An Organizational Analysis of Prison Hospice

• Published date: 01 December 2007
• Author: Kevin N. Wright,Laura Bronstein
• DOI: 10.1177/0032885507306163
• Date: 01 December 2007
• Subject Matter: Articles

The Prison Journal
Volume 87 Number 4
December 2007 391-407
© 2007 Sage Publications
An Organizational Analysis 10.1177/0032885507306163
http://tpj.sagepub.com
of Prison Hospice
hosted at
http://online.sagepub.com
Kevin N. Wright
Laura Bronstein
Binghamton University, Binghamton, New York
The integration of prison hospice programs into the prison settings poses a
unique organizational challenge. Generally, prisons adhere to strict functional
boundaries and rigid chains of command in their operations and delivery of
services. Yet hospice programs by their very nature involve interdisciplinary
collaboration and coordination. Furthermore, hospice programs require the
creation of more compassionate settings in which the end of life may occur,
which challenges widely held beliefs that prisons must be stark and punitive
and that prisoners must be treated with uniformity. Through interviews with
prison hospice coordinators, this study explores the structure and operations of
hospice programs, how well hospice programs are integrated within the larger
prison community, and the impact that prison hospice programs have on the
prison environment in general.
Keywords:
prison hospice; prison administration; prison environment;
organizational analysis
The Mission and Organizational
Structure of Today’s Prison
Incarceration has become the principal form of punishment used in the
United States. In fact, for serious and repeat offenders, imprisonment is prac-
tically the sole sanction employed to ensure public safety and exact retri-
bution and justice for miscreant acts. The deprivation of freedom of movement
through incarceration thus serves as the primary mission of prisons (P. M.
Carlson, 1999b, p. 6). However, as P. M. Carlson (1999b) notes, “The evolution
of U.S. prisons and jails has followed the shifting social forces at work in
the country” (p. 6). There is also a belief that crime is a behavioral issue that
can be directly addressed and corrected. Reform of convicted offenders is
Authors’ Note: The authors thank Nicole Rosswog, MSW, for her research assistance.
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touted as an equally appropriate means of promoting public safety as is
punishment (P. M. Carlson, 1999b, p. 6). With these opposing forces, prisons
have come to serve a common, dual mission:
To protect the citizens from crime by safely and securely handling criminal
offenders, while providing offenders some opportunities for self-improvement,
and increasing the chances that they will become productive and law-abiding
citizens. (Seiter, 2002, p. 11)
Exactly how and to what extent facilities pursue these opposing objectives
varies considerably from jurisdiction to jurisdiction and by security level.
Yet with virtually no exceptions, institutions conduct their endeavors employing
stringent and traditional bureaucratic organizational forms. This organizational
arrangement contains a highly structured chain of command with clearly
defined functional boundaries delineated among the various disciplinary areas
of the institutions (N. A. Carlson, Hess, & Orthmann, 1999, pp. 394-408; Seiter,
2002, pp. 178-183). Security is the dominant function for facilities, with
custody personnel being chiefly responsible for ensuring the safety of staff,
prisoners, and the community. Institutions typically have sizable treatment
units and personnel who provide education, occupational training, substance
abuse treatment, self-help, other treatment programming, and release prepa-
ration. Prisons, because they must meet all the basic needs of the confined
population, also have food, laundry, medical, and dental services and recre-
ational units. Physical plants must be maintained and kept clean and sanitary,
so there is a maintenance unit. Some prisons have industries. An administrative
division keeps records, provides personnel services, and takes care of fiscal
operations.
For the most part, these functional areas operate independently. Each has
its own administrator. Formal coordination occurs within the upper echelons
of the organization. Interunit interactions occur in two ways—at the point of
transaction in transferring prisoners from one unit to another, when custody
personnel deliver a prisoner to medical services, for example, or when custody
provides supervision within a functional unit (Seiter, 2002, pp. 180-183).
A few prisons have attempted to mute these functional boundaries and
strict adherence to specialization through the application of unit management.
Here, unit staff have the capacity to transcend functional areas to proactively
solve problems (N. A. Carlson et al., 1999, pp. 411-413; P. M. Carlson, 1999a;
Seiter, 2002, pp. 196-198). Otherwise, most prisons employ the more traditional
organizational form. Generally, the approach works well, as there are few
escapes, prisons are relatively safe and violence is generally contained given

