“He Needed Just About Everything”: Caring for Aging Adults Postincarceration

Abstract

Little is known about the experiences of caregivers for older adults reentering communities following incarceration. We sought to explore the challenges faced by such caregivers in Central North Carolina.

Methods:

We conducted a thematic analysis on semi-structured interviews with 11 caregivers.

Results:

Caregivers discussed how prior incarceration coupled with aging present barriers to housing, employment, and safety-net benefits—making caregiving more difficult. Caregivers assist their older care recipients to develop essential life skills (e.g., scheduling tasks, applying for services) and navigate the dynamic aging process (e.g., loneliness, illness). Caregivers struggle to gain care recipients’ trust, often due to their past trauma.

Discussion:

Caregivers play essential roles supporting older adults postincarceration, yet they experience significant challenges with limited resources. This study informed the development of a resource guide to assist caregivers. Dedicated programs and policies are needed to address these needs at the local level.

Keywords

home- and community-based care and services social work caregiving prison health care reintegration

Introduction

Older adults are the fastest growing demographic in the U.S. prison population—the largest in the world (Walmsley, 2018). From 1999 to 2016, the number of individuals experiencing incarceration and aged 55 years or older rose by 280% (McKillop & Boucher, 2018). In 2018, more than 20% of the U.S. state and federal prison population—more than 290,000 individuals—were aged 50 years or older (Carson, 2020). Individuals who are incarcerated are likely to have experienced challenges through their life course, including limited education, limited access to health care, trauma, or substance use; they may also experience “accelerated” aging while incarcerated (Smoyer et al., 2019; B. A. Williams et al., 2012). For these reasons, age 50 or 55 years is often considered to be the start of older age in incarcerated populations, rather than age 65 years, the conventional marker of older adulthood (U.S. Department of Justice [DOJ], 2004; M. E. Williams & Rikard, 2004). While the needs of the aging prison population have been highlighted by scholars, government agencies, and human rights organizations, less attention has been given to the challenges faced by older adults reentering the community following incarceration and even less focus has been given to their caregivers (American Civil Liberties Union, 2012; Di Lorito et al., 2018; Skarupski et al., 2018; U.S. DOJ, 2015).

More than 650,000 individuals are released from U.S. prisons each year (U.S. DOJ, n.d.). Increasingly lengthy prison sentences mean that many individuals age in prison and may return to their communities with additional needs (National Research Council, 2014). Older adults newly released from prison must contend with multiple barriers to community reentry related to housing, employment, and self-care; however, not all prisons provide standard preparation to individuals prior to release, such as application for benefits or navigation of civilian life (North Carolina Department of Public Safety, n.d.).

Older adults who are incarcerated have a higher burden of chronic and disabling conditions than similarly aged community-dwelling individuals (Di Lorito et al., 2018; Feinberg et al., 2018; Greene et al., 2018). In one study, about 40% of adults aged 55 years or older who were incarcerated had a cognitive impairment (B. Williams et al., 2014). Rates of mental illness, substance use, and post-traumatic stress disorder are also greater among individuals experiencing incarceration than in the general population (Baranyi et al., 2018; Fazel & Seewald, 2012; Prins, 2014). One study of incarcerated older adults found that approximately 80% of participants reported having experienced trauma, including physical or sexual abuse, as a child or adult (Haugebrook et al., 2010). Some older adults who have been incarcerated have reported the quality of prison health care as being insufficient and inadequate (Galli et al., 2019; Smoyer et al., 2019). The high burden of illness experienced by many older adults experiencing incarceration may present obstacles to reintegration upon release, placing these individuals at increased risk of homelessness (B. A. Williams et al., 2010). These challenges may, in turn, be shared by their caregivers.

Postincarceration support for older adults may be handled through a patchwork of formal and informal caregivers with additional help from community-based reentry services (Morenoff & Harding, 2014; Petersilia, 2003). Caregiving duties may place burdens on caregivers whose time and energy goes unpaid—a long-standing issue in caregiving (National Academies of Sciences, Engineering, and Medicine, 2016). Caregivers themselves have high needs related to social supports, finances, transportation, respite, and home maintenance (National Academies of Sciences, Engineering, and Medicine, 2016; The National Alliance for Caregiving, 2020). These known challenges may be compounded by the needs of an adult who has aged during incarceration, spending years apart from society, resulting in a disconnection from needed services (e.g., social welfare benefits, health insurance) and adequate familiarity with new technology (e.g., smartphones, online-based supports).

