 using death records obtained from MADOC and death certificates from the Massachusetts Vital Statistics Program. Cause of death was categorized through structured review of death certificates and supplemental MADOC medical documentation. Results Between January 1, 2021 and December 31, 2023, 87 individuals died in MADOC custody. The primary disease processes leading to death involved infection (28%), complications of chronic disease (25%), and cancer (22%). Nearly half (41.7%) of infection-related deaths were due to COVID-19. The most common causes of death categorized by primary organ system were cardiovascular conditions (26%) and respiratory conditions (25%). The majority of deaths were attributed to acute causes (58%). Conclusions In our study, nearly half of the population died in custody from a chronic condition or complications related to a chronic condition and could have been identified for medical parole eligibility. The majority of individuals died from acute causes, suggesting the need for an expedited review process and expanded eligibility criteria. A small number of correctional facilities and hospitals saw the majority of deaths, and these locations may be ideal targets for future interventions. Further work is needed to compare death data before and after the COVID-19 pandemic, assess barriers to utilization of medical parole, and explore other interventions to decrease the number of deaths in MADOC custody.

When areas of the law are ambiguous or untested, such as in the compassionate release cases that proliferated during the height of the COVID-19 pandemic, district judges must rely on their discretion to fill in legal gaps. Discretion can be beneficial, because it means that it allows district judges to consider factors that may lead to potentially harmful outcomes for litigants or their communities. But discretion is imperfect, particularly in the face of ethically or factually complex problems. Perhaps a place to start with addressing this difficulty is greater transparency about the benefits and limitations of discretion.

The COVID-19 pandemic has posed a significant health threat to people in corrections facilities due to communal living, inability to social distance, and high rates of comorbidity among incarcerated populations. Combined with the First Step Act of 2018, which granted incarcerated individuals seeking compassionate release access to the courts, the pandemic increased the number of people in federal prisons petitioning for early release due to health risk. Analysis of federal compassionate release case law throughout the pandemic reveals inconsistent judicial reasoning related to COVID-19-based requests. Inconsistently interpreted compassionate release factors include vaccination status, COVID-19 reinfection, and the “degree” of extraordinary circumstances considered. Varied application among federal districts produced inequitable access to compassionate release. Therefore, this analysis provides insight into how an unclear policy can create disparate public health outcomes and considerations for compassionate release determinations in future times of uncertainty, such as a pandemic.

PurposeThe purpose of this paper is to provide a historical overview of compassionate release policies in the USA and describe how these policies have been used during the COVID-19 pandemic. The authors then describe how these programs have been shaped by COVID-19 and could be reimagined to address the structural conditions that make prisons potentially life limiting for older adults and those with chronic illness.Design/methodology/approachThis paper is primarily descriptive, offering an overview of the history of compassionate release policies before and during the COVID-19 pandemic. The authors augmented this description by surveying state Departments of Corrections about their utilization of compassionate release during 2019 and 2020. The findings from this survey were combined with data collected via Freedom of Information Act Requests sent to state Departments of Corrections about the same topic.FindingsThe findings demonstrate that while the US federal prison system saw a multifold increase in the number of individuals released under compassionate release policies in 2020 compared to 2019, most US states had modest change, with many states maintaining the same number, or even fewer, releases in 2020 compared with 2019.Originality/valueThis paper provides both new data and new insight into compassionate release utilization during the COVID-19 pandemic and offers new possibilities for how compassionate release might be considered in the future.

PurposeCompassionate release is a process that allows for the early release or parole of some incarcerated people of advanced age, with life-limiting illness, complex medical care needs or significant functional decline. Despite the expansion of State and Federal compassionate release programs, this mechanism for release remains underutilized. Health-care professionals are central to the process of recommending compassionate release, but few resources exist to support these efforts. The purpose of this paper is to provide a guide for health-care professionals requesting compassionate release for patients who are incarcerated.Design/methodology/approachThis study is stepwise guide for health-care professionals requesting compassionate release for patients who are incarcerated.FindingsThis study describes the role of the health-care professional in requesting compassionate release and offers guidance to help them navigate the process of preparing a medical declaration or request for compassionate release.Originality/valueNo prior publications have created a step-wise guide of this nature to aid health-care professionals through the compassionate release process.

The rise in the number of older prisoners in many nations has been described as a correctional “ageing crisis” which poses an urgent financial, medical and programmatic challenge for correctional health-care systems. In 2016, the International Committee of the Red Cross hosted a conference entitled “Ageing and Imprisonment: Identifying the Needs of Older Prisoners” to discuss the institutional, legal and health-care needs of incarcerated older adults, and the approaches some correctional facilities have taken to meeting these needs. This article describes some of the challenges facing correctional systems tasked with providing health care to older adults, highlights some strategies to improve their medical care, and identifies areas in need of reform. It draws principally on research and examples from the United States to offer insights and recommendations that may be considered in other systems as well.

