Office of the Inspector General 

U.S. Department of Justice 

The Impact of an Aging Inmate
 

Population on the Federal Bureau of 

Prisons
 

Revised February 2016
 

Evaluation and Inspections Division 15-05 May 2015 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXECUTIVE SUMMARY
 

Introduction 

In September 2013, the Federal Bureau of Prisons (BOP) incarcerated 

164,566 federal inmates in 119 BOP-managed institutions.1 According to 

BOP data, inmates age 50 and older were the fastest growing segment of its 

inmate population, increasing 25 percent from 24,857 in fiscal year 

(FY) 2009 to 30,962 in FY 2013.2 By contrast, during the same period, the 

population of inmates 49 and younger decreased approximately 1 percent, 

including an even larger decrease of 16 percent in the youngest inmates (age 

29 and younger).3 Based on BOP cost data, we estimate that the BOP spent 

approximately $881 million, or 19 percent of its total budget, to incarcerate 

aging inmates in FY 2013.4 The Office of the Inspector General (OIG) 

conducted this review to assess the aging inmate population’s impact on the 

BOP’s inmate management, including costs, health services, staffing, 

housing, and programming. We also assessed the recidivism of inmates who 

were age 50 and older at the time of their release. 

Results in Brief 

The OIG found that aging inmates are more costly to incarcerate than 

their younger counterparts due to increased medical needs. We further 

found that limited institution staff and inadequate staff training affect the 

BOP’s ability to address the needs of aging inmates. The physical 

infrastructure of BOP institutions also limits the availability of appropriate 

housing for aging inmates. Further, the BOP does not provide programming 

opportunities designed specifically to meet the needs of aging inmates. We 

also determined that aging inmates engage in fewer misconduct incidents 

while incarcerated and have a lower rate of re-arrest once released; 

however, BOP policies limit the number of aging inmates who can be 

considered for early release and, as a result, few are actually released early. 

Aging inmates are more costly to incarcerate, primarily due to their 

medical needs. We found that the BOP’s aging inmate population contributes 

to increases in incarceration costs. Aging inmates on average cost 8 percent 

1 For this review, we examined sentenced inmates incarcerated in BOP-managed 

institutions only. We excluded approximately 29,000 inmates who are incarcerated in contract 

institutions, as well as approximately 14,000 pre-trial inmates. 

2 For the purposes of this review, we define inmates age 50 and older as “aging.” For 

more information, see page 2. 

3 The percentage decrease in the youngest inmates (age 29 and younger) was listed 

incorrectly as 29 percent when this report originally was issued in May 2015. We discovered 

the error and have revised the report to correct it. 

4 For more information, see Appendix 1. 

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more per inmate to incarcerate than inmates age 49 and younger (younger 

inmates). In FY 2013, the average aging inmate cost $24,538 to incarcerate, 

whereas the average younger inmate cost $22,676. We found that this cost 

differential is driven by increased medical needs, including the cost of 

medication, for aging inmates. BOP institutions with the highest percentages 

of aging inmates in their population spent five times more per inmate on 

medical care ($10,114) than institutions with the lowest percentage of aging 

inmates ($1,916). BOP institutions with the highest percentages of aging 

inmates also spent 14 times more per inmate on medication ($684) than 

institutions with the lowest percentage ($49). 

BOP institutions lack appropriate staffing levels to address the needs of 

an aging inmate population and provide limited training for this purpose. 

Aging inmates often require assistance with activities of daily living, such as 

dressing and moving around within the institution. However, institution staff 

is not responsible for ensuring inmates can accomplish these activities. At 

many institutions, healthy inmates work as companions to aging inmates; 

but training and oversight of these inmate companions vary among 

institutions. We further found that the increasing population of aging 

inmates has resulted in a need for increased trips outside of institutions to 

address their medical needs but that institutions lack Correctional Officers to 

staff these trips and have limited medical staff within institutions. As a 

result, aging inmates experience delays receiving medical care. For example, 

using BOP data from one institution, we found that the average wait time for 

inmates, including aging inmates, to be seen by an outside medical specialist 

for cardiology, neurosurgery, pulmonology, and urology to be 114 days. In 

addition, we found that while Social Workers are uniquely qualified to 

address the release preparation needs of aging inmates, such as aftercare 

planning and ensuring continuity of medical care, the BOP, which employs 

over 39,000 people, has only 36 Social Workers nationwide for all of its 

institutions. Institution staff told us they themselves did not receive enough 

training to identify the signs of aging. 

The physical infrastructure of BOP institutions cannot adequately 

house aging inmates. Aging inmates often require lower bunks or 

handicapped-accessible cells, but overcrowding throughout the BOP system 

limits these types of living spaces. Aging inmates with limited mobility also 

encounter difficulties navigating institutions without elevators and with 

narrow sidewalks or uneven terrain. The BOP has not conducted a 

nationwide review of the accessibility of its institutions since 1996. 

The BOP does not provide programming opportunities specifically 

addressing the needs of aging inmates. BOP programs, which often focus on 

education and job skills, do not address the needs of aging inmates, many of 

whom have already obtained an education or do not plan to seek further 

employment after release. Though BOP institutions can and do design 

programs, including release preparation programs, to meet the needs of their 

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individual populations, even institutions with high percentages of aging 

inmates rarely have programs specifically for aging inmates. 

Aging inmates commit less misconduct while incarcerated and have a 

lower rate of re-arrest once released. Aging inmates, comprising 19 percent 

of the BOP’s inmate population in FY 2013, represented 10 percent of all the 

inmate misconduct incidents in that year. Also, studies have concluded that 

post-release arrests decrease as an individual ages, although BOP does not 

maintain such data. The OIG conducted a sampling of data and found that 

15 percent of aging inmates were re-arrested for a new crime within 3 years 

of release. Based on our analysis, the rate of recidivism of aging inmates is 

significantly lower than the 41 percent re-arrest rate that the BOP’s research 

has found for all federal inmates. We further found that most of the aging 

inmates who were re-arrested already had a documented history of 

recidivism. 

Aging inmates could be viable candidates for early release, resulting in 

significant cost savings; but BOP policy strictly limits those who can be 

considered and, as a result, few have been released. Over a year ago, the 

Department concluded that aging inmates are generally less of a public 

safety threat and the BOP announced an expanded compassionate release 

policy to include them as part of the Attorney General’s “Smart on Crime” 

initiative. However, the Department significantly limited the number of 

inmates eligible for this expanded release policy by imposing several 

eligibility requirements, including that inmates be at least age 65, and we 

found that only two inmates had been released under this new provision. 

According to institution staff, it is difficult for aging inmates to meet all of the 

eligibility requirements of the BOP’s new provisions. Our analysis shows that 

if the BOP reexamined these eligibility requirements its compassionate 

release program could result in significant cost savings for the BOP, as well 

as assist in managing the inmate population. 

Recommendations 

In this report, we make eight recommendations to improve the BOP’s 

management of its aging inmate population. These recommendations 

include enhancing BOP oversight and training of inmate companions, 

studying the impact of the aging inmate population on infrastructure, 

developing programs to address the needs of aging inmates during their 

incarceration and as they prepare for release, and revising the requirements 

that limit the availability of compassionate release for these inmates. 

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TABLE OF CONTENTS
 

BACKGROUND ............................................................................................... 1
 

PURPOSE, SCOPE, AND METHODOLOGY............................................................ 9
 

RESULTS OF THE REVIEW ............................................................................. 10
 

Aging inmates are more costly to incarcerate, primarily due to their medical 

needs..................................................................................................... 10
 

BOP institutions lack appropriate staffing levels to address the needs of an aging
 

inmate population and provide limited training for this purpose..................... 16
 

The physical infrastructure of BOP institutions cannot adequately house aging 

inmates.................................................................................................. 23
 

The BOP does not provide programming opportunities specifically addressing the
 

needs of aging inmates ............................................................................ 30
 

Aging inmates commit less misconduct while incarcerated and have a lower rate 

of re-arrest once released......................................................................... 37
 

Aging inmates could be viable candidates for early release, resulting in 

significant cost savings; but new BOP policy strictly limits those who can be
 

considered and as a result, few have been released..................................... 41
 

CONCLUSION AND RECOMMENDATIONS......................................................... 51
 

APPENDIX 1: EXPANDED METHODOLOGY....................................................... 55
 

APPENDIX 2: THE BOP’S RESPONSE TO THE DRAFT REPORT ............................ 60
 

APPENDIX 3: OIG ANALYSIS OF THE BOP’S RESPONSE.................................... 63
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BACKGROUND
 

Introduction 

From fiscal year (FY) 2009 to FY 2013, the BOP experienced a shift in 

the age demographic of its inmate population. During those 5 years, the 

number of inmates age 50 and older in BOP-managed institutions was the 

fastest growing segment of the BOP population, increasing by 25 percent, 

from 24,857 to 30,962. During the same period, the population of inmates 

49 and younger decreased approximately 1 percent, including an even larger 

decrease of 16 percent in the youngest inmates age 29 and younger.

5 

The OIG assessed the impact of an aging inmate population on the 

BOP’s inmate management, including costs, health services, staffing, 

housing, and programming, between FY 2009 and FY 2013. In this 

background section, we define the BOP’s aging inmate population and discuss 

the demographics and trends of this population. In addition, we outline the 

new compassionate release provisions related to aging inmates. Finally, we 

discuss the similar challenges faced by state correctional systems and the 

different methods they use to address the growing aging inmate population. 

Defining the BOP’s Aging Inmate Population 

The BOP does not establish a specific age at which an inmate is 

considered “aging.”6 For the purposes of this report, we define inmates age 

50 and older as aging.

7 Our definition is based on several factors including 

studies, state programs and policies, as well as the opinions of BOP officials 

and institution staff. In a 2004 report, the BOP’s National Institute of 

Corrections (NIC) defined inmates age 50 and older as aging.

8 The NIC 

further reported that seven state correctional agencies considered inmates 

age 50 and older to be aging.

9 Several studies, including one published by 

the American Journal of Public Health, state that an inmate’s physiological 

5 The percentage decrease in the youngest inmates (age 29 and younger) was listed 

incorrectly as 29 percent when this report originally was issued in May 2015. We discovered 

the error and have revised the report to correct it. 

6 When we asked BOP staff how they defined aging, their responses ranged from age 

40 to age 78. 

7 Throughout this report, we will use the term “aging inmates” to refer to inmates age 

50 and older and the term “younger inmates” to refer to inmates age 49 and younger. 

8 The NIC is an agency within the BOP. The NIC provides training, technical 

assistance, information services, and policy and program development assistance to federal, 

state, and local correctional agencies. 

9 The NIC surveyed correctional systems in all 50 states, the District of Columbia, 

U.S. territories, and Canada and found that seven states (Alaska, Florida, Idaho, New Mexico, 

North Carolina, Ohio, and West Virginia) and Canada defined inmates as aging at age 50. 

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age averages 10–15 years older than his or her chronological age due to the 

combination of stresses associated with incarceration and the conditions that 

he or she may have been exposed to prior to incarceration.10 During our 

review, BOP officials and staff agreed that the combination of these factors 

expedites the aging process. A Clinical Director told us that because most 

aging inmates have preexisting conditions and are sicker than the general 

population, they appear to be older than their actual age. 

The BOP’s aging inmate population made up 19 percent of the BOP’s 

overall population in FY 2013 

Aging inmates made up 16 percent of the BOP’s total population in 

FY 2009 and increased to 19 percent of the BOP’s total population in 

FY 2013. Table 1 presents the total number of sentenced BOP inmates, the 

number of younger inmates, and the number of aging inmates from FY 2009 

through FY 2013.11 

Table 1 

Total Sentenced Inmate Population by Age 

Fiscal Year Sentenced 

Inmates 

Aging Inmates 

(50 and older) 

Younger Inmates 

(49 and younger) 

2009 159,189 24,857 134,332 

2010 159,660 26,221 133,439 

2011 165,797 28,239 137,558 

2012 164,257 29,332 134,925 

2013 164,566 30,962 133,604 

Source: BOP population snapshots. 

According to BOP data, not only are the numbers of aging inmates 

increasing, they are generally increasing at a faster rate in older age groups. 

Specifically, the number of inmates age 65 to 69 increased 41 percent; 

inmates age 70 to 74 increased 51 percent; inmates age 75 to 79 increased 

43 percent; and inmates age 80 and over increased 76 percent. 

Nevertheless, inmates age 65 and older represented only 14 percent of the 

aging inmate population in FY 2013, while inmates age 50 to 64 represented 

86 percent of the 30,962 aging inmates. Figure 1 shows the increase in the 

10 B. Williams, et al., “Aging in Correctional Custody: Setting a Policy Agenda for 

Older Prisoner Health Care,” American Journal of Public Health 102, no. 8 (August 2012): 

1475–1481, p. 3. 

11 For this review, we examined sentenced inmates incarcerated in BOP-managed 

institutions only. We excluded approximately 29,000 inmates who are incarcerated in contract 

institutions, as well as approximately 14,000 pre-trial inmates. 

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number of aging inmates, distributed in 5-year increments, from FY 2009 

through FY 2013. 

Figure 1 

Percent Change in Population of Aging Inmates from FY 2009 to 

FY 2013 

 

 

Percent Change 

0% 

10% 

20% 

30% 

40% 

50% 

60% 

70% 

80% 

50-54 55-59 60-64 65-69 70-74 75-79 80+ 

Age Cohorts 

Source: BOP population snapshots. 

Elimination of parole, use of mandatory minimum sentences, increases 

in average sentence length over the past 3 decades, and an increase 

in white collar offenders and sex offenders, among other things, 

contribute to the aging inmate population 

Research indicates that the growth in the aging inmate population can 

be attributed to sentencing reforms beginning in the late 1980s, including the 

elimination of federal parole and the introduction of mandatory minimums 

and determinate sentences.12 BOP staff and management officials agreed 

that these sentencing reforms contributed to longer sentences, leading to an 

increase in aging inmates. In addition to the increase in the aging inmate 

population, there has also been a 9 percent increase in the number of 

younger inmates who will be age 50 and older when they are ultimately 

released.

13 (See Table 2 below.) 

12 Nathan James, “The Federal Prison Population Buildup: Overview, Policy Changes, 

Issues, and Options,” Congressional Research Service, April 15, 2014. 

13 We based our analysis on each inmate’s release date as of the date we received 

BOP data. We did not include younger inmates with life sentences, death sentences, or those 

inmates who did not have release dates. 

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Table 2
 

Number of Younger Inmates Who Will Be Age 50 and Older at
 

Release
 

Fiscal Year Number of Younger 

Inmates 

2009 19,385 

2010 19,790 

2011 20,488 

2012 20,761 

2013 21,221 

Percent Change 9% 

Source: BOP population snapshots. 

The growth of the aging inmate population can also be attributed to 

the increase in the number of aging offenders who are first-time white collar 

or sex offenders.14 From FY 2009 to FY 2013, the BOP experienced a 

28 percent increase (7,944 to 10,153) in the number of first-time, aging 

offenders. Further, the number of aging inmates incarcerated for fraud, 

bribery, or extortion offenses increased by 43 percent and the number of 

aging inmates incarcerated for sex offenses increased by 77 percent. White 

collar offenders and sex offenders made up approximately 24 percent of the 

aging inmate population in FY 2013. Conversely, these offenders made up 

less than 10 percent of the younger inmate population. 

Aging inmates make up a disproportionate share of the inmate 

population in institutions providing higher levels of medical care 

In 2002, the BOP implemented a system that assigned care levels to 

inmates based on the inmate’s medical needs and to institutions based on 

the resources available to provide care. Under this system, the BOP assigns 

each inmate a care level from 1 to 4 based on documented medical history, 

with Care Level 1 being the healthiest inmates and Care Level 4 being 

inmates with the most significant medical conditions. The BOP also assigns 

each institution a care level from 1 to 4, based on the institution’s level of 

medical staffing and resources. Inmates are designated to an institution with 

a corresponding care level.15 (See Table 3 below.) 

14 BOP data also indicated that 17,995 of the 30,962 (58 percent) aging inmates in 

FY 2013 were sentenced at age 50 and older and 7,351 (41 percent) of those sentenced at 50 

and older were first-time offenders. 

15 For more information about the BOP’s care level system, see DOJ, OIG, The Federal 

Bureau of Prisons’ Efforts to Manage Inmate Health Care. 

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Table 3
 

Description of the BOP’s Care Levels
 

Care Level Description 

1 

Inmates who are younger than 70, with limited 

medical needs requiring clinical contact no more than 

once every 6 months 

2 Inmates who are stable outpatients, with chronic 

illnesses requiring clinical contact every 3 months 

3 Inmates who are fragile outpatients, with conditions 

requiring daily to monthly clinical contact 

4 Inmates requiring inpatient care: Care Level 4 

institutions are BOP medical centers. 

Source: U.S. Department of Justice (DOJ), OIG, The Federal Bureau of 

Prisons’ Efforts to Manage Inmate Health Care, Audit Report 08-08 

(February 2008). 

According to BOP data, in FY 2013 aging inmates made up a 

disproportionate share of the inmates housed in Care Level 3 and 4 

institutions. Specifically, aging inmates made up 21 percent of the 

population of Care Level 3 institutions and 33 percent of the population of 

Care Level 4 institutions, compared to only 19 percent of the overall inmate 

population.

16 Figure 2 illustrates the proportion of aging inmates assigned to 

each care level. 

Figure 2 

Percentage of Aging Inmates Assigned to Each Care Level, FY 2013 

100% 

20% 

40% 

60% 

80% 

Percentage 

0% 

1 2 3 4 

Care Level 

Younger Inmates Aging Inmates 

Source: BOP population snapshots. 

16 Care Level 4 institutions also house cadre inmates who have work assignments and 

are primarily made up of healthier, non–Care Level 4 inmates. 

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BOP Program Statement 5050.49 (Compassionate Release) 

The increase of the aging inmate population adversely affects crowding 

levels, particularly in minimum security, low security, and medical 

institutions. At the end of FY 2013, the BOP as a whole was 34 percent over 

capacity, with minimum security institutions at 19 percent over capacity, low 

security institutions at 32 percent over capacity, and medical centers at 

16 percent over capacity.

17 According to BOP data, aging inmates made up 

26 percent of the population of minimum-security institutions, 23 percent of 

the population of low-security institutions, and 33 percent of the population 

of medical centers. 