Improving the reentry experience and life thereafter for older adults requires further identification of their needs in the context of the communities to which they will return (The Osborne Association, 2018; B. A. Williams & Abraldes, 2007). Given the essential role that caregivers play in the reentry process, it is critical to understand their needs as well as their assessment of their care recipients’ needs. However, this crucial perspective is largely missing from research on the older adult reentry experience.

Our early conversations with reentry experts serving in three abutting counties in Central North Carolina (NC) as well as the Los Angeles and Boston areas revealed inconsistent family support resources for this population and predicted some difficulty in reaching family caregivers on this issue—a paradigm reflected in the existing literature (Martinez, 2006; Naser & La Vigne, 2006). Accordingly, we sought to understand the experiences of caregivers of older adults returning to the community postincarceration through exploratory, in-depth interviews—recruiting family, friends, volunteers, or paraprofessionals serving in a caregiving role for this population. Our goal was to explore and describe the challenges encountered by caregivers of this older reentering population (referred to as “caregivers” hereafter) and devise an early version of a resource guide aimed at caregivers living in Central NC (Supplemental Material). Reentry handbooks have previously been used to supplement prelease programming or provide guidance for prisoners without any community supervision (Mellow & Dickinson, 2006). Our resource guide is one of the first aimed at caregivers.

Method

For this study, qualitative data were obtained from our interviews with caregivers living in Central NC. “Caregivers” were defined as those assisting the older adult with daily or weekly tasks such as transportation or household functions. This study was approved by Duke University Campus Institutional Review Board (IRB; approval number: 2020-0109).

Design

To explore caregivers’ experiences in caring for aging individuals reentering the community following incarceration, we chose an exploratory design comprising of semi-structured interviews and conducted a thematic analysis.

Four local reentry professionals reviewed and helped improve the language and relevance of the semi-structured interview guide questions. The final 15-question interview guide (Supplemental Material) focused on daily and weekly caregiving tasks and services used to care for the older adult following their release, highlighting where supports might be lacking and which services had helped most in the surrounding community.

Participants

We recruited eligible participants with the following inclusion criteria: (a) an adult caring for an individual aged 50 years or older and reentering the community following incarceration, (b) residing in Central NC, and (c) able to participate in a recorded interview in English.

We employed a purposive sampling strategy. Local reentry councils along with other justice professionals and organizations in Central NC were asked to inform their networks about the study and distribute the approved study flyer. In an effort to increase awareness about the study to our population of interest—noted to be a difficult-to-reach group—we conducted four informational sessions at support groups for family members and reentering individuals in Central NC.

Interested participants contacted the principal investigator (N.A.B.) and left their name, phone number, and time to be contacted by the interviewer. The interviewer (L.B.J.) then contacted the interested participants to give further information on the study, confirm voluntary participation with verbal consent, and set a date for the phone interview. If an in-person interview was preferred by the caregiver, written consent was obtained, and the interview was conducted in a private room at a local transition house whose director had partnered with the study team.

Participants were provided with a list of local mental health resources following the interview in case the interview brought up any emotions needing support. Participants were provided a US$25 gift card as an honorarium for their time. Anonymity of participants was maintained by assigning each a unique study ID.

Data Collection

Eleven caregivers participated, seven self-identified as women and four as men. Three participants were either a family member or friend of the care recipient, two were unpaid volunteers (e.g., church-based and prison reform organizations), and six were in a professional role (e.g., community health worker, transition house employee, nursing assistant). Table 1 provides an overview of the characteristics of caregivers. Table 2 provides the time spent on caring activities by overall, formal (paid), and informal caregivers (unpaid). Table 3 provides an overview of the characteristics of the care recipients as reported by caregiver interviewees. A single interview was conducted in-person; the remainder were conducted by phone.

Table 1.

Sociodemographic Characteristics of Caregivers (Participants; N = 11).

