Elderly other in Vacaville, California. Because of these

inmates are the fastest growing in the United States prison populations which
poses difficult challenges for correctional and public health entities and dying
alone in prison can be merciless. Prisoners not having family, friends, or any visitors
while incarcerated usually die a lonely, painful, isolated death. Hospice
programs, in prisons, started in the late 1980s due to increased deaths of
prisoners with Acquired Immunodeficiency Syndrome (AIDS) to be addressed in two
prisons, one in Springfield Missouri and the other in Vacaville, California.  Because of these two prisons, others started
to adopt the hospice programs to provide dying prisoners humane treatment and
to not have to die alone. Dignity, communicating respect, and compassion among
prison staff and prisoners was brought about through hospice (Wright &
Bronstein 2007).

U.S. Medical Center for Prisoners, opened the first prison hospice, in
Springfield, Mo, in 1987. The dedication and interest of a master’s prepared
psychotherapist, Fleet Maull, incarcerated for drug trafficking, the hospice movement
began. Sentenced to 25 years, during the 14 years served, he taught meditation
to fellow inmates and developed the momentum that lead to hospice care for prisoners.
Hospice first began as a volunteer visitation program and not a program for
medical care. Maull believed “hospice restores humanity by giving both
guards and prisoners permission to care,” (Head, 2005).

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 The Federal Bureau of Justice Statistics found
that the incidence and prevalence of chronic illness in the prison population
is quickly rising. Nationwide there are 42.8% of prisoners with serious chronic
medical conditions, 3% are more likely to have asthma, 55% diabetes, and 90% suffer
a heart attack, compared to other Americans of the same age. Those who had been
in prison over 72 months reporting medical problems are the greatest, 30.4%. With
the increase of elderly prisoners that have complex medical and mental health
issues, correctional institutions are required to provide a variety of health services,
including end-of-life (EOL) care. There are more than thirty-five U.S. state
prisons that now have hospice and palliative care programs to care for
prisoners at the EOL (Supiano, Cloves, & Berry, 2014).

A major contribution for the prison
hospice movement was made by the Robert Wood Johnson Foundation, which funded the
Cuiding Responsive Action in Corrections at End of Life (GRACE) Project, an initiative
of the lead partner, Volunteers of America. Many ways of intervention were
demonstrated to improve pilot sites, (McCain Correctional Hospital Hospice in
North Carolina, Coxsackie Regional Medical Unit Hospice of the New York Department
of Correctional Services, and the Federal Medical Center Carswell in Texas) for
the hospice program funds which allowed for the establishment of a resource
center, development of standards, and a handbook for correctional end-of life care.
In 1996, the establishment of hospice services for terminally ill prisoners, who
qualified, were supported by a compassionate release program initiated by the
American Correctional Association Task Force. Also, the nature of prisoners
with terminal illness, procedures to direct treatment and written policies were
developed by the group (Head, 2005).

 The GRACE Project, learned the
efforts and identified all the current end-of-life programs by examining the
1988, Prison-Based Hospice and Pallative Care Programs’ survey data collected
on 53 correctional jurisdictions, by the National Institute of Corrections (NIC).
The information collected for the end-of-life care program to be put into place
were, program goals, benefits and problems that might come about, funding,
policies and procedures, legal issues, licensing, inmate deaths, services
provided, inmate eligibility requirements, inmate classification, staffing, the
use of inmate volunteers, community involvement and family roles, resources and
needs. The programs were usually developed by individual hospice champions in
the prison, which included chaplains, wardens, administrators, local hospices
or hospitals and the National Prison Hospice Association, but took anywhere
from a few months to several years to plan. The program was not authorized or
restricted by any laws. Legal competency, guardianship and the requirement for
do-not-resuscitate orders are the few legal problems faced with the program in
prison health and privatized or contracted services (Ratcliff, & Cohn,

end-of-life care provided in prisons
is not an easy task and present great challenges: 1) rather than individual
preference, conformity is promoted, 2) overcrowding lessens inmates to be
treated as individuals, 3) state-of-the-art pain management is limited due to
drug abuse concerns, and 4) the use of aggressive treatment not elected by the
inmate can create liability and litigation, are just some of the challenges.