Introduction
Ageing prisoners
Prisoners over the age of 50 years are deemed as ageing prisoners in light of their poorer health status when compared to persons of similar age in the general populations (Binswanger, Krueger and Steiner Reference Binswanger, Krueger and Steiner2009; Loeb, Steffensmeier and Lawrence Reference Loeb, Steffensmeier and Lawrence2008; Wilper et al. Reference Wilper, Woolhandler, Boyd, Lasser, McCormick, Bor and Himmelstein2009). Although the use of this age-denominator is debated (Aday Reference Aday1994; Ahalt et al. Reference Ahalt, Trestman, Rich, Greifinger and Williams2013), 50 years remains the commonly agreed-upon delimiter defining an older prisoner (Loeb and Abudagga Reference Loeb and Abudagga2006). The topic of ageing prisoners, particularly their health-care concerns, is gaining traction in gerontology literature due to their rising numbers (Fazel et al. Reference Fazel, Hope, O'Donnell, Piper and Jacoby2001; Marquart, Merianos and Doucet Reference Marquart, Merianos and Doucet2000; Maschi, Viola and Sun Reference Maschi, Viola and Sun2013; Wangmo et al. Reference Wangmo, Meyer, Bretschneider, Handtke, Kressig, Gravier, Bula and Elger2015). The increase in the older prisoner population is seen particularly in the developed economies. In 2013, the United States of America (USA) incarcerated 271,521 older persons, constituting 18 per cent of the adult (18+ years) prison population (Carson Reference Carson2014). In England and Wales, this number was 10,555, representing 12.5 per cent of the total prison population (Ministry of Justice 2015). In Switzerland, 616 older persons were imprisoned in 2013, accounting for 13.2 per cent of the total prison population (Bundesamt für Statistik 2014b ).
In light of their increasing numbers, three broad groups of older prisoners are identified: (a) those who entered prison at a young age and have aged there; (b) those who entered prison in old age and will further age and die there; and (c) those that move in and out of the prison system (Crawley and Sparks Reference Crawley and Sparks2006; Neeley and Addision Reference Neeley and Addision1997). Available studies on older prisoners' health note their higher disease burden when compared to younger prisoners (Fazel and Baillargeon Reference Fazel and Baillargeon2011; Fazel et al. Reference Fazel, Hope, O'Donnell, Piper and Jacoby2001; Wangmo et al. Reference Wangmo, Meyer, Bretschneider, Handtke, Kressig, Gravier, Bula and Elger2015). The ageing of the prison population, as well as their increasing numbers, heterogeneity and high disease burden, exert additional health-care costs on strained prison resources. In the USA, the annual cost of incarcerating an older prisoner is estimated at US $69,000 (Rikard and Rosenberg Reference Rikard and Rosenberg2007; Williams and Rikard Reference Williams and Rikard2004). This amount is estimated to be three times greater than that of a younger prisoner (Adams Reference Adams1995; Ahalt et al. Reference Ahalt, Trestman, Rich, Greifinger and Williams2013; Vestal Reference Vestal2013). Maschi, Viola and Sun (Reference Maschi, Viola and Sun2013) have argued that the high cost of ageing prisoners is an international concern.
To respond to the increasing number of older prisoners and their greater demand for health care, separate prison facilities to house this group are in place (Aday Reference Aday1994, Reference Aday2003) with the goals of cost reduction and targeted health care. In the USA, at least 18 states have such age-segregated prison facilities (Rikard and Rosenberg Reference Rikard and Rosenberg2007). Similar arrangements are also available in the United Kingdom (Howse Reference Howse2003) and in Switzerland, two prison facilities have a geriatric wing. The debate on age-segregation within prisons, not surprisingly, is US dominated (Aday Reference Aday2003; Kerbs and Jolley Reference Kerbs and Jolley2009; Kerbs, Jolley and Kanaboshi Reference Kerbs, Jolley and Kanaboshi2015).
Current debate on age-segregation in prisons
Opponents of age-segregated facilities highlight benefits of a mixed living situation among prisoners of different age groups. These include the calming effect of older prisoners on younger inmates and their position as role models (Goetting Reference Goetting1985; Yates and Gillespie Reference Yates and Gillespie2000). The impact of segregated facilities on access to work opportunities and different prison programmes has also been considered (Adams Reference Adams1995; Goetting Reference Goetting1985; Yates and Gillespie Reference Yates and Gillespie2000). Of most importance though are the centralised medical services available in consolidated (age-mixed) facilities which ‘[benefit] all inmates, not just the elderly’ (Thivierge-Rikard and Thompson Reference Thivierge-Rikard and Thompson2007: 51). Opponents argue that in order to fill these facilities once they are built, older prisoners might be forced to transfer into them, even if they wish to continue living in a consolidated prison (Adams Reference Adams1995).
