Saturday, August 23, 2008

Hospice in Prison vs. Hospice for Released Prisoners

Multiple news organizations have recently highlighted the release of aging and terminally ill prisoners back into the community. Of course if you have very sick and possibly dying people coming into your community one of the services they may need is hospice. While in the prison system, the health care is paid for by the government, but once they leave the prison, they have to find their own coverage most likely through Medicare (if eligible), but of course there is a very good chance they may not ever get any coverage. The main focus of the news articles is the ballooning cost of health care for prisoners.

Many hospice agencies are likely to get at least a few referrals from recently released prisoners, which brings up many logistical issues about safety, potential charitable coverage for their care, addiction or diversion concerns, and possible complex family dynamics with the reintroduction of the person back into the family. These issues can come up in any hospice admission of course, but this unique situation may take some detailed care planning on the part of the hospice team.

Interestingly, few of the articles highlighted the role of prison hospice, which was featured in a excellent JAMA article last year. The focus on medical release for terminally ill patients was relegated to two paragraphs at the end of the article. The article cited a stat on average 8 of 18 annual requests are granted for release secondary to a terminal illness.

For our field, it can pose a major dilemma. Do we advocate for the well-being of our patient to possibly return home despite being a criminal who has not completed their given sentence? How do we compare our duty to the patient versus the societal justice and completion of the punishment accorded the prisoner? Should it matter what the offense is for?

Reference:
Linder, J.F., Meyers, F.J. (2007). Palliative Care for Prison Inmates: "Don't Let Me Die in Prison".
JAMA: The Journal of the American Medical Association, 298(8), 894-901. DOI: 10.1001/jama.298.8.894 (free access with JAMA registration)

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