Correctional Nurse . Net

Lorry Schoenly, PhD, RN, CCHP

Save Healthcare $$$ – Deliver Care Behind the Walls

PrisonTower

Prison Tower, Joliet, IL

A West Virginia jail is discovering what many county and state governments have confirmed – inmate healthcare is less expensive when delivered onsite rather than in the community. Why is that? Lets discuss the factors that make onsite healthcare efficient and effective for the corrections community.

Officer Manpower

The greatest savings, by far, in delivering care, treatment and diagnostics behind the security wall of the prison or jail is sheer manhours. Every time an inmate must leave the facility, officers need to attend them, often putting the facility into overtime mode. More than one officer may be needed to deal with transportation, shackles, and continuous observation. Consider the round-the-clock needs while caring for an inmate in a hospital setting. Some states reduce costs by having a locked unit within the hospital which can decrease manpower needs. A few states have an entire prison hospital and/or long-term care facility within a security perimeter.

Telemedicine Behind Bars

A popular way to increase the specialty care delivered behind bars is the use of telemedicine. Televideo equipment beam the specialty practitioner into the facility to dialog with the inmate-patient and the facility medical staff. This operation is most effective for specialty areas like infectious diseases (ongoing management of HIV/HCV) and psychiatry. More sophisticated equipment has been developed to allow accurate assessment of heart and lungs, but they can be ost-prohibitive.

Mobile Diagnostic Units

Another way care is coming to the inmates rather than transporting the inmates to the care is through mobile units. X-rays, Mammography, MRI, and CT Scan Units are now available to come to the facility. Secure outlets from the facility to the mobile unit are arranged and staffed during special periods of operation.

Healthcare is a major component of any Department of Corrections budget. The recent Pew Report on America’s prisons cites an average of 6.8% of state budgets goes toward corrections. Investigating methods to deliver effective and efficient healthcare within the walls is a priority.

September 17, 2009 Posted by | Inmate Issues, Medical Conditions | , , , , , , , , | 1 Comment

HIV & Inmates

New York State is considering increased oversight of HIV inmate care. This article had me considering the many issues and barriers to providing care for inmates with HIV. To be sure, healthcare providers have education, drug protocols and clinical practice guidelines specific for the correctional environment. Many of the medication regimens have been standardized and commonly available through prison pharmacy distributors. However, several elements of the operation of correctional facilities and the patients themselves mitigate against consistent care.

HIV is Now a Chronic Condition

Due to advances in treatment and pharmacologics, HIV is now considered a chronic condition. This can result in less attention to the details – not good for long-term outcomes. Many prison medical units now place HIV inmates into an Infectious Diseases Chronic Care Clinic. This is a good practice, as is regularly scheduled visits with ID specialists. The advent of televideo medicine allows for this specialty care practice without the burden of specialist access beyond the security perimeter.

HIV Treatment Requires a Well Educated Patient

The complexities of the treatment plan and medication regimen can overwhelm the most educated of individuals. The average inmate is undereducated and undermotivated toward long-term health, although there are always exceptions to this generality. Information about their condition and directions for any actions on their part need to be clear, simple and repeated often. This information can be mixed with social myths and misconceptions. An open and honest communication channel allows these myths to emerge and be dispelled.

Too Many PillsDOT or KOP Medications – Decisions, Decisions

The two options for medication administration in corrections are DOT (Direct Observation Therapy) which requires the inmate to come to a pill line and receive a single dose of medication where it can be observed to be taken, or KOP (Keep on Person) which allows the inmate to self-medicate, having been given a 30 day supply of the prescribed medication.

DOT is inconvenient for the inmate but assures more consistent treatment. KOP allows inmate independence and self-care but requires a highly motivated and diligent patient. Both are used for HIV management depending on the philosophy of medical and correctional leadership.

Inmates Don’t Stay in One Place

I know this may seem hard to believe – it was for me – but inmates are not always that easy to find. Just when they are settled into a routine at one of the state prisons, there is a reason for transfer. Security may need to transfer an inmate related to classification, time remaining in the sentence or due to altercations, gang activity, or attempted collusion. In any case, the inmate is moved to another facility. Communication of medical condition or treatment plan can be missed since a medical condition is not a primary consideration, but secondary to the security issue warranting the move.

For all these reasons, and some I probably missed, HIV inmate care will remain a challenge. It requires a well-running system to overcome the inherent barriers to care in a security environment. Many medical units find success through the designation of a nurse who provides case management for the HIV inmates in the facility. However, all staff members, from those working sick call to those working the med pass line, must understand their role in the HIV treatment plan.

What are your thoughts on HIV inmate care? I look forward to your comments.

September 11, 2009 Posted by | Infectious Diseases, Medical Conditions | , , , , , , , , , , | 1 Comment

Elderly Inmates – Increasing the Need for Correctional Nurses

With the current economic woes, governments are looking at ways to trim costs. The burgeoning correctional system is one place being reviewed.  Upwards of 25% of a state’s budget may be allocated to this concern. However it is unlikely that much can be spared from correctional healthcare budgets. Costs have been escalating for many reasons, not a small one is the increasing age of the inmate population. Information in this blog post comes from two excellent articles. The Council of State Governments published a report – Graying Prisons. Dr. Glenda Reimer’s extensively referenced article The Graying of the U.S. Prisoner Population appeared in the July, 2008 issue of the Journal of Correctional Health Care.

The Extent of the Problem

 The elderly inmate (defined as over 50 years of age) is the fastest growing segment of the incarcerated US population. The National Institute of Corrections documents a 172.6% increase in the decade ending 2001 when a total of 113,000 inmates had this designation. This growth is expected to continue for many reasons including longer sentencing, the general aging of the US population as a whole, and get-tough-on-crime reforms.

An Aging Inmate is Older than You ThinkElderly Man pixel.eight

Due to a tendency toward poor dietary and exercise habits, coupled with high levels of substance abuse, the inmate population has a physiologic age an average of seven to ten years older than chronological age. This is exacerbated by a general lack of access to health-care services and a poorer socio-economic background than the general public. In fact, a study by the Florida Department of Corrections found, in 2000, that two-thirds of the inmates surveyed had their first significant health care experience while in prison.

Most Common Chronic Conditions Affecting the Older Inmate

 Elderly inmates have high levels of chronic illness that must be managed within the security environment. A study by the National Institute of Corrections found these conditions of greatest frequency:

  • Arthritis
  • Hypertension
  • Ulcer Disease
  • Prostate Problems
  • Myocardial Infarction

Correctional Nursing Needed More Than Ever!

The increasing percentage of aging inmates and their corresponding chronic disease load is requiring an increase in need for correctional nurses. Government statistics do not seem to be kept on current and projected employment in correctional nursing. This needs rectified. Inquiries are in process. 

Nurses are needed to provide patient education, medication compliance counseling, and management of the care coordination necessary to deliver chronic care is a security environment.

Systemically, some state governments have initiated designated facilities for housing long-term care and acute care delivery in a centralized fashion. Concentrating healthcare services can lead to cost savings overtime, but can be expensive to initiate.

The need for dedicated quality nursing care to the incarcerated population is great. This specialty nursing practice needs attention and increased visibility.

July 20, 2009 Posted by | Inmate Issues, Medical Conditions | , , , , , , | 7 Comments

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