In the Sentencing Reform Act of 1984, Congress authorized the BOP 

Director to request that a federal judge reduce an inmate’s sentence based 

on “extraordinary and compelling” circumstances. Under the statute, the 

request can be based on either medical or nonmedical conditions that could 

not reasonably have been foreseen by the judge at the time of sentencing. 

The BOP has issued regulations and a Program Statement entitled 

“Compassionate Release” to implement this authority. In April 2013, the OIG 

released a report that found significant problems with the management of 

the BOP’s compassionate release program and that an effectively managed 

program would help the BOP better manage its inmate population and result 

in cost savings. We also found, in considering the impact of the 

compassionate release program on public safety, a recidivism rate of 

3.5 percent for inmates released through the program. By comparison, the 

general recidivism rate for federal inmates has been estimated as high as 

41 percent. 

In August 2013, following the release of our review, the BOP 

implemented new provisions to its Compassionate Release Program 

Statement making inmates at least age 65 eligible for consideration for both 

medical and nonmedical reasons.18 One provision applies to inmates 

sentenced for an offense that occurred on or after November 1, 1987, who 

are age 70 years or older at the time of consideration for release and who 

have served 30 years or more of their sentence of imprisonment. A second 

provision applies to inmates: 

17 Over-capacity level is based on our analysis of the BOP’s FY 2013 population 

snapshot, combined with information about each institution’s security level as reported on the 

BOP’s website. Our analysis excluded detention centers and contract institutions. The BOP’s 

Long Range Capacity Plan, which includes all institutions, reports that at the end of FY 2013 

the BOP as a whole was 36 percent overcrowded. At the end of FY 2014, the BOP reported 

that its inmate population had dropped slightly from the year before. However, for this report 

we examined population data only through FY 2013. 

18 See BOP, Compassionate Release/Reduction in Sentence: Procedures for 

Implementation of 18 U.S.C. § 3582(c)(1)(A) and 4205(g), Program Statement 5050.49 

(August 12, 2013). 

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1.	 age 65 and older, 

2.	 suffering from chronic or serious medical conditions related to the 

aging process, 

3.	 experiencing deteriorating mental or physical health that substantially 

diminishes their ability to function in a correctional facility, 

4.	 for whom conventional treatment promises no substantial
 

improvement to their mental or physical condition, and
 

5.	 who have served at least 50 percent of their sentence. 

A third provision applies to inmates who are age 65 and older and 

have served the greater of 10 years or 75 percent of their sentence. An 

inmate’s medical condition is not evaluated under the first or third provisions. 

To determine whether inmates applying under any of the three provisions are 

suitable for compassionate release, the BOP further evaluates each inmate in 

light of several factors, including but not limited to the nature and 

circumstance of the inmate’s offense, criminal history, input from victims, 

age at the time of offense and sentencing, release plans, and whether 

release would minimize the severity of the offense. 

States have begun addressing the challenges the of the aging inmate 

population 

State correctional systems are also facing an increase in aging inmate 

populations. Specifically, according to a 2014 report, the number of inmates 

age 55 and older in state and federal institutions increased 204 percent 

between 1999 and 2012.19 State correctional systems have also experienced 

a substantial increase in healthcare costs. According to the report, 

correctional healthcare spending rose in 41 states by a median of 13 percent 

during the 5-year period from FY 2007 to FY 2011. The report indicates that 

states generally incurred higher inmate healthcare spending where aging 

inmates represented a larger proportion of the inmate population. For 

example, the median healthcare spending per inmate in the 10 states with 

the highest percentage of inmates age 55 and older averaged $7,142, while 

the 10 states with the lowest percentage of these inmates averaged $5,196 

per inmate. Later in this report, we provide a similar analysis based on BOP 

institutions with the highest and lowest percentage of aging inmates. 

To address the growth of aging inmate populations, at least 15 states 

have provisions that would allow for the consideration of early release for 

19 Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, 

“State Prison Health Care Spending,” July 8, 2014, http://www.pewtrusts.org/en/researchand-analysis/reports/2014/07/08/state-prison-health-care-spending (accessed April 9, 2015). 

The report did not break out the increase between state and federal institutions. 

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aging inmates, but with varying eligibility requirements.

20 Some states 

restrict eligibility to aging inmates with physically or mentally debilitating 

conditions, while other states open eligibility to all aging inmates who meet 

age and time served requirements. Outside of early release considerations, 

several states have developed separate housing units or institutions for aging 

inmates, including housing units dedicated to older inmates with chronic 

health problems. For example, the Florida Department of Corrections has 

several institutions with units designed specifically for aging inmates, 

including one dedicated for inmates age 50 and older. States have also 

recognized the need for different programming for aging inmates, including 

one program in Nevada designed for inmates age 55 and older to enhance 

their overall health through daily activities. 

20 Tina Chiu, “It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric 

Release,” VERA Institute of Justice, April 2010. 

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PURPOSE, SCOPE, AND METHODOLOGY
 

Purpose 

Our review examined the BOP’s aging inmate population by assessing 

the population’s impact on incarceration costs, health services, staffing, 

housing, and programming. We also determined the recidivism rate of aging 

inmates released from BOP custody. 

Scope and Methodology 

Our review analyzed BOP inmate population and cost data, as well as 

BOP policies and programs from FY 2009 through FY 2013. Our review 

focused on federal offenders incarcerated in the 119 institutions operated by 

the BOP during our scope years. We excluded inmates housed in private 

correctional institutions, contract community corrections centers, and 

contract state and local institutions from our analysis. We also excluded 

inmates who were in pre-trial detention. 

Our fieldwork, conducted from February 2014 through 

September 2014, included interviews, data collection and analyses, and 

document reviews. We interviewed BOP officials, including the Assistant 

Directors responsible for eight Central Office divisions.21 We conducted 

13 site visits to BOP institutions, including 5 institutions through video 

teleconferences and 8 institutions in person. For each site visit, we 

interviewed institution officials and staff. For those institutions that we 

visited in person, we also interviewed inmates, toured housing units, and 

observed the physical landscapes. Our site visits encompassed 

BOP institutions representing all security levels, including minimum-, low-, 

medium-, and high-security institutions, as well as administrative security 

institutions such as federal medical centers and detention centers. A detailed 

description of the methodology of our review is in Appendix 1. 

21 The BOP’s Central Office is located in Washington, D.C. We interviewed the 

Assistant Directors of the Administration; Human Resource Management; Health Services; 

Information, Policy, and Public Affairs; Reentry Services; Correctional Programs; and 

Industries, Education and Vocational Training Divisions. We also interviewed the General 

Counsel. 

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RESULTS OF THE REVIEW
 

Aging inmates are more costly to incarcerate, primarily due to their 

medical needs 

According to BOP officials and staff, an aging inmate population’s most 

significant impact is on medical costs. From fiscal year (FY) 2009 to 

FY 2013, the BOP’s spending on inmate healthcare increased by 29 percent, 

according to BOP data. In FY 2009, the BOP spent $854 million of its 

$5.5 billion budget (16 percent) to provide medical care for its inmate 

population. By FY 2013, medical costs increased to $1.1 billion, representing 

17 percent of the BOP’s $6.5 billion budget that year. While the BOP states 

that it cannot determine the specific medical costs associated with individual 

inmates, we found that aging inmates, as a group, are more expensive to 

incarcerate than younger inmates, primarily due to their medical needs. We 

also found that medical costs are increasing at a rate higher than the BOP’s 

total budget, especially at institutions housing more aging inmates, and are 

driven by medications and medical trips outside of institutions. Finally, we 

found aging inmates are receiving more medical services, both within BOP 

institutions and from outside healthcare providers. 

Using BOP inmate population and cost data, we estimated costs per 

inmate based on security level and the number of days incarcerated within a 

fiscal year.22 We found that an aging inmate, on average, costs 8 percent 

more to incarcerate than a younger inmate. For example, in FY 2013, the 

average aging inmate cost $24,538 to incarcerate, whereas the average 

younger inmate cost $22,676. We also found that average cost per inmate 

rises with age, with the 8,831 inmates age 18 to 24 costing an average of 

$18,505 each and the 157 inmates age 80 and older costing an average of 

$30,609 each. While the aging inmate population represents only 19 percent 

of the BOP’s total population, the costs to incarcerate them are increasing at 

a faster rate than for younger inmates. For example, the cost of 

incarcerating aging inmates grew 23 percent, from $715 million in FY 2010 to 

$881 million in FY 2013, while the cost of incarcerating younger inmates 

grew 3 percent, from $3.5 billion to $3.6 billion over the same period. (See 

Figure 3 below for the average annual cost per inmate in FY 2013.) 

22 The BOP determines the average cost to incarcerate inmates by the type of 

institution where an inmate is housed, such as a low-security institution or a federal medical 

center, not by the specific cost to incarcerate each inmate. Therefore, we calculated the 

number of days served by each inmate in each fiscal year and applied the cost of the type of 

institution where that inmate was housed. See Appendix 1 for more details on our analysis. 

10
 
 

 

 

 

 

 

Figure 3
 

Average Annual Cost per Inmate by Age, FY 2013
 

Average Cost 

$35,000 

$30,000 

$25,000 

$20,000 

$15,000 

$10,000 

$5,000 

$0 

Age 

Source: BOP population and daily cost data. 

According to the BOP’s Assistant Director for Health Services and 

Medical Director, inmates in their fifties and sixties place the greatest burden 

on the BOP because their numbers are increasing and many of them have 

significant health problems stemming from years of substance abuse. 

Similarly, BOP officials and staff at each institution we visited said the most 

significant impact of aging inmates on the BOP is the cost associated with 

addressing their increased medical needs. For example, a Health Services 

Administrator of an institution where aging inmates were 27 percent of the 

population told us that her institution’s medical budget increased from 

$3 million to $9 million in FY 2012 alone due to the aging inmate population. 

Aging inmates we interviewed also acknowledged their impact on the BOP’s 

medical costs. One aging inmate told us that he has had two heart attacks, 

two strokes, open-heart surgery, cancer, and has diabetes. He told us that it 

must cost the BOP “a fortune” to keep him incarcerated. We discuss the 

impact aging inmates have on BOP institutions’ medical costs, as well as 

factors that drive increased medical costs for aging inmates, below. 

11
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Healthcare spending per inmate is greater at institutions with the highest 

percentage of aging inmates 

Using BOP population and medical cost data, we calculated medical 

spending per inmate within each institution and found that the BOP’s 

healthcare spending coincides with the percentage of aging inmates at an 

institution.

23 Specifically, we found that the five institutions with the highest 

percentage of aging inmates spend significantly more per inmate on medical 

costs than the five institutions with the lowest percentage of aging inmates 

(see Table 4).24 

Table 4 

Medical Spending per Inmate at Institutions with the Five Highest 

and Lowest Percentages of Aging Inmates 

FY 2009 

Percentage 

of Aging 

Inmates 

Cost Per 

Inmate FY 2013 

Percentage 

of Aging 

Inmates 

Cost Per 

Inmate 

Highest 27% $6,528 Highest 31% $10,114 

Lowest 5% $2,110 Lowest 7% $1,916 

Source: BOP medical spending data. 

As Table 4 shows, in FY 2009, institutions with the highest percentage 

of aging inmates spent on average $6,528 per inmate on medical costs while 

institutions with the lowest percentage of aging inmates averaged $2,110 per 

inmate. The same pattern of spending emerged in FY 2013, when 

institutions with the highest percentage of aging inmates spent on average 

$10,114 per inmate while institutions with the lowest percentage of aging 

inmates spent $1,916 per inmate. 

23 According to the BOP, there is no direct way to associate medical care provided 

with the costs incurred for each inmate because its electronic medical records system and 

financial management system are not connected. The BOP’s Assistant Director for 

Administration told us that the BOP does not track costs by inmate because its accounting 

system tracks spending by program area only. 

24 We excluded BOP medical centers, detention centers, and correctional complexes 

from this analysis. We excluded correctional complexes because spending data is reported in 

the aggregate instead of separately for each institution within the complex. For example, one 

correctional complex spent $99 million on medical care in FY 2013 but we could not determine 

how much was specifically spent by a medical center and each of three other institutions 

within the complex. Because we excluded these institution types, our cost estimates of 

spending per inmate are lower. See Appendix 1 for additional details. 

12
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Institutions with the highest percentage of aging inmates spend more per 

inmate on medical care provided both inside and outside BOP institutions 

All BOP institutions operate ambulatory clinics that incur medical 

expenses for inmate care provided inside the institution. If an inmate has a 

medical condition that becomes emergent, escalates, or requires further 

examination or diagnosis from a specialist, the inmate may be transported 

outside the institution for services. We found that medical costs incurred for 

care provided both inside and outside institutions account for 86 percent of 

the BOP’s medical costs each year.

25 According to the BOP, costs for medical 

services provided inside all BOP institutions increased 19 percent, from 

$413 million in FY 2009 to $493 million in FY 2013. Costs for medical 

services provided outside BOP institutions (often in private or public 

hospitals) increased even more sharply, rising 31 percent, from $320 million 

in FY 2009 to $420 million in FY 2013. 

We also found that costs for medical services provided both inside and 

outside institutions increased at a higher rate at institutions with the highest 

percentage of aging inmates when compared to institutions with the lowest 

percentage of aging inmates. For example, in FY 2009, institutions with the 

highest percentage of aging inmates spent about four times as much on 

medical care provided outside of institutions than those with the lowest 

percentage of aging inmates. By FY 2013, the gap widened even more 

significantly, with institutions with the highest percentage of aging inmates 

spending on average over 10 times more on outside medical care than 

institutions with the lowest percentage of aging inmates. (See Table 5 

below.) 

Table 5
 

Average Cost Per Inmate for Medical Services Provided Inside and
 

Outside Institutions with the Highest and Lowest Percentages of
 

Aging Inmates
 

FY 

2009 

Percentage 

of Aging 

Inmates 

Inside 

Services 

Outside 

Services 

FY 

2013 

Percentage 

of Aging 

Inmates 

Inside 

Services 

Outside 

Services 

Highest 27% $2,551 $2,826 Highest 31% $3,436 $5,751 

Lowest 5% $1,244 $658 Lowest 7% $1,224 $563 

Source: BOP medical spending data. 

25 Medical costs also include salaries for U.S. Public Health Service employees, who 

staff many institution medical clinics; medical transport costs; and costs of handling 

unforeseen medical events at institutions. These costs, when combined with inside and 

outside medical services, total the BOP’s medical budget. See Appendix 1 for additional 

details. 

13
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Institution staff also 

told us that aging inmates 

incur more medical costs 

due to increased visits to 

medical clinics inside the 

institution and medical trips 

outside the institution. For 

example, a Warden told us 

that aging inmates are more 

likely to be chronic care 

patients seen more 

frequently by healthcare 

services.

26 Aging inmates 

also told us they are 

receiving more medical 

services. For example, a 

different aging inmate from 

the one referenced above 

told us he gets two shots 

per day, requires dialysis, 

and has a number of ailments including congestive heart failure, diabetes, 

sleep apnea, cataracts, and Hepatitis C. In addition to medical care provided 

inside the institution to treat his medical conditions, every 6 months he 

receives outside medical care for his heart. Below, we discuss two specific 

factors that we found drive increased medical costs associated with an aging 

inmate population: medication costs and staff overtime to meet inmate 

medical needs. 

Budgetary Impact of Hepatitis C Treatment 

According to the BOP, as medication costs continue 

to increase, they will place even greater pressure on 

the BOP’s budget in the future. For example, 

institution staff told us about treatments recently 

approved by the Food and Drug Administration (FDA) 

regarding Hepatitis C, a condition that is particularly 

prevalent among aging inmates. Approximately 

12,000 inmates have Hepatitis C, and 47 percent of 

those are aging inmates. Medical staff at a BOP 

medical center told us that while they did not yet 

know the cost of the new Hepatitis C medication at 

the time of our interview, they anticipated costs to be 

“astronomical” because Hepatitis C is one of the most 

common infectious diseases in the inmate population. 

The BOP reports that former treatments cost $6,600 

per patient, while the treatment recently approved by 

the FDA will cost an additional $20,000 to $40,000 

per patient. 

Source: BOP FY 2015 congressional budget 

justification. 

14
 

Medications and staff overtime to meet inmate medical needs are significant 

drivers of increasing medical costs 

Due to their medical needs and chronic health problems, aging 

inmates require more medications and are substantially driving up the BOP’s 

medical costs. We found that the BOP’s spending on medications increased 

32 percent, from $62 million in FY 2009 to $82 million in FY 2013. We also 

found that the BOP’s spending on medications was higher, and increased 

faster, at institutions with the highest percentage of aging inmates. The 

BOP’s Assistant Director for Health Services and Medical Director told us that 

medication for inmates requiring chronic care is one of the BOP’s major 

healthcare cost drivers. A Warden also said that a high percentage of aging 

inmates are being treated for chronic medical conditions and that 

medications drive the costs to care for these inmates. By contrast, 

medication costs were lower and increased more slowly at institutions with 

26 The BOP schedules inmates with ongoing medical problems for frequent 

appointments with BOP medical staff to reassess their status and renew their prescriptions. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the lowest percentage of aging inmates. For example, in FY 2013 institutions 

with the highest percentage of aging inmates spent an average of $684 per 

inmate on medications, or about 14 times more than those with the lowest 

percentage of aging inmates, which spent an average of $49 per inmate on 

medications in FY 2013. 

Institution staff also told us that aging inmates with chronic conditions 

require treatment from specialists outside the institution and that overtime 

paid to Correctional Officers who escort inmates to such appointments is a 

significant budget item. According to BOP data, in FY 2013, in addition to 

paying for outside medical care, the BOP spent $53 million in overtime to 

transport inmates to outside medical care, a 17 percent increase from the 

$46 million spent in FY 2009. As one example, an Associate Warden said 

overtime costs associated with transporting aging inmates to outside medical 

appointments and hospitalizations were “phenomenal” and that his institution 

was over its allotted overtime budget less than half way through the fiscal 

year for this reason. 

Aging inmates disproportionately require catastrophic medical care 

In May 2012, the BOP Assistant Director for Health Services and 

Medical Director issued to all institutions a memorandum on “Catastrophic 

Case Management”; it defined catastrophic medical cases as those where the 

estimated or actual cost of outside medical care for an inmate housed in a 

nonmedical BOP institution exceeds $35,000 for a single medical event and 

provided guidance on how to track and monitor these cases.

