The prison data don’t include deaths that occur in privately run federal prisons or deaths by execution.

For prisoners clamoring to spend their dying days at home, U.S. prison jurisdictions have some laws on the books, often called “compassionate release” or “medical parole,” allowing for early release if prisoners are very sick and not a threat. But in practice, very few inmates are set free through these programs, said Dr. Brie Williams, director of the University of California Criminal Justice and Health Project in San Francisco.

Williams and others have called for expanding these programs — in part to alleviate strained state budgets. Inmates are not eligible for Medicaid, so state prisons and jails pay full freight for their medical care, which may include expensive trips, chaperoned by guards, to emergency rooms or specialists in hospitals. Medical care for older prisoners costs three to nine times more than for their younger peers, according to Human Rights Watch.

Williams has lobbied for compassionate release programs to include prisoners who have significant functional decline or cognitive impairment — not just those who are deemed to have six months or a year to live, which has historically been the standard and is difficult to predict.

But many of these older inmates committed violent offenses, such as murder or rape, and political pressure from victims’ advocates and the public makes it hard to release prisoners early, said Dr. Marc Stern, a criminal justice consultant who served as medical director of Washington State’s corrections department from 2002 to 2008.

Stern said when he oversaw the medical component of Washington’s compassionate release program, the first prisoner he approved for release “went horribly.” The man had claimed he was so debilitated he couldn’t walk. But once the prisoner was set free, TV news cameras caught him walking outside his home, manicuring his lawn, Stern said. The state threw the man back behind bars — and grew much more cautious about whom it released, Stern said.

Massachusetts also cracked down on early release after a former prisoner, Dominic Cinelli, killed a police officer in 2010 while out on parole from a life sentence.

That fatal shooting had far-reaching effects for other ailing prisoners. Dianne Babcock, of Vermont, was lobbying for her dying husband to be released from Massachusetts prison. She described her husband, John Babcock, as a “career criminal” whose heroin addiction had driven him to rob banks. He spent over two decades behind bars. At the end of his life, he developed liver cancer from Hepatitis C. At age 57, she said, he was “in tremendous amounts of pain.”

“He would’ve been lucky if he could’ve walked to the bathroom,” she said. Prison health officials cleared Babcock for early release, but the state parole board wouldn’t let him out, and he died in prison in 2011.

“I wanted him to be able to come home and live what remaining time he had left in some sort of comfort,” she said. “That didn’t happen.”

Meanwhile, Williams has been watching the population of older prisoners continue to grow, outpacing the general population of the U.S. As this trend continues, she said, prisons and jails need to catch up.

“I’m talking about a massive expansion of the field of palliative care into the correctional system,” she said, “so it’s integrated into the fabric of correctional care.”

Originally published on KHN website.¶

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.