“We Are All Humans and Deserve a Decent Way to Go”: Examining Professional’s Experiences With Providing End-of-Life Care in Correctional Institutions

• Author: Brooke Cooley,Mollee Steely Smith,Tusty ten Bensel
• DOI: 10.1177/07340168211020810
• Date: 01 June 2022
• Published date: 01 June 2022
• Subject Matter: Articles

Article

“We Are All Humans and

Deserve a Decent Way to

Go”: Examining Professional’s

Experiences With Providing

End-of-LifeCarein

Correctional Institutions

Mollee Steely Smith

1

, Brooke Cooley

2

, and Tusty ten Bensel

1

Abstract

The aging prison population has increased dramatically over the past two decades. As this population

increases, correctional institutions are faced with health care challenges. Specifically, providing

adequate end-of-life (EOL) carefor terminally ill inmates hasbeen a concern. Despite issuesrelating to

providing EOL care, little is known about medical and correctional staff’s attitudes toward the

implementation of EOL care. The purpose of this study was to understand the challenges faced by

correctionaland medical professionals, focusing on job satisfaction, obstacles,and emotional effects of

providing EOL care in correctional institutions. Our data included 17 semistructured, face-to-face

interviews with medical and correctional staff assigned to the EOL care unit in a southern state.

Although the entire sample stated overall satisfaction with their job, participants noted several chal-

lenges and stressors, which included the lack of resources and difficultiesin balancing care. Participants

agreed that it was emotionally stressful to maintain appropriate relationships with the inmates, deal

with patientmanipulation, and be surrounded by dying and death.Implications are discussed relative to

the needs andexperiences of service providersand how to more effectivelytreat EOL inmate patients.

Keywords

end-of-life care, correctional health care, job satisfaction

Over the past two decades, the aging inmate population has become the fastest-growing demo-

graphic in prisons, representing a dramatic shift in the prison population (Luallen & Cutler, 2017;

Skarupski et al., 2018; U.S. Department of Justice, 2015). According to the Bureau of Justice

1

School of Criminal Justice and Criminology, University of Arkansas at Little Rock, AR, USA

2

Department of Criminal Justice and Criminology, Ball State University, Muncie, IN, USA

Corresponding Author:

Mollee Steely Smith, School of Criminal Justice and Criminology, University of Arkansas at Little Rock, 2801 S. University

Ave., Little Rock, AR 72204, USA.

Email: mksteely@ualr.edu

Criminal Justice Review

ª2021 Georgia State University

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DOI: 10.1177/07340168211020810

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2022, Vol. 47(2) 225–242

Statistics, approximately 1.4 million individuals are currently serving a prison sentence nationwide

(Carson, 2020; Kaeble & Alper, 2020) and 20.5%of this population are inmates older than 50 years

of age. As a result, correctional institutions are facing challenges in providing adequate health care,

especially for those with chronic or terminal illnesses, such as liver and heart disease, cancer, and

respiratory disease (Carson et al., 2020; Psick et al., 2017; Richter & Hostettler, 2017). In fact,

deaths from chronic illnesses have outp aced drug and alcohol deaths, homicide s, suicides, and

accidents in state prisons (Carson et al., 2020). Due to chronic illnesses among the aging prison

population, a significant challenge for prison administrations is the effective implementation of

end-of-life (EOL) care.

Currently, there are no uniform definitions or criteria for EOL care and a clear understanding of

how these programs are implemented in correctional institutions is also limited (Stone et al., 2012;

Wright & Bronstein, 2007b). EOL care is often defined synonymously with hospice or palliative

care, which is a humane model of treatment specifically for inmates who are unlikely to be released

from prison before their death (Wright & Bronstein, 2007a, 2007b). Traditionally, these programs

are intended to provide terminally ill inmates with effective pain management during the dying

process, while also meeting physical, emotional, and spiritual needs (Maull, 1998; Wright &

Bronstein, 2007a, 2007b).

Although clinical professions in EOL care can be rewarding, these individuals are routinely

exposed to mental and emotional stressors that stem from providing care for dying patients (Peters

et al., 2012; Slocum-Gori et al., 2013; Vachon, 1995; Whitebird et al., 2013). These stressors can

include burnout, fatigue, diminished compassion, poor quality of care, and difficulty coping with

dying patients (Kamal et al., 2016; Meier et al., 2001). In addition, correctional health care profes-

sionals may face different challenges in providin g EOL care to inmates as opposed to clinical

professionals. Inmates are often marginalized and considered undeserving of the care afforded to

the general public, especially regarding EOL measures (Byock, 2002). The conflicting ideologies

between prisonization culture and compassionate care can cause role ambiguities for those who

work in these types of programs (Penrod et al., 2016).

There has been limited research on the perceptions and attitudes of those who work with termin-

ally ill inmates (Cloyes et al., 2016; Maeve & Vaughn, 2001; Maull, 1998; Penrod et al., 2016;

Wright & Bronstein, 2007b). To our knowledge, however, no study has examined the challenges

faced by those who work in EOL units, the mental and emotional effects of their duties, and job

satisfaction among those working directly with inmates near the EOL. The internal and external

stressors experienced while working with the inmate population could potentially influence the care

they provide to terminally ill inmates. Therefore, the purpose of the current study was to explore the

effects of providing EOL care to inmates for health care professionals and correctional staff. More

specifically, we explored (1) how health care providers perceived their role in EOL care, (2)

challenges they faced while providing inmates with EOL care services, and (3) job satisfaction

working in an EOL care unit. We conducted semistructured, one-on-one interviews at the Depart-

ment of Corrections in a southern state with 17 health care and corr ectional staff who worked

specifically with terminally ill inmates. Based on our results, we provided recommendations that

can assist in identifying programming needs and develop strategies to better equip staff in providing

EOL care within correctional settings.

Literature Review

The care for older prisoners has become a concern across the nation as the incarcerated population

are aging in place at an alarming rate (Williams et al., 2012; Zimmermann et al., 2002). The Bureau

of Justice Statistics indicated that incarceration ages inmates by 10–15 years, which increases the

likelihood of chronic illnesses experienced in prison (Carson et al., 2020). As the demographic of the

226 Criminal Justice Review 47(2)