27 We analyzed 

catastrophic care data from one BOP region between FY 2009 and FY 2013 

and found that while only 18 percent of the inmates in this region were aging 

inmates during this period, 59 percent of the catastrophic medical cases 

involved aging inmates (see Table 6). Moreover, because the aging inmate 

population in this region was about four times smaller than the younger 

inmate population, the probability of an aging inmate having a catastrophic 

medical issue was about eight times higher than for a younger inmate. 

27 As of FY 2012, all BOP regions adopted a catastrophic case management system 

designed to track and monitor cases and to measure the fiscal and clinical outcomes of care. 

While beyond the scope of this review, we learned that the BOP’s six regions do not 

consistently track catastrophic medical cases and that the BOP’s Central Office does not 

process or analyze that data to better understand the impact of catastrophic healthcare events 

on budget and decision-making. Due to the inconsistency of regional tracking, we were able 

to analyze catastrophic case spending in only one region. See Appendix 1 for details. 

15
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 6
 

Catastrophic Cases in One BOP Region, FY 2009 to FY 2013
 

Age FY 

2009 

FY 

2010 

FY 

2011 

FY 

2012 

FY 

2013 Total 

Cases Involving Younger 

Inmates 53 58 70 60 79 320 

Cases Involving Aging 

Inmates 58 76 104 104 126 468 

Total 111 134 174 164 205 788 

Percent of Aging Inmates 

in this Region 16% 17% 18% 18% 19% 18% 

Percent of Catastrophic 

Cases Involving Aging 

Inmates 

51% 57% 60% 63% 61% 59% 

Source: BOP catastrophic case data. 

We also found that during this time, this region spent $71 million on 

catastrophic medical care, 60 percent ($45 million) of which was spent on 

aging inmates. Based on our review of available data, we found that aging 

inmates received catastrophic medical services for a variety of medical 

conditions, particularly heart and lung conditions. Services from this region 

included treatment of clogged arteries, heart failure, cardiovascular issues, 

respiratory failure, lung disease, and cellulitis. Finally, while the costs 

associated with catastrophic care cases must all exceed at least $35,000, we 

found cases with significantly more costs. For example, the most expensive 

case from this region involved over $850,000 spent for an aging inmate who 

was treated for complicated coronary artery disease. 

In addition, we found that the increase in catastrophic medical cases in 

this region was not limited to Care Level 3 institutions, which, as described 

above, are specifically intended to care for outpatient inmates with medical 

conditions that require daily to monthly outpatient clinical contact. For 

example, a Care Level 2 institution, which incarcerates inmates who are 

stable outpatients and typically require clinical contact only every 3 months, 

accounted for 30 percent of the region’s catastrophic medical cases in 

FY 2013. Aging inmates comprised 62 percent of this institution’s 

catastrophic medical cases, even though they represented only 27 percent of 

its population. 

BOP institutions lack appropriate staffing levels to address the needs 

of an aging inmate population and provide limited training for this 

purpose 

As described above, the increasing aging inmate population has 

resulted in an increase in trips outside of institutions to address their medical 

needs. We found that institutions lack Correctional Officers to staff these 

trips and have limited medical staff within institutions to address aging 

16
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

inmates’ medical needs. As a result, aging inmates experience delays in 

receiving medical care. In addition, the needs of aging inmates differ from 

their younger counterparts, including the need for increased assistance with 

activities of daily living. According to BOP staff, however, staff is not 

responsible for ensuring inmates can accomplish these activities. We found 

that, instead, institutions rely on local inmate companion programs in which 

healthy inmates provide assistance for aging or disabled inmates. Further, 

aging inmates, specifically those with unique medical needs, also require 

advanced release preparation. We found that Social Workers are uniquely 

qualified and trained to address these needs, yet few institutions have them. 

Finally, we found that institution staff has limited training to identify signs of 

aging in inmate conduct, which can be mistakenly viewed as reflecting 

disciplinary issues rather than signs that the inmate needs medical or mental 

health care. 

Understaffed health services units limit access to medical care and contribute 

to delays for aging inmates 

Aging inmates have an increased need for health services; but, 

according to BOP officials, staff, and inmates, institutions lack adequate 

health services staff to address these needs.28 For example, the Clinical 

Director of a medical center told us that only 80 percent of that institution’s 

health services positions are staffed and that the vacancies limit the number 

of inmates, including aging inmates, the institution can treat.29 A Case 

Manager at a nonmedical institution told us that the institution was “over a 

thousand inmates behind” in servicing those enrolled in chronic care clinics. 

An aging inmate told us that the health services staff at his institution is 

“inundated” with requests for care and that, while they work hard, they can 

only do so much. Aging inmates at numerous institutions also told us that 

limited health services staff sometimes resulted in long waiting periods for 

care.30 For example, an aging inmate told us that he requested dentures in 

28 BOP officials told us that hiring health service staff is difficult. According to the 

Assistant Director for Human Resources, it is difficult to hire medical staff in urban areas 

because the BOP cannot offer doctors and nurses salaries and benefits that are comparable to 

those offered by private employers. Although the salaries and benefits are more competitive 

in rural areas, the BOP is challenged with finding medical staff willing to live in remote areas. 

The BOP uses some incentives such as periodically increasing employee pay, paying relocation 

expenses, and offering to a pay a portion of student loans. Nevertheless, as of August 2014, 

only 84 percent of the BOP’s medical doctor positions were filled, which is below the BOP’s 

goal of 90 percent. 

29 This medical center had two physician vacancies, two mid-level practitioner 

vacancies, and several nurse vacancies open at the time of our fieldwork. 

30 The BOP’s Assistant Director for Health Services and Medical Director told us that in 

November 2014 the BOP launched a survey of inmates in all BOP institutions to assess 

inmates’ access to healthcare. He told us that once the survey is complete, the Health 

Services Division will analyze the results by institution. For institutions where inmates report 

delays in receiving care, the BOP will try to determine the underlying causes of delay at each 

institution in order to develop potential responses. 

17
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2010 and had yet to receive them.31 He said this makes it extremely hard to 

eat because he cannot chew food. 

Additionally, the lack of an adequate number of health services staff 

increases the need for outside care. A Case Manager told us that the lack of 

health services staff at his institution has led to more emergency trips to 

hospitals outside the institution because the institution does not have a 

Physician Assistant to address medical needs. We also found that trips to 

outside medical providers are often limited by the availability of Correctional 

Officers to escort inmates. According to BOP policy, correctional staff is 

required to escort inmates to outside medical appointments.

32 The limited 

availability of Correctional Officers restricts aging inmates’ access to medical 

care outside the institutions, and institution staff told us that, as a result, 

there are waitlists to send inmates to outside medical specialists. 

Using BOP data from one institution, we found that the average wait 

time for inmates, including aging inmates, to be seen by an outside medical 

specialist for cardiology, neurosurgery, pulmonology, and urology to be 

114 days. The wait time at this institution increased to 256 days for those 

inmates waiting to see outside specialists for additional or routine 

appointments.33 The Assistant Health Services Administrator at this 

institution told us that there was no doctor at the institution and, while staff 

used to be able to send inmates on 10 medical trips per day, the institution 

now has the staff to provide only 6 planned trips and 2 emergency trips per 

day. We found similar difficulties staffing outside medical trips at other 

institutions. The Associate Warden at one institution told us his staff can 

accommodate 6 trips to outside medical specialists per day, even though the 

inmate population requires 8 to 10 trips per day. We also noted that outside 

medical trips depend on appointment availability and that, while an 

institution may be able to provide the necessary number of medical trips per 

week, specialists in the community must also be available and willing to see 

an inmate. 

We additionally found that the management of outside medical care 

waitlists affects the medical care provided to aging inmates. Specifically, we 

were provided examples of inmate appointments not being rescheduled when 

canceled, being rescheduled when the appointment had already taken place, 

31 Inmates with dental problems, such as abscesses, that could cause harm if left 

untreated, receive priority for dental appointments. The BOP’s Assistant Director for Health 

Services and Medical Director told us that the BOP has also initiated a National Dental Waiting 

List so that inmates awaiting dental care do not fall back to the end of the list if they are 

transferred to a different institution. 

32 BOP, Escorted Trips, Program Statement 5538.06 (August 29, 2014). 

33 Only one institution tracked waitlist times, and we requested this data from the 

BOP. Based on the data available to us, we could not determine how much of the delay in 

receiving outside medical care is due to limited staffing and how much is due to limited 

availability of appointments with specialists. 

18
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or not being scheduled at all. A Health Services Administrator told us that 

inmates who are on waitlists for outside medical care can “fall through the 

cracks” if their appointments are canceled and not rescheduled. An aging 

inmate told us that he was sent outside the institution for a medical 

appointment and 2 months later was rescheduled for the same medical need. 

When he brought the issue to the Clinical Director, he was told that it was 

just an appointment reminder. However, the inmate told us that he believes 

staff did not realize he had already been seen. Another aging inmate told us 

that at the time of our interview he had been waiting 2 years to be taken 

outside his institution for an examination to receive eyeglasses and had 

resorted to using a magnifying glass in the meantime. 

The availability and purpose of inmate companion programs used to help 

aging inmates accomplish their activities of daily living vary by institution 

All inmates are expected to perform activities of daily living, including 

dressing, cleaning their cells, and moving around within the institution. 

However, staff told us that aging inmates often cannot perform these 

activities on their own because of their medical conditions and staff is not 

responsible for ensuring inmates can accomplish these activities. Some 

institutions we visited have established local inmate companion programs to 

address the increasing number of aging inmates who need assistance with 

these activities. These programs utilize healthier inmates to provide support 

to inmates, including aging inmates, who experience difficulty functioning in 

a correctional environment. 

Institution staff we interviewed found their local inmate companion 

programs beneficial to both aging inmates and staff. For example, a Health 

Services Administrator described to us an aging inmate with dementia and 

Alzheimer’s disease who needed increased resources and attention. In this 

case, an inmate companion served as staff’s “eyes and ears,” alerting them 

to changes in the inmate’s behavior. A Counselor told us he does not know 

how he would manage the unit without the assistance of inmate companions. 

However, not all institutions have inmate companion programs. At one 

institution without an inmate companion program, an Assistant Health 

Services Administrator told us that aging inmates typically pair with a friend 

or cellmate for assistance. A Health Services Administrator at another 

institution said that inmates who cannot perform their activities of daily living 

and require daily or weekly assistance beyond what the inmate companions 

there are trained to provide are referred for transfer to an institution that can 

meet their needs.34 

34 Inmates needing a medical transfer had been waiting for an average of 1–2 months 

in October 2014. We further discuss issues regarding transfers for medical reasons below. 

19
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Also, the implementation of inmate companion programs varies by 

institution, particularly between nonmedical institutions and medical centers. 

For example, medical centers had local policies and position descriptions 

establishing expectations for inmate companions. Inmate companions at one 

medical center are expected to work in contact with bodily fluids and to help 

care for inmates suffering from chronic and acute diseases. They also 

provide assistance with moving inmates within an institution, feeding, 

answering patient call lights, and changing diapers. However, at nonmedical 

institutions, including those with high percentages of aging inmates, inmate 

companion programs have no policies or job descriptions. Instead, inmate 

companions are often referred to as “wheelchair pushers” because their 

primary responsibility is to help inmates confined to a wheelchair travel 

within an institution. Staff at two institutions we visited said they use inmate 

companions only as part of their institution’s suicide prevention programs. 

An Associate Warden told us that each of the eight institutions where he has 

worked implemented its local inmate companion program differently. We 

found other differences between how institutions implement inmate 

companion programs, including: 

•	 Training: At some institutions we visited, inmate companions are 

provided training on medical safety standards, confidentiality, listening 

skills, and job expectations. However, training at other institutions is 

less extensive. For example, at one institution where inmate 

companions are utilized as wheelchair pushers, inmate companions 

complete 1 day of training on wheelchair ergonomics and safety 

precautions. At another institution, there is no formal training for 

wheelchair pushers. 

•	 Selection: Each institution we visited that had an inmate companion 

program selected inmates who were considered responsible and had 

few misconduct incidents. Institutions with more robust programs also 

require inmate companions to meet specific selection criteria, such as 

having passed a General Education Development (GED) test. 

•	 Compensation: At institutions we visited, inmate companion pay 

varied based on companions’ levels of responsibility. For example, a 

Counselor at an institution where inmate companions have more 

responsibility told us that most companions are paid $40 a month. A 

Case Manager at an institution where inmates have less responsibility 

told us that companions are paid $5 to $7 a month. 

•	 Oversight: One institution with a local inmate companion policy 

developed a committee of nursing staff and selected inmate 

companion representatives to oversee the program. The committee 

reviews inmate companion assignments, develops plans of care, and 

identifies training needs. At another institution, where the program 

20
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

does not operate out of the health services or nursing departments, 

unit teams informally manage the inmate companions.35 

According to institution staff and inmates, despite the benefits of and 

need for inmate companion programs, aging inmates face risks when these 

programs are inconsistently implemented. An aging inmate told us that most 

inmate companions really try to help, but sometimes companions take 

advantage of aging inmates. For example, a Supervisor of Education told us 

about an inmate who had an inmate companion who was threatening the 

inmate’s wife and forcing her to send money in return for the inmate’s 

protection. The inmate told the Supervisor that it had been going on for a 

long time but that he had been unable to tell institution staff because the 

companion accompanied him everywhere, including to personal meetings 

with staff. Institution officials and staff said that the inmate companion 

program should be a standardized national program, with a program 

statement establishing policies that hold inmate companions accountable for 

their responsibilities. At one institution with program guidelines, inmate 

companions are expected to sign the guidelines, acknowledging they will 

abide by program rules. If a companion violates any of the guidelines, the 

inmate companion committee conducts a misconduct review. Without the 

protections or oversight of national guidelines, however, each institution can 

run the program inconsistently. 

Social Workers are uniquely qualified and trained to address the needs of 

aging inmates, particularly with release planning, but few institutions have 

Social Workers 

We found that Social Workers are a great benefit for aging inmates. 

While Case Managers, Counselors, Social Workers, and other institution staff 

work in concert to prepare inmates for release, only Social Workers have 

extensive training in addressing the unique needs of aging inmates. Licensed 

Social Workers can proficiently help with aftercare planning, resource 

brokering, and medical continuity of care during reentry. A Social Worker 

told us that they help aging inmates with accessing medical services and 

equipment in the community upon release. 

However, relatively few institutions have Social Workers. Specifically, 

as of November 2014, there were only 36 Social Workers throughout all of 

the BOP’s institutions. A Social Worker told us that at her institution there 

are approximately 1,000 inmates for every Social Worker. Another Social 

Worker told us that because there are so few Social Workers, he has to 

prioritize the inmates he helps based on their more difficult problems and 

35 The unit teams consist of a Unit Manager, Case Managers, Correctional Counselors, 

Unit Secretaries, Correctional Officers, an Education Advisor, and a Psychologist who work with 

all inmates assigned to live in a particular housing unit. The unit team directly observes an 

inmate’s behavior and can make recommendations in programming areas. 

21
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

greater reentry needs, limiting his ability to assist all inmates, including 

aging inmates.36 Although the BOP employs six Regional Social Workers to 

assist institutions that do not have a Social Worker, they are limited in 

availability because each of them is responsible for between 15 and 

17 institutions. We reviewed the BOP’s Community Release Planning 

Guidelines for Social Work and found that it did not define any duties for 

regional Social Workers that were distinct from the duties for institution 

Social Workers. BOP institution staff told us that regional Social Workers 

provide resources so that institution staff can work with individual inmates. 

We also found that the lack of availability of Social Workers within BOP 

institutions hinders the BOP’s ability to effectively prepare aging inmates to 

reenter society because other BOP staff do not have the training unique to 

Social Workers. A Case Manager at an institution with Social Workers told us 

that she relies on Social Workers because they know things she does not, 

such as the “ins and outs” of applying for Social Security benefits. A Case 

Management Coordinator at an institution without Social Workers said that 

he has to try to find resources on the internet to assist aging inmates in 

applying for Social Security. Staff at institutions without a Social Worker also 

told us about the benefits a Social Worker would bring to their institution, 

including addressing issues related to halfway house placement, explaining 

eligibility for benefits to many uninformed or confused aging inmates before 

they are released, and removing some of the burdens placed on Case 

Managers. 

Recognizing the benefit that Social Workers play in helping inmates 

prepare for release, the BOP recently approved and budgeted for the hiring 

of seven additional Social Workers to be assigned to 5 correctional 

complexes, 1 medical center, and 1 female institution. 

Institution staff is not adequately trained to identify the signs of aging, which 

mistakenly can be viewed as reflecting disciplinary issues rather than a need 

for medical or mental healthcare 

The BOP provides brief, limited training for institution staff on 

recognizing the signs of aging in its Annual Refresher Training, which states 

that the significant increase in aging inmates requires staff to contend with 

increased mobility issues, terminal illness, and cognitive impairments. The 

training includes ways staff can be aware of changes in aging inmates and 

provide increased monitoring to help with inmates’ cognitive and physical 

deterioration. The training further elaborates on aging inmates’ 

36 In October 2014, the BOP released Community Release Planning Guidelines for 

Social Work (Guidelines) to assist inmates in identifying necessary community resources for 

release planning. While these Guidelines identify Social Workers as a resource for inmate 

release planning, Social Workers are currently available only at Care level 3 and 4 institutions, 

making their availability to Care level 1 and 2 inmates limited. 

22
 
 

 

 

 

 

 

 

vulnerabilities, such as being forgetful, losing track of time, taking longer to 

complete tasks, not being able to follow directives, and having increased 

physical stress. The training also informs participants that aging inmates will 

require time and understanding to acclimate to an institutional environment. 

However, the Annual Refresher Training Instructor Guide states that training 

on signs of aging as well as medical emergencies can be completed in 

30 minutes. 

