ASSESSING THE NEEDS OF THE AGING OFFENDER POPULATION IN BRITISH COLUMBIA AND THE YUKON by Jenni-Leigh Martin Bachelor of Arts, Simon Fraser University 2006 MAJOR PAPER SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS (CRIMINAL JUSTICE) In the School of Criminology and Criminal Justice © Jenni-Leigh Martin, 2021 UNIVERSITY OF THE FRASER VALLEY Winter 2021 All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. Approval Name: Jenni-Leigh Martin Degree: Master of Arts (Criminal Justice) Degree Title: Assessing the Needs of the Aging Offender Population in British Columbia and the Yukon Examining Committee Dr. Irwin Cohen GPC Chair Associate Professor, School of Criminology and Criminal Justice ________________________________________ Dr. Amanda McCormick Senior Supervisor Associate Professor, School of Criminology and Criminal Justice ________________________________________ Dr. Zina Lee Second Supervisor Associate Professor, School of Criminology and Criminal Justice ________________________________________ Phil Peachey External Examiner Executive Director, John Howard Society British Columbia ________________________________________ Date Defended/Approved: ____April 27, 2021_____________________ ii Abstract The aging offender population has represented a growing segment of the incarcerated population in Canada over the last decade. However, there is limited academic research on aging offenders in custody and in community residential facilities (CRFs) in Canada. The purpose of the current study was to assess the needs and perceived gaps in services available to the aging offender inmate population in British Columbia and the Yukon. The survey sample consisted of 54 staff and managers who are currently working in CRFs across British Columbia and the Yukon. The results indicated that few CRFs are prepared to accept aging offenders, who are more likely to present with physical, cognitive, and mental health needs that must be accommodated. Based on the literature and survey results, it is recommended that program evaluations are conducted on existing aging offender programs in custody and aging offender CRFs in the community, to determine whether they are meeting the needs of aging offenders. It is also recommended that a reallocation of funds be directed from the institutions to CRFs to care for individuals in the community and to support alternatives to incarceration for aging offenders who are considered lower risk. Additionally, communities need more well-funded resources and partnerships that promote multisector collaboration and support the transition of aging offenders from the institutions, into CRFs, and then the community. Finally, it is recommended that the reallocation of funds is invested into training for CRF staff who are working with aging offenders. These are viable first steps towards a national strategy to address the needs of aging offenders in Canada. The issues of a growing offender population cannot be ignored, and practical solutions are needed to more effectively supervise aging offenders for iii the remainder of their sentences with considerations of dignity and public safety at the forefront. iv Acknowledgements Dr. Amanda McCormick and Dr. Zina Lee-supervising professors at the University of the Fraser Valley. Thank you for all your help through this process! My mom and dad- for being there for me and encouraging me. Erica-for editing all my papers and cheering me on. Jessie-for your encouragement and support through all of this. Pat-for teaching me and mentoring me. My friends and work family- for everything they have done to support me through this journey. Finally, thank you to my classmates for sharing this wild ride together! v Dedication This research is dedicated to the members of the British Columbia Yukon Halfway House Association. The managers and staff of halfway houses in British Columbia and the Yukon are dedicated to providing tireless advocacy on behalf of the folks we serve. Their work contributes to public safety and creates opportunities for those who have been previously incarcerated to live a better life and reintegrate safely back into the community. Their frontline work and contributions are recognized and acknowledged. It is hoped that their participation in this research will contribute to the growing body of knowledge regarding the aging offender population and will influence changes in policy. vi Table of Contents Abstract ............................................................................................................................... iii Acknowledgements ............................................................................................................... v List of tables ......................................................................................................................... ix Introduction .......................................................................................................................... 1 Definition of an Aging Offender ............................................................................................. 2 Subgroups of Aging Offenders ............................................................................................ 4 Offence Profile................................................................................................................... 5 Origins of the Aging Prison Population ................................................................................... 8 Challenges ........................................................................................................................... 15 Physical Health ................................................................................................................ 15 Mental Health ................................................................................................................. 21 Social Needs and Isolation ............................................................................................... 27 Infrastructure and Safety Issues ....................................................................................... 31 Ethical Issues and Human Rights ...................................................................................... 33 Programs ............................................................................................................................. 37 True Grit Program (High Desert State Prison, Nevada) ...................................................... 38 Psycho-Geriatric Unit (Pacific Institution) ......................................................................... 39 Assisted Living Unit (Bowden Institution) ......................................................................... 41 Pre-Release Planning: The Hocking Correctional Facility, Ohio .......................................... 41 Community Residential Facilities...................................................................................... 42 Phoenix Society Aging Offender Program ......................................................................... 43 Haley House .................................................................................................................... 44 The Current Study ............................................................................................................... 44 Methodology ................................................................................................................... 45 Participants ........................................................................................................................... 45 Procedure ............................................................................................................................. 46 Results............................................................................................................................. 47 Attitudes Towards and Perceptions of Aging Offenders .................................................... 47 Barriers to Placing Aging Offenders at CRFs........................................................................ 50 Resource Needs in the Community and CRFs ..................................................................... 54 Training Needs ...................................................................................................................... 56 Discussion ........................................................................................................................... 58 Attitudes and Perceptions of Aging Offenders ................................................................... 58 Barriers to Placing Aging Offenders at CRFs........................................................................ 61 Resource Needs in the Community and CRFs ..................................................................... 64 Training Needs ...................................................................................................................... 66 Recommendations .............................................................................................................. 68 Formal Needs Assessment ............................................................................................... 68 vii Program Evaluations ........................................................................................................ 70 Training ........................................................................................................................... 70 Reallocation of Funds ...................................................................................................... 71 Limitations .......................................................................................................................... 71 Conclusion........................................................................................................................... 72 Appendix A: Research Ethics Approval ................................................................................. 74 Appendix B: Assessing the Needs of Aging Offenders at BC and Yukon Community Residential Facilities Survey ................................................................................................................... 76 References .......................................................................................................................... 84 viii List of tables Table 1: Attitudes Towards and Perceptions of Aging Offenders ................................................ 48 Table 2: Extreme Barriers Before, During, and After Residency at a CRF .................................... 54 Table 3: Resource Needs for Aging Offenders in the Community (n=54) .................................... 55 Table 4: Resource Needs for Aging Offenders at CRFs (n=54)...................................................... 56 ix List of figures Figure 1: Barriers to acceptance at a CRF for Aging Offenders .................................................... 51 Figure 2: Barriers for Aging Offenders While Residing at a CRF (n=54) ....................................... 52 Figure 3: Barriers for Aging Offenders When Released from the CRF (n=54) .............................. 53 Figure 4: Perceived Training Needs of Staff Working with Aging Offenders (n=54) .................... 58 x Glossary ADL BCYHHA CHRC CRFs CSC DPE EOL IPO Lifer OCI OPiC PBC PTSD TBI - Activities of Daily Living British Columbia Yukon Halfway House Association Canadian Human Rights Commission Community Residential Facilities (AKA halfway house) Correctional Services Canada Day Parole Eligibility End Of Life Institutional Parole Officer Long-Term Offender serving a life sentence in Canada Office of the Correctional Investigator Older Persons in Custody Parole Board of Canada (formerly known as the National Parole Board) Post-Traumatic Stress Disorder Traumatic Brain Injury xi Introduction The elderly inmate population has been on the rise globally for the past decade (Murolo, 2020; Office of the Correctional Investigator, 2019a). This has been identified in a number of countries such as Canada, the US, Australia, as well as in Europe. In Canada, the Office of the Correctional Investigator (OCI) reported that one in four (25%) offenders are categorized as aging (OCI, 2019a), yet there is no national strategy in place to address this issue. Given the complex needs of this vulnerable population, the OCI has identified the rise of the incarcerated elderly population as one of the growing concerns for the Correctional Service of Canada (CSC). However, this is a complicated issue, as it involves balancing the human rights of elderly prisoners with the safety and security of the community. There are very few prisons that can accommodate the complex needs of this population in Canada and even fewer community facilities that elderly offenders can be released to (OCI, 2019b). This paper will address these issues through a review of the existing literature and an analysis of survey data collected from a sample of staff and managers working in community residential facilities (CRFs; colloquially known as halfway houses) in British Columbia and the Yukon where elderly inmates may be released to from custody. This paper will define the term aging offender and discuss why the growing elderly inmate population has become a greater concern over the past ten years. Additionally, this paper will explore current programs and suggested or best practices in other jurisdictions, and provide recommendations that may better serve the aging offender population in Canada, respecting their dignity and human rights while simultaneously considering the safety of the general public. 1 Definition of an Aging Offender The definition of an aging offender can vary, depending on the context and myriad of factors that contribute to the aging process. In the US, the chronological age of 65 is used to define someone who is considered elderly, which is derived from the average age of onset of health issues (Dulisse et al., 2020). According to the OCI (2019b), society typically considers an elder citizen as someone who is 65 years of age and older, who has retired, or someone who has begun to show physical signs of aging. The factors that commonly contribute to a higher estimation of physiological age include a combination of lifestyle choices, socioeconomic status, substance abuse, adverse childhood experiences, trauma, and chronic health issues (Aday & Krabill, 2013; Barry, et al., 2016; Burles et al., 2016; Dulisse et al., 2020; Kerbs & Jolley, 2009; OCI, 2019a). Approximately 80% of aging offenders have at least one major health condition and require medical treatment (O’Hara et al., 2016). In the US, aging offenders who are 50 years of age and over are three times more likely to have a chronic health condition as compared to younger offenders (Dulisse et al., 2020). Chronic health conditions in elderly offenders contribute to a higher cost of incarceration when compared to the cost of housing younger persons in custody (Dulisse et al., 2020; Murolo, 2020; O’Hara et al., 2016). In the US and Australia, health care costs for aging offenders are approximately two to four times greater than for younger offenders (OCI, 2019b). Similarly, the costs for housing offenders in custody as opposed to in the community are much greater. However, in Canada, there is no information available on the community-based estimated costs associated with older versus younger parolees. 2 In addition to life stressors that have occurred prior to incarceration, the factors that continue to accelerate the aging process for people in custody are the stressors resulting from overcrowding, lack of meaningful socialization, and continued exposure to and fear of prison violence from younger counterparts (Maschi, Viola, & Sun, 2012). Interactions with younger offenders are described as a source of stress and fear of victimization by aging offenders, especially those with declining health issues (Baidawi et al., 2016). Additionally, over the past 15 years, research findings in the United Kingdom, the United States, and Switzerland suggested between 85% to 93% of aging offenders experienced difficulties with activities of daily living (ADL) (Baidawi et al., 2016). The physical structures of prisons were originally designed for younger, able-bodied offenders and present challenges to aging offenders who require assistance with simple tasks, such as getting out of bed and showering (Baidawi et al., 2016; OCI, 2019b). In comparison to the general population, the aging offender population is estimated to be approximately 10 years greater than their chronological age (Aday & Krabill, 2013; Dulisse et al., 2020; Kerbs & Jolley, 2009; OCI, 2019a; Stensland & Sanders, 2016). Due to the number of reported chronic health conditions and other significant health factors often experienced by offenders, as well as the pre-incarceration risky behavioural and lifestyle choices, the aging process is accelerated, which means that incarcerated adults may be considered to have a physiological age range anywhere from between seven to fifteen years older than their chronological age counterparts in the general population (Barry et al., 2016; Burles et al., 2016). The general consensus globally is that the age range of 50 to 55 years and older in the context 3 of a prison setting is the threshold for elder status. Given this, for the purposes of this paper, an aging offender is defined as someone who is 50 years of age and older. Subgroups of Aging Offenders There are three identified subgroups of aging offenders: those who are chronic or repeat offenders; offenders who are serving long-term sentences due to an offence or offences committed at a young age and are now aging in custody; and those who are sentenced and incarcerated later in life and who are typically first-time offenders (Aday & Krabill, 2012). A fourth group identified in the literature further divides the first-time offenders incarcerated later in life into two categories: those who are given short sentences and those who are given long sentences (Turner et al., 2018). A variation of these subgroups is described by Goetting’s (1984) typology: the long-term offender serving more than 20 years, chronic recidivists, lifers (those serving a life sentence), and the later in life-first time entering the correctional system offender. Regardless of how these subgroups are defined, the needs of each subgroup will vary, depending on their circumstances and the prevalence of factors that, as previously discussed, contribute to premature aging. For example, individuals incarcerated later in life may come from very different socioeconomic backgrounds that