Texas prison provides compassionate care
Prison hospice brightens inmates’ last days
When a dying inmate enters the Michael Hospice Facility in the maximum-security Texas Department of Criminal Justice facility in Tennessee Colony, he sees bright, creative murals of landscapes, water scenes, and even a New England shoreline. His room is white with one wall painted in a soothing, pastel color. If he needs a change of scenery, he can look at a patio that was built with bricks and decorated with plants.
The hospice, formed two years ago by the state criminal justice department, has 21 beds and typically has a census of about 18 patients, says Jo B. Green, MS, associate clinical psychologist in the prison’s Michael Unit.
A prison hospice can be a good thing for dying inmates, often even better than compassionate release, she says.
"These patients have been incarcerated for a long time, and some have been out of touch with their families," Green explains. "We don’t want to turn terminally ill incarcerated people into terminally ill homeless people."
A prison hospice operates differently than a free-world hospice because it is subject to prison rules and security constraints, Green says.
However, the Michael Hospice focuses on quality of care and allows patients to have visitors, even children, seven days a week. The hospice contacts a patient’s family upon arrival.
"Visitors can’t bring personal items to the patient, but they can make deposits to the prison commissary account and buy things out of the commissary," Green says.
The hospice was built in a hospital-like setting that has been transformed by murals painted by inmates. "We didn’t get any more money than a normal infirmary, but we were able to be creative," she says.
Here is how the hospice works:
• Reimbursement: There is no third-party reimbursement. The hospice is the result of an integration of the University of Texas Medical Branch in Galveston, TX, managed care, and the 3,100-bed prison. Green is an employee of the University of Texas Medical Branch, which is the contract medical provider of the prison.
• Dying population: The dying inmates typically suffer from cancer, HIV/AIDS, or liver disease caused by hepatitis. "These guys’ bodies are not in really good shape," Green says. "They’ve abused their bodies all their lives and now they’re incarcerated."
The dying population is getting older due to longer prison sentences. Dying inmates stay in hospice care for an average of 81 days, she adds.
• Security issues: "The cooperation we have with our security is absolutely essential," Green says. "They are our gatekeepers, and we don’t have any amenities without their approval."
For example, the hospice’s Christmas party had to be approved by the prison warden, and anything unusual done for a patient has to be approved. One patient considered his dog his family member, so prison officials gave permission for the hospice to bring the man’s dog in for a visit.
"This is the warden’s house, and we’re guests," Green says. "Nothing comes in and out without the warden’s approval."
• Spirituality: The hospice helps dying inmates accept their illness and come to terms with their lives. "Obviously, their lives didn’t work out the way they expected, because they are here, dying in prison," Green says.
However, this lack of freedom and material comforts can serve as a springboard that allows a patient to grow spiritually because the spiritual component of their lives is about all they have left, she adds.
• Volunteers: The Michael Hospice uses inmate volunteers. The prison chaplain’s office identifies potential volunteers, and inmate volunteers refer other inmates to the hospice. The inmates know exactly who would be a good volunteer because they live with these people 24 hours a day, Green says.
"When we have a volunteer applicant, we run his name by the other inmate volunteers," she adds.
• Training: Inmate volunteers participate in a 30-hour training program and receive on-the-job training by the hospice staff.
"We also meet weekly to discuss the issues," Green says. The hospice currently has 14 inmate volunteers who provide all the care and activities of daily living assistance that a family would provide for a hospice patient.
• Palliative care: Patients receive palliative care, if they desire. All narcotics are counted at the beginning and end of each shift, and all medication is kept in medical custody until presented, Green says.
"Patients do refuse it sometimes, and that’s documented."
The keys to the narcotics are closely guarded and monitored, and offenders are not allowed in the doorway of the room where they are kept. "That’s another consideration of how it would be different from a hospital," Green adds. "We probably keep closer tabs on our narcotics."
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