Proponents of age-segregated facilities consider that grouping older prisoners together is necessary primarily to protect this vulnerable group. In addition to protecting them from abuse, these specialised facilities would allow the streamlining of services for older prisoners (Adams Reference Adams1995; Trotter and Baidawi Reference Trotter and Baidawi2015; Yates and Gillespie Reference Yates and Gillespie2000). Kerbs and Jolley (Reference Kerbs and Jolley2009) stated that such facilities would ensure cost savings, reduce liability and enable tailored rehabilitation programmes. They may provide older prisoners the opportunity to build friendships as well as reduce loneliness (Adams Reference Adams1995; Yates and Gillespie Reference Yates and Gillespie2000). Williams and Rikard (Reference Williams and Rikard2004) noted that the housing needs of prisoners are different because of the older prisoners need for social networks and the rebuilding of family ties compared to younger inmates.
Segregation is already in place for juvenile and female prisoners (Goetting Reference Goetting1985; Kerbs and Jolley Reference Kerbs and Jolley2007). To ensure that discrimination and injustice does not occur (Goetting Reference Goetting1985), it is recommended that segregation based on age takes place only with the consent of older prisoners (Kerbs, Jolley and Kanaboshi Reference Kerbs, Jolley and Kanaboshi2015; Vito and Wilson Reference Vito and Wilson1985).
Finally, a few empirical studies have explored the opinions of those concerned. A study of inmate victimisation with 65 male prisoner participants reported a preference for age-segregated housing (Kerbs and Jolley Reference Kerbs and Jolley2007). Marquart, Merianos and Doucet (Reference Marquart, Merianos and Doucet2000) described older prisoners being in agreement with the need for special facilities for this group. The authors stressed that the health-care workers also supported the need for age-segregated living, citing that it would keep the older prisoners safe and address their care needs. Related to the issue of accommodation in prison, Aday and Farney (Reference Aday and Farney2014) reported that the need for older female prisoners to be assigned to the lower bunk bed for health reasons was frequently dismissed, emphasising the necessity for age-appropriate living conditions for older prisoners.
Study purpose
There is a paucity of research exploring the views of older prisoners in relation to the current debate on age-segregated housing for this population. The perspectives of older prisoners and stakeholders in relation to segregated housing have not been explored in Europe to date. This study represents the first qualitative analysis of older prisoners and stakeholders in Europe exploring the issue of age-segregated housing. In so doing, this study contributes new and much needed data for creating useful and appropriate policy for older prisoners.
Design and methods
The data for this paper come from a nation-wide Swiss study called ‘Agequake in Prisons’, aimed at understanding the health and ageing experiences of older prisoners in the country. For this study, the age limit designating an older prisoner was set at 50 years (Loeb and Abudagga Reference Loeb and Abudagga2006). Ethics approval was obtained from ten responsible ethics committees in Switzerland and the national ethics committees of the two other European Union countries.
Swiss prison context
In 2012, Switzerland had 109 prisons with a total population of 6,978 places (Bundesamt für Statistik 2014a ), with the largest prison holding 426 places. Hence, Swiss prisons are relatively small. The Swiss Criminal Code (SCC) contains provisions on sentences and measures (Title Three of the SCC). The latter includes therapeutic measures (article 59 SCC) and indefinite incarceration (article 64 paragraph 1 SCC). Article 59 SCC allows courts to mandate in-patient therapeutic measure for offenders suffering from serious mental disorders. Life-long incarceration (article 64 paragraph 1bis SCC) was instituted in 2004 in the Swiss Federal Constitution (123a SFC). This was done in response to a citizens' initiative aimed at protecting the Swiss population from ‘extreme dangerous sexual and violent offenders’, who ‘are assessed as being permanently untreatable’. In contrast to that, indefinite incarceration (article 64, paragraph 1 SCC) shall be ordered for (a) offenders who are expected to commit further offences of the same type, and for (b) those individuals where ‘a measure in accordance with article 59 does not promise any success’. When these conditions do not apply, the prisoner can be released. Furthermore, the SCC demands periodic re-evaluation of prisoners receiving measures (article 62d SCC), but upon negative evaluation, the measure can be extended each time.
Participants
In total, 75 individuals participated in the study. Of these, 35 were older prisoners and 40 were national and international professionals working in the prison setting (i.e. stakeholders). The 35 older prisoners hailed from 12 different Swiss prisons (Handtke and Wangmo Reference Handtke and Wangmo2014). On average, our prisoner participants were 61 years old (range 51–75 years) and most of them were male (N = 30). Seventeen were serving indeterminate sentences (i.e. measure according to article 59 SCC or article 64 SCC) and the other 18 had a custodial sentence with a specified date of release.