Type of caregiver, N (%)
Family member or friend (unpaid/informal)	3 (27)
Volunteer (unpaid/informal)	2 (18)
Professional (paid/formal)	6 (55)
Gender, N (%)
Men	4 (36)
Women	7 (64)
Age (years), N (%)
<30	1 (9)
30–40	2 (18)
41–50	3 (27)
51–60	2 (18)
61+	3 (27)
M, median (SD); range	51.7, 49 (13.1); 29–71
Education level, N (%)
Some high school	1 (9)
Some college credit/Vocational training	6 (55)
Master	4 (37)
Employment status, N (%)
Employed	9 (82)
Retired	2 (18)
Marital status, N (%)
Single	4 (36)
Married/Domestic partnership	3 (28)
Divorced/Separated	4 (36)
Health insurance, N (%)
Private and provided by employer	5 (45)
Private and not provided by employer	3 (27)
Public	1 (9)
Not insured	1 (9)
No response	1 (9)
Length of time caring for older adult (years), N (%)
0–2	4 (36)
3–5	4 (36)
6+	3 (27)
M, median (SD); range	3.9, 3 (2.9); 1–11

Table 2.

Time (in Hours) Spent on Caring Activities Each Week Overall (N = 11) and by Formal (N = 6) and Informal (N = 5) Caregivers.

Time	Overall	Formal	Informal
<10	2 (18)	1 (17)	1 (20)
10–20	3 (27)	1 (17)	2 (40)
21–30	2 (18)	1 (17)	1 (20)
31–40 (full time)	4 (36)	3 (50)	1 (20)
M	23.7	27.2	19.7
Median (SD)	20 (11.4)	28.8 (11)	15 (10.5)
Range	5.5–40	8–40	5.5–35

Table 3.

Sociodemographic Characteristics of Care Recipients (N = 12; One Caregiver Regularly Cared for Two Care Recipients).

Gender, N (%)
Men	9 (75)
Women	3 (25)
Age (years), N (%)
<55	4 (33)
55–65	5 (42)
65+	3 (25)
M, median (SD); range	60, 59 (10.5); 45–80
Ethnicity, N (%)
Black/African American	10 (83)
White	2 (17)
Education level, N (%)
Did not complete high school	6 (50)
High school graduate, General Education Diploma	4 (33)
Professional bachelor or higher	2 (17)
Employment status, N (%)
Employed	3 (25)
Out of work and looking for work	4 (33)
Retired/Unable to work	5 (42)
Marital status, N (%)
Single	3 (25)
Married/Domestic partnership	1 (8)
Divorced/Separated	6 (50)
Widowed	2 (16)

Two participants screened in as caregivers of 50+ year-olds but later indicated their uncertainty of the exact age. Due to the similar themes described in their interviews to the rest of the 50+ year group and the caregivers’ apparent substantial involvement in daily care, we decided to retain them as participants in our study. The average interview length was 31.5 min (plus time taken for demographic data collection), as time burden was a significant factor for caregivers.

Data Analysis

Each audio-recorded interview was transcribed using IRB-approved Temi.com. Our research team employed thematic analysis (Braun & Clarke, 2006) to identify, analyze, and report patterns found within the data. Analysis began with the first interview in an effort to refine question framing, order, and use of probes to obtain additional information or clarification (e.g., “Please tell me more about what you just shared.”). Descriptive themes, categories, and codes of caregivers’ needs—related to social supports, finances, transportation, respite, home maintenance, and duties related to caring for other family members—were achieved through a stepwise process. This began with reading all transcripts, noting the topics shared both in response to the interview questions and those generated spontaneously.

Next, codes were organized into categories and subcategories. The transcripts were reread to determine whether categories were common across the sample. We determined, as a team, the categories and subcategories that best reflected the research question. There were additional emergent themes (e.g., gaining care recipients’ trust, developing care recipients’ essential skills). These themes were distinct from the anticipated challenges like time management, providing transportation for care recipient, and playing a role in securing housing and employment for care recipients.

While there was one lead coder (S.H.C.), the research team (L.B.J., N.A.B., S.H.C.) completed two rounds of individual coding with discussion followed by two rounds of confirmation coding with discussion (Morse et al., 2002). All authors regularly discussed the emerging categories and early themes—documented immediately following the interviews using memos and at each meeting. The lead researcher (N.A.B.) was continuously involved, staying close to both interview processes and the data, using a constant comparative approach (Boeije, 2002)—comparison of subsequent findings to previous findings to determine whether they were new categories, part of an existing category, or indicated a higher level category—to strengthen the dependability of findings.