The Assistant Director for Human Resources told us that the BOP 

currently trains all staff to meet the local needs of its population and that, as 

a result, staff at Care Level 3 and 4 institutions should be able to recognize 

mobility issues and make necessary accommodations. However, we found 

that inmates in Care Level 2 institutions also have mobility issues that would 

require staff to recognize and accommodate those and other health issues in 

aging inmates. For example, an anemic, wheelchair-bound aging inmate at a 

Care Level 2 institution told us that he was disciplined several times for 

pushing himself inside a building to wait for his medication rather than 

waiting outside, including in cold weather, to receive it. 

In March 2010, the BOP’s National Institute of Corrections (NIC) 

released a training video on aging inmates, aimed at officials running state 

and local institutions, which said that the most critical step institutions could 

take to address an aging inmate population is staff training. According to the 

video, training is important to help staff understand that aging inmates may 

have a medical reason that explains behavior that would otherwise be 

subject to discipline, such as an aging inmate who is in the wrong place 

because he has dementia. Institution staff with whom we spoke agreed that 

this type of training at the BOP would be helpful and provided us examples. 

A Case Manager described to us how she once asked an inmate several 

questions and received strange responses. She said she thought the inmate 

was trying to “fool her,” but she later learned that the inmate had medical 

conditions that prevented him from responding. She said training on how to 

recognize behaviors resulting from dementia or other debilitating conditions 

would be helpful. A Social Worker also said staff should be trained to 

understand the behaviors associated with dementia. The Assistant Director 

for the Health Services Division and Medical Director said that the BOP has 

started to put more into annual training regarding officer sensitivity but that 

the BOP should permanently incorporate training specifically for the care of 

aging inmates across the institutions. 

The physical infrastructure of BOP institutions cannot adequately 

house aging inmates 

The BOP’s mission includes confining federal offenders in controlled 

environments that are safe, humane, cost-efficient, and appropriately secure. 

However, the BOP’s ability to confine its aging inmate population is 

insufficient due to overcrowding in its institutions, as well as problems with 

23
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

their internal and external infrastructures. Lower bunks, essential for 

accommodating aging inmates with mobility limitations or medical conditions, 

is limited by the overcrowding of BOP institutions. As a result, institutions do 

not always have enough lower bunks as well as handicapped-accessible cells 

and bathrooms, and others cannot accommodate the number of inmates with 

mobility devices that require elevators. Further, aging inmates cannot 

consistently navigate the narrow sidewalks and uneven terrain at some 

institutions. Staff and inmates told us that separate housing units, or entire 

institutions, would be more appropriate to house aging inmates. 

Lower bunks are limited due to the overcrowding of BOP institutions 

According to BOP staff and officials, aging inmates generally require 

lower bunks because of their physical limitations and risk of falling. 

However, BOP institutions are consistently overcrowded, limiting the number 

of available lower bunks.37 Several officials and staff told us that their 

institution has run out of lower bunks for aging inmates. We found that the 

lack of sufficient lower bunks affects aging inmates in several ways. 

First, the lack of lower bunks may prevent or delay aging inmates from 

receiving lower bunks. Consequently, aging inmates may be housed in upper 

bunks until a lower bunk becomes available. For example, a Warden told us 

that aging inmates are sometimes assigned to an upper bunk out of 

necessity, which could be a problem for aging inmates because climbing into 

an upper bunk is not always easy. During our visits to BOP institutions, we 

observed upper bunks that did not have ladders or steps, which required 

inmates to climb on desks, chairs, or makeshift pedestals to access the upper 

bunks. 

Second, the lack of lower bunks has forced institutions to retrofit other 

space to create additional lower bunks. A Supervisor of Education told us 

that her institution was unable to accommodate all of the inmates who 

needed lower bunks. As a result, the institution had to add beds to a room 

not originally intended for housing. We also found that institutions modified 

or added lower bunks within existing housing cells to accommodate aging 

inmates and inmates with mobility limitations, including retrofitting two-man 

cells or “cubes” to hold three inmates. A Case Manager told us that while 

many three-man cells are composed of one double bunk and one single 

bunk, her institution created some triple-level bunk beds in which both the 

middle and bottom bunks are considered “lower bunks.” She also told us she 

observed inmates with histories of seizures and high blood pressure receiving 

middle bunks, which she said could create a liability for the BOP if the 

inmates were to fall. 

37 In FY 2013, the BOP as a whole operated at 36 percent over capacity and aging 

inmates represented the fastest growing segment of the BOP’s population. 

24
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Finally, the lack of lower bunks requires staff to regularly reassign 

lower bunks by prioritizing and reorganizing bed assignments, which 

sometimes creates tension among the inmates being moved. Specifically, 

institution staff told us that managing lower bunks can be a very difficult, 

time-consuming endeavor and that it often takes a collaborative effort 

between inmates and staff from other units to accommodate aging inmates. 

A Counselor told us that trying to find a lower bunk is comparable to “finding 

a needle in a haystack.” Moreover, accommodating aging inmates with lower 

bunks has repercussions. Staff from institutions across all security levels 

described to us situations in which moving a younger inmate to an upper 

bunk to accommodate an aging inmate created tension or animosity within 

the housing unit. In one case, a Counselor told us that the tension from 

assigning a younger inmate from a lower to an upper bunk led to an assault. 

To help manage lower bunks, institution medical staff issues lower 

bunk passes to those inmates who meet criteria in a memorandum issued in 

June 2012 by the Assistant Director of the BOP’s Health Services Division. 

The memorandum, entitled “Lower Bunk Criteria,” standardizes the 

assignment of lower bunks across the BOP by providing specific medical 

criteria for institution medical staff to consider before assigning a lower 

bunk.38 However, several nonmedical institution staff told us that lower bunk 

passes are given to inmates who do not need them. One Counselor said that 

there is a disconnect between medical and nonmedical staff concerning 

inmates’ needs for lower bunk passes. We found that other institutions faced 

similar circumstances and issued lower-bunk passes exceeding the 

availability of lower bunks. A Health Services Administrator told us that his 

institution was operating at maximum lower-bunk capacity at all times and 

provided us with a document that showed 452 inmates had lower bunk 

passes at that time while the institution had only 444 lower bunks. 

Overcrowding also limits the BOP’s ability to move aging inmates to the 

institutions that best address their medical needs 

The BOP primarily utilizes its Care Level 3 and 4 institutions to house 

inmates with the most significant medical issues. The BOP’s Care Level 3 

institutions treat inmates with medical conditions that require daily to 

monthly outpatient clinical contact. These inmates may also require 

assistance in some activities of daily living. But, we found that inmates 

needing a transfer to a Care Level 3 institution may be temporarily housed in 

38 The memorandum identifies a range of specific medical conditions for which a lower 

bunk pass is recommended, including but not limited to orthopedic conditions, neurological 

conditions, blood-clotting problems, balance problems, pregnancy, and obesity. The 

memorandum does not specify at what age an inmate should receive a lower bunk. However, 

staff told us they attempt to assign lower bunks to inmates by age, which varied by institution. 

At one institution, the Health Services Administrator stated that he always places inmates over 

the age of 70 on lower bunks. A Counselor at a different institution said that the majority of 

inmates over the age of 55 are in lower bunks. 

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the receiving institution’s Special Housing Unit while waiting for an available 

bed.39 A Medical Designator in the BOP’s Office of Medical Designations and 

Transportation told us that when an inmate is being transferred due to 

medical needs, the BOP may decide to transfer the inmate as quickly as 

possible, even if that means the inmate has to be assigned to the Special 

Housing Unit until a bunk in the general population becomes available. An 

Assistant Health Services Administrator and a Case Manager at a Care 

Level 3 institution confirmed that their institution has sometimes placed 

aging inmates in their institution’s Special Housing Unit until a bunk became 

available elsewhere in the institution. 

Access to the BOP’s Care Level 4 institutions, which comprise the 

BOP’s six medical centers, is determined, in part, by the availability of bed 

space, and we found that transfers to these institutions are often difficult to 

complete in light of overcrowding. Inmates waiting for transfer to a BOP 

medical center must remain in their institution’s general population until a 

bed becomes available or their condition worsens. A Health Services 

Administrator told us that inmates waiting for transfer place a huge strain on 

staff because his institution does not have an infirmary. A Case Manager told 

us that space is at a premium at the medical centers and if an inmate’s 

condition is not an emergency most inmates will wait 2–3 months for a 

transfer. We asked the BOP for all data on pending medical transfers and 

found that in October 2014 two inmates awaiting an emergency transfer had 

been waiting on average 11 days, inmates awaiting a routine urgent transfer 

had been waiting an average of 31 days, and inmates awaiting a routine 

transfer had been waiting an average of 57 days.40 If an inmate’s condition 

worsens, he is sent to a local hospital at government expense until the BOP’s 

Office of Medical Designations and Transportation can approve his transfer to 

a medical center. 

A Medical Designator in the Office of Medical Designations and 

Transportation said that institution staff is always inquiring about the wait 

period for transfer, often requesting that inmates be transferred sooner. 

However, because transfers depend on the availability of bed space, inmates 

are placed in a queue and have to wait for a bed to become available in a 

BOP medical center. A Health Services Administrator at a medical center told 

us that one of her biggest concerns is delaying care for inmates who need to 

39 A Special Housing Unit is a separate unit used to segregate inmates in 

administrative detention status or disciplinary segregation status from the rest of the inmate 

population. Inmates can be in administrative detention status for a variety of reasons, 

including a pending transfer to another institution or a need for protection from the general 

population. Inmates in disciplinary segregation status are being punished for violating 

institution rules. See 28 C.F.R. §§ 541.20–541.24. 

40 Routine urgent transfers occur for medical conditions such as operative wound care 

and dialysis. Routine transfers occur for medical concerns such as poor medication compliance 

or for further evaluation pending surgery approval. 

26
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

transfer to her institution but cannot do so because there are no available 

beds. 

Institutions have difficulty accommodating inmates requiring handicappedaccessible facilities 

All BOP institutions are required to comply with the Architectural 

Barriers Act of 1968, which requires that public buildings and infrastructure 

be accessible to individuals with disabilities, including handicapped-accessible 

hallways, doors, and cells.41 The specific guideline addressing institutions 

and cells states that “accessible cells or rooms should be dispersed among 

different levels of security, housing categories, and holding classifications to 

facilitate access.” Officials from the BOP’s Administrative Division said each 

institution is built to meet all accessibility standards that were in place at the 

time of its construction, with newer institutions being more accessible than 

older institutions. However, the Deputy Chief from the BOP’s Design and 

Construction Branch told us that some BOP institutions were built over a 

century ago and many continue to have accessibility difficulties even after 

retrofitting and renovation. A Case Manager at a medical center told us that 

the institution is old and that many of the units cannot house wheelchair 

inmates because they do not have wide enough doors. Also, BOP officials 

and staff told us that the infrastructure of more recently built institutions was 

not designed to handle the number of aging and handicapped inmates who 

are housed in these institutions. 

The BOP’s care level system has led to higher concentrations of aging 

inmates in institutions with higher care levels and more inmates needing 

handicapped-accessible infrastructure than the institutions were designed to 

handle. During our visits to BOP institutions, we found a number of 

infrastructure difficulties that limit the BOP’s ability to provide appropriate 

accommodations to house aging inmates, particularly those with physical 

disabilities. Institution staff expressed similar concerns regarding the 

accessibility of housing units. Due to housing limitations, inmates using 

wheelchairs and walkers are often housed together, creating cells with very 

limited space. In one case, a Social Worker observed a cell that housed two 

wheelchair inmates together where the wheelchairs had to be placed outside 

the room because the cell could not accommodate both wheelchairs. We 

were also told that when multiple inmates with physical disabilities are 

housed in the same unit their wait time for the limited number of accessible 

showers and bathrooms increases. An aging inmate told us that his unit 

houses approximately 160 inmates, with only one handicapped-accessible 

toilet. A second inmate in the same unit confirmed that, as a result, he often 

sees wheelchair-bound inmates waiting in line for that toilet because the rest 

of the toilet stalls are too narrow to accommodate wheelchairs. 

41 42 U.S.C. §§ 4151–4157. 

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We found that institutions also have difficulty accommodating the 

growing number of aging inmates who need elevators. A Case Manager told 

us that many units could not house aging inmates with mobility issues, 

particularly those who require a wheelchair, because the units lack elevators. 

In these cases, inmates with mobility issues are housed in the same unit, 

increasing the use of elevators to that unit. Staff at several institutions said 

that as a result, a common problem is frequent elevator outages, which may 

take days to be repaired. A Social Worker told us that she observed inmates 

walking down stairs with walkers because elevators were broken. We found 

that some institutions had handicapped-accessible cells and lower bunks that 

could be accessed only by stairs, and therefore aging inmates who may need 

the additional space provided in handicapped cells have to climb stairs to 

reach the larger cells or be placed in a regular-size cell within the general 

housing unit. At one institution we visited, staff and inmates told us that 

aging inmates with mobility issues sometimes have to walk up stairs to the 

second floor to access their lower bunk. One inmate told us that sometimes 

inmates with walkers remain assigned to an upstairs housing unit for weeks 

until space becomes available on the bottom floor. Staff from another 

institution told us that their institution was not handicapped accessible 

because inmates have to navigate steps in order to reach their cells. 

Inmates who cannot climb stairs cannot be housed at the institution and 

must be transferred to a nearby BOP institution. 

Institutions have the authority to pay for their own maintenance and 

small renovation projects. We found that one institution had to retrofit 

education space to create a wheelchair repair shop due to the number of 

wheelchair-bound inmates. However, an institution cannot spend more than 

$10,000 of its own funding on renovations and larger projects have to be 

coordinated with their regional office or the BOP’s Central Office. The Chief 

of the BOP’s Facilities Programs told us that institutions rarely submit 

proposals to the BOP’s Central Office for major renovations to make housing 

units more accessible. 

We also found that from 1994 to 1996 the BOP inspected all 

institutions to evaluate their accessibility for inmates with mobility 

impairments and funded recommended renovations based on those 

inspections. For example, an inspection in one institution found that the 

medical and dental areas were accessible only by stairs. As a result, the 

institution had an elevator installed in that area to make it accessible for 

inmates with mobility issues. The Chief of the BOP’s Facilities Program 

stated that all high-priority and some of the medium-priority renovations 

were completed but that renovations funded by the Central Office stopped 

prior to addressing the lowest priorities. We were also told that the BOP has 

not conducted another BOP-wide review of the accessibility of all institutions 

since 1996. 

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External infrastructure, including narrow sidewalks and uneven terrain, 

present difficult and sometimes unsafe conditions for aging inmates to 

navigate 

We found that the conditions of the external infrastructure of some 

institutions, such as uneven terrain or narrow sidewalks, makes it difficult 

and sometimes unsafe for aging inmates, particularly those with mobility 

issues, to move within the premises. A Clinical Director said some housing 

units are far from the cafeteria, on uneven terrain, and become dangerous in 

snow or inclement weather. In addition, a Counselor told us that the visiting 

room at his institution is at the top of a hill and wheelchair-bound inmates 

have to use a service road to access the visiting room, rather than the stairs 

the other inmates can use. Further, many of the handicapped inmates at 

this institution are located at the bottom of a hill because that is where the 

only handicapped-accessible units are located. An inmate at this institution 

also told us that the sidewalks are narrow and do not allow enough space to 

accommodate inmates in a wheelchair.42 Additionally, a Warden at another 

institution told us that the housing units at his institution are on a hill, which 

makes it harder for aging inmates in wheelchairs and walkers to move about. 

He said that while the institution was built less than 20 years ago, it was not 

built to accommodate the number of aging inmates in wheelchairs and 

walkers currently housed there. To address challenges associated with an 

institution’s external infrastructure, we found that in some cases institution 

staff would move aging inmates to housing units that are closer to common 

areas to shorten walking distances. However, as described above, bed space 

and accessible areas are often limited and not all aging inmates can be 

placed in accessible areas. 

According to BOP staff and officials, separate units, or entire institutions, 

would be more appropriate to house aging inmates 

The BOP does not provide specialized housing units based on age. 

Some staff told us that the current system of having housing units contain a 

mix of ages enables aging inmates to mentor younger inmates and that the 

presence of aging inmates in general improves the behavior of the entire 

inmate population. The BOP operates a number of segregated or specialized 

housing units, including units for inmates under administrative detention or 

disciplinary segregation and units to provide programming and treatment for 

sex offenders, drug offenders, and inmates diagnosed with mental health 

conditions. The BOP’s Assistant Director for Health Services and Medical 

Director told us that BOP officials have discussed the possibility of similarly 

housing aging inmates together. However, he said that doing so would 

42 During our visit to this institution, staff showed us how wheelchairs take up nearly 

the entire width of sidewalk and explained that not only was this unsafe for inmates in 

wheelchairs, it was also problematic for other inmates since they are not permitted to walk on 

the grass. 

29
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

require “a real trade-off” because it would require the BOP to house many 

aging inmates farther away from their families.43 

However, other staff and inmates provided several reasons why 

separate units, or entire institutions, would be more appropriate to 

accommodate the increasing population of aging inmates. For example, and 

as described above, the internal and external infrastructures of institutions 

often limits the BOP’s ability to safely confine its aging inmate population. A 

Unit Manager suggested that given the number of aging inmates at his 

institution, the BOP should retrofit an entire building dedicated to 

accommodating aging inmates who need lower bunks that are strategically 

located in areas easily accessible to certain institution services, such as 

healthcare. A Clinical Director told us that the BOP should create a separate 

institution for aging inmates with an “aging-friendly infrastructure” in a 

location that has flat terrain. Additionally, a Counselor told us that having 

aging-inmate units with dedicated, round-the-clock nursing support could cut 

down on medical costs because a nurse could consistently help with their 

chronic health issues. The Assistant Director for the Administration Division 

said that requests for geriatric units and institutions have been made before, 

and that he would “love” to have these units if it did not require costly 

construction. 

In addition, BOP officials and staff told us that separate housing units 

or institutions would provide safer housing for aging inmates who may be 

more susceptible to being victimized by younger inmates. While we were 

told that younger inmates often respect aging inmates, we were also told 

that younger inmates sometimes victimize aging inmates.

44 For example, a 

Unit Manager in a Care Level 3 institution told us that his institution receives 

aging inmates directly from a BOP medical center and houses them in the 

general population. He said this is an unsafe practice because they are 

vulnerable to being victimized when surrounded by younger inmates. 