Our stakeholder sample included experts from Switzerland and two other high-income nations in the European Union. For confidentiality reasons, country names cannot be disclosed. The 40 stakeholder participants were on average 49.5 years old (range 32–69 years) and 27 were male. Stakeholders were categorised into three different professional groups: Group 1 was composed of 18 health-care professionals or researchers; Group 2 included 16 prison administrators or policy makers; and Group 3 was formed from six scholars working with non-governmental or international organisations.
Data collection procedures
Older prisoners were informed about the study by Prison Healthcare Services (PHS) and their recruitment followed purposive sampling (Patton Reference Patton1990) implemented by the PHS (Handtke and Wangmo Reference Handtke and Wangmo2014). Prior to interviews, participants were told that the researchers were independent of the PHS and thus taking part in the interview had neither positive nor negative consequences. They were also briefed that any information they shared would be kept confidential and not transmitted to the PHS. Interviews took place in the prison and space was made available by the PHS. The language used was either German or French, based on older prisoners' preference. On average, these interviews were 96 minutes long. During the interview, different topics concerning life in prison, being an older prisoner (including questions about prison housing, work responsibilities, retirement and challenges of being in prison), health and access to health care were discussed.
Stakeholders were recruited via purposive and convenience sampling (Patton Reference Patton1990) and were informed about the study either via e-mail or telephone. A total of 77 requests for interviews were sent, with 40 positive responses (Bretschneider and Elger Reference Bretschneider and Elger2014). When possible, interviews were conducted in person. Since experts from three different countries were included, 16 interviews were done via Skype or telephone. Interviews were on average 75 minutes long and took place either in English, German or French. The topics of discussion with stakeholders included: general experience in the prison context, issues concerning health and health care provided to older prisoners, ageing in prison, and social concerns for older prisoners such as availability of work opportunities, retirement, free-time activities, compassionate release and housing.
Data analysis
All interviews were recorded, transcribed verbatim either by the interviewers or by independent assistants, double-checked for errors and contained no identifying information. Since the topic of this paper is living situations for older prisoners, only segments relating to the current housing situation and responses to one question in particular, ‘What is your opinion on separate housing for older prisoners?’, were examined. If issues related to housing and accommodation came out spontaneously during the interview, these were also included.
Segments of the French transcripts pertaining to the topic were sorted by VH and translated by assistants fluent in both French and English. The German and English segments were sorted by TW. She analysed all sorted segments using thematic analysis (Braun and Clarke Reference Braun and Clarke2008; Guest, MacQueen and Namey Reference Guest, MacQueen and Namey2012). Another author, WB, coded the German interviews independently. TW compared her coding with that of WB. Exemplary quotes were chosen for the paper that represented the main themes and all translated quotes used in the paper were carefully evaluated by two authors to ensure proper transfer of meaning. Presentation of study results as well as their interpretation were checked by and agreed upon by all authors.
Study findings
All prisoners interviewed for this study had their own prison room (cell). They generally found that their living situation was not particularly adapted for their health needs as older persons. For example, several participants mentioned how uncomfortable the basic furniture available for their use was. They had a bed, table, stool and lamp. They found it difficult to sit on the stool for several hours in a row and stated that the lighting was not bright enough to read and do other work. Additionally, the mattress and pillow were deemed uncomfortable. Noise in prison was mentioned as bothersome to older prisoners by both participant groups.
Participants' opinions regarding age-segregated housing were bifurcated. Almost half of the participants in each group supported a separate living situation for older prisoners, while the other half felt that age-mixed prisons would be better (four participants reported having no opinion on the topic). Upon further examining these opinions by sub-group of prisoner participants (male versus female; indeterminate or custodial sentences) and stakeholders (Group 1, 2 or 3), the results were similar in most cases. It was only in stakeholder Group 1 where twice as many respondents preferred an age-mixed setting.
The arguments in favour of and against such living arrangements were similar in each participant group. They were categorised into three main themes. First, consolidated housing was deemed desirable as it mirrored society. Second, a separate unit within the prison itself would be preferable to a completely separate institution. Such separation, however, should not be based solely on age but also on type of prison sentence. Third, the criteria for placing an ageing prisoner into such a unit were discussed. These themes are presented below using exemplary anonymised quotes from the interviews. For example, P1 represents prisoner participant 1 and S1 denotes stakeholder participant 1.