Interviews were discontinued when consensus was reached regarding thematic saturation, that is, when the team noted further observations and analysis were no longer yielding new themes (Saunders et al., 2018). NVivo 12 (QSR International Pty Ltd. Version 12, 2018) was utilized for later coding stages and illustrative quote abstraction. Expert review of anonymized, aggregated data improved our understanding of what we were hearing in interviews. Illustrative quotes from the interviews are provided to indicate context and voice.

Results

We discuss three main themes and subthemes encountered in the data set: developing self-sufficiency skills (scheduling tasks and forgetfulness, applying for benefits and services, adapting to new technology); considerations in advancing age (loneliness and social isolation, serious illness and end-of-life preparations); and intersections of trust, trauma, and mental health.

Developing Self-Sufficiency Skills

Caregivers noted their care recipients have poor time management and struggle with tasks such as paying bills on time. Having had their needs taken care of while incarcerated, many now require assistance when applying for benefits and services. Some care recipients had forgotten how to obtain housing or even how to prepare meals. Caregivers described improving care recipients’ self-sufficiency—balancing doing a task for them versus teaching them how to complete tasks themselves:

When he first came here, he needed just about everything . . . Now he’s able to prepare his own food . . . get on the bus by himself and go to Walmart . . . articulate some of the things that he would like to do . . . [and] use the computer . . . cell phone. (Professional caregiver for a 62-year-old man)

More than three quarters of the care recipients had no college education, and half of the care recipients lacked a high school diploma (Table 3). Caregivers provided assistance and guidance in areas where education may have given the care recipient an advantage (e.g., applying for a job):

I was a life skills teacher for them (Step Up Ministry, local non-profit providing employment obtainment assistance) . . . and they [formerly incarcerated individuals] . . . come in and . . . go to these life skills classes that teach about life because there are a lot of individuals that got in trouble [and] have no clue what life is really about! . . . How to be a wife, a husband . . . a daughter, an adult. (Volunteer caregiver for a 71-year-old woman)

Scheduling tasks and forgetfulness

Many caregivers discussed assisting their care recipients with scheduling tasks.

[I] help with managing money or with trying to pay some of her bills and just making sure she stays on top of her appointments. (Friend and caregiver for a 53-year-old woman)

One caregiver described in-depth how he helped his care recipient develop a routine and the need to frequently remind him about essentials, such as paying rent:

We had to develop a routine . . . I call, and then I go by, and then I make sure . . . that he’s [done what he’s] suppose’ to . . . prepared to go to his appointments—bathing, having his clothes on, being at least 30 minutes ready before Durham Access (disabled transport company) pulls up to take [him] towards [his] appointments . . .

[He struggles with] remembering when things need to be done . . . They almost lost their house . . . because this person [care recipient] had truly forgotten that every block of their rent is actually taken out of their SSI chip. (Professional caregiver for a 72-year-old man)

Applying for benefits and services

Many caregivers described assisting care recipients with applications for insurance, benefits, driver’s license, and other services. They emphasize the necessity of these applications for care recipients’ livelihood, and many doubt their care recipients have sufficient knowledge to complete these tasks themselves:

They need medical insurance; they need [a] driver’s license; they need housing . . . Some of these people haven’t been incarcerated before, so they may not know what it is they’re supposed to [do once they’re released]. (Volunteer caregiver for a 60-year-old man)

Adapting to new technology

Some caregivers described needing to assist their care recipients with technological skill development.

They’ve been away from just society in general, so things have changed . . . with technology. (Volunteer caregiver for a 60-year-old man)

Now . . . he can operate a cell phone, and that’s amazing. [He is] adjusting to technology, and he uses a computer. We enrolled him in a class at Durham Tech (community college), so he’s learning computer basics. (Professional caregiver for a 62-year-old man)

Considerations in Advancing Age

Many caregivers reported struggling with their care recipients’ age-related needs and the loneliness and difficult emotions often accompanying aging and end-of-life preparations.

Loneliness and social isolation

Several caregivers reported socialization as a critical component of supporting meaningful community reintegration.

