American prisons are turning into nursing homes. Medical and geriatric parole offer a solution.
Wheelchair ramps, CPAP machines and hospital beds are now standard equipment in American prisons, which now hold more elderly inmates than at any other point in recorded history. Paradoxically, the number of incarcerated people 55 or older has quadrupled over the last few decades, even as the overall prison population has declined. By 2030, an estimated one in three prisoners will be eligible for the senior discount at Denny’s.
Medical and geriatric parole provide pathways for older and medically vulnerable individuals to be considered for release when they no longer pose a significant public safety risk. Both mechanisms recognize two basic realities: people age out of crime, and correctional healthcare costs rise dramatically with age.
Historically, the United States relied heavily on the executive branch to provide sentencing relief. That system worked as long as elected officials were willing to grant commutations and pardons when appropriate. However, clemency became politically radioactive during the “tough-on-crime” era of the 1980s and ‘90s, weakening parole boards across the country and causing several states to eliminate them entirely. Mandatory minimums set fixed sentencing floors, and three-strikes laws imposed long terms following third felonies.
Not only did these laws strip away judicial discretion and drive up incarceration, they also planted a fiscal time bomb. Now, 30 years later, that bomb is set to explode.
It costs roughly five times as much to incarcerate an elderly inmate than a young one, which is why spending on prisons continues to grow despite flat (or even falling) inmate populations. Since 1977, corrections departments have consumed an ever-larger share of all justice system expenditures, increasing by 346 percent compared to law enforcement’s 189 percent (adjusted for inflation). The rising costs are driven largely by healthcare. In 2024, just 9 percent of Virginia’s prison population accounted for 86 percent of total medical costs. In Texas, prisoners over 55 make up one-eighth of the population but half of all hospitalization costs.
Expenditures related to chronic illness, mobility accommodations, and end-of-life care are straining budgets, with states spending enormous sums to incarcerate people who pose little threat to public safety. This isn’t just expensive—it’s unnecessary.
Research has shown that criminal activity rises through adolescence, peaks in early adulthood, and then declines steadily. Statistically, a 65-year-old released from prison has roughly a 6 percent chance of returning to prison for a new conviction, compared to 66.6 percent for people 25 and under. Last year in Colorado, the three-year recidivism rate for people in their 60s was just 1.3 percent. This is government at its least efficient: massive spending with little return on investment.
Medical parole generally applies to people with a terminal illness, severe incapacitation, or serious medical condition, while geriatric parole focuses on older incarcerated people who have served a significant portion of their sentence. These policies can improve institutional safety and prison management in addition to cutting costs. The possibility of eventually getting out provides a stronger incentive for incarcerated people to comply with correctional rules, participate in programming, and proactively prepare for release at whatever age they may be eligible. Thus, medical and geriatric parole can create safer environments for both inmates and guards while redirecting correctional resources to where they are needed most.
Across the country, states have adopted a wide range of medical and geriatric parole systems, though many remain underutilized because eligibility standards are too narrow, application processes are overly burdensome, or politics get in the way. To strike a balance between public safety and human dignity, effective policies often include independent medical review requirements, victim notification procedures, appropriate supervision conditions, and individualized risk assessments.
Fiscal conservatives who believe in limited government should be asking whether states are using correctional resources in ways that actually improve public safety. The money spent on prison dialysis machines and round-the-clock nursing staff could instead support law enforcement, victim services, violence intervention, and other policies with a far greater return on investment.
Effective correctional policy is smart, targeted and fiscally responsible. As America’s prison population continues to age, states should expand medical and geriatric parole to release those who pose the least risk and cost the most to incarcerate. Otherwise, our correctional institutions will become the world’s most expensive, highest-security assisted-living network.