Prisons should mirror society – consolidated housing
An important reason given by almost half of the older prisoner and stakeholder participants, supporting mixed prison housing, was that in society we normally do not isolate one age group from the other. Prisons should likewise mirror society. Epitomising this notion, a stakeholder (S28, Group 2) stated, ‘We would expect to see a prison replicate the community. So if there is a mix of ages in the community, there should be a mix of ages in the prison’. Similarly, S4, Group 1 noted, ‘I am not unhappy about it because I think they [older prisoners] feel more integrated if they live in a mixed setting. It is clearly the same outside [the prison]’. Two sub-themes emerged in support of a consolidated living situation: generational exchange and risk of ghettoisation.
Generational exchange
The relationships that form between prisoners of different ages were seen to be of considerable importance. They contributed towards reducing boredom, remaining active, sharing knowledge and wisdom, and helping one another. A separate prison just for older prisoners was viewed as too ‘boring’ since everyone was in the same boat and would be sharing the same story. As stated by P3 (58 years), ‘The day is always the same, every [day]. There are seven days a week … and the seven days a week are the same, the same daily grind’. Another stakeholder (S40, Group 1) reported that being with only the elderly age group meant hearing them complain about their diseases. S40 further explained that ‘a good mixture in life is good, that you have some younger prisoners with older ones and that there is a certain dynamic’.
Consolidated prisons were considered preferable because the participants believed that they provided more opportunities to help one another. Opposing prisons only for ageing detainees, a stakeholder (S29, Group 2) asked, ‘How can an older person help another elderly person? There I think that the responsibility towards other inmates is stronger between the different generations compared to when each is fighting against similar problems'. Ageing prisoner participants emphasised their role as advisors and explained that they enjoyed sharing their experiences with younger prisoners. For instance, one (P2, 68 years) stated, ‘I think that's terrible [separating older prisoners]! Because the younger ones, they can still learn a lot [from us]’. Another participant (P8, 60 years) highlighted that older prisoners often act as informal counsellors:
No, I think that having a mixed [setting] is better … And there are some young [prisoners] coming to ask you a question, thinking that you have experience that comes with age. I do think that this is good. The point is that if you confine the old people together, what are we going to speak about? Our age? Our minor ailments?
Along with the theme of generational exchange between younger and older prisoners, remaining active and staying in an ‘energetic’ atmosphere was regarded as being positive results of age-mixed housing:
Certain younger people can, of course, how should I say … bring a bit of a dynamic, which is perhaps also good for the elderly [prisoners]. If you have only elderly people together … then the standard is totally different. But when you also have younger people … then you get a different dynamic. So, that way there is perhaps a little bit more of a boost for the elderly. (P27, 63 years)
Risk of ghettoisation
The second reason for supporting mixed housing was the concern that such ‘segregation’ of older prisoners could result in a ‘ghetto’. This theme was only evident in the interviews with the stakeholders.
I am always suspicious with ghettos … So if you are in an environment, there are several persons who are a little bit like you and with the same rhythm … slower or faster, it can be beneficial. But then, the risk is that we … it becomes a ghetto for elderly people, and then we forget about them a tiny bit, because they are older and are more discrete. (S23, Group 2)
Realising that a separate prison may provide the quieter and slower environment that older prisoners at times need and also desire, these participants nevertheless succinctly pointed to the issue of possible discrimination. For instance, stakeholder S6 (Group 1) told the interviewer, ‘He [an older inmate] was going to a unit which was labelled “elderly unit”, whereas here they are mixed … I am not sure they want to have another label, you know’. Finally, one stakeholder (S9, Group 1) underlined his scepticism towards any sort of segregation as such:
But … we have a mix of types and ages [in prison]. It is true in real life too, right? … So you are going to have older detainees stay separately? And then you are going to put the sex offenders separately and then schizophrenic persons separately. But when you are all three at the same time, where do you go? … It is always the same story, right? Specialisation, segregation, you know.
A separate unit – allows continuity and provides needed adjustments
Among those who supported segregating older prisoners in special accommodation, most recommended a separate unit within the prison for ageing prisoners rather than a designated prison for this group. They felt that a customised section within a prison for ageing prisoners that addresses their health needs is desirable. The benefit was that it still allowed generational exchange, which was highly valued, as expressed by 61-year-old P15: ‘Exactly, just normal, just normal contact, but perhaps that they, that they are accommodated in a separate floor’. Stakeholder S35 (Group 1) voiced a similar opinion:
Some of the things that keep older people feeling younger and able are being around younger people. So yes, again I sit on the fence a bit for a lot of these issues. I think what I would agree [with] is special wings within prisons for older people because, you know, resources would be able to be more focused on those individuals. So, I wouldn't say prisons for older people, but maybe wings within prisons would be helpful.
