Colorado hopes to persuade nursing homes to admit older, ill parolees

As Colorado’s prison population ages, Department of Corrections officials are asking lawmakers for additional money to help the department find new homes for older and ill inmates upon their release.

The request — $702,000 for each of the next two fiscal years — is relatively small compared with typical budget requests. The money will “guarantee beds in a privately-run nursing facility to allow elder and indigent inmates a place to safely exit the prison system,” according to Democratic Gov. Jared Polis’ Nov. 1 budget request.

In a memo last week to the lawmakers on Colorado’s Joint Budget Committee, who approve or deny such funding requests, the DOC explains that most people granted parole through the current “compassionate release” program have high medical needs and are eligible for subsidized health insurance through Medicaid.

“The department has found, however, that many nursing homes and long term care centers refuse to take this population because of their criminal records,” the memo states.

A total of 17 people who were approved for release under regular or special needs parole over the past two years are stuck in DOC facilities for this very reason, according to the memo. An additional six people reviewed and approved for special needs parole under a process triggered by recent legislation were still with DOC as of Dec. 7.

With the $702,000, DOC hopes to incentivize nursing homes and long-term care facilities to accept the parolees by supplementing what Medicaid pays.

Most of the money in the governor’s budget request — $469,000 a year — would come from federal funds, while $168,000 a year would come out of the state general fund. The remaining $64,200 would come from state cash funds.

During a Monday hearing, Ruth Coffman, DOC’s deputy executive director of community operations, told lawmakers on the JBC that she sympathized with nursing homes, who must meet Medicaid’s quality standards and would be penalized if a formerly incarcerated person caused a security problem.

If the money doesn’t work to incentivize nursing homes, Coffman said, the state could try a different tactic.

“The next step for this would be, other states have helped in the construction of just a standalone place that is just dedicated to those people,” she said, naming Connecticut as a state that established a nursing home for former inmates by partnering with a private company.

Special needs review underway

Earlier this year, state lawmakers passed Senate Bill 21-146 to overhaul the previous system of special needs parole. Sponsored by Sen. Pete Lee, a Colorado Springs Democrat, and Rep. Jennifer Bacon, a Democrat from Denver, the legislation triggered a review process by DOC to streamline parole applications for older people and people with disabilities. Polis signed the bill into law in July.

As a result of SB-146, DOC is reviewing the following characteristics for everyone in its facilities to determine whether they’re eligible for special needs parole, according to the department’s memo to JBC:

• 55 or older and seriously impaired from a chronic medical or mental health condition
• Any age and incapacitated from a chronic or irreversible condition
• 64 or older and served 20 years in prison
• Incompetent due to a mental health or medical condition, and unlikely to become mentally or medically competent
• Meets one or more of the above qualifications and has a terminal illness

As of Nov. 30, DOC has submitted applications for 20 people who meet the criteria for special needs parole under SB-146 to the Parole Board, according to the memo. The board granted 12 of those people compassionate release, but six of them are still in prison because DOC can’t find a nursing home or long-term care facility where they can stay.

DOC is reviewing the health records of an additional 740 people to determine if they’re eligible for special needs parole.

Christie Donner, executive director of the Colorado Criminal Justice Reform Coalition, approved of the governor’s plan to incentivize nursing homes to take special-needs parolees. But Donner worried the money wouldn’t be enough to solve an adjacent problem.

“Elders over 65 (leaving prison) have a very unique set of barriers to accessing insurance, including Medicare,” Donner said. This population must enroll in Medicare in order to access Medicaid benefits that would accommodate long-term care.

A key barrier, Donner said, is that prison work doesn’t count toward the work requirements necessary for Medicare, even if someone held a job for their entire sentence.

And Medicare charges late penalties to people who don’t apply for the public insurance program during their initial enrollment period, which begins three months before someone’s 65th birthday and lasts for 15 months. DOC hasn’t been applying for Medicare on people’s behalf when they’re still in prison at 65, Donner said.

“Medicare also doesn’t see release from prison as a qualifying life event that would allow people to enroll prior to the open enrollment period,” Donner added. The open enrollment period covers three months out of every year, January to March. Elderly people released from prison in April or later can’t sign up for Medicare until the next open enrollment period.

“Incentivizing nursing homes is great. It’s really necessary,” Donner said, “and it still may not be enough to get people into placement if they can’t figure out this Medicare nightmare.”

Most life sentences — or sentences long enough to mean essentially the same thing — come with the possibility of parole, but not the requirement for it. So, people on life sentences or de facto life sentences who are granted special-needs parole can wait in the corrections system for a long-term care placement. However, those with mandatory release dates have to leave prison regardless of whether they have family members to stay with or access to health care.

Donner mentioned a man with severe dementia who recently died within the corrections system. He had a long sentence and had been eligible for parole for decades, but had outlived his family members and didn’t have anywhere to go if he’d been released.

If the man had a mandatory release date, “I don’t know what they would have done,” Donner said. “Put him in a shelter? I mean literally, this is a nightmare scenario for people with very serious medical and mental health needs.”

Because of long sentencing schemes for some crimes in Colorado, some prisons are almost like a “geriatrics ward,” Lee said. “There are inmates down there pushing other inmates around in wheelchairs.”

Lee emphasized that the bill he sponsored, SB-146, passed on a bipartisan basis in the Senate. The five no votes belonged to four Republicans and one Democrat, Sen. Robert Rodriguez of Denver. In the House, all Republicans present voted against it, along with Democratic Rep. Tom Sullivan of Centennial.

Besides streamlining special needs parole, SB-146 directed cost savings from reducing the prison population to the Work and Gain Education and Employment Skills, or WAGEES, program. WAGEES allows the corrections department to partner with local, community-based organizations to help connect people leaving prison with education and job opportunities.

“You can’t just release a person with a hundred bucks and expect them to succeed,” Lee said. “They really need to have a place to go when they go out the door, have connections in the community, have employment prospects. They can’t begin that process the day they are released.”