The BOP does not provide programming opportunities specifically 

addressing the needs of aging inmates 

All BOP institutions offer programs and activities for inmates to further 

their education, obtain vocational and occupational training, practice their 

religion, enhance interpersonal and life skills, and participate in recreation 

43 The BOP considers incarceration close to family members an important aspect of an 

inmate’s rehabilitation and therefore attempts to place inmates in institutions that are within 

500 miles of the release area, especially when an inmate is within 36 months of release. 

44 We requested data from the BOP on incidents where aging inmates were victimized 

by younger inmates, but we were informed that the BOP does not keep statistics in this 

manner. 

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and leisure activities.45 However, there are no programs, and limited 

activities, that specifically address the needs of aging inmates, many of 

whom have already obtained an education or do not plan to seek further 

employment once released. Aging inmates who want to participate in 

programs face obstacles, including having already completed all the 

programs available at an institution. Institution officials and staff told us that 

the lack of programming and activities specifically designed for aging inmates 

makes them more likely to be idle and not participate in any activities or 

programs at all. Finally, general release preparation programs do not 

address the unique release programming needs of aging inmates. 

There are no programs, and limited activities, specifically designed or 

appropriate for aging inmates 

All BOP institutions are required to provide GED classes, as well as 

English as a Second Language, Adult Continuing Education, and parenting 

classes, and to have a library.46 The BOP also offers programs with 

standardized curricula in multiple institutions for residential and 

nonresidential drug treatment, psychological treatment, occupational 

education classes that teach trade skills, and work through Federal Prison 

Industries, or UNICOR.

47 In addition, institutions have the flexibility to 

develop local programs. 

At the outset of our review, the BOP told us that there are no 

programs specifically designed for the needs of aging inmates but that aging 

inmates participate in standardized programs and local programs. The 

Assistant Director of Correctional Programs said there are no programs set 

aside for inmates of a particular age and that everything is based on inmate 

need rather than age. A Supervisor of Education also told us there are no 

age-specific programs but there are activities such as music appreciation and 

45 Programs are formal educational opportunities, with start and end dates, required 

attendance, a curriculum, and measurable achievement standards. Activities are less formal 

events, including one-time events and sports or game tournaments, in which inmates can 

participate for recreation. 

46 Detention centers, metropolitan correctional centers, and the Oklahoma City 

Federal Transfer Center are exempted from providing programs beyond these minimal 

requirements. Additionally, satellite camps (minimum-security camps next to a larger, 

higher-security institution) are exempt but more programs are available at the higher-security 

institutions to which the camps are attached. 

47 Federal Prison Industries, commonly referred to by its trade name UNICOR, is a 

wholly owned government corporation whose mission is to employ and provide job skills 

training to the greatest practicable number of BOP inmates and produce market-priced quality 

goods and services for sale to the federal government with minimal impact on private business 

and labor. See http://www.bop.gov/inmates/custody_and_care/unicor.jsp. See also DOJ, 

OIG, Audit of the Management of Federal Prison Industries and Efforts To Create Work 

Opportunities for Federal Inmates, Audit Report 13-35 (September 2013), 

http://www.justice.gov/oig/reports/2013/a1335.pdf (accessed April 9, 2015). 

31
 
 

 

 

 

 

 

 

 

 

 

 

 

 

exercise courses that aging inmates gravitate toward. We reviewed the 

BOP’s Directory of National Programs and found that the BOP has 

18 standardized programs but none specifically addressing the needs of 

aging inmates. Finally, when we asked BOP officials and staff whether aging 

inmates had different needs than younger inmates, they cited different 

physical needs but did not cite different programming needs related to age. 

Institution staff told us that they frequently recommend the BOP’s 

standard parenting class to aging inmates because many of them have adult 

children and grandchildren. However, we found that this program had one of 

the lowest rates of aging inmate participation. According to BOP data, only 

11 percent of inmates who participated in the parenting program in FY 2013 

were aging inmates. Overall, we found that aging inmates participated in 

only two of the BOP’s eight largest standardized programs at rates equal to 

or higher than their percentage of the overall BOP population. (See Figure 4 

below.) 

Figure 4 

Aging Inmate Participation in the BOP’s Largest Programs, FY 2013 

0% 

5% 

10% 

15% 

20% 

25% 

Percentage of Participation 

Program --- BOP Aging Population 

Note: The figure includes only those programs that had more than 10,000 inmate 

participants in FY 2013. Adult Continuing Education was the largest program, with 

71,235 participants, including 13,693 aging inmates. 

Source: BOP program participation data. 

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BOP officials and institution staff also suggested local health and 

wellness programs for their aging inmates because aging inmates often have 

health concerns. We were unable to evaluate aging inmate participation in 

these programs because inmate participation in local programs is tracked 

only at the local level and we were told that the programs offered vary by 

institution. 

Although BOP officials and staff told us that programs do not focus on 

inmate age, we found one that the BOP created exclusively for younger 

inmates. The Bureau Rehabilitation and Values Enhancement (BRAVE) 

program is designed for medium-security male inmates who are 32 or 

younger, have a sentence of at least 60 months, and are beginning their first 

federal sentence. The BOP describes the program as helping inmates adjust 

to incarceration and reducing their incidents of misconduct. In FY 2013, not 

more than 2,580 inmates met the criteria for the BRAVE program.48 

Meanwhile, in FY 2013, there were 30,962 aging inmates for whom no 

specific programs existed. 

While institutions have the flexibility to create programs that could address 

aging inmates’ needs, few have such programs 

According to the BOP, each institution can assess where its inmates’ 

interests lie and offer programs and activities that appeal to the interests and 

needs of its population. However, despite having the flexibility to develop 

and offer local institution programs, we found that even institutions with a 

high percentage of aging inmates did little to identify the unique 

programming needs of aging inmates who already have an education or job 

skills and to provide programs to address their unique needs. A Supervisor 

of Education said that age has a big impact on the types of programs inmates 

participate in because aging inmates are less likely to participate in physically 

demanding activities. Staff at the institutions we visited told us that their 

institutions could do more for the aging inmates and that if programs for 

aging inmates were offered, those inmates would be more interested in 

participating. For example, a Reentry Coordinator told us his institution held 

a health fair for inmates of all ages and found it was popular with aging 

inmates because it gave them the opportunity to learn about age-related 

diseases. A Case Manager suggested to us that the BOP should survey its 

aging inmates to determine what additional programming they would like to 

see. Other staff said the BOP should implement programs similar to those 

offered at nursing homes or community senior centers, such as disease 

awareness and therapy. Aging inmates described to us a number of 

additional programs that would meet their needs, including a wider variety of 

48 We could not determine from BOP data how many inmates were serving their first 

federal sentence, but we could determine that there were 2,580 medium-security male 

inmates age 32 or younger who began serving sentences of 60 months or more during 

FY 2013. BRAVE is offered at two institutions. 

33
 
 

 

 

 

 

 

 

 

 

 

 

 

computer classes, wellness classes on prolonging physical and mental health, 

foreign languages, college preparation or similar academic courses to keep 

their minds sharp, singing, and quilting. 

Aging inmates who want to participate in programs face obstacles 

We found that even when aging inmates are interested in participating 

in programs, their ability to participate can be hindered by a lack of programs 

that are new to them. Aging inmates at institutions we visited told us that 

the number of programs available was limited and rarely changed. Inmates 

at different institutions said that they participated in more programs at the 

beginning of their incarceration but had completed everything of interest to 

them after a few years, or that their institutions never offered programs that 

interested them. 

We also found that aging inmates might not participate in programs to 

avoid revealing their vulnerabilities or limitations to younger inmates. One 

Warden told us that some aging inmates ask to be exempt from GED classes 

because they do not want other inmates to discover they cannot read. An 

aging inmate at a different institution agreed, saying that she had seen 

inmates become discouraged and embarrassed in the GED classes because 

they were so far behind academically. 

Further, the Assistant Director for the Industries, Education and 

Vocational Training Division told us that the BOP has the responsibility to 

accommodate aging inmates’ physical needs so that their participation in 

programs is not limited. Some aging inmates have physical limitations that 

make program participation more difficult, and so some institutions have 

devised alternatives to facilitate program participation. For example, an 

Assistant Supervisor of Education told us that her institution had begun 

providing books from a local library as a substitute to attending classes for 

aging inmates who cannot physically leave their units. 

Activities designed specifically for aging inmates are limited 

BOP institutions are required to provide recreational activities for 

inmates to pursue in their free time. Institution staff told us they often 

recommended art, music, and hobby classes for aging inmates. Some of the 

aging inmates we spoke with participated in these and other low-impact 

activities such as reading in the library, playing cards or other games, and 

exercise such as walking on the track. However, in other cases, aging 

inmates who may want to participate in more physical activities cannot keep 

up with younger inmates. Overall, we found that a few of the institutions we 

visited considered age when designing activities, mainly by creating athletic 

leagues with varying age cutoffs to increase opportunities for aging inmates 

to participate. One institution we visited established a basketball league for 

inmates age 35 and older, while a second institution has a league for inmates 

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age 40 and older, and a third institution has a league for inmates age 50 and 

older. However, not all institutions offered age-specific athletic leagues. 

Beyond athletic leagues, only 1 of 13 institutions we visited offered an 

activity designed specifically for aging inmates: an aerobics and nutrition 

class for inmates age 65 and older, which was held at a BOP institution with 

one of the highest percentages of aging inmates. 

Due in part to the lack of programming and activities designed 

specifically for aging inmates, idling is a common sight in BOP institutions, 

according to institution officials and staff. However, one inmate told us that 

aging inmates do not idle by choice, but rather because there is nothing for 

them to do. Another inmate said that the aging inmates who idle seem to 

deteriorate mentally and become depressed. 

The BOP does not address the specific release needs of aging inmates 

Aging inmates often have different release needs than do younger 

inmates. We found that the BOP’s release preparation program focuses on 

workforce reentry and does not address the unique circumstances, such as 

finding new healthcare providers or collecting Social Security benefits, which 

apply to aging inmates. We also found that aging inmates’ increased 

healthcare needs can make transitioning into home confinement difficult.49 

Pre-release programs do not address the unique needs of aging 

inmates 

The BOP implements a release preparation program in all institutions 

to prepare inmates to reenter the community and the workforce in 

particular.50 Each institution designates a staff member to determine the 

release needs of the institution’s population and coordinate a release 

preparation program. The program consists of six core topics: health and 

nutrition, employment, personal finance, community resources, release 

procedures, and personal development, with each institution developing its 

own program to address each core topic. 

We found that institutions we visited provide release preparation 

information to every inmate on the same six core topics rather than tailoring 

the information to individual inmates or categories of inmates. For example, 

one of the six core topics in the release preparation program focuses on 

employment. However, release preparation programs do not consistently 

49 The BOP’s Home Confinement Program allows federal inmates to live at home and 

work at gainful employment while remaining in official detention status. To participate, 

inmates must be within the last 6 months or 10 percent of their sentence. 

50 BOP, Release Preparation Program, Program Statement 5325.07 (December 31, 

2007). The OIG is currently reviewing the BOP’s implementation of this program. See 

http://www.justice.gov/oig/ongoing/bop.htm (accessed April 9, 2015). 

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include assistance for those aging inmates who will not be employed after 

release. We found that programs that did include assistance for those aging 

inmates briefly discussed accessing Social Security or Veterans benefits, but 

did not include community reintegration. A Supervisor of Education told us 

that institutions have the responsibility to prepare inmates to rejoin their 

communities; but if an inmate’s role in that community will be as a retired 

person, his or her needs will greatly differ from someone reentering the 

workforce. 

Aging inmates told us that the information provided in release 

preparation programs was not helpful for them and that topics that would be 

helpful for their release were not discussed. For example, one inmate told 

us, “You have what they call core programs, such as learning to save money, 

learning to buy a house, and learning to bring up a family. I’m 67 and I have 

two houses. And I still have to [take these] programs? . . . [Aging inmates] 

don’t need to take that. We’ve already accomplished that.” Another inmate 

said that he worries about being released after retirement age and would like 

to have programs that prepare him for that future. “What’s going to happen 

when I step out at 70? Because if I live to be 70, I’m going to reenter 

society when I’m past the working age. So how will I survive? . . . What do I 

do with my medical issues? How am I going to provide for myself if there’s 

no family support?” 

Institution staff described to us several ways in which they believed 

BOP release preparation programs could be adapted to address aging 

inmates’ needs. For example, a Social Worker suggested that the BOP tailor 

life skills programs for different age cohorts so that younger inmates could 

learn how to search for jobs and live independently while aging inmates could 

learn how to apply for Social Security benefits and find assisted living 

communities. Institution staff also suggested that aging inmates be provided 

with updated information on life skills, such as online banking, and on health 

situations that people encounter as they age, such as managing blood 

pressure. 

Insufficient support and access to medical care may limit the 

placement of aging inmates on home confinement 

The BOP has the authority to assign inmates to home confinement for 

up to the final 6 months of their sentences.51 Although the population of 

aging inmates placed on home confinement is relatively small, aging inmates 

placed on home confinement increased 258 percent, from 161 to 

577 inmates, from FY 2009 through FY 2013.52 Institution staff told us that 

51 BOP, Home Confinement, Program Statement 7320.01 (September 6, 1995). 

52 During this time, the total number of inmates placed on home confinement 

increased 323 percent, from 382 inmates in FY 2009 to 1,616 inmates in FY 2013. 

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home confinement is a good option for many aging inmates. Specifically, 

institution staff said that as long as an inmate has the resources to pay for 

medical care, home confinement offers more flexibility in addressing his or 

her medical needs.53 

However, we were told that there are a number of obstacles, 

particularly concerning access to medical care, that limit the BOP’s ability to 

place aging inmates on home confinement. A Social Worker told us of an 

aging inmate with dementia who was released from a medical center into 

home confinement. The inmate returned just days later because he did not 

have sufficient support to live in his home. Subsequently, the inmate had to 

serve the remainder of his sentence in the medical center’s inpatient unit 

because his dementia could not be managed in the general population. 

Institution staff also expressed liability concerns because the BOP remains 

ultimately responsible for an inmate’s medical care while the inmate is on 

home confinement. The Assistant Director for Health Services and Medical 

Director said that the BOP has an obligation to link inmates being released to 

home confinement with healthcare providers in their communities but after 

that connection is made it is ultimately up to the inmate to visit the provider 

for care. He further said that inmates on home confinement are eligible to 

enroll in Medicaid, Medicare, or private insurance and that BOP Social 

Workers can help facilitate this enrollment.

54 

Aging inmates commit less misconduct while incarcerated and have a 

lower rate of re-arrest once released 

Based on BOP data and feedback from officials and staff, we 

determined that aging inmates engage in fewer disciplinary problems during 

their incarceration. For example, aging inmates have been sanctioned for 

disproportionately fewer misconduct incidents compared to younger inmates 

during their incarceration. Also, in considering the impact that releasing 

aging inmates has on public safety, aging inmates have a lower rate of 

re-arrest in comparison to younger inmates and the rate of re-arrest 

decreases with age. Those aging inmates who are re-arrested often have a 

53 Unlike inmates in institutions, inmates on home confinement do not have to wait 

for an institution to schedule a trip for an outside medical appointment. Additionally, inmates 

on home confinement do not have to adhere to halfway house rules on employment and 

check-in hours, making their schedules more flexible for arranging medical appointments. 

Finally, home confinement may be more appropriate than halfway houses for aging inmates 

who will be retired since the primary purpose of halfway houses is to support inmates seeking 

employment. 

54 The Assistant Director of the Reentry Division said that institution staff focuses on 

enrollment in benefits programs, in lieu of employment skills, for aging inmates who may not 

be seeking employment. She further said that Medicaid enrollment is particularly challenging 

because, although no one can receive Medicaid benefits while in an institution, the rules vary 

from state to state regarding eligibility for benefits and whether inmates can submit their 

Medicaid applications while they are still in an institution or only after release. 

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history of criminal behavior and are most commonly arrested for drug 

offenses. 

Aging inmates engage in fewer misconduct incidents while incarcerated 

compared to younger inmates 

According to BOP data, 53,885 inmates engaged in misconduct 

incidents consisting of violations of institution rules at least once during 

FY 2013. We found that aging inmates represented about 10 percent 

(5,621) of these misconduct incidents, while accounting for 19 percent of the 

BOP’s total population during that period. Further, the misconduct of aging 

inmates was typically of lower severity. According to BOP data, 67 percent 

of aging inmates’ misconduct was of moderate or low severity compared to 

60 percent of younger inmates’ misconduct.

55 

This data is consistent with what we were told by BOP officials and 

institution staff. In general, they said that aging inmates are less likely than 

younger inmates to violate institution rules. The Director of the BOP’s Office 

of Research and Evaluation stated that age is one of the biggest predictors of 

misconduct, and that inmates tend to “age out” of misconduct as they get 

older. Further, if aging inmates engaged in misconduct incidents, it was 

usually for less serious infractions that did not demonstrate violent or 

aggressive behavior. For example, a Social Worker told us that an aging 

inmate with dementia engaged in a misconduct incident by not standing up 

during the daily inmate count. Another Case Manager said that if aging 

inmates engage in misconduct incidents it is more likely to be for refusing to 

participate in programs, often because they are not motivated. As discussed 

below, we found similar trends in our analysis of aging inmates who were 

re-arrested after release from BOP custody. 

Aging inmates have a lower rate of recidivism compared to younger inmates 

At the outset of this review, the BOP told us they were unaware of any 

entity with comprehensive data on recidivism, including data on the 

recidivism of inmates age 50 and older. BOP research from over 20 years 

ago found that aging inmates have a lower rate of re-arrest than younger 

inmates do. Specifically, a 1994 BOP study of inmates released in 1987 

found that 15 percent of inmates age 55 and older released from its custody 

were re-arrested for either a new crime or a probation violation within 

3 years of release, as compared to 57 percent of inmates age 25 and 

younger who were re-arrested. This study also found that 41 percent of 

federal inmates of all ages were re-arrested for either a new crime or a 

55 Moderate-severity misconduct incidents, which include incidents of refusing to obey 

an order, refusing to work, or refusing to accept a program assignment, were the most 

common level of violation for inmates of all ages. 