have afforded them the opportunity to have reasonable access to health care, proper nutrition, and the ability to avoid incarceration earlier in life (Turner et al., 2018). Furthermore, variations in sentence histories and lengths will impact the ability to develop coping strategies for adjusting to prison life (Aday & Krabill, 2012). In addition to identifying different subgroups, aging offenders also face intersectional challenges. The majority of research focuses on incarcerated men, as they comprise the largest number of older people in custody. Despite the growing number of older females in custody, 4 there is little to no research conducted on the challenges that this population faces. According to Leigey and Hodge (2012), the services available for aging incarcerated women in the US are lacking and there is limited gender-specific health and wellness programming. They noted that the female aging offender population in the US is on the rise, with stricter sentencing for drug offences and fewer options for parole. In Canada, the number of incarcerated women has doubled over the past ten years (OCI, 2019b). Incarcerated women between the ages of 50 to 64 represent approximately 13.5% of women in custody, while those who are 65 years of age and older represent 2% of incarcerated women (OCI, 2019b). Similarly, the aging Indigenous offender population has also increased in the past ten years, representing approximately 13.9% of aging Indigenous persons in custody in Canada and this trend has continued to increase every year since 2007 (OCI, 2019b). However, there is virtually no research regarding the unique barriers that Indigenous, as well as minority and transgendered, aging people in custody face. Offence Profile Aging offenders in each subgroup vary in their criminal offence histories. In a crosssectional study of 677 prisoners aged 50 years and older in New Jersey, Maschi and colleagues (2014) reported that the length of time served ranged from one year to life imprisonment. Approximately one-third (38%) served sentences between one and five years, 28% served between six and 19 years, 24% served 20 or more years, and 5% served 51 years to life (Maschi et al., 2014). Approximately one-third of the participants had not spent any previous time in custody, while two-thirds had at least two or more prior custodial sentences. The majority of offences were violent in nature (64%), followed by drug-related offences (46%), administrative 5 crimes, such as parole (42%) or probation (44%) violations, and sexual offences (25%) (Maschi et al., 2014). In contrast to the American research by Maschi et al. (2014) where sex offences were the least common offence type reported among elder prisoners, Turner and colleagues (2018) found that approximately 45% of the incarcerated population aged 50 years of age and older in England and Wales were convicted of sex offences. Similarly, another study involving four prisons in the UK over a two-year period reported that approximately 50% of older offenders were currently incarcerated for sexual offences (Crawley & Sparks, 2006). Approximately onethird of the participants that were interviewed reportedly had received a lengthy or life sentence and had grown old while incarcerated, while the remainder of the group were convicted later in life for historical sexual offences and had entered custody for the first time (Crawley & Sparks, 2006). The sentence lengths ranged from two years to life and in addition to sex offences, their convictions included fraud, manslaughter, murder, or war crimes (Crawley & Sparks, 2006). These studies did not speak to the different subtypes of aging offenders. Future research should include an analysis of offender profiles by subtype to further understand how offender subtypes vary in terms of their offence profiles. According to Aday and Krabill (2012), many aging offenders are serving time for serious offences. For example, aging male offenders are more likely to be serving time for murder, sexual offences, or drug offences and aging female offenders are more likely to be serving time for murder and drug-related offences, as compared to younger offenders. Additionally, approximately close to half of those aging offenders were first time offenders and 50 years of 6 age or older at the time of their first conviction. Of those offenders, they were more likely to be convicted of a serious, violent offence (Aday & Krabill, 2012). In Canada, the OCI (2019b) reported that approximately 50% of all individuals serving a life or indeterminate sentence were aged 50 years of age or older and were serving time long past their release eligibility dates. However, this group only encompassed about 24% of aging offenders who are incarcerated. As previously noted, there has been an increase in the number of individuals entering custody later in life for historical offences, such as sexual offences. In fact, offenders convicted later in life represent about 28% of the aging offender population (OCI, 2019b). The largest group of elder inmates consists of chronic or repeat offenders (45%), who are those that have typically served more than one federal sentence (OCI, 2019b). There has been an increase since the year 2000 in the number of individuals that are entering custody for the first time that are 50+ years of age, often convicted of a sexual offence (OCI, 2019b). Given that aging sex offenders appear to be a common sub-category, it is important to explore this group further. Sex offenders appear to be overrepresented in the aging offender population (Baidawi et al., 2016; Crawley & Sparks, 2006; Maschi et al., 2014; OCI, 2019b; Parrot et al., 2019; Turner et al., 2018). Furthermore, Kerbs and Jolley (2009) suggested that one-third of all aging offenders are sex offenders. This may be attributed to the increase in the number of offenders admitted to custody later in life for historical sex offences (Turner et al., 2018). Additionally, in the UK, it was reported that due to the nature of the crimes, police and prosecutors are highly motivated to obtain convictions against sex offenders, which contributes to the increase in aging sex offenders in custody (Crawley & Sparks, 2006). In Canada, another 7 possible explanation is that first-time sex offenders who received a long or indeterminate sentence are now growing older in custody (OCI, 2019b). Additionally, aging sex offenders reported high rates of victimization or fear of being victimized due to the stigma associated with their offence (Crawley & Sparks, 2006; Kerbs & Jolley, 2009). An American study conducted by Kerbs and Jolley (2009) with a sample of 65 male offenders aged 50 years and older suggested the types of victimization aging offenders experience in custody includes property damage, theft, and psychological, physical, and sexual abuse. Furthermore, they may be more likely to request administrative segregation for their own safety, given the lack of alternatives (OCI, 2019b). It was noted by Crawley and Sparks (2006) that aging offenders convicted of sexual offences also have high rates of anxiety related to their release, due to fear of victimization in the community, sex offender notifications, and a lack of appropriate, available housing. Some sex offenders have restrictions related to where they can reside in the community, so finding housing that follows their conditions, as well as meets their needs, can be challenging and a source of distress for this sub-category of aging offenders. Origins of the Aging Prison Population The aging prison population did not increase suddenly; there are a number of factors that have contributed to this issue. As noted earlier, the aging incarcerated population has been increasing globally over the past 15 years (Stevens et al., 2018). According to Turner and colleagues (2018), prison populations have increased in Australia, New Zealand, Canada, the US, and the UK by about 20% over the last 15 years, with the aging offender population increasing 8 the fastest. Tough on crime approaches for criminal behaviour in the US that began in the 1980’s, and have continued since, have also influenced international justice policies all over the world (Maschi et al., 2012). Mandatory minimum sentences and stricter sentencing policies resulted in mass incarceration in many countries (Aday & Krabill, 2012). As a result of the tough on crime policies, this contributed to not only an increase in the number of prisoners, but also the growing aging population in prisons as longer sentences were imposed (Iftene, 2019; Maschi et al, 2014; Murolo, 2020). Increased use of punitive sentencing laws and mandatory minimums have also resulted in an increase in the number of individuals incarcerated in Canada (Iftene, 2019; Zinger, 2016). Since 2005, the OCI has identified the need to address the increasing number of older people in custody (OCI, 2019b). The 2010-2011 OCI report investigated the issue of the aging offender population in more depth and offered recommendations to address their growing needs (OCI, 2011). In February 2019, the OCI and the Canadian Human Rights Commission published a report investigating the lived experiences of those who are aging and dying while incarcerated (OCI, 2019b). At the time of the investigative report, CSC was developing a policy framework entitled “Promoting Wellness and Independence of Older Persons in Custody,” which was released in May 2018. The OCI suggested that CSC revise its policy framework to include the 16 recommendations regarding the health and wellbeing of aging offenders (OCI, 2019a). In response, CSC indicated that a review of the framework was underway and would be completed in the spring of 2020. However, an updated version is not currently available. The policy framework that CSC proposed primarily focuses on providing a strategy for older offenders who are still incarcerated and promotes an aging in place approach. This 9 approach focuses on aging offender needs while incarcerated. One of the recommendations from the joint investigative report suggested reallocating institutional funding to the community to better address the needs of aging offenders during reintegration (OCI, 2019b). However, CSC’s approach does not include a framework to promote the reallocation of institutional resources to the community to support reintegration. Furthermore, the OCI (2019b) reported that only approximately 6% of CSC’s budget is allocated to the community for supervision and resources, despite the fact that there are more individuals being released from custody now than are being admitted. As previously discussed, the average cost of incarceration in Canada is higher when compared to the cost of supervising an offender in the community (OCI, 2019b). Furthermore, there are a lack of community options available to those who are non-violent and would possibly be better suited to reside in the community. The joint investigative report also suggested increased partnerships with community service providers to secure bed space options for lower risk aging offenders (OCI, 2019b). Additionally, the report recommended on-going review of institutional alternatives for aging offenders who do not pose an undue risk to the public, as there currently is no existing framework to mandate this. There are a number of reasons why compassionate release and community alternatives should be considered for some aging offenders. Despite public opinion and political pressure to deny compassionate release for eligible aging offenders, fiscally it costs significantly more for prison health care than it does for health care in the community (Burles et al., 2016). Many prisons are not outfitted with the necessary staff, adaptive equipment, or health care tools to address the complex physical and mental health needs that this population experiences. Furthermore, Canadian prisons do not have the capacity for palliative care services to be made 10 available to those who require hospice and end of life (EOL) care. Retrofitting prison units to serve the needs of the aging offender population is more costly and not always possible in prisons with aging infrastructure. A second reason to consider compassionate release and community alternatives is that age is one of the most reliable factors in predicting desistance from crime (Kerbs & Jolley, 2009; Lussier & Healey, 2009; Psick et al., 2017; Walker et al., 2020; Walters, 2020). Most aging offenders pose minimal risk to the public and have lower rates of recidivism. In fact, despite the challenges that some aging offenders face reintegrating back into the community, they still show lower rates of recidivism (Psick et al., 2017). Moreover, reoffending and a return to custody for new offences is much lower for older offenders than for younger offenders (Maschi et al., 2012). It is important to note that there is not a consistent age at which it can be determined that offenders begin to desist from crime (Walters, 2020). It is suggested that there are a number of factors that promote desistance and that the combination of these factors over time can have an effect on recidivism (Walker et al., 2020). Positive family and social supports promote positive reintegration and prosocial values for offenders. Additionally, finding support from other offenders during incarceration who are also interested in making positive changes can contribute to desistance from crime (Walters, 2020). Changes in attitude facilitated by cognitive behavioural programming while incarcerated are also associated with lower recidivism rates (Walters, 2020). Still, safety of the community is important to acknowledge when determining alternatives to incarceration for the aging offender population, considering that a high number 11 of aging offenders are serving time for violent offences (Aday & Krabill, 2012). A Canadian study by Walker et al. (2020) focused on assessing the factors that contribute to desistance from crime for sex offenders. According to their research, approximately 60% of participants surveyed in the general population believed that sex offenders have high recidivism rates (Walker et al., 2020). However, their meta-analysis of available research revealed that approximately between 3% and 27% of sex offenders re-offend, while the recidivism rates for other offenders was 25% to 36%. The large variability of sex offender re-offending rates is explained by the difference between the types of sex offenders and their risk to recidivate. According to Walker et al., (2020), offenders who commit sex offences against adult women have a higher likelihood of recidivism, as compared to offenders who offend against children. Furthermore, they also conceded that individuals who sexually offend against adult woman have a higher likelihood of increased anti-social behaviors, prior criminal history, and prevalence of personality disorders. Walker et al.’s (2020) longitudinal study revealed that of the sample of 318 Canadian adult males convicted of a sexual offence and who were considered a medium to high risk to reoffend, approximately 8% were reconvicted of a sexual offence and 58% were convicted of a general offence over a three-year period (Walker et al., 2020). The study also revealed that despite two groups emerging, one involving higher rates of reoffending and one with lower rates of reoffending, all individuals showed a decrease in offending over time (Walker et al., 2020). The study focused on family and social support as a protective factor for desistance from crime and noted that stable family support contributed to significantly reduced rates of reoffending. Those with more positively established social supports may be better able to 12 problem-solve strategies for reducing their risk to reoffend. They also suggested that consistent with Gottfredson and Hirschi’s age-crime curve theory, for offenders who were older at the onset of their criminal history, the likelihood of lower risk to reoffend increased by 80% (Walker et al., 2020). Still, they indicated that further research is required on the contribution that social support and coping strategies has on risk to reoffend. Further to that, although the study did include aging offenders, the average age of the individuals was 44 years old, so future research should focus on recidivism rates specifically for sex offenders 50 years of age and older. In Canada, when deliberating on conditional release, the Parole Board of Canada (PBC) is required to consider a number of factors in each case that is presented to them. Factors used to demonstrate viable release plans include prospective employment in the community and housing options. For many aging offenders, these factors are either irrelevant or out of their control to plan for, due to the lack of housing options available for aging offenders in the community. They are often denied release due to the lack of appropriate release options, rather than based on their risk to reoffend or lack of ability to reintegrate into the community (Iftene, 2017a). Institutional behaviour is often used as a measure of an individual’s risk if released, as well as whether they should be released (Iftene, 2017a). Making decisions on conditional release based on poor institutional behaviour without context can be problematic, as they do not account for the differences in contributing factors for misconduct in young, middle-aged, and elderly offenders. There is a gap in research when it concerns the behavioural differences between younger, middle-aged, and elderly offenders and institutional misconduct and what it means for predicting risk (Sheeran et al., 2020). According to deprivation theory, when 13 offenders first enter custody, they experience a deprivation of autonomy, freedom, and choice, which can contribute to frustrations and non-compliance with institutional rules (Sheeran et al., 2020). Furthermore, it has been argued that the higher the security level of the institution, the more behavioural problems there will be, based on more restrictions and less liberty. Conversely, another model to explain misconduct while incarcerated is importation theory. Irwin and Cressey’s importation theory described misconduct as behaviour that exists prior to incarceration and continues on while incarcerated (Sheeran et al., 2020). Therefore, how one adjusts to prison life is similar to how they would behave in the community to cope with tough situations. A recent study was conducted in the US to identify the contributing factors to prison misconduct among young, middle-aged, and elderly offenders (Sheeran et al., 2020). Data was obtained from the North Carolina Department of Public Safety on 128,103 incarcerated individuals in 2013. The study looked at four outcome variables of prison infractions from the most serious (assault, verbal threats) to least serious (disobeying orders, fighting). The predictor variables were age, age at initial arrest, age at first prison entry, race, marital status, education, employment, children, and gang affiliation. They concluded that younger inmates were more frequently involved in prison misconduct, as compared to aging offenders (Sheeran et al., 2020). Furthermore, the older someone is when they are first arrested and when they first enter custody, the lower the number of institutional infractions. Still, there are a number of factors that contribute to aging offenders engaging in misconduct, such as prior incarcerations and length of time served. However, when aging offenders engage in institutional misconduct, it tends to be minor in nature (Sheeran et al., 2020). 