As evident in the quote above, such a unit should exist to provide better health care. It was also mentioned that the separate unit could be adapted to the environmental and social needs of ageing prisoners. Furthermore, such a separate unit should not only consider age but also type of sentence (discussed later in the article).
A separate unit to address health care needs
A section or unit of the prison designated for older prisoners was judged as useful. Being in a smaller setting, elderly prisoners would be able to receive the care that they need. A prisoner participant (P15, 61 years), highlighting the ‘better care’ argument, explained, ‘Well, I think, if you can still do something, it would perhaps be a kind of floor for fragile [old] people. Let's say if there are 12 or so, then you can fill a floor and then you could do more health controls'. Another older prisoner (P23, 61 years), discussing how health-care access could be better organised in such a unit, suggested, ‘If they built such a block of flats just for older prisoners … a doctor would be present in that block … who would guarantee the medical care and would take the responsibility’. One participant even stated that such a separate section should only be used when the prisoner needs special health care. For instance, a prisoner participant (P9, 56 years) said:
I think it's better to be in a mixed [setting] as long as our health is alright, even [if someone is] old … But as soon as we have some troubles or [need] some specific medical care or [have] some chronic diseases, we should [then] maybe be separated and receive special care.
For these participants, a separate health care based unit meant that needed access to care as well as better care could be made available. A stakeholder (S22, Group 2) concluded that a unit for older prisoners would be ‘a step in the right direction … specific units with more freedom and better care’. Another (S24, Group 1) stated, ‘I think for someone who is fragile [vulnerable] in many ways or who has complicated medication needs, for those [prisoners], it [a separate unit] is really good, because care is guaranteed more easily’. Access to care also meant better health-related care provided by professionals, ‘something similar to an old people's home or a care institution’, as suggested by ageing prisoner participant P26 (52 years).
Age-segregation adapted to the environmental needs of older prisoners
Participants who supported the idea of a separate living situation for older prisoners noted that it should be adapted to the environmental needs of ageing prisoners. Generally, one of the complaints about living with younger prisoners was the noise, and thus, such an adapted unit was envisioned as having the advantage of being quieter. A stakeholder (S26, Group 2) described such a unit as ‘a small section … which should be a little bit isolated, rather calm … which would be [located] on the ground floor to not have the issue of the stairs and so forth’. Several participants recommended that this type of living environment for older prisoners should be akin to group living with more space and freedom to make small choices, such as cooking, as well as better adapted rooms. For instance, another stakeholder (S15, Group 2) suggested it should be ‘pavilion-like … [with] shared flats which are oriented towards the standards of old people's homes, with rooms that are adequately big, floors that would fit wheelchairs, all such things'. Similarly, an older prisoner (P25, 70 years) said it might be ‘just like a room, which we have now, but essentially a bit bigger, probably. And your own cooking facilities, including the opportunity to eat [together with other prisoners] so that one is not that isolated’. Another older prisoner, P22 (65 years), reported the following:
I just don't imagine a giant building where everyone is inside … I imagine shared flats, where people are clustered in living groups depending on the amount of care they need, according to their ability to self-care, and perhaps even other … criteria. If the whole institution is just open in itself and a fence is only put up around the outside … one can go out [of his living space], one can meet people of the other living groups.
A few older participants pointed out that a separate unit that takes into consideration their different capabilities but allows them to remain active by engaging in prison work would be ideal. For example, P33 (53 years) revealed the need to adapt prison schedules related to basic activities of daily living for older prisoners: ‘perhaps he takes longer [to shower] because he can no longer move that easily, because he drops the soap three times … Or eating within 15 minutes or stuff like that [is not possible]’. Explaining his vision of an age-appropriate unit, participant P29 (57 years) reported:
So, I could indeed imagine that, during the day, one is together with the younger prisoners, for example, at work place, but in the evening, [with] young people, [there is] music, a lot of music: They do not care [that this] 76-year-old man, he usually goes to sleep at eight, nine o'clock. And there it would perhaps be ideal – a unit where effectively the older prisoners are among themselves.
Separation based not only on age but type of sentence
Several participants that largely supported the separation of prisoners by age group suggested that it would be preferable to have separation not based on age per se, but on type of sentence. Stakeholder S32 (Group 2) recounted:
In [name of the country] we are very likely to see an increase of the length of detention and that there will be more and more [prisoners serving indeterminate sentences] who will stay for years and years, who will grow old in prison actually … Why not … build, put them together … in a prison constructed for this?