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probation violation within 3 years.56 The Department’s Bureau of Justice 

Statistics (BJS) released a study in 2014 about recidivism rates for state 

inmates which also showed that recidivism rates were lower for older inmates 

than for younger inmates; but the study did not specifically break out 

recidivism rates for inmates over age 50. The BJS studied inmates released 

from 30 state correctional systems in 2005 and reported that 60 percent of 

inmates age 40 and older were re-arrested for a new crime or probation 

violation within 3 years, while inmates under age 30 had recidivism rates 

exceeding 70 percent within 3 years (with 76 percent of released inmates 

age 24 or younger re-arrested within 3 years). The BJS includes both rearrests for new crimes and re-arrests for probation violations, and we could 

not separate the two categories.57 

In light of this absence of data on recidivism rates for aging inmates, 

the OIG undertook its own analysis. The Federal Bureau of Investigation’s 

(FBI) Criminal Justice Information Services Division provided us with criminal 

history records of all 37,271 aging inmates who were released from BOP 

custody between FY 2006 and FY 2010.58 We based our analysis on a 

randomly selected sample of 381 inmates released during this period. 

We reviewed the criminal history of these 381 aging inmates and 

found that 58 (15 percent) were re-arrested for new crimes within 3 years of 

their release. We also found that the re-arrest of aging inmates within our 

sample generally declined with age. For example, 34 of 181 released 

inmates (19 percent) age 50 to 54 were re-arrested for a new crime 

compared to no re-arrests for released inmates age 70 and older. See 

Table 7. 

Table 7
 

Re-Arrest Rate of Aging Inmates Released Between FY 2006 and
 

FY 2010
 

Age Cohort Total Re-Arrested for 

New Crime Percentage 

50–54 181 34 19% 

55–59 99 16 16% 

56 BOP, Recidivism Among Federal Prisoners Released in 1987 (August 4, 1994), p. 3, 

http://www.bop.gov/resources/ research_projects/published_reports/recidivism/ 

oreprrecid87.pdf (accessed April 9, 2015). 

57 See BJS, Recidivism of Prisoners Released in 30 States in 2005: Patterns from 2005 

to 2010 (April 2014), http://www.bjs.gov/index.cfm?ty=pbdetail&iid=4987 (accessed April 9, 

2015). In its report, BJS cautions against making direct comparisons between recidivism 

statistics published at different times for a number of reasons, including that criminal record 

histories have become more comprehensive and reliable in recent years. 

58 We analyzed aging inmates released between FY 2006 and FY 2010 to ensure that 

every inmate in our sample had been released for at least 3 years. See Appendix 1 for more 

details. 

39
 
 

 

 

 

 

 

 

 

 

 

 

Age Cohort Total Re-Arrested for 

New Crime Percentage 

60–64 64 5 8% 

65–69 27 3 11% 

70–74 9 0 0% 

75+ 1 0 0% 

Total 381 58 15% 

Source: FBI data. 

In addition to those who were re-arrested for new crimes, we found 

that 28 of 381 aging inmates (7 percent) in our sample were re-arrested for 

probation violations. In total, 23 percent of inmates age 50 and older were 

re-arrested within 3 years of their release from BOP custody for either new 

crimes or probation violations. 

Aging inmates were most frequently re-arrested for drug offenses and for 

offenses similar to those that resulted in their prior incarceration 

Aging inmates who were re-arrested were most commonly charged 

with drug offenses (41 percent), followed by violent offenses (17 percent) 

and immigration offenses (16 percent).59 See Table 8. 

Table 8 

Re-Arrest Offense of Aging Inmates 

Type of Offense Number 

Re-Arrested Percentage 

Drugs 24 41% 

Violent Offense 10 17% 

Immigration 9 16% 

Burglary/Larceny 5 9% 

Miscellaneous 4 7% 

Court 3 5% 

Counterfeiting/Embezzlement 2 3% 

Sex Offenses 1 2% 

Note: Miscellaneous offenses are those that do not fit into any of the 

other categories and include driving under the influence and driving 

with a suspended license. 

Source: FBI data. 

59 Violent offenses include offenses defined in BOP, Categorization of Offenses, 

Program Statement 5162.05 (March 16, 2009). Violent offenses also include simple assault, 

battery, corporal injury, and robbery that are not included in Program Statement 5162.05. 

See the Appendix for more details about how we categorized offenses. 

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We also found similarities between aging inmates’ criminal history and 

the offenses for which they were re-arrested. On average, 45 percent of 

aging inmates were re-arrested for crimes similar to those that led to their 

previous incarceration. For example, 58 percent of aging inmates who were 

re-arrested for drug offenses and 78 percent who were re-arrested for 

immigration violations were previously incarcerated for similar crimes. 

Finally, we found that only 8 of the 58 (14 percent) aging inmates in 

our sample who were re-arrested had been first-time offenders at the time 

they were released from the BOP. The remaining 50 aging inmates in our 

sample who were re-arrested were already recidivists at the time they were 

released from the BOP. Therefore, 86 percent of aging inmates in our 

sample who recidivated were already known recidivists. 

Aging inmates could be viable candidates for early release, resulting 

in significant cost savings; but new BOP policy strictly limits those 

who can be considered and as a result, few have been released 

In April 2013, the OIG released a report that found significant 

problems with the management of the BOP’s compassionate release 

program, and that an effectively managed program would help the BOP 

better manage its inmate population and result in cost savings. Among other 

issues, the OIG found that the policy was being applied only to inmates with 

terminal medical illnesses who had less than 12 months to live. On 

August 12, 2013, the Attorney General announced expanded provisions for 

inmates age 65 and older to seek compassionate release as part of the 

Department’s “Smart on Crime” initiative, which was implemented to, among 

other things, address concerns about unfair sentencing disparities, and 

reduce overcrowded institutions.

60 That same day, the BOP revised its 

compassionate release policy to expand the eligibility provisions for elderly 

inmates for medical and nonmedical reasons.61 In announcing the revised 

policy, the Department said that the BOP would generally consider for 

compassionate release inmates age 65 and older who had not committed 

violent crimes and had served significant portions of their sentences. 

60 In the Sentencing Reform Act of 1984, Congress authorized the BOP Director to 

request that a federal judge reduce an inmate’s sentence for “extraordinary and compelling” 

circumstances. The statute permits requests based on either medical or nonmedical reasons 

that could not reasonably have been foreseen by the judge at the time of sentencing. The 

BOP issued regulations and a Program Statement entitled Compassionate Release/Reduction in 

Sentence: Procedures for Implementation of 18 U.S.C. § 3582(c)(1)(A) and 4205(g), Program 

Statement 5050.49 (August 12, 2013), to implement this authority. 

61 The program statement establishes eligibility provisions for “elderly” inmates. For 

the purposes of our review, we refer to inmates who requested compassionate release under 

these provisions as “aging inmates” because each provision falls within our definition of an 

aging inmate. 

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Few aging inmates are eligible for early release consideration under the new 

BOP policy 

Following the release of our compassionate release report in 2013, 

Department and BOP officials formed a working group to expand the use of 

compassionate release by identifying inmates who do not present a threat to 

the community and who present a minimal risk of recidivism.62 The working 

group determined that inmates age 65 and older could be appropriate 

candidates for compassionate release, and the BOP revised its program 

statement to include three new provisions under which these inmates could 

request compassionate release. The BOP based its revisions to the 

compassionate release program on provisions that had already been 

established by the Violent Crime Control and Law Enforcement Act of 1994, 

the United States Sentencing Guidelines, and the Second Chance Act of 

2007. These provisions, however, already existed at the time of the BOP’s 

earlier compassionate release policy, and none had resulted in the release of 

many BOP inmates. 

The first new eligibility provision applies to inmates who are age 70 

and older and have served 30 years or more of their sentence for an offense 

that was committed on or after November 1, 1987 (referred to as “new law” 

elderly inmates).63 Therefore, no inmate will be eligible for compassionate 

release consideration under these provisions until at least November 1, 

2017.64 As a result, no inmate has yet to be released under this provision. 

Moreover, we determined that just 18 inmates would likely be eligible for 

consideration under this provision in the first year after November 1, 2017. 

The second new eligibility provision applies to inmates: 

62 DOJ, OIG, The Federal Bureau of Prisons’ Compassionate Release Program, 

Evaluation and Investigations Division Report I-2013-006 (April 2013). The working group 

consisted of representatives from the Office of the Attorney General, the Office of the Deputy 

Attorney General, the Executive Office for United States Attorneys, the Office of Legal Policy, 

three U.S. Attorneys’ Offices, and the BOP. 

63 18 U.S.C. 3582(c)(1)(A)(ii) states that upon motion of the BOP Director, a federal 

judge may reduce an inmate’s sentence if the inmate is age 70 or older; has served at least 

30 years in prison, pursuant to a sentence imposed under 18 U.S.C. § 3559(c), for the offense 

or offenses for which the defendant is currently imprisoned; and the BOP Director has 

determined that the defendant is not a danger to the safety of any other person or the 

community, as provided under 18 U.S.C. § 3142(g). The BOP’s provisions do not require 

inmates to be serving a sentence imposed under 18 U.S.C. § 3559(c), which mandates a life 

sentence for a defendant convicted of a third serious violent felony or a second serious violent 

felony plus a serious drug felony. Because 18 U.S.C. § 3559(c) was passed in 1994, inmates 

would not have served the minimum 30 years until 2024. 

64 The BOP General Counsel said that, even though the provision would not be 

effective for several years, the BOP included it when revising the program statement in 2013 

so that it would not need to resubmit the program statement to the union for negotiation 

shortly after it had been revised. 

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1.	 age 65 and older, 

2.	 suffering from chronic or serious medical conditions related to the 

aging process, 

3.	 experiencing deteriorating mental or physical health that substantially 

diminishes their ability to function in a correctional facility, 

4.	 for whom conventional treatment promises no substantial
 

improvement to their mental or physical condition, and
 

5.	 who have served at least 50 percent of their sentence. 

Officials with the BOP’s Office of General Counsel told us that the 

Department’s working group chose 65 as the eligibility age after considering 

several factors, such as when inmates become eligible for federal benefits 

and how their health compares to aging individuals who are not in prison. 

The working group also decided that inmates should serve a minimum of 

50 percent of the sentence to justify the resources that the Department 

spent to prosecute the inmate. The BOP’s General Counsel said that the 

medical provisions were based on the United States Sentencing 

Guidelines (USSG) definition of the term “extraordinary and compelling 

reasons.”65 However, we note that, unlike the new BOP policy, the USSG 

policy statement applies to inmates of all ages, not just those age 65 and 

older, and it does not require inmates to have served a minimum percentage 

of their sentence. According to BOP data, as of September 2013, there were 

2,204 inmates age 65 and older who had served at least 50 percent of their 

sentence. 

Finally, the third new eligibility provision applies to inmates without 

medical conditions who are age 65 and older and who have served the 

greater of 10 years or 75 percent of their sentences. The BOP’s General 

Counsel told us that the provisions were based on the Elderly and Family 

Reunification for Certain Non-Violent Offenders Pilot Program (pilot program) 

created as part of the Second Chance Act of 2007.

66 In a report to Congress 

65 The USSG defines “extraordinary and compelling reasons” to include: (1) a 

terminal illness; (2) a permanent physical or medical condition, or deteriorating physical or 

mental health because of the aging process, that substantially diminishes the inmate’s ability 

to provide self-care and for which conventional treatment promises no substantial 

improvement; (3) the death or incapacitation of the only relative capable of caring for the 

inmate’s minor child; and (4) any other circumstance that the BOP Director finds to be 

extraordinary and compelling. USSG § 1B1.13 (Policy Statement), Application Notes, Note 1. 

66 The Second Chance Act directed the BOP to conduct the pilot program during 

FYs 2009 and 2010 to determine the effectiveness of placing eligible elderly inmates on home 

detention until the end of their sentences. The Act excluded inmates with a life sentence; a 

history of violence, espionage, sex offenses, or acts in connection with terrorism; or a history 

of escape or attempted escape. The statute also required the BOP to determine that eligible 

inmates were not at substantial risk of recidivating or endangering the public. 

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after the conclusion of the pilot program in September 2010, the BOP 

recommended that the pilot program not be made permanent for a number 

of reasons, including that few inmates were eligible under the provisions.

67 

Specifically, the BOP reported that there were relatively few inmates over the 

age of 65 in its population (approximately 4,000 at that time) and that many 

were already at an advanced age when they committed the crime for which 

they were incarcerated. As a result, the eligibility provisions precluded 

consideration of the vast majority of these inmates. The BOP reported that 

71 of 855 inmates (8 percent) who requested to participate in the pilot 

program were ultimately placed on home detention, while 750 inmates of the 

855 inmates (88 percent) were ineligible because they did not meet the 

provisions.

68 The BOP’s Central Office did not approve the transfer of the 

remaining 32 inmates to home detention because the BOP determined the 

inmates were a risk for recidivism or endangering the public. According to 

BOP data, as of September 2013, there were 529 inmates age 65 and older 

who had served the greater of 10 years or 75 percent of their sentence. 

Few inmates age 65 and older were released under the new compassionate 

release policy 

In our 2013 review of the BOP’s compassionate release program, we 

found that from 2006 through 2011, 24 inmates on average were released 

from BOP custody each year.69 Since the BOP expanded the compassionate 

release program in August 2013 to include inmates age 65 and older as part 

of the Department’s Smart on Crime initiative, only two inmates were 

released under the new age 65 and older eligibility provisions (see Table 9). 

By contrast, 83 inmates were released under the provisions in the new policy 

not tied to age. 

67 The report to Congress also concluded that the pilot program did not result in any 

cost savings. However, the Government Accountability Office questioned the BOP’s cost 

estimates, concluding that the BOP could not determine the actual cost of monitoring inmates 

who were on home detention. See U.S. Government Accountability Office, Federal Bureau of 

Prisons: Methods for Estimating Incarceration and Community Corrections Costs and Results 

of the Elderly Offender Pilot, GAO-12-807R (July 27, 2012), pp. 2, 15–16. The BOP told us 

that as of February 2013 it requires all entities bidding on contracts for halfway houses and 

home detention to separate the costs of those two services. 

68 Seventy-three inmates were deemed eligible for the pilot program, but two were 

not placed on home detention. One inmate died before he could be placed on home detention. 

The second inmate’s placement was denied because staff from community corrections and 

U.S. Probation and Pre-trial Services were unable to perform the necessary home visits and 

therefore unable to provide adequate supervision. 

69 DOJ, OIG, The Federal Bureau of Prisons’ Compassionate Release Program. 

44
 
 

 

 

 

 

 

 

 

 

 

Table 9
 

Compassionate Release Requests,
 

August 12, 2013, through September 12, 2014
 

Requests by 

Inmates 

Requests 

Approved by 

Institutions 

Requests 

Approved by 

the BOP 

Director 

Released 

All Provisions 2,621 320 111 85 

“New Law” Elderly 

Inmates 52 12 0 0 

Elderly Inmates with 

Medical Conditions 203 33 0 0 

Elderly Inmates 

without Medical 

Conditions 93 19 3 2 

Notes: Included in the “All Provisions” row are requests for compassionate release 

made under the three provisions available to inmates age 65 and older, as well as the 

provisions available to inmates of all ages such as the provision for inmates with a 

terminal or debilitating medical condition. 

Some requests by inmates were still pending a decision by institutions as of 

September 12, 2014. Additionally, some requests approved by institutions were still 

pending a decision by the BOP’s Central Office as of September 12, 2014. Finally, 

although the BOP Director can approve the requests, the sentencing court makes the 

ultimate decision as to whether an inmate is released. 

Source: BOP. 

As shown in Table 9, since the new provisions went into effect, 

inmates made 2,621 requests for compassionate release, but only 

348 requests (13 percent) were made under the new eligibility provisions for 

inmates age 65 and older. The remaining 2,273 requests (87 percent) were 

made under eligibility provisions available to inmates of all ages, including 

those with a terminal illness. 

The new eligibility provisions for inmates age 65 and older are unclear 

In our 2013 review of the BOP’s compassionate release program, we 

found that the BOP failed to provide institution staff with adequate guidance 

regarding appropriate requests for compassionate release. As part of this 

review, BOP officials and staff told us that the eligibility provisions for 

inmates age 65 and older are unclear. For example, the BOP’s revised 

program statement includes eligibility for an inmate age 65 and older under 

the medical or nonmedical provisions. However, institution staff said that 

determining whether an inmate age 65 and older qualifies under the medical 

or nonmedical provisions is difficult. The BOP’s Assistant Director for Health 

Services and Medical Director, who told us he was not consulted on the 

development of the provisions, including the medical provisions, described 

45
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the provisions as “vague.” The BOP’s General Counsel told us that the BOP is 

aware of the need to include more clarification regarding the different 

medical provisions. The BOP held in-person training for all institution-level 

compassionate release coordinators in December 2014 to answer the 

coordinators’ questions and better ensure consistent implementation of the 

program statement across institutions. The BOP also issued an Operations 

Memorandum in March 2015 that provided more-specific examples of medical 

conditions and problems with activities of daily living that make an aging 

inmate eligible for compassionate release under the medical provisions. 

Institution staff also found the nonmedical eligibility provision 

confusing. The program statement says that inmates age 65 and older 

without medical conditions must serve the greater of 10 years or 75 percent 

of their sentence to be eligible to apply for compassionate release. A Case 

Manager told us that when he contacted the BOP’s Office of General Counsel 

to clarify the provision, he was told that the Office of General Counsel 

interprets the provision to mean an inmate must serve both a minimum of 10 

years and 75 percent of the sentence. As a result, only elderly inmates who 

receive sentences in excess of 10 years are eligible to seek early release 

under this provision. The BOP’s General Counsel confirmed that this is the 

BOP’s interpretation of the provision and told us that while the BOP received 

a lot of questions regarding this provision when the program statement was 

first released and that it does need to be clarified, the BOP has not discussed 

making any changes to the program statement itself. 

In general, BOP officials and staff we interviewed did not believe that 

the existing aging inmate provisions would significantly reduce the size of the 

BOP’s aging inmate population. For example, a Warden told us that laws and 

policies are sometimes written with good intentions; but if policymakers do 

not do the homework in advance, the result will be a policy that sounds good 

but does not accomplish much. He added, “I think that’s what this [the 

aging inmate provisions] is going to pan out to be too. There is always a thin 

line between being compassionate to the elderly and protecting society. 

When you have that thin line, you normally write in provisions that start 

excluding a lot of people from consideration.” 