PurposeThe purpose of this study was to systematically review literature to investigate trends in compassionate release policies, facility implementation, barriers at both the incarcerated individual and institutional levels, as well as gaps in the literature. The absence of uniform and appropriate policies to address suitable interventions at the end-of-life has aggravated the challenges and issues facing health-care systems within a correctional facility. A response to address and alleviate these barriers is policies related to compassionate release, a complex route that grants eligible inmates the opportunity to die in their community. Despite the existence of compassionate release policies, only 4% of requests to the Federal Bureau of Prisons are granted, with evidence demonstrating similarly low rates among numerous state prison systems, signifying the underuse of these procedures as a vital approach to decarceration.Design/methodology/approachA systematic review was completed using preferred reporting items for systematic reviews and meta-analyses guidelines. Centre for Agriculture and Biosciences International Abstracts, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Education Resources Information Center, Google Scholar, MEDLINE, PsycINFO, PubMed, Social Services Abstracts and Social Work Abstracts were searched from inception to March 2021. Inclusion criteria included: the compassionate release policy (or related policy) is implemented in the USA; reported qualitative and/or quantitative outcomes; and reported original data.FindingsTwenty studies formed the final data set. Data analysis revealed four main themes: language barriers, complexities of eligibility criteria, over-reliance on prognostication and social stigma. Barriers to inmates’ access to compassionate release policies include unclear or technical language used in policy documents. Eligibility criteria appear to vary across the country, including disease prognoses and the ability to predict terminal declines in health, creating confusion amongst inmates, lawyers and review boards. Stigmas surrounding the rights of incarcerated individuals frequently influence policymakers who experience pressure to maintain a punitive stance to appease constituents, thus discouraging policies and interventions that promote the release of incarcerated individuals.Research limitations/implicationsFurther research is vital to strengthen the understanding of compassionate release policies and related barriers associated with accessing various types of early parole. To promote social justice for this marginalized population, end-of-life interventions in corrections need to be consistently evaluated with outcomes that improve care for dying inmates.Practical implicationsWithin correctional facilities, correctional health-care workers should play an integral role in influencing prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population. Social workers should participate in research that focuses on effective guidelines for correctional facilities to provide compassionate end-of-life care for inmates.Social implicationsRacial disparities in the US criminal justice system are prevalent and well documented, as individuals of color are arrested far out of proportion to their share of all individuals in the USA. This particular population is thus challenged with poor access to and quality of health care in corrections. Correctional health-care workers can play an integral role in influencing policymakers, as well as prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population.Originality/valueCurrently, there are no published research articles that provide a systematic review of compassionate release policies in the USA.

Purpose of the Review The United States (US) has the highest number of incarcerated people in the world. This incarcerated population is aging disproportionately compared with the general population. Correctional facilities need to develop geriatric competencies to respond to this aging crisis. Recent Findings Older inmates have an increased burden of chronic medical conditions. This leads to higher healthcare utilization and costs across correctional systems. Daily symptoms, such as pain, and geriatric syndromes, such as cognitive impairment, frailty, and sensory impairment, are common but are frequently undertreated. Summary There is a national shortage of geriatricians and minimal geriatric expertise within the correctional system. Geriatric models of care need to be embedded within correctional facilities to help patients maintain function, health, and dignity as people age within the criminal system.

The purpose of this paper was to analyze the compassionate and geriatric release laws in the USA and the role of advanced age and/or illness. In order to identify existing state and federal laws, a search of the LexisNexis legal database was conducted. Keyword search terms were used: compassionate release, medical parole, geriatric prison release, elderly (or seriously ill), and prison. A content analysis of 47 identified federal and state laws was conducted using inductive and deductive analysis strategies. Of the possible 52 federal and state corrections systems (50 states, Washington D.C, and Federal Corrections), 47 laws for incarcerated people, or their families, to petition for early release based on advanced age or health were found. Six major categories of these laws were identified: (1) physical/mental health, (2) age, (3) pathway to release decision, (4) post-release support, (5) nature of the crime (personal and criminal justice history), and (6) stage of review. Recommendations are offered, for increasing social work policy and practice expertise, and advancing the rights and needs of this population in the context of promoting human rights, aging, health, and criminal justice reform.

Rosemary (Rosie) Willeby died on October 22, 1999. Rosie was one of many female prisoners diagnosed with both HIV and the hepatitis C virus (HCV). On February 28, 1998, Rosie came here (the Central California Women’s Facility, or CCWF) to serve a short sentence and then return to her mother and children. My peers and I watched as, earlier this year, Rosie’s health began to decline: her abdomen was swelling inch by inch, which gave her the appearance of being nine months pregnant. Her legs and feet were swollen tight; walking became a task, and regular shoes no longer fit