P3 (58 years) echoed the above opinion and added that separating by type of sentence may also result in changes in the level of security:
There should be a separation between [those who should be incarcerated in] open or closed regimes … Because we are all placed in the same regime, [we are under] the same pressure as they … Therefore one must separate that. And then you can have a certain relaxing [of rules]. I'm not saying it must be run like a hotel, but a little bit more relaxed … Because we [those serving indeterminate sentences] are no longer in a penal system in that sense … Why must we … be run like a penal system?
Correspondingly, a stakeholder participant emphasised that those who continue to be imprisoned as part of indeterminate sentences have, in reality, served their actual sentence. Yet these prisoners are not released because they are presumed to still pose a danger to society. For such prisoners, this stakeholder recommended what was previously suggested for older prisoners: group housing with greater freedom.
When an older prisoner has served his sentence, then I would prefer a more open regime, not more open towards outside, but more open towards inside. I would have here, or would prefer, a system with shared flats. That presupposes that, internally, the prisoners do not pose any danger, and secondly, they must be able to live in this living community. That means they must still be able to do certain jobs, like cooking and so on, themselves. (S20, Group 2)
The criteria for entering ageing prisoners' units
A limited number of the participants from each group described concerns in relation to the conditions under which an ageing prisoner would be placed in an ‘older’ unit or institution. In particular, the definition of an older person and placement based on choice were discussed.
Age when a prisoner becomes ‘older’
Participants who talked about this criterion indicated that 50 years is too young to be eligible for the older unit/institution. A prisoner participant (P4, 57 years) stated, ‘50 is a little exaggerated, but I think from 65 on one should be in a special unit or home or care service’. Highlighting that 50 is a very low denominator, a stakeholder (S11, Group 1) expressed this opinion:
Because in [country in Europe], older prisoners are people who are over 50, which means that if I was in prison, I would be an older prisoner! Does that mean I would only want to be with people over 50? I don't think so. I think that would be really strange.
Another participant (S2, Group 1), underscoring this concern, brought forth two important considerations. The first was that not all older prisoners will fare well emotionally in such specialised housing. The second was a need for further separation based on whether or not the older prisoner has a chance of being released into the community:
One would have to define the entering criteria clearly … What is an elderly prisoner? Do we do it strictly and say 65 plus or is it 55? … Because there are also 70-year-old people who are quite well in this environment and who would not be as well in, let's say, an old people's prison … And if one had that list of criteria, then one would probably need two different options. The first for those in custody who have to deal with: I will die in this block here [those serving indeterminate sentences] … Then there would be a group of those elderly people who still have a good chance of getting out [of prison] in two, three, four, five years.
Placement in an ‘ageing’ unit should be based on choice
Being placed in an ‘ageing’ unit automatically was not supported by some participants, even if they saw its health benefit to prisoners. Thus, a few participants such as stakeholder S12 (Group 1) noted that living in such a unit ‘would have to be the possibility, but it should not be obligatory’. Endorsing the notion of choice, a prisoner participant (P9, 56 years) questioned whether his choice would be respected: ‘I think we should ask the older prisoners about their wishes … But will they listen to our wishes?’ In fact, some stakeholders did underscore the importance of knowing the wishes and the choice of prisoners who would be living in such a unit. For example, S30 (Group 3) stated, ‘indeed the fact to have a unit where they are sort of better protected, better supervised … I think … should be done on a “consent” basis; that is to say, it should not be mandatory’.
Discussion
The current study adds to the debate on the need for age-segregated prison housing. The views of older European prisoners and professionals working in the prison setting has relevance for ageing and public policy not only in Europe but abroad where empirical data, especially research involving prisoners (Elger Reference Elger2008), is rare. To date, the debate about the segregated living situation has been driven by research showing the higher prevalence of illness among older prisoners as compared to younger prisoners and older individuals in the community (Binswanger, Krueger and Steiner Reference Binswanger, Krueger and Steiner2009; Loeb, Steffensmeier and Lawrence Reference Loeb, Steffensmeier and Lawrence2008; Wangmo et al. Reference Wangmo, Meyer, Bretschneider, Handtke, Kressig, Gravier, Bula and Elger2015; Wilper et al. Reference Wilper, Woolhandler, Boyd, Lasser, McCormick, Bor and Himmelstein2009), the fact that older prisoners are more likely to become victims of violence and abuse (Kerbs and Jolley Reference Kerbs and Jolley2007; Marquart, Merianos and Doucet Reference Marquart, Merianos and Doucet2000; Trotter and Baidawi Reference Trotter and Baidawi2015), the high prevalence of sleep problems and consequent use of hypnotics prescriptions (Elger Reference Elger2009; Elger et al. Reference Elger, Goehring, Revaz and Morabia2002), and the increasing number of older prisoners (Aday Reference Aday2003). Our study findings were mixed. There was some support for the current segregation arguments but, just as importantly, there were new perspectives gained from the current investigation.
