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Lorry Schoenly, PhD, RN, CCHP Correctional Healthcare
with Lorry Schoenly, PhD, RN, CCHP


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Dealing with the dementia dilemma

The corrections community is coming to terms with the need to address growing numbers of inmates with dementia

By Lorry Schoenly

Those of us working in corrections have known for some time that our population is aging. Look around most housing units or rec yards and it is clear that the numbers of over-50 inmates are growing. A recent report confirms this, stating that the number of prisoners over age 65 had grown 94 times the rate of the total prison population in just three years (2007-2010).

With increased age comes additional chronic illness, disability, mobility issues, and hearing or vision impairment. In addition, the corrections community is coming to terms with the need to address growing numbers of inmates with dementia.

Dementia is caused by brain deterioration that leads to significant forgetfulness, loss of recognition of people and places, with inability to express thoughts. Inmates with dementia can become easily agitated, be unable to follow simple commands, or find their way back to their cell.

Some prison systems have taken steps to deal with this special inmate population. New York is thought to have started the first specialized dementia unit in 2007. A recent New York Times article describes efforts in California. Successful interventions to deal with the dementia dilemma have these common characteristics:

Specialized staff
Custody and healthcare staff need training to understand and deal with the behaviors and special needs of inmates with dementia. The New York program requires all staff to complete a 40-hour training program. The behaviors of those with dementia are unintentional, requiring a different response than what might be given an inmate testing staff limits. Appropriate responses to confused inmates can reduce agitation and decrease stress.

At the California Men’s Colony, inmate volunteers, called Gold Coats for their distinctive-colored jackets, assist inmates in the dementia unit with their daily needs. They are also active in weekly support meetings with staff, as they often know more about the particular behavior patterns of their inmate charges than staff members.

Safe environment
Most dementia programs involve a protected environment separate from the general inmate population. Individuals with dementia can be vulnerable to predation or manipulation by other inmates. In addition, their erratic behaviors and easy agitation can lead to an aggressive or violent response from other inmates.

Certain standard behavior rules may be eased in a dementia unit. These inmates may not be able to follow direction or understand complicated questions. They may also need more time to process and respond to commands.

Examples of alterations in housing arrangements for dementia inmates include names on cell doors so the inmate can find their cell. These inmates may eat at a different time than the general population and be allowed longer periods for meals.

Individualized management
Another primary characteristic of dementia-focused inmate management is the consideration of the individual. Each inmate will response differently to social and environmental cues. Staff can develop interactional styles that reduce agitation and enhance compliance. This means that regularly assigning the same staff to these units can be less disruptive and more therapeutic.

For more information on the growing need for dementia care in jails and prisons, check out my earlier column.

Do you deal with dementia in your inmate population? Share your story in the comments section.
 

About the author

Dr. Schoenly has been a nurse for over 25 years and is currently specializing in correctional healthcare. She is a clinical education specialist and author actively advocating for excellence in this practice setting. Her web-presence www.correctionalnurse.net provides a forum to interpret correctional healthcare to the public and healthcare community. Lorry is a strong advocate for development of the specialty practice of correctional nursing. She speaks and writes frequently on correctional nursing practice issues. Her book, Essentials of Correctional Nursing, will be published in July, 2012.

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