14 Given this research, and due to lower rates of recidivism and declining ability to engage in criminal activity for some aging offenders, incarceration appears to greatly exceed what is necessary to manage this population. With the lack of beds and resources to facilitate the supervision of aging offenders in the community, there is an overreliance on incapacitation to manage risk. Yet the population and characteristics of offenders has evolved over time, so it is necessary for interventions and strategies to likewise evolve and adapt to the current needs of aging offenders balanced against the protection of the public. Challenges The literature has identified a number of barriers that aging offenders often face while incarcerated and when released to the community. The most common challenges frequently mentioned by researchers that the aging offender population struggles with are aspects of health, both physical and mental, as well as social needs and isolation, infrastructure and safety, and ethical issues and human rights. Therefore, each will be discussed in more depth below. Physical Health While it is clear that aging offenders experience issues with physical and mental illness (Maschi et al., 2014; O’Hara et al., 2016; Turner et al., 2018), it is difficult to determine whether aging offenders have higher rates of physical and/or mental illness as compared to the aging population in the community, due in part to the lack of consistency with assessments and the absence of comparison studies (Solares, et al., 2020). The discrepancy and inconsistent measurement of what constitutes an older offender has also contributed to this difficulty. 15 Regardless of whether the rate of these issues is higher in custody, the presence of mental and/or physical ailments combined with age-related ailments may be more difficult to manage while incarcerated, as compared to in the community. Age-related issues and ailments tend to go unnoticed and undiagnosed in a prison setting (Dulisse, et al., 2020). Symptoms that are common amongst individuals who are aging include vision and hearing loss, incontinency, and frailty. Behaviour that is associated with symptoms of aging, but not understood as such, may be viewed as a disciplinary problem in a prison setting and subsequently punished (OCI, 2019b). For example, an aging offender that finds it difficult to stand for long periods of time may struggle to stand for count. Similarly, someone who has a hearing impairment might not be able to hear and respond to direction. These behaviours may be mistaken for disobedience and viewed as problematic. Additionally, the OCI (2019b) noted that aging offenders have limited access to equipment that can mitigate some of the symptoms of aging. For example, canes, walkers, and appropriate footwear and sleep-aids, such as supportive pillows and mattresses to relieve chronic pain, all assist older persons to better function and accomplish daily tasks independently. With a declining ability to be independent, some aging offenders may need more assistance with activities of daily living (ADL), but there might not be enough staff or qualified staff to assist (Murolo, 2020). To address this issue, peer programming may be helpful. One example is the Peer Assisted Living (PAL) program that operates within the Psycho-Geriatric Unit at Pacific Institution for federal offenders in BC (OCI, 2019b). Fellow offenders are screened and trained as caregivers to provide assistance to aging offenders who require help with ADL. There is limited research on 16 this program, but it could be argued that the program contributes to reduced isolation and increased exposure to positive role-modeling. Chronic illness and disease in aging offenders can be exacerbated by previous lifestyle behaviours (Aday & Krabill, 2012). These factors, combined with the effects of incarceration, can contribute to the development of poor health in this population. There is a higher prevalence of infectious disease, history of trauma and abuse, drug and alcohol use, as well as socioeconomic factors that have contributed to developing chronic health issues earlier in life amongst this population (Aday & Krabill 2012; Maschi et al., 2015). In the US, it is estimated that approximately 45% of offenders 50 years of age and older and 82% of offenders that are 60 years of age and older experience one or more chronic illnesses (Aday & Krabill, 2012). In the UK, a study on aging male prisoners in Northwest England found that 28% were in poor health, 91% indicated that they had at least one health condition, 56% had three or more health conditions, and 22% had five or more health conditions (Turner et al., 2018). Furthermore, individuals are often underdiagnosed and undertreated, so it is relatively unknown to what extent socio-demographic, physical and mental health, social, and environmental factors increase the likelihood of developing a chronic illness (Baidawi et al., 2016). Older people in custody have high rates of comorbidity that include physical impairments, pain, and chronic diseases (Aday & Krabill, 2012; Psick, Simon, Brown, & Ahalt, 2017; Turner et al., 2018). According to the OCI (2019b), the number of aging offenders experiencing a chronic illness is higher than the general Canadian population of a similar age. Among the chronic illnesses identified, obesity, hypertension, high cholesterol, type II diabetes, and chronic pain were the most prevalent of those 65 years and older who were incarcerated in 17 a Canadian prison (OCI, 2019b). However, due to the lack of peer-reviewed research on this topic, further research is needed to determine whether the prevalence rates or types of chronic illness are higher for incarcerated individuals as compared to the general Canadian population of a similar age. In relation to these diseases, another factor that can impact chronic illness is nutrition. Loeb and Steffenmeier (2011) conducted a focus group in a US state prison with 42 inmates aged 50 years and older to identify a number of barriers to a healthy lifestyle while incarcerated. Concerns regarding appropriate nutrition were among the barriers commonly identified by the participants. Typically, the food available in prison is high in carbohydrates and sodium, which can contribute to the prevalence of chronic illnesses, such as diabetes and hypertension (Loeb & Steffenmeier, 2011). There is limited access to health care, social supports, and staff who are knowledgeable about this population’s unique needs. Health care in prisons is intended to meet the acute needs of inmates and is not designed for the long-term care that chronic illness typically presents in the aging offender population (Baidawi et al., 2016). As most prison facilities are not equipped to address the needs of the aging offender population, they need to access health care services outside of the prison (Turner et al., 2014). This contributes to the increase in associated costs of health care. For example, older inmates would be required to be escorted by officers to appointments, which can result in overtime costs (OCI, 2019b). If there were insufficient staff available, the offender would not be able to attend their appointment. This causes delays in access to treatment and contributes to increased stress experienced by aging offenders. 18 With higher rates of chronic illnesses coupled with symptoms of aging and chronic pain, there is an increased need for specialists to be involved with elderly offender care (Psick et al., 2017). Furthermore, there is a growing need for hospitalization, surgery, and follow-up care. This contributes to the high cost of incarceration in relation to the increase in accessing health care services by this population (Loeb & Steffenmeier, 2011). In addition to the limited number of staff available to escort aging offenders to appointments, accessible transportation is also a barrier (OCI, 2019b). The transport vans can be difficult for some aging offenders to get in and out of and the use of restraints during transport can be uncomfortable and painful. The difficulties that aging offenders face when it comes to health care is not limited within the prison walls. When someone is released after serving an extended period of time, they will experience institutionalization (Crawley & Sparks, 2006). Every aspect of prison life is regulated and monitored, so when an individual is released, they face the challenges of having to take care of everything on their own. This is particularly challenging for ex-inmates who have spent a significant number of years institutionalized, which may be the case with some elder offenders. For example, while incarcerated, individuals are provided with specific times to retrieve their medication and appointments are set up by staff. This becomes a challenge on the outside for individuals who have never had to take on these responsibilities independently. Some aging offenders will lack the capacity to follow through with these obligations and they may not have the ability to complete them on their own. This is particularly challenging for anyone with memory impairment or limited mobility, with little to no community support to assist them. 19 In Australia, Stevens and colleagues (2018) conducted a meta-analysis of the existing literature regarding interventions for the aging offender population for both men and women. One of the key findings they identified was the growing need for specific health care programming to address the inequalities in accessing health care between men and women in custody. Women’s health care issues are significantly different from men, whether in custody or not and specifically in regards to aging. For example, women experiencing menopause require health care specifically tailored to their needs. There is also a discrepancy between how aging incarcerated men and women experience access to health care and treatment (Baidawi et al., 2016). Aging women reported that they felt they were infantilized and tended to feel that their illnesses and symptoms were dismissed. The majority of research focused on aging male offenders’ health, so further research studies are required to identify the gaps and challenges that aging female offenders face. Participants of Loeb and Steffenmeier’s (2011) focus group identified some of the things they would like to see to improve their overall health. They indicated that they would like to have access to information on healthy diets, medications, and specific diseases. Additionally, they preferred health care programming regarding preventative care and age-appropriate exercise. Granting access to information would allow aging offenders the ability to exercise some autonomy and play a role in managing their own health and well-being. Individuals with better health may be better prepared before their release to the community, which can result in more positive outcomes and successful community reintegration (Aday & Krabill, 2012; Haesen et al., 2018; Maschi et al., 2015). Furthermore, access to age-appropriate programming that emphasizes education on disease management, nutrition, and healthy living can contribute 20 to overall improved health, well-being, and outcomes for older people in custody (Aday & Krabill, 2012). Mental Health In addition to chronic physical health issues, the aging offender population also faces mental health challenges. It is not uncommon for incarcerated individuals to experience one or more co-occurring illness, such as depression and anxiety, and take multiple medications to manage them (OCI, 2019b). Furthermore, as compared to younger people who are incarcerated, aging offenders have a higher prevalence of mental health disorders (Haesen et al., 2018). In the UK, approximately 50% of incarcerated individuals who are 50 years of age or older identified having one or more mental health issues (Baidawi et al., 2016). In France, a study completed by Beaufrèrè and Chariot (2015, as cited in Parrot et al., 2019), 211 arrestees aged 60 years of age and older had a higher prevalence of physical and mental health issues as compared to younger individuals who were arrested. Stevens and colleagues’ (2018) metaanalysis revealed similar findings globally, noting that while the existing research was limited, between 40% to 50% of aging offenders appear to have at least one mental health issue. Moreover, they also identified depression as the most common mental health diagnosis amongst this population. In Canada, approximately 19% of incarcerated individuals aged 65 years and older were diagnosed with depression (OCI, 2019b). In addition to depression, the most frequently diagnosed mental health issues for aging offenders are schizophrenia/psychosis and anxiety (OCI, 2019b; Solares et al., 2020). It is unclear as to whether these diagnoses existed prior to incarceration or developed during incarceration. According to O’Hara and colleagues (2016), 21 depression is particularly common amongst older offenders when initially admitted to custody, especially if it is their first time. Furthermore, higher rates of depression were reported if experiencing one or more chronic health conditions. Nonetheless, few studies have been conducted that compare the mental health of the older general population to the incarcerated aging population. Irrespective of this, considering the conditions of incarceration with the increased levels of isolation, separation from family, and declining physical health for some aging offenders, there will likely be a negative impact on their mental health. Importantly, older persons have been described as experiencing a state of trauma when they first enter custody (Crawley & Sparks, 2006; O’Hara et al., 2016). At any age, becoming incarcerated and losing family, friends, and freedom can suddenly activate a trauma response in the brain (Maschi et al., 2015). The ability to adapt in prison may depend on previous life circumstances the individual has faced and contribute to their aptitude to cope. For example, individuals who are incarcerated tend to have higher incidents of personal trauma and are more likely to experience multiple traumatic events in their life (Flatt et al.,2017; Maschi et al., 2015). They enter the criminal justice system having already experienced stress histories that can include, but are not limited to, family violence, divorce, single-parent household, parental substance abuse, or unexpected death of a close family member or friend (Maschi et al., 2015). Flatt and colleagues (2017) conducted a study in a US county jail of 238 inmates aged 55 and older to identify the prevalence of post-traumatic stress disorder (PTSD) in older inmates. The majority of participants were men (95%), approximately 24% identified as a veteran, and 64% were Black. In their study, nearly 40% of offenders screened positive for PTSD, yet only 10% had a diagnosis prior to incarceration. Although the authors did not address it as such, it 22 could be presumed that incarceration was a contributing factor for triggering the onset of PTSD for individuals with previous trauma. Those with higher rates of early life trauma, a reported traumatic brain injury (TBI), and two or more ADL impairments were more likely to screen positive for PTSD (Flatt et al., 2017). Based on this information, they suggested that initial screening assessments for PTSD may be crucial at intake in county jails, as well as more expansive reintegration programs that ensure continuity of care when returning to the community. It can be difficult to assess the mental health needs of the aging female offender population, as there are very few research studies on female offenders in general and they typically do not differentiate between age categories. In the US, available research indicates depression is common among older incarcerated women (Leigey & Hodge, 2012). The authors gathered information from the Bureau of Justice Statistics on 997 aging male offenders and 142 aging female offenders who had been incarcerated for at least one year. Notably, the group was disproportionately comprised of minorities. According to the study, aging female offenders were more likely to report mental health issues over their lifetime, as well as over the past year, as compared to aging male offenders (Leigey & Hodge, 2012). Furthermore, 23% of aging female offenders had made a suicide attempt in their lifetime as compared to 8% of male aging offenders. Aging female offenders reported experiencing significantly more mental health conditions (X = 5) compared to aging male offenders (X = 3). The results of the study also suggested that over a lifetime, aging female offenders were more likely to have received interventions for mental health as compared to their male aging counterparts, and that older incarcerated females enter custody with a higher prevalence of experiencing mental health 23 issues and accessing services prior to incarceration (Leigey & Hodge, 2012). They acknowledged that the results of the study could not accurately estimate the extent to which incarceration exacerbated mental health conditions for both men and women. Despite these findings, there is still limited research and information available on the mental health of older females in custody. Further research is required to address the unique needs of this prison population. Suicide and suicidal ideations are also very prevalent in older people in custody. In the US, the Bureau of Justice Statistics reported that suicide mortality rates were highest among older people who are incarcerated (Barry et al., 2016). Furthermore, there is a higher likelihood of attempts at suicide ending in death and an overrepresentation of attempted suicide among older inmates. In Canada, suicide deaths in custody are relatively low compared to other countries, but there are