Do care homes take serving and former prisoners?

You may want to know if prisoners with dementia, elderly prisoners and ex-prisoners with care needs can be moved in to a care home.

There are 141 prisons in the UK. There are 122 prisons in England and Wales, 15 prisons in Scotland and 4 prisons in Northern Ireland. The proportion of older prisoners aged over 50 was 17% in 2020. 

Her Majesty’s Prison and Probation Service (HMPPS) considers 50 to be ‘old age’ in prisons because of the significant health needs of prisoners.

Prisoners are described as experiencing accelerated ageing because the average age of death in prison is 56. This is compared to 81 years old in the general population. This ageing prison population creates extra pressure on prison staff.

Elderly prisoners’ care needs can arise because there are prisoners with dementia, mobility issues, sensory problems, physical disabilities and other health conditions, which have a higher prevalence among the older prisoner population.

What issues might an elderly prisoner face in prison? 

In some prisons, the adaptations needed to assist older prisoners, including prisoners with dementia, are not available. 

• Elderly prisoners prisoners placed in cells that do not have any sanitation, must either ring a bell at night and queue to access a toilet or use a pot in their cell. This disproportionately affects older prisoners as their need for night time access to sanitation is more frequent.  
• Older prisoners often share cells with other prisoners but the bunk beds used in shared cells are difficult to access for those with limited mobility.

One prisoner quoted in the House of Commons Justice Committee report ‘Ageing Prison Population’ said: “I am not supposed to be in a top bunk because of mobility problems and severe COPD, but I have had to share a cell with a prisoner much less mobile and so I had to use the top bunk.

“Changing the sheets of a top bunk bed was a particularly perilous task. I had to perch on a chair feeling very unsafe and at high risk of a fall which at my age could have been very serious.”

Older prisoners often become institutionalised while serving long sentences. They require practical help when preparing to re-join society, particularly when it comes to their health and social care.  

What happens to elderly prisoners in the UK?

The charity Age UK has stated: ‘Older prisoners should be held in establishments that meet their basic needs, receive the same basic level of health and social care as non-prisoners, and receive adequate support on release.’

However, prisoners have less access to health care than the general public. They have a poorer diet, and potentially face alcohol or drug misuse, mental health problems and traumatic brain injuries.

These are all factors that can increase the chance that they will develop dementia. 

Prisoners with dementia 

There are more than 820,000 people living with dementia in the UK. The term dementia is used to describe conditions which affect the brain and result in an impairment of the person’s function.

Although dementia is more prevalent with increasing age, it is not a normal aspect of ageing. There are many different types of dementia.

What are the symptoms of dementia?

Dementia is caused by different diseases that do damage to the brain. Symptoms vary depending on what part of the brain is damaged. 

Common symptoms of dementia can include: memory loss, difficulty performing everyday tasks, changes in behaviour, mood or judgement, language problems, disorientation and confusion.   

What issues might a prisoner with dementia face?  

Prisoners with dementia may be unable to follow prison rules. They may display behaviour that might aggravate other prisoners, in an already tense and potentially violent environment.

Tina Maschi authored a 2012 study in the Gerontologist which found that prisoners with dementia are vulnerable to “victimization.” 

Prisoners with dementia are vulnerable to abuse and sexual assault because they can no longer defend themselves. 

If prison staff are not trained to manage patients with dementia, they can mistake challenging behaviour as acting out.    

Not all prisons have effective procedures in place to identify prisoners with social care needs, according to the Care Quality Commission (CQC).  

DEEP is a UK network of groups of people with dementia. DEEP states: “Rates of [dementia] diagnosis are very low because the awareness of dementia is low and so symptoms are missed or misidentified as other conditions”.

This “means that diagnoses are delayed and prevent the right support from being received and appropriate care plans being put in place. 

“Currently the prison service does not have the resources to regularly and consistently diagnose dementia. Staff don’t have the right training to enable them to detect the symptoms and manage the more problematic aspects of dementia as it progresses”. This could potentially causing significant disruption on the prison wings and to the prison regime.
 
“Through awareness raising and having access to the right training and information, staff can facilitate an early diagnosis and provide the right support that addresses individual care and support needs, ensuring a person-centred approach throughout their sentence and upon release.”

What care needs can affect young prisoners? 

Regardless of age, prisoners have poorer physical and mental health than non-prisoners.     

There are also younger prisoners with social care needs. This includes people with mental health conditions, those with substance misuse (drugs and alcohol dependence), prisoners with learning disabilities, autistic spectrum disorders, physical disabilities or long-term health conditions. 

