Outside the small town of Somerset, 70 miles southeast of Pittsburgh and just a twenty-minute drive from field where Flight 93 plunged to the ground on 9/11, doctors and nurses provide around-the-clock medical care to more than 100 elderly and chronically ill men, offering them everything from nutritional support to end-of-life care.

The patients exhibit many of the same ailments as patients in any other long-term care facility in the state, including respiratory ailments, Alzheimer’s disease, cancer and pulmonary disorders. But they share one significant difference: These patients are under the care of the Pennsylvania Department of Corrections, and even if their prognoses were to miraculously improve, many of them will still die behind these walls.

Welcome to the State Correctional Institution at Laurel Highlands, the Commonwealth of Pennsylvania’s only prison that is specially tasked with handling what is becoming a serious problem across the state and the nation: a surge in the number of sick and elderly prison inmates.

According to a report from Human Rights Watch released last month, the number of senior citizens under American correctional supervision is higher than it’s ever been, and growing at an alarming rate. The study found the number of state and federal prisoners that are 55 or older — the official threshold for old age behind bars — grew at six times the rate of the overall prison population between 1995 and 2010. The number of prisoners over 65, meanwhile, surged 63 percent — or 94 times the rate of the general prison population — in the three years prior to 2010.

Jamie Fellner, a senior advisor at Human Rights Watch and the author the report, blamed the increase on “tough on crime” policies such as mandatory minimum sentences, three-strikes laws and the now more than four-decades-long War on Drugs.

“Prisons were never designed to be geriatric facilities,” she said, “yet U.S. corrections officials now operate old age homes behind bars.”

The graying of Pennsylvania’s prisons

The Keystone State has not only followed the trend, it has exceeded it. According to HRW, Pennsylvania has the second-highest proportion of geriatric inmates in the nation, behind Oregon. At the end of 2010, there were 8,462 inmates in Pennsylvania’s prisons over the age of 50, representing 16.5 percent of the inmate population. A decade ago they made up less than 10 percent of all prisoners. Inmates over the age of 40, meanwhile, now represent more than a third of Pennsylvania’s total prison population.

“We have a lot of elderly prisoners because we tend to have longer sentences, and we have one of the largest populations serving life without parole, and who will be there until they die,” explained William DiMascio, executive director of The Prison Society, the nation’s oldest prisoner advocacy group. “As these prisoners get older — and they get older earlier because prison life is just harder than it is for people on the outside, so people tend to break down sooner — we hear of all kinds of problems mostly relating to access to health care.”

Pennsylvania is one of six states that denies parole to lifers, and according to the Sentencing Project, has the second highest percentage of inmates serving life without parole, behind Louisiana.

The number of people of all ages locked up in Pennsylvania has grown more than five-fold since 1980, and now exceeds 51,000 — with nonviolent offenders accounting for the bulk of the increase, according to Department of Correction statistics. Over the same period, spending per inmate has nearly tripled, and funding for the state’s prison system is now our third largest expense behind medical assistance and education. Health care costs average three to four times higher for inmates over 55 than for younger inmates, studies show.

Last year, Auditor General Jack Wagner joined lawmakers including Republican State Senator Stewart Greenleaf, a former Montgomery County prosecutor, in calling for an aggressive reform program that seeks to trim the prison population by promoting alternative-sentencing programs, among other things.

“While most economic sectors in the commonwealth remain mired in recession, prisons remain Pennsylvania’s largest growth industry,” Wagner said.

A reform bill sponsored by Greenleaf that would institute some of those changes passed the Senate and is currently making its rounds in the House. In the meantime, Pennsylvania is busy building three more prisons and expanding nine others, to the tune of $685 million.

Not your average old age home

SCI Laurel Highlands was opened in 1996 in buildings that once housed Somerset State Hospital to provide specialized services unavailable in the state’s other 23 adult male prisons (there are not nearly as many elderly or infirm female prisoners, who are housed at the state’s two female prisons, Muncy and Cambridge Hills.)

A minimum security facility, Laurel Highlands houses 1,382 inmates, according to the DOC, 412 of whom are over 50. The rest are younger inmates who require special medical treatment and healthy prisoners who work in food service, maintenance and janitorial services.

According to DOC spokesperson Susan McNaughton, the prison has two “skilled care units” housing a total of about 100 inmates, many of whom are transferred from other prisons. But not every old or sick inmate makes it to Laurel Highlands, she says.

“Our prisons have infirmaries that provide medical treatment in line with community standards, and those infirmaries are able to care for the prison population’s medical needs regardless of the age of the offender or the type of illness,” McNaughton explained. “We house inmates of all ages throughout our prison system.”

An average of 100 prisoners over the age of 50 die of natural causes every year across Pennsylvania’s prison system. While some states maintain special units for end-of-life care, McNaughton says Pennsylvania doesn’t have a dedicated prison hospice program; instead, she says medical personnel are trained across the system to deal with end-of-life issues, including palliative care for terminally ill patients.

But an ongoing study being conducted by the Penn State School of Nursing found that care behind bars differs in some important ways from similar treatment outside the prison system.

“For example, morphine drips are generally not an option,” said Dr. Susan J Loeb, a registered nurse and associate professor at Penn State who is leading the research, in an article published on the study. “Availability of food items such as puddings, ice creams or other special foods varies between institutions, and reportedly within each prison depending upon who is working at any given time.”

The Penn State team, whose work is funded by a $1.27 million grant from the National Institute of Nursing Research, is working with employees from six Pennsylvania prisons and the DOC in an effort to improve end-of-life care for inmates.

Compassionate Release

Inmates who are terminally ill and still have time left on their sentences have two choices: die in prison or hope they qualify for Pennsylvania’s recently introduced compassionate release program.

In 2002, the Pennsylvania Senate passed a resolution creating a task force to study the problem of the state’s aging inmate population. It took a year to get off the ground and another two years to complete its work, which culminated in a set of recommendations that included updating the state’s medical release law.

According to Senator Greenleaf, who chaired the panel, the existing law, which dated to 1919, was archaic, and applied only to prisoners who couldn’t be cared for in prison. Greenleaf said there was a general agreement on the panel that if a prisoner is terminally ill and not a risk to society there should be a consideration for early release.

“The average cost of caring for a terminally ill patient can run as high as $100,000 a year, which is the responsibility of the state, but if we release them to a private facility the federal government takes over,” he said. “But this was a public policy decision, so public safety had to take precedent over cost.”

Numerous studies show that older prisoners rarely re-offend once released, particularly those that have been incarcerated for an extended period of time, which most elderly inmates have. Data from the Pennsylvania Parole Board shows that of the 492 prisoners over the age of 50 that were released in 2003, only seven re-offended, a recidivism rate of just 1.4 percent.

In 2008, over the objection of some victim advocates, Gov. Ed Rendell signed a Correction Reform Package, Act 81, which included stringent new guidelines for medical release. Under the program, the corrections officials or the prisoner may petition a temporary suspension of sentence for release to a treatment facility or hospice only if it can be shown that the inmate will receive more appropriate care there, that they pose no threat to the community, and that they are seriously ill and likely to die within a year. If any of those circumstances change, authorities can petition to have the inmate sent back to prison.

McNaughton says approximately six inmates a year are released through the program. Similar programs in other states are notoriously under-utilized, according to prisoner advocates.

Asked if he thought the program he helped champion is working appropriately, Greenleaf said, “We put the mechanisms in place — but I can’t say at this point whether the mechanisms have been adequately utilized.”