no specific statistics on the aging offender population (OCI, 2019a). Barry and colleagues (2016) recognized that research is limited in early suicide detection and prevention in custody, so their study attempted to identify factors that contributed to suicidal ideations in the older incarcerated population in the US. The study excluded aging offenders who did not speak English and who were hospitalized or in segregation, which resulted in a participation rate of approximately 39%. They acknowledged that these factors contributed to an under-sampling of aging offenders with possible suicidal ideations. In their sample of 124 aging offenders, 22% had current passive suicidal ideations (thoughts or plans wishing one’s own death without thoughts of killing oneself) and 12% had current active suicidal ideations (thoughts or plans to kill oneself) (Barry et al., 2016). This was compared to a study by Corna, Cairney and Streiner (2010, as cited by Barry et al., 2016), that suggested 2% of older people living in the community reported current active suicidal ideations. Early detection 24 for suicidal ideation can be difficult to detect if they are not reported. Of the 27 participants that reported suicidal ideations in the study, only three were officially documented in prison medical charts. Some possible explanations included reliance on self-reports of suicidal ideations and aging offenders not wanting to be placed on suicide watch. Another potential explanation is that the factors that contribute to suicidal ideation in aging offenders may differ from that of their younger counterparts. For example, the report indicated that passive suicidal ideation was highly associated with poor and declining health associated with aging (Barry et al., 2016). While the reasons for not reporting suicidal ideations were not reported, possible contributors include a fear of stigma and isolation, if the only intervention is to be placed in segregation. They recommended future research to identify the factors that contribute to suicidal ideation in the aging population and to develop early interventions and treatment accordingly (Barry et al., 2016). Future research should also explore whether these risk factors differ for older versus younger inmates, and within the older subgroup of inmates, whether there are additional differences for Indigenous inmates as compared to non-Indigenous, or for female inmates as compared to males. In addition to mental health disorders, aging offenders may experience neurocognitive deficits as well as neurological disorders (Solares et al., 2020). The development of disorders, such as Alzheimer’s and dementia, has some association with previous brain traumas suffered, such as from prolonged substance abuse (Solares et al., 2020). These neurological disorders can severely impact the behaviours of those who are diagnosed with such diseases and challenge the ability of staff to effectively manage them safely in custody. According to the OCI (2019b), staff in Canadian prisons are provided with very little training and there are limited resources 25 for proper assessments and diagnoses. Furthermore, there is a lack of consensus of when to screen aging offenders for these types of disorders (CSC, 2018). Some experts recommend screening all aging offenders once they turn 65 years old, whether they show symptoms of a neurological disorder or not (CSC, 2018). However, it is unknown whether screening asymptomatic aging offenders is necessary or beneficial. There is also a lack of agreement on what assessment tools are appropriate to use for screening. Due to the absence of assessments, the number of incarcerated individuals with neurological disorders is unknown. For aging offenders in custody, a huge factor that causes stress and anxiety is the fear of death and dying in prison (Baidawi, et al., 2016; Burles, et al., 2016; OCI 2019b; Turner et al., 2018;). In the US, there are numerous examples of palliative care units to meet the specific needs of aging offenders at the end of their life, which will be explained further on. However, in Canadian prisons there are no specific units dedicated to end-of-life (EOL) care. Some aging offenders have no alternative options other than to rely on staff when making choices for their health; this does not always lend itself to a trusting relationship. The mandate of the correctional staff is safety and there is a very clear power imbalance between offender and guard which differs from the relationship the offender would have with a care provider in the community (Stensland & Sanders, 2016). There are limited resources, such as access to social workers and other appropriate professionals to address EOL planning with aging offenders, which is a source of anxiety and stress for aging offenders who are dying (Stensland & Sanders, 2016). The stress of incarceration and psychological trauma that this population faces, compounded by mental illnesses, such as depression and anxiety, can contribute to a fast- 26 tracked aging process and lower life expectancy (Dulisse, et al., 2020; O’Hara et al., 2016). Fears associated with victimization and dying while in prison add stress and anxiety to aging offenders. For some, nearing death brings the need for closure, recompense, and saying goodbye to loved ones, which is not always accommodated (Stensland & Sanders, 2016). There is a lack of research information available about the extent to which aging offenders are able to access counselling and bereavement support. However, what is available suggests there is an absence of bereavement support for incarcerated friends of those who have passed, to help grieve and cope (Howe & Scott, 2012; Maschi et al., 2012). This is unfortunate, as strategies to increase social connection and peer support among aging offenders may contribute to better outcomes and less anxiety for this population (Parrott et al., 2019). Social Needs and Isolation The social needs of the aging offender population are strongly associated with the mental and physical health concerns that have been reviewed. Alongside the prevalence of chronic health conditions and mental health issues, there is a risk of individuals withdrawing from the general prison population (Aday & Krabill, 2012). There are a number of variables that contribute to isolation and loneliness, which can increase the likelihood of deterioration of their health and well-being. As mentioned earlier, upon initial entry into custody, individuals may experience a form of trauma (Crawley & Sparks, 2006; O’Hara et al., 2016). While adjusting to incarceration can be a traumatic experience for everyone upon initial intake, for aging offenders, the fear of the possibility of dying in prison, especially for those with longer prison sentences, can contribute to withdrawing and isolating from family and friends in the community (Aday & Krabill, 2012). 27 Aday and Krabill (2012) also reported that aging offender populations tend to have smaller social networks as compared to their younger counterparts. A higher number of aging offenders are typically single, divorced, or separated from a spouse. With an aging offender’s own declining physical and mental health, they may be less motivated to put the effort into maintaining relationships with friends and family outside of custody (Aday & Krabill, 2012). In addition to the initial shock of the new environment and adjusting to prison life, offenders have to come to terms with very limited access to family and friends. For some aging offenders serving longer sentences, their family and friends may choose to sever ties and cut communication with them completely due to the circumstances surrounding their crime (Crawley & Sparks, 2006). For some aging offenders serving longer sentences, they make the difficult choice to cut ties with their family and friends in the community, as they feel it is a burden for them to visit and travel long distances. This is particularly true for Indigenous men and women who are incarcerated far from their homes. Crawley and Sparks (2006) even suggested that cutting ties with family is a coping mechanism for some older offenders, as visits from family and friends can be two-fold. On one hand, the social connection with loved ones can boost mood and have a positive effect on the offender, while on the other hand, saying good-bye every time brings the reality of the situation to the forefront and it can be difficult to grieve that loss every single time. To reduce the stress of going through that, offenders may choose to limit their visits or cut them off all together for self-preservation. With offenders moving from different prisons, for various reasons, this can also create a hardship of travel that might not be possible for some family and friends to accommodate on a regular basis (Stensland & Sanders, 2016). This is especially true for aging offenders who need 28 to transfer to an institution that can better suit their needs. Furthermore, due to the limited or lack of access to social supports in the community, fellow inmates become a source of social support. In turn, with a move from one prison to the next, this can cause stress with the loss of that social support, too. Maschi et al., (2015) studied the stress, trauma, and coping mechanisms of aging offenders while in custody. They reported on the prison experiences of 677 aging offenders using mailed questionnaires. Approximately 45% of participants reported that they experienced trauma related to the stress of being separated from family and friends. However, without a comparison study on younger offenders, it is difficult to determine whether aging offenders have higher rates of stress and trauma related to separation from their social network. There may be a transition period of losing one’s identity and grappling with a negative self-image, in particular for those aging offenders who have committed serious crimes (Crawley & Sparks, 2006). Often in prison, offenders lose their identity and become a number, which can trigger another sense of loss for aging offenders, especially if they held a respected position in the community. Furthermore, Aday and Krabill (2012) identified that offenders may grieve the loss of their former role in the community, such as one of being a parent or grandparent. In particular, aging offenders nearing the end of their life fear how they will be remembered when they are gone and what someone might say at a memorial service about them (Stensland & Sanders, 2016). It can be a challenge to be able to motivate aging offenders to participate in programming (Loeb & Steffenmeier, 2011). Without the connection to the outside world, aging offenders may become more comfortable in the prison environment and do not believe they 29 will return to the community. As well, their ability to adapt and reintegrate back into the community can become diminished. The loss of mobility, compounded with chronic health conditions and mental health concerns can decrease the ability for an aging offender to participate in programs and in socializing in the prison environment, unless there are appropriate programs and strategies in place to address this need. CSC acknowledges the need for programming specific to older offenders’ needs, but they are currently lacking (CSC, 2018). There is a need for meaningful and age-appropriate activities for aging offenders to be able to participate in while they are incarcerated (Aday & Krabill, 2012; Crawley & Sparks, 2006; Maschi et al., 2014). Additionally, it is beneficial to have staff who are specialized in assessing geriatric needs to facilitate appropriate programming. There are numerous examples in the literature of innovative programming that offers aging offenders the ability to have meaningful engagement and a sense of purpose. A few examples of programming include diversion therapy activities, such as pet therapy, music appreciation, arts and crafts, and writing groups (Aday & Krabill, 2012). Offerings for some of these types of programs will depend on the security level of the institution. The ability to actively engage aging offenders and create a social network of support can have a positive impact on this population. As previously noted, there is evidence that having a positive family and social support structure contributes to desistance of offending for aging sex offenders (Walker et al., 2020). There are programs in BC, such as Circles of Support and Accountability (COSA), M2/W2, and Long-term Inmates Now in the Community (LINC), that are intended to provide wraparound support for long-term offenders who are reintegrating back into the community. Unfortunately, outcomes for these programs have not been independently 30 evaluated and programs like these rely heavily on the support of volunteers, which can limit the capacity of these programs to accept new intakes, resulting in long waitlists. However, with an investment into prison and community programming, programs like these may help bridge the gap for aging offenders as they may enhance engagement and overall wellbeing (Maschi et al., 2014). Infrastructure and Safety Issues The physical structure of prisons was not originally designed to accommodate the needs of aging offenders and presents a serious barrier for this population (Aday & Krabill, 2012; Kerbs & Jolley, 2009; Stevens et al., 2018). Globally, the majority of prisons do not have the infrastructure that supports offenders with mobility issues or symptoms that are associated with aging (OCI, 2019b; Turner et al., 2018;). In Canada, the aging infrastructure of federal institutions is one of the biggest issues identified (Zinger, 2016). There are four federal institutions that are over 100 years old with layouts that are not conducive to housing aging offenders. Not only are the prison cell doorways too small to accommodate a wheelchair or a walker, many cells are double-bunked and inmates are required to climb up on top bunks. The lack of accessible showers and washrooms creates a challenge for those with incontinency issues and are a barrier to accessing proper hygiene (OCI, 2019b; Turner et al., 2018). The beds and mattresses, as well as limited access to physical aids, such as supportive pillows, can further exacerbate chronic pain and health conditions (Loeb & Steffenmeirer, 2011). Furthermore, the procedures for inmate movement within the prison can pose unrealistic expectations for aging offenders. For example, having to leave the unit to the healthcare building to line up for medications for extended periods of time or waiting in line for canteen can prove to be difficult 31 (Aday & Krabill, 2012; OCI, 2019b). Ultimately, the physical environment of the prison can negatively affect the health and wellbeing of aging offenders (Psick et al., 2017). In consideration of the physical living environment that aging offenders reside in while incarcerated, the conditions present a myriad of challenges that make prison life significantly harder to negotiate. Relative to the issue of inadequate infrastructure of prisons is the matter of safety. The inefficiency of prison infrastructure contributes to an increased risk of falling due to heavy reliance on stairs and poorly designed cells. Aging offenders also identified that victimization and bullying are concerns for them (Aday & Krabill, 2013; Baidawi, et al., 2016; Turner et al., 2018). Not only is there a concern for victimization from other inmates, older offenders also noted that staff personnel who refused to assist them put their safety at risk as well (Kerbs & Jolley, 2009). Furthermore, incidents involving physical altercations may go unnoticed and underreported, for fear of retaliation. Murolo (2020) noted that aging offenders not only experience physical violence, but also psychological stress and property damage. For example, aging offenders may be intimidated by younger inmates to give up items from canteen or purchase items for them (OCI, 2019b). Aging offenders may request to go to segregation for their own safety and for reprieve from bullying by younger inmates (OCI, 2019b). In the absence of segregated living spaces for older offenders, this is sometimes the only option available, which is not ideal for preventing isolation and mitigating the negative effects on mental and physical health. Along with limited social supports, difficulties faced in the physical environment appeared to significantly contribute to psychological distress in the aging offender population (Baidawi et al., 2016). Further research in this area may look at determining whether different 32 subgroups of aging offenders experience higher levels of victimization in relation to their gender and/or type of offence. With the majority of prisons apparently ill-equipped to meet the needs of an aging offender population, there is a need to look at alternative options. Currently, prisons warehouse older offenders who are eligible for release due to the lack of facilities in the community, which are also ill-fitted to accept them for residency (OCI, 2019b). For individuals that require elevators, ramps, and other adapted equipment, their options may be very limited to accommodate their housing need. In Canada, there are a limited number of options available for aging offenders looking to be released to the community. The lack of options in the community contributes to the fear of dying in custody for many aging offenders (Turner et al., 2018). Ethical Issues and Human Rights Consideration for ethical issues and human rights is largely interconnected with all the challenges that have been reviewed. The United Nations has identified older adults and those who are terminally ill as a subgroup of people who require special considerations to address their complex needs (Maschi et al., 2012; Psick et al., 2017). This consideration is meant to include all people, including those who are incarcerated, but many countries fall short of fulfilling this need due to the deficits of prison systems, as discussed above. Under the Universal Declaration of Human Rights, everyone should have the right to safety, equality, and dignity (Maschi et al., 2012). Furthermore, everyone has the right to be free from cruel and humiliating punishment, even for those who are convicted of crimes. 