In response to the debate on separate versus consolidated housing for older prisoners, it is noteworthy that irrespective of diversity of participants interviewed, they presented similar arguments on the topic. This confirmed the bifurcated nature of the debate so far. Similar to what is already known (Goetting Reference Goetting1985; Kerbs, Jolley and Kanaboshi Reference Kerbs, Jolley and Kanaboshi2015; Marquart, Merianos and Doucet Reference Marquart, Merianos and Doucet2000; Thivierge-Rikard and Thompson Reference Thivierge-Rikard and Thompson2007; Yates and Gillespie Reference Yates and Gillespie2000), one reason provided by older prisoners from Switzerland and stakeholders from three European countries in support of consolidated prisons was that it mirrored society. Furthermore, it was preferred by those stakeholders who felt strongly that segregation of any sort should not take place since it might result in ghettoisation (Howse Reference Howse2003). The value of a consolidated prison setting lay with its potential for generational exchange by providing older prisoners with the opportunity to share their wisdom and experience with those who are younger.
Our results provide empirical support for partial segregation, a compromise to the debate on consolidated versus segregated housing (Kerbs and Jolley Reference Kerbs and Jolley2007; Vito and Wilson Reference Vito and Wilson1985). Partial segregation of older prisoners from the general prison population is deemed to ‘provide the best of both worlds’ (Kerbs, Jolley and Kanaboshi Reference Kerbs, Jolley and Kanaboshi2015: 90), as older prisoners could live in a separate unit that addresses their physical and medical needs, while at the same time enjoying dynamic relationships with prisoners of different ages. Consistent with previous research (Elger et al. Reference Elger, Goehring, Revaz and Morabia2002; Marquart, Merianos and Doucet Reference Marquart, Merianos and Doucet2000; Neeley and Addision Reference Neeley and Addision1997), such a separate unit should ideally include more open space, shield older prisoners from the generally high noise level late during evenings, have lower levels of security given this group's reduced likelihood and capability of escaping, and give residents the responsibility for their daily choices. It should further include measures to adapt the daily prison schedule to older prisoners' declining physical health.
In contrast to other studies, the present study found that violence against older prisoners did not appear to be a critical reason in support of segregated living situations. Victimisation of older prisoners who are deemed more vulnerable has been one of the key reasons put forth for segregated prisons (Adams Reference Adams1995; Kerbs and Jolley Reference Kerbs and Jolley2007, Reference Kerbs and Jolley2009; Trotter and Baidawi Reference Trotter and Baidawi2015). There could be several reasons for the lack of support for this concern in our sample, including the prison culture and population. As noted earlier, prisons in Switzerland tend to house a smaller number of inmates and the prisoners that were interviewed reported having a prison cell to themselves. These conditions may result in fewer opportunities for violence.
Another empirical finding reported less often in the debate is the significance of choice and consent of older prisoners with regard to such separate placements. Complete or partial segregation without taking into account the wishes of the prisoner, as well as the individual's actual health needs, was not recommended. This is because older prisoners who are healthy may choose to stay with the general population. Choice in such a decision was critical (Vito and Wilson Reference Vito and Wilson1985). We emphasise that respecting prisoners' choices is important, as doing so may allow better somatic and mental health of the person concerned.
Finally, in light of harsher prison sentencing, greater numbers of older prisoners are entering prisons and ageing there (Aday Reference Aday2003; Crawley and Sparks Reference Crawley and Sparks2006; Fazel and Baillargeon Reference Fazel and Baillargeon2011; Ginn Reference Ginn2012; Human Rights Watch 2012). Recommendation to separate prisoners by the sentence type is important. This allows segregating prisoners by security levels and by their likelihood of release. Security level has previously been reported as an important factor in the segregation debate (Adams Reference Adams1995). Such separation may also have some cost benefits for the prison. Older prisoners who are less healthy, have aged in prison, have no social contacts in the community and possibly will die in prison may not require high levels of security. Given these circumstances, consideration could be given to allowing them to have some pockets of freedom, as reported by our participants.
Limitations
As a qualitative study based on interviews with older prisoners and stakeholders in three countries, this study is bound to the limitations inherent to this design. We do not claim our data to be generalisable to every context and all older prisoners since availability of resources, quality of care provided and individual preferences could be different in other contexts. Social desirability is a concern since older prisoners as well as stakeholders may have tended to provide responses deemed ‘correct’. However, we do believe that this limitation is minor since the topic of housing is less personal in nature. Additionally, the propositions in support of and against separate housing for older prisoners were similar from each participant group. Our sample included mostly older male prisoners, with a representation of five older female prisoners, whose opinion did not appear to be qualitatively different from their male counterparts. But this should not be taken for granted in light of their very small numbers. Finally, we were unable to tease out differences in opinion based on three types of older prisoners as specified in the literature (Crawley and Sparks Reference Crawley and Sparks2006; Neeley and Addision Reference Neeley and Addision1997). However, it is reasonable to assume that older prisoners who aged in prison may have different preferences than those who enter prison at old age.