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the population under custody, prisoners are successfully fed and clothed and
their medical and spiritual needs are attended to, and education and other
forms of treatment are provided.
The Impact of Special-Needs Prisoners
A sphere in which prisons must transcend functional specialization occurs
in the handling of special needs offenders. The deinstitutionalization of mental
health services that began in the 1960s has led to steadily increasing numbers
of mentally ill offenders finding their way into prisons (Wallenstein, 1999,
pp. 51-53). Many of these individuals have committed violent offenses and
are serving long sentences. Correctional institutions and their administrators
must carefully coordinate custody and mental health services to ensure the
safety of these special needs prisoners along with the safety of others. Many
states ascribe responsibility for housing and treatment of mentally ill prisoners
to correctional agencies and institutions but rely on state and local mental
health agencies to provide support, training, and resources to correctional staff
(Seiter, 2002, p. 423). Given this, not only is interunit coordination within the
prison necessary, but so too is interagency collaboration.
Another subgroup of special needs offenders that has grown in number
and has risen in prominence in requiring increased attention for their care and
custody is the older incarcerated offender. Longer sentences, the abolition of
parole, and natural life legislation have resulted in increasing numbers of
older offenders within the incarcerated population. The number of older
prisoners rose from 9,000 in 1986 to 4 times that in 1997 (Radcliff & Cohn,
2000). In 2002, 120,933 prisoners older than 50 (the designated chronological
age used by most correctional systems based on medical needs and lifestyles
to define “older” prisoners) were housed in the nation’s prisons (Anderson,
1999, p. 219). This segment of the prison population represents 8.6% of the
total population, compared to 5.7% found a decade earlier (McMahon, 2003).
As the prison population ages, an increased number of deaths occur within
prison walls (Kolker, 2000). In 2001, a total of 3,008 prisoners died while
confined in state and federal prisons. Although one might suspect that many
deaths resulted from acts of violence, only 2% of the total was caused by
another person. Suicides accounted for 6% of the total, with accidents and
executions each claiming another 2%. Of the deaths occurring in prisons in
2001, the vast majority, 2,258 of the 3,008, or 75% of the total, were the result
of natural causes other than AIDS. AIDS deaths accounted for another 9% of
the total. So, in one year, a total of 2,514 prisoners died from cancer, AIDS,
other extended and chronic illnesses, and old age (Pastore & Maguire, 2003).

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Prison Hospice
In the late 1980s, the first two prison hospice programs were piloted in
Springfield, Missouri, and Vacaville, California (Maull, 1998a). These programs
were initially started to address the high incidence of AIDS-related deaths
occurring in prisons (Maull, 1998a). There was an attitude developing among
some in corrections that prisoners should have the right to die with dignity.
The Springfield and Vacaville hospice programs paved the way for other U.S.
prison systems to adopt a more compassionate, humane way of providing
care to dying prisoners (Maull, 1998a). In 1991, the National Prison Hospice
Association was formed to serve as an educational resource for federal and
state prison systems that were interested in developing prison hospices (Maull,
1998a). The American Correctional Association instituted a mandate in 1996,
stating that prisoners should receive health care proportionate to community
standards, including services for terminally ill prisoners and compassionate
release when deemed appropriate (Craig & Craig, 1999; Maull, 1998a).
Hospice is a humane model of treatment for prisoners who are not likely
to be freed from the prison environment by means of compassionate release.
The goal of prison hospice programs is to provide the terminally ill inmate
with effective pain management during the dying process while also meeting
the individual’s physical, emotional, social, and...