33 In Canada, the Charter of Rights and Freedoms also applies to persons in custody. However, the challenges that the aging offender population face puts into question issues of dignity and respect. For example, with the physical structural challenges in prisons and limited access to health care, aging offenders with mobility and/or incontinency issues are deprived of their right to dignity (Turner et al., 2018; OCI, 2019b). The prison policies that apply to everyone force older offenders to face challenging barriers to daily living, especially those with chronic illness and debilitating conditions (Iftene, 2017b). Additionally, older offenders that experience victimization and bullying are restricted from enjoying safety and security while incarcerated (Aday & Krabill, 2012; Baidewai et al., 2016; Turner et al., 2018). Due to challenges such as the physical environment, limited access to health care, and poor social engagement, some have argued that the conditions of confinement amount to elder abuse and neglect (Iftene, 2017b; Maschi et al., 2014). While the primary role of prison personnel is to manage safety and security, there is also an increased expectation within the prisons to provide a secondary role of caregiver (Humblet, 2020; OCI, 2019b). While providing healthcare is not the primary goal of corrections, it becomes an aspect of the job when working with terminally-ill and aging prisoners. Staff may be inclined not to trust inmates who they believe are manipulative or drug-seeking, while an aging offender goes without pain medications to ease the condition of their chronic illness. That is not to say that some offenders will not try to play to the sympathies of staff to get what they want, which makes it difficult to determine who is being truthful about their needs. Staff may also have biased opinions about who is worthy of services, especially if the offender is convicted of a particularly heinous crime (Humblet, 2020). Prison staff may also experience 34 what is referred to as avoidant behaviours when working with aging offenders (Humblet, 2020). The conditions that some aging offenders find themselves in can lead to some embarrassing encounters that staff may want to avoid. This may contribute to negative attitudes towards this population and add a dehumanizing effect. In turn, aging people in custody may not fully trust staff with their health care decisions, which is especially true for people from different cultural and racial backgrounds based on historical discrimination (Stensland & Sanders, 2016). With the increase of aging offenders in custody, there has also been an increase in deaths in custody due to natural causes (Stensland & Sanders, 2016). In Canada, the majority of prison deaths for the aging offender population are due to natural causes (OCI, 2019b). The increase in the number of prison deaths brings forth the topic of dying with dignity and choice when it comes to EOL planning (Burles et al., 2016; Loeb et al., 2014; Stensland & Sanders, 2016). Burles and colleagues (2016) describe the notion of a “good death” that involves planning, as well as being comfortable, having the ability to be in control of one’s own health decisions, and to obtain some closure. Additionally, the patient would be at the centre of decision-making and planning, which would be consistent with the ethical standards of patient care in the community. There is a lack of patient involvement when it comes to EOL planning for inmates, as well as anxiety associated with the fear of dying in prison. In Canada, CSC developed the Hospice Palliative Care guidelines to follow the national standards set for providing hospice care; however, Canada is severely behind when it comes to providing EOL planning and hospice services to the aging and dying offender population (Burles et al., 2016). While palliative care would be best served in the community in a hospice setting, many aging offenders who are 35 dying are denied this. Due to the restrictions associated with releases based on compassionate reasons, terminally-ill offenders either are denied release because their illness has not fully incapacitated them, or pass away before a decision is made (CSC, 2018). Some individuals indicated they would prefer to die in custody, as their family and friends had moved on and their only social support was in custody. However, the OCI argues that although this may be true, it may also be a reflection of the inability to access social networks in the community to facilitate a comfortable release and limited choices while incarcerated (OCI, 2019b). Canada, along with a limited number of countries, allows medical assistance in dying (MAiD) while incarcerated (OCI, 2020). While this right is afforded to terminally ill offenders, the question remains whether it is a choice or due to the lack of alternative options other than to die in custody. A case study in Canada examined an aging offender with an indeterminate sentence who was diagnosed with a terminal illness (OCI, 2020). This individual was also diagnosed with mental health issues and suffered from suicidal ideations. Upon denial of leave for compassionate reasons, the individual opted for MAiD. In this case, the reasons for denying compassionate leave were not available. With some aging and dying offenders suffering due to their conditions of incarceration, it begs the question of whether prison is the appropriate place for these individuals (Fazel et al., 2002). As an example, there is debate on whether it is necessary to keep someone with dementia incarcerated when their cognitive capacity is severely diminished. Fazel and colleagues (2002) argue that continued incarceration places a heavy importance on prison as punishment, as opposed to serving as a deterrent for the aging offender, as they are not capable of understanding or remembering why they are incarcerated. There is the issue of 36 whether continued incarceration amounts to cruel and unusual punishment, based on the diminished capacity of the offender to appreciate their situation (Maschi et al., 2015). Arguably, these inmates would be better placed in community facilities or, if possible, released under conditions to the care of their families. Public and political pressure for retribution and concern for public safety influence the reluctance to grant compassionate releases and seek community alternatives for aging offenders (Turner et al., 2018). A collective negative attitude towards offenders contributes to the anxiety associated with release to the community and the fear of victimization from community members (Maschi et al., 2015) and particularly for sex offenders (Rosselli & Jeglic, 2017). It can be difficult to find a balance between the human rights of an offender and justice or perceived justice for victims and their families (Turner et al., 2018). It is not unreasonable for people to demand safety in their communities, but there is an argument to advocate for the ethical treatment of aging and dying people in custody. Still, there is little empathy from the public, who hold on to the belief that justice means diminished human rights, regardless of mitigating factors and circumstances. Importantly, while some human rights may be suspended (e.g., the right to liberty), other human rights are not justifiably limited by incarceration (e.g., right to adequate standard of living). Programs There are several aging offender programs that are currently operating in the US and Canada. These programs were developed out of an abundant need to accommodate the growing aging offender population. According to Aday and Krabill (2012) housing aging 37 offenders with similar health care needs is a more efficient way of addressing the needs of this population. Additionally, quieter living spaces with structural modifications are considered necessary for the safety and well-being of the aging offenders (Aday & Krabill, 2012). Below are a few examples of aging offender programs in custody and in the community. True Grit Program (High Desert State Prison, Nevada) The True Grit Program in Nevada is an example of a pilot project aimed at meeting the needs of the aging offender population as well bridging the gap between incarceration and reintegration into the community (Aday & Krabill, 2012). This program was developed by the Department of Corrections and modeled after palliative and elder care in the community (Aday & Krabill, 2012). The program is voluntary, has a client-centred focus, and the program objectives evolve according to the needs of the participants. Participants must have good institutional behaviour and be willing to participate in the programming offered. The program offers interventions for addictions, anger management, violence, sex offences, and for victim empathy. Additionally, it offers activities that are specifically geared towards aging offenders, such as exercises, crafts, and appropriate health interventions, to meet their complex needs, keep them engaged, and reduce isolation (Maschi et al., 2014). The True Grit Program also provides palliative care services for those in the end stages of life while still incarcerated (Maschi et al., 2014). In contrast, regular programming in the prison is typically geared toward younger inmates, such as education and job training. This inhibits aging offenders from being paroled, as their correctional plans will not include any programming where they can demonstrate their ability to be managed in the community to the parole board. The structured 38 programming of True Grit provides assistance with bridging the gap from the institution to the community. A case study of the program was unable to provide evaluation results, but it would stand to reason that the more resources an aging offender has available to meet their complex needs, the better prepared for release they will be. However, the case study did identify some barriers to implementing these types of programs. Maschi and colleagues (2015) pointed out that some correctional staff and members of the public did not believe that a program to segregate elderly offenders was necessary and was in some ways coddling offenders. The role of education to the staff and the public was therefore vital in gaining the support that was needed to continue this program. More empirical research and program evaluation is necessary to provide insight into the benefits and effects of segregated, structured programming for aging offenders. Psycho-Geriatric Unit (Pacific Institution) The psycho-geriatric unit is a 64-bed unit located at the Regional Treatment Centre (RTC) in Pacific Institution, a federal facility in Abbotsford, BC (CSC, 2018). The staff team consists of multiple professionals from various disciplines, which include doctors, nurses, elders, correctional officers, and social workers who engage in a collaborative approach to meet the needs of older men in custody. Programming within this unit includes the Peer-Assisted Living Care Giver program (CSC, 2018). Institutional peers are screened and trained to provide support to aging offenders who struggle with ADL, such as dressing, showering, eating, and grooming. According to the OCI (2019b), there are still gaps in fully addressing the needs of aging offenders, as there is no non-governmental body intervening and advocating on behalf of inmates to guarantee patient rights and access to care. Additionally, this program is only 39 available to aging male offenders. To date, there are no current evaluations or assessments on the success or gaps in service for this program. 40 Assisted Living Unit (Bowden Institution) Located in Innisfail, Alberta, Bowden Institution is a federal facility that offers a 14-bed assisted living unit with a multidisciplinary team and access to a variety of programs targeted for aging offenders, such as counselling, pet therapy, and cognitive therapy (CSC, 2018). Additionally, the assisted living unit also boasts a peer-assistant program to assist offenders who are unable to perform ADL. The unit is designed to reduce the risk of falling and addresses other mobility barriers and the correctional staff develop comprehensive assessments to meet this population’s complex needs (CSC, 2018). Similar to Pacific Institution, there is a lack of oversight from an advocacy group that can lobby for accessible patient care to the individuals living on this unit (OCI, 2019b). If an aging offender’s health conditions worsen while incarcerated, it is possible for inmates to be transferred to these facilities, but there are a number of factors to consider. Considerations for transfers depend on the presence of incompatible inmates at the institutions, how well they are to travel, the distance away from social supports and loved ones and finally, regional restrictions on travel. According to the policy framework proposed by CSC to address wellness and independence of older persons in custody, they have not yet assessed whether separate living accommodations are more beneficial or whether existing programs meet the needs of the aging offender population in custody (CSC, 2018). Pre-Release Planning: The Hocking Correctional Facility, Ohio Investment in pre-release planning better prepares individuals who are leaving custody, which can contribute to overall well-being and improved outcomes (Maschi et al., 2012). With deficiencies noted in social determinants of health, such as appropriate housing, employment 41 or financial means, identification, and community functioning skills, this may impede the ability for someone to reintegrate successfully into the community and abstain from criminal activity. The ability for some older offenders to be able to afford basic needs like food and shelter can be difficult upon release, as they would normally be retiring, rather than working (Maschi et al., 2012). With some aging offenders who have served decades behind bars, simple tasks can be daunting and overwhelming to this population. Increased connection to supports in the community, such as connecting with a community residential facility prior to release, can provide assistance with developing a viable strategy and hopefully ease some anxiety regarding pending release. The Hocking Correctional Facility located in Ohio provides a pre-release program for aging offenders to prepare for reintegration (Maschi et al., 2012). They receive assistance with accessing social security, appropriate housing, and self-care programming. In addition, training is provided to improve the ability for staff to provide appropriate care and intervention to the aging population. Currently, there is no available data on the effectiveness of this program and whether it reduces recidivism. Community Residential Facilities In Canada, long-term offenders and offenders serving life sentences are subject to scheduled reviews for release (CSC, 2019). When they have reached their day parole eligibility date (DPE), they are able to apply for conditional release to the community. When an offender requests a day parole hearing by the Parole Board of Canada (PBC), the Institutional Parole Office (IPO) prepares a report for a community residential facility (CRF) manager to review and determine whether they can be accepted to their facility. Managers at CRFs look at various factors, such as their motivation and willingness to address their risk factors, their institutional 42 and community behaviour while on previous conditional release, and whether their release plan is viable. For aging offenders looking to be released to a facility where their complex needs will be met, the options are few and far between in Canada. Many CRFs are not equipped with the proper infrastructure and staffing models to meet the needs of this vulnerable population. Below are two examples of community residential programs in Canada that are specifically designed to address aging offenders’ complex needs. However, there is still a large gap in services available to this population and more facilities and community partnerships are needed. Phoenix Society Aging Offender Program The Aging Offender Program in Surrey, BC, is operated by the non-profit organization the Phoenix Society (Phoenix Society, 2020). The program was developed in consultation with CSC and the Phoenix Society to address the growing need to accommodate aging offenders in the community. This 8-bed facility opened its doors in May 2020 and is complete with amenities such as hospital beds, accessible showers, and elevators, and is specifically designed for aging offenders on conditional release from federal custody. The residents are provided with programming specifically tailored to meet their age-specific needs. They work closely with a multidisciplinary team to ensure the needs of the residents are being met and the safety of the community is maintained (Phoenix Society, 2020). Aging offenders that present complex physical, as well as age-related impairments are screened for this facility for acceptance on conditional release. If they have reached capacity, the aging offender is placed on a waitlist until a bed becomes available. This program is currently in its infancy and has not undergone a formal evaluation to date. 43 Haley House Haley House in Peterborough, Ontario is an example of a long-term care facility and halfway house hybrid model (Pacheco, 2018). This facility, which can accommodate up to 10 individuals who have been released from federal custody, was founded in 2016 by Dan Haley. Operated by the non-profit organization Peterborough Reintegration Services, this house was specifically designed to care for the needs of aging offenders released to the community. Additionally, they are also equipped to provide palliative care services to this vulnerable population. Their 24-hour staff work collaboratively with a multidisciplinary team of police officers, doctors, and health care providers to balance the need for community safety and the dignity of the aging and dying residents (Pacheco, 2018). Currently, there are no official evaluations of this CRF model. The Current Study While aging offenders represent a growing segment of the incarcerated population in Canada, there is very little academic research on aging offenders in the Canadian context and even fewer studies conducted regarding aging offenders upon release from custody. The current study examines a question that has not yet been addressed in the literature, concerning the barriers to placement of aging prisoners into CRFs. The purpose of this study is to assess and address the perceived gaps in resources available to the aging offender population and recommend possible alternatives to incarceration and other solutions for this vulnerable population on the basis of a sample of staff and managers currently working in CRFs across British Columbia and the Yukon. 