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Caution urged before releasing prisoners with dementia

Friday, June 26, 2020 @ 12:47 PM | By Heather Campbell Pope and Eddy Elmer

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Seven years ago, a B.C. judge sentenced a 63-year-old man with dementia to jail because there was no suitable place for him to live in the community (R. v. McPherson [2013] B.C.J. No. 2127). He required housing in a secure facility capable of handling dementia patients who posed a risk for violence and other inappropriate conduct, but at the time, such a placement was unavailable. Jail was the only alternative.

Since then, accessing appropriate housing has remained one of the foremost problems for older offenders with dementia and other age-related illnesses. The COVID-19 pandemic has made this challenge even more difficult, as congregate settings including halfway houses, shelters and psychiatric hospitals struggle to contain the virus.

Prior to the current public health crisis, the housing vulnerability of offenders with dementia continued despite repeated warnings from correctional watchdogs and advocates that the reintegration needs of aging prisoners were outpacing community resources. For instance, Canada’s Correctional Investigator has long drawn attention to the shortage of accessible spaces in halfway houses for older offenders who require specialized health services like dementia care.

Many shelters also have limited capacity to meet the unique needs of justice-involved dementia patients.

Long-term care homes are better equipped to provide care to this population, but even in normal times, they have long wait lists and staff shortages. Moreover, while older offenders generally pose a low-risk to reoffend, many nursing homes are reluctant to house them, especially those with a history of violence or sexual misconduct.

Despite these limited options, correctional authorities are facing intense pressure from prison reform and civil rights activists to immediately release all low-risk elderly inmates, including those with dementia. Among the reasonable solutions offered is to relocate them to empty hotels, similar to a pilot project in Nova Scotia. Others have reasonably advocated for placement within the family home.

While these options may be suitable for many inmates, especially younger ones, they may be precarious for older offenders with complex cognitive issues like dementia who need specialized care and supervision. Notably, special security measures must be in place to monitor wandering, a common symptom of dementia. At the best of times, it is difficult to implement the right balance between personal safety and autonomy. Even nursing homes struggle with this task — and they are designed to care for this population.

Changing the daily routine of an offender with dementia by relocating them to a hotel or family home may also trigger delirium, an acute medical emergency causing confusion and one that needs to be treated quickly. With dementia and delirium sharing many symptoms, and sometimes mistaken for depression, care partners must be skilled in identifying the difference and responding appropriately.

Although aggression generally declines with age, persons with dementia may become increasingly agitated and combative. While serious violence is rare, they may exhibit behaviours such as hitting, kicking and biting. Others may swear and throw things. Some may suffer hallucinations or delusions, which care providers may not know how to manage. If offenders shelter with family, these symptoms can cause considerable fear, depression and burnout for loved ones and lead to suboptimal care.

Offenders with dementia may also be at risk of elder abuse and neglect. These societal problems are worrying enough in normal times; with the added economic and emotional strain of COVID-19, the number of cases may surge. Indeed, emerging evidence suggests that there has been a significant increase in financial scams and family violence during the pandemic.

Older offenders are also at risk of mistreatment by younger offenders. In a recent joint investigation, the Correctional Investigator and the Canadian Human Rights Commission found that many senior inmates reported being a victim of bullying and intimidation by younger prisoners. Offenders with dementia who are asking repetitive questions, repeatedly calling out or wandering through the unit may be especially at risk of being targeted by younger inmates. It is reasonable to fear that these violations might continue in congregate community settings.

The COVID-19 crisis has clearly exposed gaps in the continuity of care for offenders with dementia. While correctional authorities have made improvements in managing the geriatric prison population and have recently announced funding to help halfway houses reduce the spread of the virus, there remains an inadequate supply of safe and suitable community housing with access to skilled dementia care.

For many offenders, innovative and rapid solutions such as using hotels may help fill the housing shortage; however, caution must be exercised before they are used to accommodate offenders with dementia. While the status quo of remaining in prison is tragic, decarceration during the pandemic must not further jeopardize the health and safety of these vulnerable seniors.

Heather Campbell Pope (LLB, LLM) is a former B.C. lawyer and founder of Dementia Justice Canada. Follow her at @SeniorsLaw. Eddy Elmer is a PhD candidate at Vrije Universiteit Amsterdam and vice-chair of Correctional Service Canada’s Citizen Advisory Committee for Metro Vancouver West Community Corrections. Follow him at @Eddy_Elmer. The views are the authors’ own and not necessarily those of CSC or its committees.

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