Ex-prisoners can have significant care needs and are particularly vulnerable following release. 

What are a local authority’s responsibilities towards prisoners?   

Under the Care Act 2014, local authorities are responsible for identifying and meeting the social care needs of prisoners. This includes while a prisoner is in custody and on release.

• The local authority in whose area a prison is located is responsible for identifying and assessing all prisoners with potential social care needs. 
• If these needs meet the national eligibility criteria, the local authority is responsible for providing or commissioning care and support for the prisoner. 
• Even if they do not have a prison in their area, all local authorities are responsible for the continuity of care of people who come into their area with a package of care on release. 
• If prisoners are released into a different local authority area, the two authorities must communicate to make arrangements.

Type of care and support prisoners may need  

A prisoner may need care and support with, for example:  

• Personal care e.g. help washing, going to the toilet, dressing.    
• Nursing care.
• Dementia care. 
• Support to tackle substance misuse including past or present alcohol or drug dependence. 
• Support with challenging behaviour.  
• Mental health support for issues such as bipolar, manic depression, schizophrenia. 

How does a prisoner get social care while serving a sentence?

If you are a prisoner with social care needs, you may find it difficult to look after yourself and do daily tasks such as showering. This could be because of a disability or long-term illness.

According to the CQC, a prisoner’s social care needs may be identified upon first entering the prison or at any other time during the prisoner’s time in prison. 

• Prisons, healthcare services or the prisoner themselves can request a social care referral assessment. 
• Referrals will then be made by staff to the relevant local authority, who is responsible for assessing the prisoner’s needs. 
• A local authority must carry out a care needs assessment to determine if a prisoner has social care needs which they should help with. 
• Some local authorities have staff based within prisons who can provide assessments. 

-The council will talk to the prisoner, prison staff, and if required, healthcare staff.

-They will ask about a prisoner’s daily life and ask what the prisoner finds difficult.

-If a prisoner has difficulty understanding information, they must ask for an advocate to help support them. 

• If eligible for support, the local authority will put a support plan in place which should include those involved with the prisoner’s health and well being, for example healthcare staff.

A spokesman for the Care Quality Commission stated: “Prisons should provide access for local authority staff to assess prisoners and their living environment and deliver any necessary support, and also support any adjustments to living spaces where needed.” 

Who gives a prisoner care and support? 

• Some local authorities have staff in prisons who can provide support. 
• Care may be delivered by visiting staff from a community care provider or by the main healthcare provider in the prison (depending on local commissioning arrangements). 
• Prisoners with social care needs may also receive some formal support with their daily activities from trained and vetted peers. This would not include any personal or intimate care. 

Do prisons work with care homes and home care providers to provide social care support?  

• The prisoner’s agreed care plan should include those organisations which are responsible for the prisoner’s health and wellbeing. 
• This could potentially include care homes and home care providers, if they have been identified as being required to help deliver support. 

Do prisoners have to pay for the social care they receive?

If a prisoner has savings outside prison, they might have to pay for some or all of their care costs. They do not have to use prison earnings to pay for care.

What type of social care should be provided in prison?

The HM Inspectorate of Prisons states prisoners ‘are cared for by services that assess and meet their health, social care and substance use needs and promote continuity of care on release. The standard of provision is similar to that which patients could expect to receive elsewhere in the community.’

Collaboration between the prison, commissioners and care providers ensures that health, social care and substance use services meet assessed needs of the prison population.

HM Inspectorate of Prisons recommends a health professional screens all new prisoners on the day of arrival to prison to identify a prisoner’s immediate health and social care needs. The HM Inspectorate of Prisons also recommends:  

• Relevant risk and care planning information is shared between prison and health staff on reception and throughout a prisoner’s sentence.
• Patients with palliative and end of life needs receive person-centred care delivered jointly by the prison and community services. 
• Prisoners access all necessary primary care services, including pain management, memory/dementia support services and effective out-of-hours GP services.
• Prisoners with social care needs are promptly identified and referred for a local authority social care assessment. Sufficient trained, supervised and screened social care staff implement agreed care plans that ensure privacy and dignity.
• Required equipment and adaptations are provided.
• Agreed packages of care are continued on transfer within the prison estate and on release.

Delivering effective social care for prisoners relies on there being appropriate accommodation and adjustments to the physical environment for those with care needs. 