44 Methodology Two surveys were distributed, one for staff and managers and one exclusively for managers. The manager survey was designed to gather demographic information for each CRF and was to be completed by one manager per site. Since there was a low response rate, the focus of this major paper will be on the results of the staff survey. Participants Participants of this study were staff and managers that work at CRFs in BC and the Yukon. CRF staff are identified as frontline residential workers or house supervisors, who generally have the most interaction with the individuals who reside at their facilities. They have first-hand experience with and knowledge about the challenges of working with this population and would be most informed about the gaps in resources available for successful reintegration into the community as they work directly with offenders to access appropriate resources in the community to obtain employment, medical, and other support services. Managers are identified as individuals in charge of screening and accepting offenders to their facility. There were 54 participants who completed the staff survey: 16 managers (30%) and 38 staff (70%). The 54 participants were comprised of 10 males (19%), 43 females (80%), and one participant who identified as non-binary (2%). Most participants (77.8%) were from the Lower Mainland and Fraser Valley (Abbotsford, Chilliwack, Surrey, New Westminster, Vancouver, and North Vancouver); 11.1% were from the Thompson-Okanagan region (Kelowna and Kamloops), 7.4% were from the Northern Interior (Prince George and the Yukon), and 3.7% were from Vancouver Island (Victoria and Nanaimo). 45 This pattern is consistent with the distribution of CRFs in BC and the Yukon. Participants’ length of service ranged from four months to 324 months (approximately 27 years) at their current CRF. On average, the length of service was 47.87 months (approximately four years), with a standard deviation of 65.66 months (approximately five and a half years). Procedure The staff survey focused on assessing the perceived needs of the population of offenders who are 50 years of age or older. Participants were asked about their perceptions of, and experiences with, working with aging residents at CRFs, the extent to which they believed the needs of this population were being met, and current resourcing gaps. The survey was distributed to 42 managers and directors of the British Columbia Yukon Halfway House Association (BCYHHA) via email, using a web-based survey system (Survey Monkey). To recruit more participants using snowball sampling, the managers and directors were encouraged to forward the survey link to their staff, as email distribution lists for staff at each CRF were not readily available. The email invitation included information regarding the study, as well as a link to the survey, and the consent document. Prior to the study, the University of the Fraser Valley Human Research Ethics Board granted approval (Appendix A). The survey (Appendix B) was distributed on January 11, 2021, with a closing date of February 8, 2021. A follow-up reminder email was scheduled via Survey Monkey at the two-week mark and another reminder email February 4, 2021. 46 Results Attitudes Towards and Perceptions of Aging Offenders The survey asked a series of questions regarding participants’ attitudes towards and perceptions of aging offenders. The majority of participants believed that there is a difference between the reintegration needs of an aging offender, as compared to a younger offender, and a third agreed or strongly agreed that working with aging offenders was more stressful than working with younger offenders (see Table 1). To illustrate this finding further, one participant shared, “Based on my experience at the two CRFs I have worked at, specialized CRFs for older offenders are very much needed. As is, CRFs appear to be catered to the needs primarily of young and middle-aged offenders.” Consistent with this finding, the majority of participants (61%) disagreed or strongly disagreed with the statement that aging offenders could be more effectively managed in a correctional facility than in a CRF. In fact, the majority of participants agreed or strongly agreed that aging offenders would be better placed in a specialized CRF (91%), and that more specialized CRFs were needed in BC to accommodate aging offenders (93%). 47 Table 1: Attitudes Towards and Perceptions of Aging Offenders There is no difference between reintegration needs of aging offenders and younger offenders (n=54) Aging offenders can be more effectively managed in a correctional facility than in a CRF (n=54) Working with aging offenders more stressful compared to younger offenders (n=54) Aging offenders would be better placed at a specialized CRF (n=54) We need more specialized CRFs in BC for aging offenders (n=53) Strongly Disagree/Disagree 93% Neutral 0% Agree/Strongly Agree 7% 61% 24% 15% 32% 33% 35% 6% 4% 91% 2% 4% 93% Participants were also asked an open-ended question about the strategies their CRF had used to address the needs of aging offenders. Five participants specifically stated that their CRF did not have any specific strategies to support aging offenders; however, others commented on mobility accommodations. For example, one participant noted that they would move them into different rooms if mobility was a concern. A second participant made a similar comment, that “we need to plan out bed space for aging offenders so they are in suitable areas of the house for mobility purposes.” A third participant reported a similar approach, but noted that this was still difficult for them as the other living facilities (e.g., the dining and living room) were on a different floor than the bedroom. These kinds of challenges might require CRF staff to make accommodations in other ways. For example, one participant noted that they would “tak[e] medication up to the residents’ suites if they cannot walk.” A different participant explained that in one case, their CRF contracted home care services to attend and assist the resident with some of their hygiene and daily care needs, but they noted that this was an exception to their 48 usual practice. A different participant reported that “we have found that assigning two specific staff members to each individual with complex needs has been helpful.” Notably, only three of the participants specifically mentioned having ramps and/or elevators at their CRF. The participants also explained how they would assist aging offenders with cognitive and memory-related issues. In addition to stating that their CRF would “[t]ry our best to accommodate mobility issues,” this participant also explained that “If there are memory concerns, [we] try our best to remind them of task, medication, etc.” A participant shared that they would “…attend appointments with resident when necessary” while another specifically observed that “staff hours are flexed in order to meet the needs of the offender as their pace may be slower…” When asked about the resource needs or gaps for offenders referred to CRFs who are 50+ years of age, some participants reflected that the challenging needs posed by some aging offenders may result in the CRF being unable to accommodate them. Specifically, six participants shared that the CRF would have to seek a transfer of the aging resident if they were no longer capable of meeting their needs. Again, this commonly came down to mobility challenges. Another participant shared that their CRF had to “advocate to remove (their) residency condition and find more a suitable living arrangement- (such as) care home, living with family.” Mobility issues therefore appear to be a consistent barrier that limit the options of the CRF to support aging offenders. Similarly, the complex health needs can pose a significant challenge. As a result of these challenges, one participant stated that “[w]e have unfortunately needed to transfer [the] majority of our aging offenders with high health needs that surpass our staff’s ability and training.” Similarly, another said “[w]e have had to withdraw support when 49 their barriers become too difficult for our staff and facility to manage.” These challenges highlight the need for specialized CRFs for aging offenders, which was noted by seven participants. One participant noted, “I believe there needs to be a specialized CRF for aging offenders. One that has HCAs (health care assistants), LPNs (licensed practical nurses), who are trained and comfortable in assisting with health concerns (physical or mental), medications, meal prepping, someone available to bring them to appointments and assist with their day-today basic needs.” Barriers to Placing Aging Offenders at CRFs Participants were asked about their experiences with a number of issues and to what extent they saw each as a barrier to accepting aging offenders at their CRF. Consistent with the qualitative responses previously discussed, the most commonly identified ‘extreme’ barriers were mobility issues and the lack of ability to live independently, which includes issues with self-care and hygiene (see Figure 1). Participants believed that complex physical and mental health needs, and lack of community support/isolation were a moderate barrier to acceptance. 50 Figure 1: Barriers to Acceptance at a CRF for Aging Offenders 50% 45% 40% 43% 46% 45% 39% 46% 37% 35% 35% 32% 30% 25% 22% 20% 15% 15% 10% 5% 0% Mobility Complex Physical Complex Mental Lack of Ability to Lack of Health Needs Health Needs Live Community Independently Support/Isolation Not a barrier Slight Barrier Moderate Barrier Extreme Barrier Note: Mobility (n=53), Complex physical health needs (n=53), Complex mental health needs (n=54), Lack of ability to live independently (n=54), Lack of community support/isolation (n=54) Participants were asked to what extent the same issues are a barrier for aging offenders while residing at the halfway house. Similar to the previous findings, the most common extreme barriers for aging offenders while residing at the CRF were mobility and lack of ability to live independently (see Figure 2). The factors that were identified as a moderate barrier for aging offenders while residing at the CRF included complex physical health and mental health needs, and lack of community support/isolation. 51 Figure 2: Barriers for Aging Offenders While Residing at a CRF (n=54) 60% 50% 50% 48% 46% 41% 37% 40% 33% 32% 30% 22% 20% 15% 9% 10% 0% Mobility Complex Physical Complex Mental Lack of Ability to Lack of Health Needs Health Needs Live Community Independently Support/Isolation Not a barrier Slight Barrier Moderate Barrier Extreme Barrier Participants were then asked to what extent the same issues are a barrier for aging offenders when they are released from their CRF. The lack of ability to live independently, complex mental health needs, and the lack of support and/or isolation were considered extreme barriers when released to the community from the CRF (see Figure 3). Participants indicated complex physical health needs and mobility needs were moderate barriers. One participant shared, “Finding a living arrangement for them (aging offenders) come warrant expiry (end of sentence)/full parole (no residency condition) is tricky because depending on their needs they may require admittance to a retirement home or care facility, these are hard to plan out, especially in sync with WED/FP [warrant expiry date/full parole] dates because of the financial aspects and waitlists.” 52 Figure 3: Barriers for Aging Offenders When Released from the CRF (n=54) 57% 60% 50% 50% 40% 46% 41% 39% 46% 41% 41% 33% 32% 30% 20% 10% 0% Mobility Complex Physical Complex Mental Lack of Ability to Lack of Health Needs Health Needs Live Community Independently Support/Isolation Not a barrier Slight Barrier Moderate Barrier Extreme Barrier According to the survey results, participants’ opinions on what presented as an extreme barrier differed between acceptance at, residence, and release from a CRF (see Table 4). Before and during residency, mobility is considered an extreme barrier, but after residency, mobility is considered a moderate barrier. One participant noted, “CRFs are generally old…so there are issues for access and mobility.” Another participant shared, “I believe we need to make CRFs more accommodating to residents with mobility issues.” Lastly, a participant commented, “This (my) CRF has the ability to support an aging offender in terms of accessibility, wheelchair ramp, elevator, however we do not accept residents with mobility barriers. This is probably because of lack of training and funding.” 53 Table 2: Extreme Barriers Before, During, and After Residency at a CRF Extreme Barriers Mobility Complex Physical Health Needs Complex Mental Health Needs Lack of Ability to Live Independently Lack of Community Support/Isolation Acceptance 43% 37% 22% 46% 15% While Residing 50% 33% 15% 41% 9% After Release 32% 41% 46% 57% 46% When comparing the results from barriers before, during, and after residency at a CRF, there are some interesting highlights to note. The factor that was consistently identified as an extreme barrier regardless of where the aging offender was is the lack of ability to live independently. The factor that was consistently identified as a moderate barrier regardless of where the aging offender was is complex physical health needs. The two factors that were considered moderate barriers before acceptance and during residency, but considered an extreme barrier after residency was complex mental health needs and lack of community support and isolation. In contrast, mobility concerns were extreme barriers primarily during their residence at the CRF, as well as during the acceptance process, but were less often identified as a concern when the aging offender was being released. Resource Needs in the Community and CRFs Participants were asked about the resource needs and gaps in services for aging offenders in the community and CRFs. For resource needs in the community, the majority of participants did not feel there were enough resources concerning employment, mental health, and social needs for aging offenders in the community (see Table 3). One participant commented that there are not enough “employment resources for offenders that are around 50 (years of age) and still capable of working. The majority of program(s) seem to be geared to 54 those under 30 (years of age).” Another participant shared, “I have noticed that aging offenders struggle… with technology. I have worked with many aging clients who have done significant time and don’t know how to use cell phones, laptops, iPads, etc. This is a huge barrier for many, considering many important tasks are done online. I think classes/workshops to help our older clients in this area would be beneficial.” Approximately 54% of the participants did not feel there was collaboration from their local health authority. Almost all participants agreed that there should be pre-release programs for aging offenders while in custody. One participant commented, “There needs to be additional resources and pre planning in order to serve the aging population. This needs to start at the institutional level. There needs to be connect(ion)s made to community resources prior to release or there needs to be specialized facility set up with the resources and training to provide with the appropriate care.” Table 3: Resource Needs for Aging Offenders in the Community (n=54) There are enough resources in the community I work in to meet employment needs of aging offenders There are enough resources in the community I work in to meet the mental health needs of aging offenders There are enough resources in the community I work in to meet the social needs of aging offenders There is collaboration with the health authority in my region There should be pre-release planning programs for aging offenders while in custody Strongly Disagree/Disagree 74% Neutral 13% Agree/Strongly Agree 13% 65% 15% 20% 59% 19% 22% 54% 22% 24% 0% 2% 98% 55 In regards to resource needs in CRFs, most of those surveyed believed that CRFs did not have the appropriate infrastructure and equipment to meet the needs of aging offenders (see Table 4). The majority of the participants did not feel that CRFs were adequately equipped with appropriate community resources and referrals. Again, consistent with the earlier qualitative responses, most of the participants believed that accessibility was the most important area of need. One participant commented that “[m]any aging offenders are kept inside the institutions due to the lack of CRFs that can accommodate mobility, mental health and physical health issues. If CRFs were equipped with proper training, resources and accommodations for this populations, I believe that there would be more aging offenders in the community.” Table 4: Resource Needs for Aging Offenders at CRFs (n=54) CRFs have the appropriate infrastructure and equipment CRFs are prepared with the appropriate community resources and/or referrals Accessibility of a CRF is the most important need Strongly Disagree/Disagree 80% Neutral 15% Strongly Agree/ Agree 6% 69% 30% 2% 22% 19% 60% Training Needs Participants were asked whether they felt adequately trained to manage the needs of the aging offender population. Approximately 63% of participants did not feel they were adequately trained. Participants were also asked to share what they believed were important areas for training in relation to aging offenders. Training was considered very important in mental health and addictions, Indigenous relations and effects of colonization, traumainformed care, and dementia (see Figure 4). For example, one participant explained that “[s]taff 56 need to be educated about dementia and other ailments due to aging- how this connects to mental health.” In contrast, the area of training that participants were most likely to rank as ‘not important’ concerned palliative care. One participant shared that “CRF's don't typically support individuals who require personal care of any sort. There needs to be an Assisted Living CRF facility that addresses risk and the complex medical needs of (aging offenders) at one place.” 