Implications of the study
Based on our findings, we put forth suggestions for both prison policy and future research. First, where possible, efforts should be made to provide the older prisoner population with a separate living situation within the existing prison structure. This appears to be a more favourable choice than a completely segregated prison. Such a separate unit must have the advantage that it caters to the health, social and environmental needs of this group. Second, in light of the significance of generational exchange found in this study, policy makers and prison administrators must weigh the benefits and risks carefully before older prisoners are put together in a separate prison in the name of safety. Since victimisation was not raised as an important issue in our study, we deem that any push towards segregation based only on high prison violence (known mostly from US studies) and unsubstantiated context-specific information may result in poor public policy. Third, available knowledge underlines the significance of family ties and social support for older prisoners (Aday Reference Aday2005–6; Crawley and Sparks Reference Crawley and Sparks2006; Handtke et al. Reference Handtke, Bretschneider, Wangmo and Elger2012; Kerbs and Jolley Reference Kerbs and Jolley2007; Neeley and Addision Reference Neeley and Addision1997; Williams and Rikard Reference Williams and Rikard2004). Thus, if new facilities are to be made for this prisoner group, it should not be constructed in remote areas. Distant location makes access to health care difficult, not to mention access to specialised programming, and is also not conducive to ensuring relationships with family members. Finally, it is clear that many prisoners are serving life sentences (particularly in the US context where sentences tend to be very long) and indeterminate sentences (in the European context where prisoners are incapacitated from re-offending even after serving their sentences). This category of older prisoners will have needs aside from health care that are separate from those of older prisoners who will likely be released in the future. Thus, segregating based on age as the only criterion will probably be a poor judgement on the part of prison administration. Additional criteria, such as the type of sentence, the risk of victimisation due to the crime committed and the health of the older prisoners, must also be taken into account. No matter which criteria are set for entering such a separate unit or prison, consent of the older prisoner is paramount.
Future research in the field of environmental needs of older prisoners must capture the viewpoints of older female prisoners. As a neglected group among prisoners due to their small numbers (Aday and Farney Reference Aday and Farney2014; Handtke et al. Reference Handtke, Bretschneider, Elger and Wangmo2015), there is not much information about what their particular environmental needs are and whether their views are very different (or not) to those of older male prisoners. Comparative studies reporting on outcomes of living in age-segregated and consolidated prisons are anticipated and likely to contribute towards an evidence-based prison policy.
Conclusion
Whether all older prisoners should be grouped together in an age-segregated unit or institution is questionable due to their heterogeneity. Careful individual consideration of a prisoner's history of incarceration, health and personal behaviours is needed. Each prisoner will adapt to and experience prison very differently. Consequently, they are likely to demonstrate quite different health, social and rehabilitation needs. Any unsubstantiated support for segregated living for older prisoners may result in poor public policy as there are equal voices supporting and opposing such segregated prison housing. We find an affinity towards age-mixed settings for older prisoners since even those participants who felt that separation of older prisoners would be beneficial underlined that such separation should not mean a completely different prison, but a separate wing within the prison. Such a separate unit for older prisoners within existing prisons that allows for generational exchange (like a consolidated prison), provides more freedom, as well as considers their wishes, may be valuable. The current debate on separate housing for older prisoners is centred on the provision of better health care and prevention of victimisation. Given these ideals may already exist in certain prison populations, further consideration should be given as to what age-segregation could actually achieve for these older prisoners.
Acknowledgements
The authors highly appreciate the access given by participating prisons and the prisoners who agreed to share their experiences with us. We thank our stakeholder participants for their time and for sharing their perspectives of the topic. Finally, the authors acknowledge the support of Dr Catherine Ritter and several research assistants (Eloise Gennet, Kirsten Persson and Nicolas Lagnaux) who helped with the transcriptions and translations. This work was supported by the Swiss National Science Foundation (grant number CR13I1_135035). Ten ethics committees in Switzerland approved the study. Additionally, this study was approved by the national ethics committees of the two other European Union countries. TW contributed towards the design of the project, led the analysis of the manuscript, and drafted it. VH and WB carried out the data collection for the project. BE conceived and designed the project. VH, WB and BE participated in analysing the data and agreed to its interpretation. They read and revised the manuscript, and gave their approval for publication.