The BOP’s compassionate release program could be more effective in 

assisting the BOP in managing its aging inmates, which would result in 

significant cost savings 

In announcing the Smart on Crime initiative, the Attorney General 

stated that revisions to the BOP’s compassionate release policy would help 

the Department use its limited resources to incarcerate those who pose the 

greatest threat. As we outlined previously, aging inmates commit fewer and 

less-severe misconduct incidents while incarcerated than do younger inmates 

and have a lower rate of re-arrest once released. The BOP General Counsel 

told us that the Department’s working group to expand the use of 

46
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

compassionate release concluded that aging inmates do not pose a 

significant public safety threat. 

We found that the BOP’s compassionate release program could have a 

greater impact on overcrowding and incarceration costs if the BOP revised 

the inmate age provisions to align with the NIC’s recommended definition of 

an “aging” inmate as age 50 or above. We found that the BOP does not 

define the term “aging” or “elderly” inmate.70 Rather, as stated above, the 

BOP requires inmates to be at least 65 years old to request compassionate 

release under the new provisions. However, the NIC, a Department agency 

within the BOP, has recommended since 1992 that correctional agencies 

nationwide define aging inmates as starting at age 50.71 The NIC based its 

recommendation on aging inmates’ pre-incarceration lifestyles and limited 

pre-incarceration access to medical care, two factors BOP institution staff 

commonly cited to us when they described their own views of aging inmates. 

The NIC continued to recommend that correctional agencies define aging 

inmates starting at age 50 in a 2010 online training seminar concerning the 

management of aging inmates.72 

Our analysis of BOP data shows that if the BOP revised the age 

provisions in its compassionate release policy from age 65 and older to age 

50 and older, consistent with the NIC’s recommendation, the potential pool 

of candidates for compassionate release would increase more than sevenfold, 

from 4,384 inmates age 65 and older to 30,962 inmates age 50 and older, 

based on FY 2013 population data. Our analysis also shows that the current 

age provision of 65 and older will not enable the BOP to effectively address 

its overcrowding issues in BOP institutions because that age group, while 

growing, constitutes only 3 percent of the BOP’s total inmate population. 

We found that lowering the eligibility provision to age 50 and older 

could assist the BOP in addressing its overcrowding issues, particularly in its 

minimum- and low-security institutions where more aging inmates are 

incarcerated. For example, at the end of FY 2013, BOP minimum- and lowsecurity institutions had a population of 71,679 inmates and were operating 

at 27 percent over capacity. In order to eliminate over-capacity in these 

70 When we asked BOP staff how they defined these terms, their responses ranged 

from age 40 to age 78. 

71 DOJ, NIC, An Administrative Overview of the Older Inmate (1992). The NIC 

provides training, technical assistance, information services, and policy and program 

development assistance to federal, state, and local correctional agencies. The NIC also 

provides leadership to influence correctional policies, practices, and operations nationwide in 

areas of emerging interest and concern to correctional executives and practitioners as well as 

public policymakers. 

72 See DOJ, NIC, Effectively Managing Aging and Geriatric Offenders, 

Satellite/Internet Broadcast, March 11, 2010, http://nicic.gov/library/024363 (accessed 

April 9, 2015). However, we note that, while the NIC is part of the BOP, no BOP employees 

participated in the broadcast. 

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institutions, the BOP would have to reduce its minimum- and low-security 

population by about 15,000 inmates. We found that inmates age 65 and 

older represented only 4 percent (2,755 inmates) of the BOP’s minimum- and 

low-security inmate population, whereas inmates age 50 and older represent 

24 percent (17,482 inmates) of the BOP’s total minimum- and low-security 

inmate population. If a modest 5 percent (874 of 17,482 inmates) of this 

larger group of aging inmates was determined to be appropriate for 

compassionate release and were released from BOP custody, the BOP could 

reduce overcrowding in its minimum- and low-security institutions by 

2 percent.73 In comparison, the BOP would have to release 32 percent of 

minimum- and low-security inmates age 65 and older (874 of 2,755) to 

reduce overcrowding in its minimum- and low-security institutions by the 

same amount. 

Based on BOP cost data, we estimate that the BOP spent 

approximately $881 million, or 19 percent of its total budget, to incarcerate 

aging inmates in FY 2013.74 We found that lowering the threshold age from 

age 65 to age 50 in the revised compassionate release program, coupled 

with a modest 5 percent release rate for only those aging inmates in 

minimum- or low-security institutions or medical centers, could reduce 

incarceration costs by approximately $28 million per year. Specifically, we 

estimate that it cost the BOP approximately $438 million to incarcerate 

inmates age 50 and older in minimum- and low-security institutions in 

FY 2013. The early release of 5 percent (874) of these inmates could save 

the BOP over $21 million in incarceration costs per year. Also, as previously 

noted, aging inmates represent one-third of the population at the BOP’s six 

medical centers, which, at $59,000 per inmate per year, are the BOP’s 

highest-cost institutions. If 5 percent of aging inmates housed in the BOP’s 

medical centers (112 of 2,246 inmates) were released, the BOP could 

potentially save an additional $7 million in 1 year.75 

Finally, we found that revising the time-served provision in the new 

compassionate release program statement for inmates age 65 and older 

without medical conditions would also increase the potential pool of 

candidates for compassionate release. The BOP’s eligibility provisions for 

these inmates require them to serve the greater of 10 years or 75 percent of 

their sentence. As noted above, the BOP’s Office of General Counsel 

73 For this analysis, we considered only the age of the inmates, not the percentage of 

sentence served. 

74 Using BOP population snapshots and per capita costs, we calculated the costs of 

BOP’s aging inmates based on the number of days served within a fiscal year and designated 

institution security level. For more information, see Appendix 1. 

75 We did not consider the cost impact of compassionate release for aging inmates at 

medium- and high-security institutions because aging inmates represent a smaller portion of 

the population at those security levels and their potential release would have less of an impact 

on overcrowding. 

48
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

interprets these provisions to mean that an inmate must have served both 

10 years and at least 75 percent of his or her sentence. We found this 

provision excludes almost half of the BOP’s aging inmate population because 

many sentences are too short for the inmate to be eligible for compassionate 

release. In FY 2013, this policy excluded from consideration 45 percent of 

the 4,384 BOP inmates who were age 65 and older because they were 

serving sentences of 10 years or less.76 We have concerns because 

Department leadership says the compassionate release policy is designed to 

address prison overcrowding by providing for early release of aging inmates 

who did not commit violent crimes and who pose no threat to public safety. 

Yet this policy as written prohibits early release consideration for nearly half 

of the BOP’s aging inmate population who are likely to be the best candidates 

for early release. These ineligible inmates who received a shorter sentence 

are more likely to have committed a less serious offense, and present less 

danger to the public, than those inmates who are eligible because they 

received sentences of imprisonment in excess of 10 years. 

We believe the BOP should consider whether to revise this provision to 

eliminate the 10-year minimum time served requirement so that all of the 

BOP’s aging inmates could be eligible for compassionate release 

consideration once they had served 75 percent of their sentences, including 

those aging inmates who committed less serious crimes and received shorter 

sentences and therefore may be most worthy of early release consideration. 

The BOP’s General Counsel told us that these provisions might be “really 

limiting” and that it may be better if inmates just met one of the time served 

requirements.77 

We note that not all aging inmates age 50 and older will be 

appropriate for compassionate release. For each compassionate release 

request, the BOP evaluates many other factors, including the nature and 

circumstances of the inmate’s offense, criminal history, the inmate’s release 

plans, and whether release would minimize the severity of the punishment. 

Nonetheless, the BOP has already determined that aging inmates are a low 

public safety risk. We believe that reevaluating the compassionate release 

eligibility provisions for aging inmates could substantially increase the pool of 

eligible inmates. Within that larger pool of eligible aging inmates, we believe 

the BOP could further identify more aging inmates whose offenses, criminal 

histories, and release plans also make them suitable candidates for 

76 Moreover, because inmates are eligible to earn good conduct time credit under 

18 U.S.C. § 3624(b), which equates to about 87 percent of their sentences under BOP policy, 

elderly inmates who earned all of their good conduct time credit (and therefore would likely be 

the best candidates for early release) would need to be serving a sentence in excess of 

11 years in order to actually serve at least 10 years in prison. Due to good time credit, we 

found that 48 percent of BOP inmates age 65 and older were likely to be released before they 

had served 10 years in prison. 

77 The BOP’s General Counsel also said that any changes to the eligibility criteria 

would require coordination with the Department and then negotiations with the BOP’s union. 

49
 
compassionate release, resulting in reduced overcrowding and additional cost 

savings to the BOP. 

50
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONCLUSION AND RECOMMENDATIONS 

We concluded that a growing aging inmate population has an adverse 

impact on the BOP’s ability to provide a safe, humane, cost-efficient, and 

appropriately secure environment for aging inmates and to assist aging 

inmates reentering the community. Although the BOP has revised its 

compassionate release policy to expand consideration for early release to 

aging inmates, which could help mitigate the effects of a growing aging 

inmate population, few aging inmates have been released under it. Several 

aspects of the BOP’s inmate management, including costs, housing, and 

programming, are affected by an aging inmate population that is growing 

more quickly than the rest of the BOP’s inmate population. 

First, aging inmates are more costly to incarcerate than their younger 

counterparts. According to our analysis of BOP data, an aging inmate costs 

8 percent more to incarcerate than a younger inmate due in large part to 

increased medical needs. Further, aging inmates represent one-third of the 

population at the BOP’s six medical centers, which at $59,000 per inmate per 

year are the BOP’s highest-cost institutions. In FY 2013, the BOP spent 

$1.1 billion of its $6.5 billion budget (17 percent) on health services. In that 

same year, institutions with the highest percentage of aging inmates spent 

an average of $10,114 per inmate on medical costs, while institutions with 

the lowest percentage of aging inmates spent an average of $1,916 per 

inmate. The continuing increase in the aging inmate population will drive 

even greater increases in medical spending, especially at institutions with the 

highest percentages of aging inmates. 

Second, BOP institutions lack appropriate staffing levels and offer 

limited training to address the needs of an aging inmate population. Some 

institutions have established local inmate companion programs to assist 

aging inmates with the activities of daily living. However, we found that 

these programs lack consistent oversight and that implementation varies by 

institution. We believe the BOP should develop a standardized program to 

ensure consistency in the implementation of the companion program, as well 

as set clear program expectations for companions in order to reduce the risk 

of victimization of aging inmates. We also believe the BOP should implement 

more training to help staff recognize and respond to the signs of aging. If 

institution staff is appropriately trained, the inmates’ underlying medical 

needs could be met with care instead of disciplinary action. 

Third, the BOP cannot sufficiently house aging inmates at all 

institutions because of limitations in physical infrastructure. Specifically, 

overcrowding of BOP institutions results in an inadequate number of lower 

bunks needed to accommodate aging inmates with limited mobility. 

Overcrowding also restricts the BOP’s ability to move aging inmates to 

institutions, including its medical centers, that can best address aging 

inmates’ medical needs. Institutions, including those with higher care levels 

or a high percentage of aging inmates, lack sufficient handicapped-accessible 

51
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

cells and bathrooms and have difficulty accommodating the number of 

inmates who need elevators. As a result, aging inmates may be placed in 

compromising and sometimes unsafe situations due to limitations in 

institutions’ physical infrastructure. The BOP has not evaluated all 

institutions’ accessibility for inmates with mobility impairments since 1996. 

We believe that, due to the growing aging inmate population, the BOP should 

reexamine the accessibility of all of its institutions to accommodate the large 

number of aging inmates with mobility needs. BOP staff and officials told us 

that separate units, or entire institutions, might be more appropriate to 

house aging inmates. Units designated specifically for aging inmates, 

supplemented with medical staff, could help the BOP provide aging inmates 

more efficient medical care, as well as identify unique programming needs. 

Fourth, the programming opportunities to help aging inmates reenter 

the community are inadequate. There are no standardized programs 

specifically designed for aging inmates. While institutions have the flexibility 

to create local programs or activities to address the needs of their 

population, few have such programs or activities for aging inmates, including 

those institutions with high percentages of such inmates. As a result, aging 

inmates either participate in programs that may not meet their needs or are 

left idle, not participating in any activities. The BOP’s release preparation 

program does not address the unique release needs of aging inmates, 

including those aging inmates who do not plan to seek employment after 

release or require assistance with continuity of medical care. The BOP should 

consider developing programs specifically tailored for aging inmates and 

enhance its release preparation program to address the unique needs 

commonly associated with the release of aging inmates. 

Fifth, many aging inmates could be viable candidates for early release. 

We found that aging inmates have fewer misconduct incidents while 

incarcerated and a lower rate of re-arrest after release. Our analysis 

concluded that aging inmates comprised 10 percent of all BOP misconduct 

incidents in FY 2013, while accounting for 19 percent of the entire 

population. Based on our research and discussions with BOP officials and 

staff, we consider the rate of misconduct by aging inmates during 

incarceration to be relatively low compared to younger inmates. In addition, 

we found that only 15 percent of a sample of aging inmates released from 

BOP custody was re-arrested for a new crime within 3 years. Based on 

studies by the BOP and the BJS, we also consider the rate of re-arrest for 

aging inmates to be relatively low compared to the re-arrest rates of younger 

inmates. Therefore, while individual cases will vary, aging inmates are 

generally less of a threat during incarceration and less likely to be a threat to 

society once released. 

Finally, we found that the BOP’s revised eligibility provisions for 

inmates age 65 and older to request compassionate release have not been 

effective in achieving the Department’s goals. In August 2013, the Attorney 

General announced expanded provisions for inmates age 65 and older to 

52
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

seek compassionate release as part of the Department’s Smart on Crime 

initiative. While a Department working group determined that inmates age 

65 and older could be appropriate candidates for compassionate release, and 

the BOP revised its program statement to include three new provisions under 

which these inmates could apply, these provisions are based on existing 

statutes, which previously resulted in few inmates released from BOP 

custody. Because of the limitations in the revised provisions, we found that 

only two aging inmates have been released since the BOP revised the 

compassionate release policy. While we found that the BOP’s eligibility 

provisions for aging inmates to request compassionate release are currently 

ineffective, our analysis shows that the BOP could more fully achieve the 

outcomes the Department seeks by using its existing authority to further 

revise its eligibility provisions. Expanding the eligibility provisions, such as 

lowering the age requirement to age 50 and revising the time served 

provisions for those aging inmates without a medical condition, would 

increase the pool of potential candidates for compassionate release and 

further assist the BOP in reducing overcrowding and could save the 

Department millions of dollars. 

Recommendations 

To ensure the BOP continues to provide safe, humane, and costefficient care within its institutions and to further assist the BOP in managing 

its aging inmate population, reducing overcrowding, and reducing 

incarceration costs, we recommend that the BOP: 

1.	 Develop national guidelines for the availability and purpose of inmate 

companion programs. 

2.	 Consider the feasibility of placing additional Social Workers in more 

institutions, particularly those with larger populations of aging 

inmates. 

3.	 Provide all staff training to identify signs of aging and assist in 

communicating with aging inmates. 

4.	 Reexamine the accessibility and the physical infrastructure of all of its 

institutions to accommodate the large number of aging inmates with 

mobility needs. 

5.	 Study the feasibility of creating units, institutions, or other structures 

specifically for aging inmates in those institutions with high 

concentrations of aging inmates. 

6.	 Systematically identify programming needs of aging inmates and 

develop programs and activities to meet those needs. 

53
 
 

 

 

7.	 Develop sections in release preparation courses that address the postincarceration medical care and retirement needs of aging inmates. 

8.	 Consider revising its compassionate release policy to facilitate the 

release of appropriate aging inmates, including by lowering the age 

requirement and eliminating the minimum 10 years served 

requirement. 

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APPENDIX 1: EXPANDED METHODOLOGY
 

Data Analysis 

Medical Spending by Institution 

The BOP provided total medical obligations for all BOP-operated 

institutions from fiscal year (FY) 2009 to 2013. To calculate each institution’s 

medical rate per inmate, we used the population data obtained from the 

BOP’s SENTRY case management system.

78 We then divided the medical 

obligations by the total population at each institution to determine the 

average annual medical rate per inmate. 

We compared the medical rates per inmate of institutions with the 

highest and lowest percentage of aging inmates. Medical centers were 

excluded from our analysis because their populations tend to have higher 

medical rates for inmates of all ages. Detention centers were excluded 

because the population data sets do not include pre-trial inmates. Last, we 

also excluded correctional complexes because medical spending was only 

reported for the complex as a whole, not for each institution within it. 

Therefore, we could not determine which institution within a complex was 

influencing overall medical costs. 

Medical Spending Inside and Outside the Institution 

The BOP provided data on medical obligations inside and outside the 

institutions, including medical airlifts, public health service obligations, and 

unforeseen medical services that, when combined, totaled the BOP’s entire 

medical obligations. The OIG analyzed only medical obligations for expenses 

incurred inside and outside the institutions. We sorted the sub-object codes 

based on expenses inside or outside the institution to determine which codes 

had the highest rates of spending. We excluded sub-object codes such as 

administrative pay, Federal Health Benefits, and Retirement, and analyzed 

codes such as contract services, pharmaceuticals, medical hospital services, 

overtime, and night differential.79 We analyzed the sub-object codes with 

high rates of spending at the institutions with the highest and lowest 

78 SENTRY is the BOP’s primary mission support database. The system collects, 

maintains, and tracks critical inmate information, including inmate location, medical history, 

behavior history, and release data. Inmate deaths are also entered into SENTRY, but there is 

no code to determine whether deceased inmates were awaiting compassionate release 

consideration. 

79 A night differential is compensated payment above the basic rate for regularly 

scheduled night work as a non-wage employee. These costs were incurred outside the 

institution for matters such as escorting inmates to medical appointments and guarding 

inmates at local hospitals. 

55
 
 

 

 

 

 

 

 

 

 

 

 

 

 

percentage of aging inmates. When comparing institutions based on its 

percentage of aging inmates, as explained above, we excluded detention 

centers, medical centers, and all federal correctional complexes. 