57 Figure 4: Perceived Training Needs of Staff Working with Aging Offenders (n=54) 120% 100% 80% 96% 72% 61% 60% 40% 93% 89% 59% 35% 2% 4% 48% 46% 33% 30% 26% 20% 63% 11% 41%41% 19% 6% 4% 0% Not Important Somewhat Important 11% 0% 0 7% 4% 0% Very Important Discussion Attitudes and Perceptions of Aging Offenders The current study revealed that participants believed that the reintegration needs of aging offenders differed from those of younger offenders. As one participant pointed out, most CRFs cater to the needs of younger and middle-aged offenders and are not geared towards accommodating older offenders who, in particular, appear to face challenges with their mobility, as well as with their more complex health needs. Participants of the study also shared the different ways they try to assist aging offenders with navigating reintegration. However, in general, it appears that CRFs are not readily equipped to handle the complex needs of the aging 58 offender population. Strategies that are designed to reintegrate younger offenders are applied to aging offenders with some modifications, but only if it is within the CRF’s ability to do so. If the CRF is no longer capable of accommodating an aging offender, they may have no choice but to transfer them to a facility that can accommodate them. This might require the CRF staff to advocate for the removal of the residency condition, enabling them to live outside of a CRF, such as in a care home facility. Despite these challenges, the survey results indicated that staff perceived very little difference in stress levels when working with aging offenders, as compared to younger offenders. There is no empirical research to suggest why this is the case; however, this may suggest that although reintegration needs differ between younger and aging offenders, each person requires different levels of intervention and multi-sector collaboration when released to the community. Based on the results of this study, this suggests that aging offenders have different needs, not more needs, as compared to younger offenders. As referenced in the literature, correctional facilities were not originally designed with an older offender population in mind and the aging infrastructure has not kept up with the growing needs of this population. Approximately 61% of participants did not believe that aging offenders could be more effectively managed in a correctional facility. Similarly, however, the results of the survey suggest that CRFs in the community are also unable to keep up with the complex needs of this growing population. The majority of participants agreed that aging offenders should be placed at specialized CRFs and that we need more of these in BC. Although CRFs try to do what they can to advocate and make accommodations, there are no formal 59 strategies in place and they are not adequately prepared to provide for the needs of the aging offender population released to the community. When considering specialized CRFs as an option, it should be noted that segregated living and adapted living arrangements for aging offenders are controversial (Dulisse et al., 2020; Kerbs & Jolley, 2009). While the practice is to integrate populations, due to a belief that the older offenders possibly have a calming effect on younger offenders, there is no empirical evidence to support this claim (Dulisse et al., 2020; Kerbs & Jolley, 2009). Furthermore, some aging offenders prefer to be housed with younger offenders, for either personal preference or fear of being viewed as weak and frail. However, there is evidence to support that the majority of aging offenders would prefer to be housed separately for safety reasons (Aday & Krabill, 2013; Kerbs & Jolley, 2009; Maschi et al., 2014; Murolo, 2020; Turner et al., 2018;). Segregated living can often better accommodate the needs of the aging offender population, as they can be customized for their specific requirements. For aging offenders who are fearful of victimization and bullying by younger offenders, segregated living may improve quality of life (Iftene, 2017b). It is essential that age-specific CRFs are conscious of the consequences of isolating aging offenders, as this can exacerbate mental health and chronic health conditions. To mitigate this risk, age-appropriate programming can be provided to encourage social engagement (Dulisse et al., 2020). In consideration of human rights and the ethical treatment of offenders, there are international rules to consider regarding minimal acceptable standards of practice in the treatment of aging offenders. The Universal Declaration of Human Rights includes articles that are relevant to the rights of aging offenders in prison, which acknowledge the right to health, 60 well-being, and a minimum standard of living (Maschi et al., 2012). The Mandela Rules also provide a policy framework for the minimum acceptable standards in prisons (Zinger, 2016). For example, it is suggested that different categories of offenders should be kept separate in institutions or sections of the prisons, taking into consideration things such as age and treatment necessities. Furthermore, the Mandela Rules provide recommendations on accommodations for aging offenders, suggesting single-bunks, appropriate showering facilities, as well as the minimum acceptable standards for multidisciplinary healthcare. These rules can used as a guide for acceptable practice when considering specialized CRFs for aging offenders in the community. Barriers to Placing Aging Offenders at CRFs Mobility issues appear to be more of an extreme barrier while residing at the CRF, as compared to before acceptance and after release. However, it is unknown how often this barrier led to aging offenders being denied acceptance at a CRF, due to the lack of ability to accommodate. Furthermore, this study did not explore the perceived barriers aging offenders experienced with mobility while in custody. Residents may reside at a CRF for a number of years and they may develop age-related issues over the course of their residency. If the CRF lacks the appropriate infrastructure to accommodate aging offenders who develop mobility challenges during their residency, this will be seen as an extreme barrier. Some CRFs are residential houses that are not equipped with ramps or elevators to accommodate mobility issues. Even if able to accommodate an aging offender to a ground floor room, they may still face the practical challenges of minimal access to amenities, such as the kitchen and living room area, which may be located on other floors of the CRF. Ultimately, as some participants stated, 61 some aging offenders need to be removed from the CRF entirely if their needs can no longer be accommodated. Throughout the literature, community-based sentencing options, such as compassionate release or parole by exception, have been recommended as an alternative to the expensive option of retrofitting jails to accommodate aging offenders (Aday & Krabill, 2013; Iftene, 2017b; Stensland & Sanders, 2016). In Canada, parole by exception is reviewed under exceptional circumstances, such as where the offender is facing a terminal illness or severe mental and/or physical health condition prior to their eligibility date (Parole Board of Canada, 2021). Offender health has also been taken into consideration for parole by exception, which includes preexisting health conditions that would increase the risk for an inmate to contract COVID-19. A number of other factors are considered, including risk for reoffending, victims, and the nature of the offence (Government of Canada, 2021). However, even if parole by exception is granted, an aging offender may experience barriers to acceptance at a CRF if they are unable to accommodate for mobility needs. Furthermore, mobility barriers may develop while residing at the CRF, causing CRFs to have to seek transfers and withdrawal of support, as demonstrated by some of the participants’ responses. According to the results of the study, physical health needs are consistently identified as a moderate barrier for aging offenders throughout their sentence. As cited in the literature, it is unknown whether aging offenders have higher rates of physical and/or mental health issues as compared to the aging population in the community (Solares et al., 2020), but it is common for age-related issues to be undiagnosed while in custody (Dulisse et al., 2020). This can impede 62 access to health care in a timely manner for this population and explains why physical health needs are perceived as a moderate barrier for aging offenders. The results of the survey suggest that complex mental health needs appear to increase from a moderate barrier before acceptance and during residency to an extreme barrier once an aging offender is released from the CRF. This response may imply that there are not enough resources in the community for aging offenders to be referred to upon release from the CRF. Additionally, if the aging offender is no longer serving their sentence once they are released from the CRF, they no longer have access to resources funded by CSC, such as a psychologist or mental health counsellor. In relation to facing mental health challenges upon release from the CRF, the lack of community support and isolation was also identified as an extreme barrier once an aging offender was released from the CRF. As previously noted in the literature, declining mental and physical health can contribute to a lack of motivation to have one’s social needs met (Aday & Krabill, 2012). Aging offenders often have limited social supports outside of CRF staff because they have lost connection with family and friends in the community. Furthermore, it was also cited in the literature that aging offenders tend to have smaller social networks, as compared to younger offenders (Aday & Krabill, 2012). They may not have maintained previous relationships with social supports during their incarceration or ties have been completely cut with family and friends for a variety of reasons (Crawley & Sparks, 2006; O’Hara et al., 2016). Aging offenders may rely on staff and other residents at the CRF to fulfill their social support needs. This reasonably explains why the lack of community support and isolation would be identified as a moderate barrier while residing at the CRF and as an extreme barrier once released from the CRF. 63 The lack of ability to live independently was perceived to be an extreme barrier during all points of an aging offender’s sentence. While in custody, offenders do not have the same expectations for independent living as compared to living at a CRF and living on their one. In the community, frontline staff provide assistance with tasks, such as grocery shopping, meal preparation, and making appointments. Once an offender has moved out of the CRF, they are expected to live more independently. For example, some participants reported that they often remind their aging residents to attend appointments and take medications as prescribed. This type of assistance is usually offered during their residency and is either limited or non-existent once a resident has left the CRF. While living independently may not be as challenging for some younger offenders, this can be more challenging for aging offenders, particularly those who have been institutionalized during the course of a long sentence, and for those who are now experiencing aging related cognitive decline. Coupled with other barriers, such as lack of social community supports, poor mental and physical health, and mobility issues, it is reasonable to identify the ability to live independently as an extreme barrier. Resource Needs in the Community and CRFs With regards to the resource needs in the community, the results of the survey revealed that there is a perceived lack of resources concerning employment, mental health needs, and social needs. The perceived lack of sources for mental health and social needs is consistent with why staff would consider these two factors as extreme barriers for aging offenders once they are released from the CRF. Mental health and social needs are also identified in the literature as an area of need for the aging offender population. 64 In the literature, employment needs were not identified as a major need for aging offenders. However, obtaining employment may be more challenging for someone over 50 years old with a criminal record and gap in employment history. Additionally, as one participant commented on their experience with aging offenders struggling with technology, applying for jobs online or using a computer to update a resume may be difficult for an aging offender. Furthermore, some aging offenders may have a special condition limiting their use of technology, which can be a challenge when looking for employment. When an offender transitions from federal custody to the community, there may be gaps in communication regarding healthcare matters. This is especially problematic for an aging offender with physical and mental health issues. Over half of the participants in the current study did not believe there was collaboration from their local health authority. With a lack of multi-sector collaboration between institutions, CRFs, and local health authorities, aging offenders risk delays in accessing appropriate care once released to the community. Additionally, the majority of participants believed there should be pre-release planning for aging offenders while in custody. Currently, there is some pre-release planning that occurs with aging offenders prior to release, but the extent to which it is meeting the needs of this population is unknown. Pre-release planning that includes collaboration with local health authorities could bridge the communication gap for aging offenders transitioning from the institutions to CRFs. Pre-release planning catered to the specific needs of the aging offender population was also identified in the literature as a mechanism that could assist in reintegration into the community (Maschi et al., 2012). 65 Regarding the resource needs of CRFs, the results of the survey revealed that staff believed there were a lack of resources concerning accessibility, appropriate referrals, and appropriate infrastructure for aging offenders in the community. Most participants (80%) believed CRFs do not have the appropriate infrastructure and equipment to deal with aging offenders. This supports the finding that 91% of participants believe aging offenders would be better placed at a specialized CRF and also supports the finding that 93% of participants believe we need more specialized CRFs for aging offenders in BC. While some CRFs do have the appropriate infrastructure and equipment to deal with aging offenders, there are other needs, such as lack of ability to live independently, physical and mental health needs, and social needs which may be difficult to meet at a typical CRF. This could explain why only 22% of participants strongly disagreed/disagreed that accessibility was the most important need. Training Needs According to the results of this study, the perceived training needs were not particularly exclusive to working with aging offenders. Training in trauma-informed care, Indigenous relations and the effects of colonization, and mental health and addictions can be applied to working with offenders of all ages. However, the perceived need for training in mental health and addictions might also reflect the shared perception by staff that complex mental health needs were a barrier before, during, and after an aging offender’s residency at the CRF. Although 61% of participants considered training in Alzheimer’s very important, it did not rank as high as a perceived need, as compared to the other major concerns. Only 41% considered training in palliative care as very important. It is possible that participants did not feel that training in Alzheimer’s was as important as the other identified areas as they may be aware of 66 how neurocognitive disorders affect behaviour. As discussed in the literature review, some agerelated cognitive issues may exhibit as behavioural challenges, and not be understood to be reflective of issues, such as dementia. Alternatively, the participants may see this diagnosis as a more extreme healthcare issue that would be beyond their ability to safely accommodate at the CRF. Similarly, participants may not feel that palliative care training is as important because CRFs are not designed for palliative care and healthcare professionals should be relied on to provide a multidisciplinary approach to meet healthcare needs. While it is argued in the literature that palliative care should be facilitated in the community, there are often few options available in the community to meet the need of aging offenders (Burles et al., 2016; Loeb & Steffenmeier, 2011; Murolo, 2020; Kerbs & Jolley, 2009; Iftene, 2017b). Furthermore, there are no CRFs that can accommodate palliative care in BC or the Yukon. Given these challenges, more research should be conducted on this issue. Notwithstanding the issues around appropriateness of palliative care provision at the CRFs, given the complex and multi-faceted needs presented by aging offenders, equipping frontline staff with training is necessary, but not sufficient to provide the wraparound supports that this population requires. A multidisciplinary team is essential for more well-rounded care (Dulisse, et al., 2020; Iftene, 2017b). As discussed in the literature, this should include resident workers at CRFs and professionals that specialize in geriatric health care, program facilitators to provide age-specific programming and exercise, lawyers who provide literacy and advocacy on a number of legal issues that affect the aging population, and counsellors and social workers who specialize in EOL care. 67 Emphasis on specialized training for staff has been consistent throughout the literature (Baidawi et al., 2016; Crawley & Sparks, 2006; Dulisse et al., 2020; Iftene, 2017b; Maschi et al., 2014). Staff are very limited in what they can do without proper training for this population. The elderly population has very specific, unique needs and it is necessary to provide appropriate training to staff so they have the right skills to do their job. It is also important to provide training on how to assess and address the different challenges that men and women in this population face, such as screening for cognitive issues and developing case management plans that acknowledge these limitations (Baidawi et al., 2016; Stevens et al., 2018). Furthermore, there is a gap in training for the intersectional challenges of aging in female, transgender, and Indigenous offender populations (Maschi et al., 2014), in addition to a gap in sensitivity training concerning the aging offender population (Iftene, 2017b). Recommendations Formal Needs Assessment Based on the literature and the survey results of this study, it is necessary to develop comprehensive strategies that address the needs and gaps in services for aging offenders. First and foremost, a more formal needs assessment is required to determine what the resource needs are for the aging offender population in BC and the Yukon. While the study provides insight into the perceived needs of aging offenders in the community based on staff working with this population, a more formal assessment is required to establish what the actual needs are. It is important to establish the number of aging offenders that are awaiting release to a CRF in BC and