Ageing Prison Population

However, according to the ‘Ageing Prison Population’ report (published July 2020): ‘The standard accommodation in many prison establishments is not suited to prisoners with reduced mobility, disabilities, or health problems that can result in care needs and appropriate reasonable adjustments are not always provided’.

Where a prisoner is assessed as requiring a move out of a prison to an environment where care can be provided, this is a decision made by HM Prison & Probation Service (HMPPS). 

Can a prisoner be moved into a care home? 

The CQC has stated it ‘would expect to see effective planning in place to ensure continuity of care for prisoners with ongoing social care needs when released’.

When it comes to care homes’ efforts to help prisoners get quality social care, a spokesman for the National Care Forum, which represents care home providers, said: “Care homes can and do provide a place of support for those leaving the prison system. 

“It is important, however, that care providers understand the support needs of those individuals, and the potential impact having lived for long periods of time in an institutional setting may have on someone’s ability to engage fully in life in a care home. 

“Many organisations who deliver care and support in the not-for-profit sector have extensive experience of supporting people who have been involved in the criminal justice system, through day services, advice and advocacy and care homes should reach out to work in partnership to provide the best care.” 

An outstanding care home caring for former prisoners

The nature of a prisoner’s crime can result in safeguarding steps being taken to ensure the care home they move to is suitable. For example, a male prisoner who has committed sexual offence crimes against a woman, will be moved to a men-only care home. 

Care home manager Aiden Spence runs Connifinn Care in East London which operates The Grove care home. Many residents at the care home have spent time locked up in prisons and secure psychiatric hospitals such as Broadmoor.

The Grove care home cares for eight male residents aged 18+. Staff at the care home have supported men with substance misuse, mental health conditions, and those whose rights are restricted under the Mental Health Act.

Aiden Spence said: “Often we have taken residents who are under Ministry of Justice sections 37/41 or they are under a community treatment order (CTO). Some are under DOLs (Deprivation of Liberty) with movement and finance. 

How long does it take for a prisoner to move to a care home? 

Every individual prisoner’s circumstances differ. In his experience, Mr Spence said: “The process for an ex-prisoner referral can generally take up to a year or more from prison to a care home. 
“Much of this depends on the type of index offence committed and how high a risk they are assessed as.”

“For example, Gentleman A appears depressed or displays psychotic symptoms whilst in prison.
If their offence isn’t deemed as high risk (i.e. low incidence of violence) they can go straight to a psychiatric hospital in the community. From there we can assess for suitability to us.”

Tackling institutionalised behaviour in prisoners

Mr Spence explained people living in the home had a history of living in restrictive environments.  

When it comes to caring for residents who have been in the prison system, Mr Spence said: “Some will never go out on their own. 

“We have had some in the setting who can go out on their own but they get disorientated. With their agreements, we put a tracker on them so if they wander and get lost we can easily find them. We are always coming up with new ways to increase their quality of life.”

The Grove care home has been rated Outstanding by the CQC. In its 2018 report, a resident told inspectors: “the staff help to make this a safe place to live”.  

Ex-prisoners in care: Managing risks safely

Aiden Spence told inspectors about the service’s approach to risk mitigation. He stated: “Our approach is unique in that we strongly believe that we have to give people as much freedom to explore their boundaries as possible. 

“We prefer to make a situation safer for them than to take away their right to explore that situation.” 

While some residents managed their money and finances independently, others have been supported by staff. Staff carry out daily petty cash checks. Residents have their own petty cash book and box of receipts.

He believes in the importance of supporting people to learn to take risks and make mistakes in a safe way.

At care homes, extra support may be given in the form of holistic therapies and trips out. Care home activities at Grove Care home include art therapy, reiki, hot stone massage. 

Mr Spence said: “Fortnightly I’ll go out with them to Southend beach. We went to the cinema yesterday.” 

The care home manager also invites his residents to his family home for Christmas dinner. 

Some former prisoners have left Grove Care home. They developed enough independence to move into Connifinn Care’s 6-bedroom supported living accommodation, situated nearby. 

‘I feel safe’

Other former prisoners have moved from this supported living accommodation to complete independent living.  

One resident, who cannot be named to protect his anonymity, spent 30 years in secure psychiatric hospitals. 

He has mental and physical health issues. He explains that “in the secure unit there was no freedom, privacy or compromise”.

“Here when I’m out of order, staff explain why I’m being out of order and calm me down. 
“They don’t hold it against me if I swear at them. Neighbours used to cross the road but now they smile at me.”

He adds: “I feel safe in this house because I have friends now. Staff are my friends.”