The BOP’s Catastrophic Cases 

The BOP provided national data on catastrophic care costs incurred by 

each of the six regions from FY 2009 to 2013. We received data for all six 

regions, however data from five of the regions was too inconsistent to 

analyze. Three regions did not consistently provide the BOP register number 

of inmates who received care from FY 2009 to FY 2013. Without a register 

number, inmate age could not be determined. One region did not 

consistently report data from medical centers, and the other region did not 

report data until FY 2012, with the most consistent data in FY 2013. The 

data we received was also incomplete until FY 2012 and could not be 

analyzed for trends. Therefore, we isolated one region to determine the 

impact of catastrophic cases on the BOP’s medical obligations and there was 

no margin for comparison. 

Using the BOP register number provided in each inmate’s catastrophic 

case and the population snapshots provided by the BOP, we determined each 

inmate’s age. If age was not available in the snapshot, we used the register 

number to search for the inmate in the BOP’s inmate locator and calculated 

age depending on the fiscal year during which the inmate received care.80 

Once inmates were categorized by age, we grouped the data in 5-year age 

increments (under 24, 25–29, . . . 80+), and then into the two broader 

categories “under 50” and “50 and above.” Using these categories, we 

calculated the costs of catastrophic cases for each fiscal year. 

Total Costs and Average Cost by Age Cohort 

The BOP provided snapshots of its populations near the end of each 

fiscal year from 2009 to 2013: FY 2009 – September 28, 2009; FY 2010 – 

September 25, 2010; FY 2011 – September 23, 2011; FY 2012 – 

September 28, 2012; and FY 2013 – September 28, 2013. The population 

for each fiscal year represents the number of inmates incarcerated at the 

time of the snapshot dates. The snapshots included an inmate’s register 

number, name, age, sex, date of birth, citizenship, nature of offense, 

criminal history points, sentence start date, sentence length, pre-release 

date, security level, institution location, institution start date, public safety 

variables, and management variables.81 The BOP also provided daily and 

annual costs for each security classification for each fiscal year. The 

80 The BOP’s Inmate Locator can be found here: http://www.bop.gov/inmateloc/. 

81 When we discuss inmates with no criminal history in the Background section of this 

report, we are referring to inmates who have zero criminal history points. 

56
 
 

 

 

 

 

 

 

 

 

 

 

 

documents provided the average cost of an inmate at each security 

classification, which we used to calculate our cost estimates. 

Since the snapshots represented the population only as of that date, it 

did not include inmates who were either released prior to or incarcerated 

after the snapshot date. For example, the FY 2010 snapshot would not have 

included an inmate who was released prior to September 25, 2010, or an 

inmate who had entered the BOP after September 25, 2010. To improve our 

estimates by including those who have served before and after the snapshot 

dates, we combined inmates from the snapshots of other fiscal years into the 

snapshot we were analyzing. For example, for FY 2010, we used the prior 

fiscal year snapshot (FY 2009) to add all inmates released prior to 

September 25, 2010, into our FY 2010 estimates. Also, we used the 

preceding fiscal year snapshot (FY 2011) to include inmates with a sentence 

start date after September 25, 2010, but before October 1, 2010, for our 

FY 2010 estimates. We included both of these additions to include all 

inmates who served at least portion of their sentence in FY 2010 but were 

not included in the original FY 2010 snapshot. All duplicates in a snapshot 

were deleted. However, since we did not request snapshots from FY 2008 

and FY 2014, we could not include inmates who may have been incarcerated 

prior to or after the snapshots for FY 2009 and FY 2013. 

To determine the total cost and average cost based on age and 

institution security classification, we used the eight per capita cost categories 

reported by the BOP each year: high, medium, low, minimum, 

administrative, complex, detention center, and medical center. Each inmate 

was assigned the cost category for the institution where he or she was 

incarcerated at the time of the snapshot. Further, we designated minimumsecurity inmates incarcerated in the minimum security camps attached to 

standalone institutions (not part of a complex) as minimum security. We 

then calculated the number of days served for each inmate within each fiscal 

year using the institution start date and the last day of the fiscal year. If an 

inmate is projected to be released prior to the end of the fiscal year, we used 

the projected release date instead. Because a small percentage (less than 

2 percent) did not include an institution start date but were designated to an 

institution, we used the sentence start date as a substitute. We multiplied 

the number of days served for each inmate by the average daily cost based 

on security classifications provided by the BOP to find the cost of each 

inmate. 

To calculate average cost by age, we grouped inmates based on age 

cohorts: under 24, 25–29, 30–34 . . . 75–79, and 80 and older. We then 

added the cost for each inmate within each age cohort to find the total cost. 

We divided the total cost in each age cohort by the total number of inmates 

in each age cohort to find the average cost. We followed similar procedures 

to find total and average cost at each security classification. 

57
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Recidivism of Aging Inmates 

We received data from the FBI of all 36,682 federal inmates age 50 

and older released from BOP institutions from FY 2006 through FY 2010. The 

data included any reported arrest from any jurisdiction until the end of 

FY 2013. From the 36,682 inmates in the data set, we chose a random 

sample of 381 inmates. The sample size was selected by using a confidence 

level of 95 percent and a margin of error of 5 percent. For each inmate in 

our sample, we reviewed the criminal history and considered a recidivist any 

inmate who was re-arrested for a new crime within 3 years after release. We 

separately counted the number of these inmates who were re-arrested for a 

probation or parole violation. 

For inmates re-arrested for a new crime, we categorized their re-arrest 

offense based on the description provided in the criminal history. With the 

exception of the violent offense category, we used the offense categories in 

SENTRY. Our violent offense category includes offenses that fit under the 

BOP’s homicide/aggravated assault category, as well as offenses like simple 

assault, battery, robbery, and corporal injury due to the use of force on a 

victim. 

Interviews 

We conducted 169 interviews during this review. We interviewed 

Central Office officials, including the Assistant Directors responsible for eight 

Central Office Divisions; the Director of the Office of Research and 

Evaluation; a Senior Counsel in the Office of General Counsel; five staff 

responsible for overseeing construction and maintenance of BOP institutions; 

seven staff responsible for the BOP budget; the Chief of the Designation and 

Sentence Computation Center; a Medical Designator in the Office of Medical 

Designations and Transportation; and a Deputy Chief in the Industries, 

Education, and Vocational Training Division.

82 

We visited eight institutions in person, and another five via video 

teleconference, for a total of 13 institutions. During those visits, we 

interviewed 10 Wardens, 5 Associate Wardens, 7 Health Services 

Administrators, 4 Assistant Health Services Administrators, 4 Clinical 

Directors, 1 Director of Nursing, 1 Chief of Psychology, 1 Chief Social Worker, 

6 Social Workers, 7 Supervisors of Education, 2 Assistant Supervisors of 

Education, 1 Reentry Affairs Coordinator, 4 Case Management Coordinators, 

1 Deputy Case Management Coordinator, 5 Unit Managers, 23 Case 

82 We interviewed the Assistant Directors of the Administration; Human Resource 

Management; Health Services; Information, Policy, and Public Affairs; Reentry Services; 

Correctional Programs; and Industries, Education and Vocational Training Divisions, as well as 

the General Counsel. We did not interview the Assistant Director of the Program Review 

Division or the Acting Assistant Director of the National Institute of Corrections. 

58
 
 

 

 

 

 

 

Managers, and 23 Counselors. We also interviewed 6 inmates per institution 

at the 8 institutions we visited in person, totaling 48 inmates. 

Site Visits 

The team conducted site visits to eight institutions: Federal 

Correctional Institution (FCI) Butner Low, FCI Butner Medium I and Camp, 

Federal Medical Center (FMC) Butner, United States Penitentiary (USP) 

Hazelton, FCI Morgantown, FCI Cumberland, Federal Detention Center (FDC) 

Philadelphia, and Metropolitan Correctional Center (MCC) New York. We 

selected the Butner institutions because they had the highest percentage of 

aging inmates in the BOP. We selected USP Hazelton, FCI Morgantown, and 

FCI Cumberland because the institutions follow the same growing aging 

inmate trend and to interview officials, staff, and inmates at every security 

level. Last, the team visited two detention centers, FDC Philadelphia and 

MCC New York, to assess the effects the aging inmate trend has on the BOP’s 

detention centers. 

Inmate Interview Selection 

During our site visits, the team interviewed inmates who were 

randomly selected based only on our definition of aging inmates as age 50 

and older. The BOP provided a snapshot of all inmates age 50 and older at 

the end of FY 2013, which the team used to randomly select inmates. If an 

inmate was not available at the time of the interview, the team substituted a 

different inmate from a backup list that was also randomly selected. 

Video Teleconferences 

The team conducted video teleconferencing with five institutions: 

FCI Fort Worth, FMC Lexington, FMC Carswell, Federal Correctional Complex 

Forrest City, and FCI Seagoville. We selected these five institutions because 

they had a combination of a high number and a high percentage of aging 

inmates in their populations, excluding FCI Butner Low and FMC Butner, in 

FY 2013. 

59
 
APPENDIX 2: THE BOP’S RESPONSE TO THE DRAFT REPORT
 

60
 

U.S. Deparhnent of Justice 

Federal Bureau of Prisons 

Washington, DC 20534 

Apri]- 27, 2015 

Office o/tlle Director 

MEMORANDUM FOR NINA S. PELLETIER 

ASSISTANT INSPECTOR GENERAL 

EVALUATION AND INSPECTION 

FROM: 

Direct

lJiJ<b1S~ or 

Federal Bureau of Prisons 

SUBJECT: Response to the Office of Inspector General's (OIG) 

Draft Audi t Report: Review of the Impact of an Aging 

Inmate Population on the Federal Bureau of Prisons, 

Assignment Number A-2013-008 

The Bureau of p!,isons (Bureau) appreciates the opportunity to respond 

to the open recommendations from the draft report entitled, Review 

of the Impact of an Aging Inmate. Population on the Federal Bureau 

of Prisons. 

Please find the Bureau's response to the recommendations below: 

Recommendation #1: Develop national guidelines for the 

availability and purpose of inmate companion programs. 

Initial Response: The Bureau agrees with the recommendation and 

will establish national inmate companion guidelines . 

Recommendation #2: Consider the feasibility of placing additional 

Social Workers in more institutions, particularly those with larger 

populations of aging inmates. 
Initial Response: The Bureau agrees with the recommendation and has 

requested funding and will initiate the action once funding is 

received . We request this recommendation be closed. 

Recommendation #3 : Provide all staff training to identify signs of 

aging and assist in communicating w~th aging inmates. 

Initial Response : The Bureau agrees with the recommendation. 'I'he 

Bureau's Learning and Career Development Branch will work with the 

Health Services Division to deve l op curriculum to te~ch employees 

to identify signs of aging and assist in communica-t .ing with aging 

inmates. 

Recommendation *4 : Reexamine the a~cessibility and the physical 

inf~astructure of all of its i nstitutions to accommodate the large 

number of aging inmates with mobility needs. 

Initial Response: The Bureau agrees with the recommendation to 

examine the accessibility and physical infrastructure of its 

institutions to gather baseline information to help inform the goals 

of the multi division task force as discussed below in the Bu~eau's 

response to recommendation #5. The Bureau will survey a ll 

institutions to gather information on current accessibility such as : 

the numbers of handicap accessible cells, showers, toil ets, and other 

infrastructure issues affecting inmates with mobility needs. 

Recommendation IS: Study the feasibility of creating units, 

institutions, or other structures specificall y for aging inmates in 

those institutions with high concentrations of aging inmates. 

Initial Response: The Bureau agrees with the recommendation. The 

Bureau will create a mUlti-d ivision task force to study the 

feasibility of creating units specifically for aging inmates in those 

institutions with high concentrations of aging inmates. 

Recommendation #6: Systematical ly identify programming needs of 

aging inmates and develop programs and activities to meet those 

needs. 

Initial Response : The Bureau agrees with t he recommendation and 

will identify programming needs of aging inmates and deve l op programs 

and activities to meet those needs . As program needs are identified 

and new programs developed, these programs will be i ncorporated 

into the Bureau ' s Inmate Mode l Programs Catalog or national policy. 

2 

61
 
ReCommendation 17 : Dev:elop sections in release preparation courses 

that address the post-incarceration medica l care and retirement 

needs of aging inmates. 

Znitial Response : The Bureau agrees with the recommendation. The 

Bureau will identify and develop programs which will assist aging 

inmates as they transition back to the community . 

Recommendation 18; Consider revising its compassionate release 

policy to facilitate the release of appropriate aging inmates, 

including by lowering the age requirement and eliminating the minimwn 

10 years served requirement. 

Initial Response: The .Bureau agrees that the criteria concerning 

elderly offenders should be further considered and eval uated before 

any final determinations are made. The Bureau intends to raise the 

issue with relevant stakeholders for further discussion, and in 

relation to any future updates made to the r e levant policy 

statement. As the recommendation only calls for the consideration 

of new cri teria (rather than the adoption of new standards), we 

request this recommendation be closed. 

If you have any questions regarding this response, please contact 

Sara M. Revell, Assistant Director, Program Review Division, at 

(202) 353 - 2302 . 

3 

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APPENDIX 3: OIG ANALYSIS OF THE BOP’S RESPONSE 

The Office of the Inspector General (OIG) provided a draft of this 

report to the Federal Bureau of Prisons (BOP) for comment. The BOP’s 

response is included in Appendix 2. The OIG analysis of the BOP’s response 

and actions necessary to close the recommendations are discussed below. 

Recommendation 1: Develop national guidelines for the availability and 

purpose of inmate companion programs. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that it will develop national inmate companion guidelines. 

OIG Analysis: The BOP’s actions are responsive to the 

recommendation. Please provide a copy of the national inmate companion 

guidelines, including guidance describing how inmate companions will be 

selected, trained, paid, and overseen by institution staff, by July 31, 2015. 

Recommendation 2: Consider the feasibility of placing additional Social 

Workers in more institutions, particularly those with larger populations of 

aging inmates. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that it had requested additional funding and would initiate further 

action upon receipt of that funding. 

OIG Analysis: The BOP’s actions are responsive to the 

recommendation. Please provide information about the number of Social 

Workers to be hired, their institution placement, and information about how 

the BOP factored the aging inmate population into its decisions about which 

institutions should receive additional Social Workers, by July 31, 2015. 

Recommendation 3: Provide all staff training to identify signs of aging and 

assist in communicating with aging inmates. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that the Health Services Division and the Learning and Career 

Development Branch would jointly develop a training curriculum to teach 

employees to identify signs of aging and assist in communicating with aging 

inmates. 

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OIG Analysis: The BOP’s actions are responsive to the 

recommendation. Please provide a copy of the training materials provided to 

BOP staff and a description of how training was implemented by July 31, 

2015. 

Recommendation 4: Reexamine the accessibility and the physical 

infrastructure of all of its institutions to accommodate the large number of 

aging inmates with mobility needs. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that it would survey all institutions to gather information on current 

accessibility, such as the number of handicapped-accessible cells, showers, 

toilets, and other infrastructure issues affecting inmates with mobility needs. 

The BOP further stated that it will use the baseline information gathered in 

the survey to inform the goals of a multi-division task force that will study 

the feasibility of creating units for aging inmates (see the BOP’s response to 

Recommendation 5). 

OIG Analysis: The BOP’s actions are responsive to the 

recommendation. Please provide the results of the BOP’s study, to include 

its assessment of the accessibility of lower bunks, external infrastructure, 

and handicapped-accessible cells, showers, and toilets, by July 31, 2015. 

Recommendation 5: Study the feasibility of creating units, institutions, or 

other structures specifically for aging inmates in those institutions with high 

concentrations of aging inmates. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that it would create a multi-division task force to study the feasibility 

of creating units specifically for aging inmates in those institutions with high 

concentrations of aging inmates. 

OIG Analysis: The BOP’s actions are responsive to the 

recommendation. Please provide meeting minutes and the results of the task 

force’s deliberation, including the institutions that the task force studied, by 

July 31, 2015. 

Recommendation 6: Systematically identify programming needs of aging 

inmates and develop programs and activities to meet those needs. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that it would identify programming needs of aging inmates, develop 

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programs and activities to meet those needs, and incorporate those 

programs into the BOP’s Inmate Model Programs Catalog or national policy. 

OIG Analysis: The BOP’s actions are responsive to the 

recommendation. Please describe the programming needs identified and 

provide copies of program curricula and activities developed in response to 

those needs, as well as copies of any national policies updated as a result, by 

July 31, 2015. 

Recommendation 7: Develop sections in release preparation courses that 

address the post-incarceration medical care and retirement needs of aging 

inmates. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that it would identify and develop programs to assist aging inmates in 

transitioning back into the community. 

OIG Analysis: The BOP’s actions are responsive to the 

recommendation. As noted in the report, the BOP’s current release 

preparation does not address the needs of aging inmates who are retired or 

not seeking employment upon release. Further, aging inmates’ increased 

medical needs makes continuity of medical care upon release a pressing 

concern. Please provide copies of program curricula developed to address 

aging inmates’ release needs, specifically including programs for inmates not 

reentering the workforce and addressing continuity of medical care, by 

July 31, 2015. 

Recommendation 8: Consider revising its compassionate release policy to 

facilitate the release of appropriate aging inmates, including by lowering the 

age requirement and eliminating the minimum 10 years served requirement. 

Status: Resolved. 

BOP Response: The BOP concurred with the recommendation, 

stating that the criteria concerning aging inmates should be further 

evaluated. The BOP stated that it plans to raise the issue with relevant 

stakeholders for further discussion and in relation to future policy updates. 

OIG Analysis: The BOP’s actions are partially responsive to the 

recommendation. As noted in the report, the existing provisions for aging 

inmates are ineffective in part because the minimum age provision restricts 

eligibility to only a small portion of the aging inmate population and the 

minimum time served provisions restrict eligibility even further. Please 

provide minutes of meetings between the BOP and other relevant 

stakeholders to discuss this topic, copies of BOP data or other BOP 

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information reviewed by the BOP and the other stakeholders in the course of 

their deliberations, and the results of the deliberations, by July 31, 2015. 

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The Department of Justice Office of the Inspector General 

(DOJ OIG) is a statutorily created independent entity 

whose mission is to detect and deter waste, fraud, 

abuse, and misconduct in the Department of Justice, and 

to promote economy and efficiency in the Department’s 

operations. Information may be reported to the DOJ 

OIG’s hotline at www.justice.gov/oig/hotline or 

(800) 869-4499. 

Office of the Inspector General 

U.S. Department of Justice 

www.justice.gov/oig