the Yukon and what their specific barriers to being accepted might be. Additionally, it 68 is important to know what the current inventory of suitable accommodations is. The British Columbia Yukon Halfway House Association (BCYHHA) website would benefit from an updated list of CRFs and their amenities to determine the number of CRFs that are accessible and whether they provide specific supports for aging offenders. Furthermore, statistics should be collected at each CRF annually to determine the number of aging offenders who are denied acceptance due to age-related barriers and identify trends, such as the specific barriers that cannot be accommodated, as well as whether there is a growing number of aging offenders being screened or whether it is the same number of aging offenders being screened multiple times. While the OCI’s report indicated that this population is increasing, without knowing the specific number of aging offenders that are directly affected and how they are affected, it will be difficult to determine whether resources in the community match the needs or where the major barriers to aging offender placement in CRFs is resulting from. Furthermore, CRFs who are able to accommodate aging offenders should collect data on factors identified in this study, such as mobility and lack of ability to live independently that were identified as extreme barriers while residing at a CRF, as well as complex physical and mental health needs and lack of community support and isolation that were identified as moderate barriers while residing at a CRF. Additionally, CRFs should collect data on factors that were identified as extreme barriers upon release from the facility, such as ability to live independently, complex mental health needs, and lack of community support and isolation, as well as mobility and physical health needs that were identified as a moderate barrier after leaving the CRF. This would provide a better idea of what resources are in high demand in the community and at CRFs for the aging 69 offender population and contribute to better informed strategies to meet the needs of this population. Program Evaluations The available research indicates that the rise in the aging offender population is a global issue. The needs of this population are complex and multifaceted, so viable solutions will need be found beyond the realm of traditional corrections. According to the previous research and current study results, there is a need for segregated living options in the community for the aging offender population. Investing in specialized CRFs is more feasible than retrofitting the aging infrastructure of prisons and would promote rehabilitation and reintegration into the community. In Canada, CRFs such as Haley House and the Phoenix Society Aging Offender Program are examples of how aging offenders can be managed in the community. However, these programs lack formal evaluations to determine whether they are meeting the needs of the aging offender population. Program evaluations can provide insight into the effectiveness of the program and establish whether improved outcomes can be attributed to the program. The data results of the program evaluation can be used to guide improvements and possibly establish whether it is a good model to guide the development of future specialized CRFs. Training Training for staff is recommended based on the literature and results of the current study. It appears that frontline staff would benefit from training to better understand the aging process and to recognize age-related symptoms and how they might manifest physically and cognitively. As complex mental health needs for aging offenders were identified as a perceived 70 barrier before, during, and after residency at a CRF, training in relation to elderly mental health would be beneficial. Additionally, it is recommended that frontline staff are trained in neurocognitive disorders, such as dementia and Alzheimer’s, to provide a better understanding of how neurocognitive disorders can affect behaviour. Staff that are trained to address the needs of aging offenders will be better equipped to develop interventions to better manage their risk and promote reintegration into the community. Reallocation of Funds Well-funded community resources and partnerships were identified as an important need in both the literature and in the current study. Reallocating funds from institutional corrections to community corrections would support this initiative. If specialized CRFs were explored as an option, communities would also require additional funding to operate these facilities. Additionally, CRFs are operated by non-profit organizations that do not have large budgets to invest in formal needs assessments, program evaluations, and training. A redistribution of funds to community corrections would support the implementation of these recommendations. Limitations The results of this study should be considered in light of the following limitations. Primarily, there is limited generalizability due to the small sample size and the focus on BC and the Yukon. Further, the sample did not include treatment centres that have contracts with CSC to accommodate residency for offenders. Additionally, the study did not establish how frequently staff work with aging offenders, which might affect how familiar the participants 71 were with these issues. It was also unclear how many CRFs were represented in the data, as participants were not asked to identify their specific location of work. A manager survey was also distributed to capture CRF-level data, but as there were only four participants, the results were not included in the current study. The low participation rate may be due to time constraints on busy professionals, or the managers may have felt they did not have the information available to provide. Going forward, it is important to find a way to solicit the feedback of managers so that appropriate statistics can be examined, such as the percentage of individuals they are not able to accept at their facility due factors associated with aging. This would better inform CSC on the need for specialized CRFs for aging offenders and which communities have the highest needs. Finally, the current study did not collect information from service users. More research is required to determine the needs from the perspective of the aging offender population and how it compares to what is available in BC and the Yukon. This would help determine what ways are we meeting their needs and the ways we need to improve services and resources available to the aging offender population. It is recommended that aging offenders currently residing in both correctional institutions and CRFs be surveyed to examine whether their needs differ while incarcerated versus in the community. This would also allow for tailored supports and services to be provided. Conclusion The intent of this study was to assess the needs and identify the gaps in services for aging offenders in BC and the Yukon CRFs. There are no studies on the gaps in services for the 72 aging offender population in BC and the Yukon, so the results of this study can contribute to the growing body of literature that addresses the issues and concerns for aging offenders in Canada. There is also a gap in research that focuses on the unique needs of aging offenders in Canada, especially for subgroups of aging offenders, such as females, transgender, and Indigenous Peoples. Further research is required in these areas, to better inform policies and allocation of funding. The joint investigative report produced by the OCI and the Canadian Human Rights Commission (CHRC) identified the need for a national strategy to address the myriad of needs from the older prison population in Canada (OCI, 2019b). CSC’s policy framework for “Promoting Wellness and Independence Among Older Persons in CSC Custody” is a work in progress, as it focuses on solutions that promote maintaining incarceration. The recommendations from the joint investigative report promote a strategy that focuses on alternatives to incarceration for lower risk aging offenders, recognition of intersectional challenges that aging offenders face in custody, as well as an established timeframe for assessing and taking action to address aging offender needs and gaps in services. There is a clear need to develop a formal assessment of CRFs and community resources in BC and the Yukon to determine what the gaps in services are for aging offenders. This will provide better insight into what types of resources are needed and in which communities. Furthermore, this will provide the preliminary steps toward assessing the needs, developing an appropriate framework, and implementing strategies across Canada. Finally, and most importantly, this will allow us to care for aging offenders with dignity and compassion. 73 Appendix A: Research Ethics Approval Research, Engagement, & Graduate Studies Tel: (604) 557-4011 33844 King Rd Research.Ethics@ufv.ca Abbotsford BC V2S 7M8 Website: www.ufv.ca/research-ethics Human Research Ethics Board - Certificate of Ethical Approval HREB Protocol No: 100665 Principal Investigator: Ms. Jenni Martin Team Members: Ms. Jenni Martin (Principal Investigator) Dr. Amanda Mccormick (Supervisor) Dr. Zina Lee (Supervisor) Title: Assessing the Needs of Aging Offenders at BC and Yukon Community Correctional Facilities Department: College of Arts - Social Sciences\Criminology & Criminal Justice Effective: January 07, 2021 Expiry: January 06, 2022 The Human Research Ethics Board (HREB) has reviewed and approved the ethics of the above research. The HREB is constituted and operated in accordance with the requirements of the UFV Policy on Human Research Ethics and the current Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2). The approval is subject to the following conditions: 1. Approval is granted only for the research and purposes described in the application. 2. Approval is for one year. A Request for Renewal must be submitted 2-3 weeks before the above expiry date. 3. Modifications to the approved research must be submitted as an Amendment to be reviewed and approved by the HREB before the changes can be implemented. If the changes are substantial, a new request for approval must be sought. *An exception can be made where the change is necessary to eliminate an immediate risk to participant(s) (TPCS2 Article 6.15). Such changes may be implemented but must be reported to the HREB within 5 business days. 4. If an adverse incident occurs, an Adverse Incident Event form must be completed and submitted. 5. During the project period, the HREB must be notified of any issues that may have ethical implications. *NEW 6. A Final Report Event Form must be submitted to the HREB when the research is complete or terminated. 74 **Please submit your Research Continuity Plan to REGS@ufv.ca before beginning your research. The plan can be found here: https://www.ufv.ca/research/ Thank you, and all the best with your research. UFV Human Research Ethics Board 75 Appendix B: Assessing the Needs of Aging Offenders at BC and Yukon Community Residential Facilities Survey Staff Survey Consent Confirmation Page As someone who has worked with aging offenders at a community residential facility (CRF), you are invited to participate in an anonymous online survey about your perceptions of the needs and resource gaps that exist for older offenders. According to the Office of the Correctional Investigator, 1 in 4 offenders are 50 years of age or older. Due to several factors, such as lifestyle, years of incarceration, as well as complex physical and mental health concerns, offenders 50 years of age or older are considered “seniors”. This survey focuses on this population of offenders. Completing the survey will take approximately 15-20 minutes of your time. The survey will ask you about your perceptions of, and experiences with, working with aging residents at CRFs, as well as your perception of the needs of this population, the extent to which the needs of the population are being met, and current resourcing gaps. Any information that you can share with me on these topic areas is greatly appreciated. However, if you are uncomfortable answering or feel unable to answer any of the following questions, please leave the question blank and move on. By clicking “I agree”, you are giving your consent to participate. Your participation is completely voluntary. If you close your survey before submitting your responses, your answers will not be included in any analysis. However, one you submit your responses, they cannot be withdrawn as the data are anonymous. If you wish to participate in this survey, please click “I agree to participate”. Demographic Information: 1. Which region do you currently work in? 1. Vancouver Island (Victoria, Nanaimo) 2.Lower Mainland and Fraser Valley (Abbotsford, Chilliwack, Surrey, New Westminster, Vancouver, North Vancouver) 3.Northern Interior/Yukon (Whitehorse, Prince George) 4.Thompson-Okanagan (Kelowna, Kamloops) 2. Which role are you currently in? (If you are in an acting role, please select based in your current acting role) 1. Staff 2. Manager 76 3. Do you identify as: 1. Female 2. Male 3. Non-binary 4. How long have you been working at your current community residential facility? Training Please indicate to what extent you believe the following are important areas for CRF staff to receive training in, in relation to aging offenders 50+ years old. 5. Dementia 1 Not Important 2 Somewhat Important 3 Very Important 6. Alzheimer’s Disease 1 Not Important 2 Somewhat Important 3 Very Important 7. Incontinency 1 Not Important 2 Somewhat Important 3 Very Important 2 Somewhat Important 3 Very Important 8. Nutrition 1 Not Important 9. Bullying Between Older Adults in Communal Settings 1 Not Important 2 Somewhat Important 3 Very Important 77 10. Palliative Care 1 Not Important 2 Somewhat Important 3 Very Important 11. Trauma-Informed Care 1 Not Important 2 Somewhat Important 3 Very Important 12. Indigenous Relations and Effects of Colonization 1 Not Important 2 Somewhat Important 3 Very Important 13. Mental Health and Addictions 1 Not Important 2 Somewhat Important 3 Very Important Experience Please indicate to what extent the following issues are or are not a barrier to acceptance of aging offenders at your CRF. 14. Mobility Issues 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier 3 Moderate barrier 4 Extreme barrier 3 4 15. Complex physical health needs 1 Not a barrier 2 Slight barrier 16. Complex mental health needs 1 2 78 Not a barrier Small barrier Moderate barrier Extreme barrier 17. Lack of ability to live independently (e.g., ability to take care of their own hygiene, prepare own meals) 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier 18. Lack of community support/isolation 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier Please indicate to what extent the following issues are or are not a barrier for aging offenders while residing at your CRF. 19. Mobility Issues 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier 3 Moderate barrier 4 Extreme barrier 3 Moderate barrier 4 Extreme barrier 20. Complex physical health needs 1 Not a barrier 2 Slight barrier 21. Complex mental health needs 1 Not a barrier 2 Small barrier 22. Lack of ability to live independently (e.g., ability to take care of their own hygiene, prepare own meals) 1 Not a barrier 2 Small barrier 3 Moderate barrier 4 Extreme barrier 23. Lack of community support/isolation 79 1 Not a barrier 2 Small barrier 3 Moderate barrier 4 Extreme barrier Please indicate to what extent the following issues are or are not a barrier for aging offenders when released from your CRF. 24. Mobility Issues 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier 3 Moderate barrier 4 Extreme barrier 3 Moderate barrier 4 Extreme barrier 25. Complex physical health needs 1 Not a barrier 2 Slight barrier 26. Complex mental health needs 1 Not a barrier 2 Slight barrier 27. Lack of ability to live independently (e.g., ability to take care of their own hygiene, prepare own meals) 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier 28. Lack of community support/isolation 1 Not a barrier 2 Slight barrier 3 Moderate barrier 4 Extreme barrier Please indicate to what extent you agree or disagree with the following statements. As a reminder, aging offenders are defined as 50+ years old. 29. There is no difference between the reintegration needs of aging offenders and younger offenders. 80 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 30. I find that working with aging offenders is more stressful compared to working with younger offenders. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 31. I feel that I have been adequately trained to manage the needs of aging offenders. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 32. There are enough resources and services in the community I work in to meet the employment needs of aging offenders in the community. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 33. There are enough resources and services in the community I work in to meet the mental health needs of aging offenders in the community. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 34. There are enough resources and services in the community I work in to meet the social needs of aging offenders in the community. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 35. I believe there should be pre-release planning programs for offenders while in custody. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 81 36. I believe that there is collaboration with the health authority in my region to meet the needs of aging offenders. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 37. CRFs are prepared with the appropriate community resources and/or referrals to meet the needs of aging offenders. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 38. CRFs have the appropriate infrastructure and equipment to meet the needs of aging offenders. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 39. Accessibility of a CRF is the most important need for aging offenders. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 40. I believe that aging offenders can be more effectively managed in a correctional facility than in a CRF. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 41. I believe that aging offenders would be better placed at a specialized CRF. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 42. I believe we need more specialized CRFs in BC for aging offenders. 1 2 3 4 5 82 Strongly Disagree Disagree Neutral Agree Strongly Agree Final Thoughts 43. 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