There are particular emotional and health needs around reintegrating into society at the age of 63 [rather] than 25. (Friend and caregiver for a 63-year-old woman)

He’s like a part of my family . . . [we pick] him up for dinner for a holiday or something . . . . . . just [to] hang with me and my family for a little while . . . try to give him something that he’s missing. And nobody does that for [him] here. If there was like a program that would do that, [it] would be a whole lot of help . . . Sorta just help him feel like he’s wanted. (Professional caregiver for a 45-year-old man)

I take him [to grab a] meal at a restaurant . . . [I try to get him] involved in social organizations in the community, providing my own money, to buy, to take them to get clothing. (Volunteer caregiver for a 60-year-old man)

Serious illness and end-of-life preparations

Multiple caregivers worried about their care recipients’ need to make end-of-life preparations—and some reported concern that they (caregivers) were the only people available to help with these tasks. These caregivers recounted their involvement in burial planning and care related to the aging individual’s deteriorating health or current illness:

A lot of prisons are becoming nursing homes for people. Dementia and Alzheimer’s is really high . . . [It] would be extremely difficult for a caregiver taking care of someone with dementia or Alzheimer’s. (Professional caregiver for a 62-year-old man)

When my husband had a heart attack, he . . . ended up having a triple bypass, open heart surgery . . . After he had his abrupt surgery, he was diagnosed with congestive heart failure. And just last year he was diagnosed with irritable bowel syndrome. (Family caregiver for a 58-year-old man)

Hopefully I can help him live out his last [days]—where the rest of his life is comfortable [despite his illnesses] . . . [But I’m worried about] how I’m going to bury him. (Professional caregiver for a 72-year-old man)

I’m dealing with older populations . . . [it] can be stressful! . . . Any extra stressful issues [can] be fatal in their situation. (Professional caregiver for a 58-year-old man)

Some caregivers were older adults themselves (M age = 51.7 years) and acknowledged worrying their advancing age might eventually limit their caregiving abilities. One caregiver indicated that she was exploring life insurance options for her care recipient for this very reason, noting that rates were much higher for individuals with convictions:

I’m preparing myself for . . . my aging and . . . not being able to continue to care for this individual and their health deteriorating mentally and physically . . . Life insurance is hard to get for an individual who has a felony because their policy rates are so high . . . [I worry about taking] care of burial expenses. Is cremation better or is burial better? . . . of course, cremation is much cheaper . . . (Professional caregiver for a 62-year-old man)

Intersections of Trust, Trauma, and Mental Health

Many participants described struggling to gain their care recipients’ trust which they perceived to be a crucial feature of a successful relationship, particularly as they were usually the sole caregiver. Although some distrust may stem from experiences within the criminal justice system, many care recipients appear to suffer from anxiety, depression, or other trauma-related mental health issues unrelated to their incarceration. Several caregivers highlight the need for additional mental health assistance for their care recipients beyond the emotional support that they (caregivers) provide.

Before me, so many people had taken advantage of him . . . (Professional caregiver for a 72-year-old man)

He didn’t like for people to look at his stuff . . . he was a very private person . . . if you picked up [his] stuff, he would automatically jump to defense. And he was like, ‘what are you doing with my stuff?’ And it was like, ‘okay, you asked me to straighten this out, I’m doing it for you.’ . . . He now apologizes . . . because he don’t mean to be that way. But that’s how prison made [him] . . . (Professional caregiver for a 45-year-old man)

There needs to be more attention and care around mental health services. [These] folks have a tremendous amount of trauma that manifest during their time of incarceration. (Friend and caregiver for a 63-year-old woman)

Discussion and Implications

Participants gave a rich account of their challenges and experiences as caregivers of older adults who were reentering the community following incarceration. These interviews reveal that caregivers encounter significant challenges while supporting these individuals, including skill development, age-related needs, and trauma or mental health issues. We found that care recipients generally had a patchwork-like caregiving network—be they paid professionals or unpaid volunteers, friends, or family.

Overall, caregivers reported feeling overwhelmed by caregiving tasks likely due to the lack of community-based supports. Most of our participants mentioned their care recipient lacked others who could assist. Some professional caregivers mentioned that caregiving boundaries could become blurred, with duties often extending beyond their scope of work (e.g., helping outside work hours). Four of the 11 participants reported spending more than 30 hours a week on caring activities—three of these participants were paid professionals (Table 2). It should be noted that some of the paid professionals, in addition to providing care to the older formerly incarcerated individual, provide care to other individuals; this time was not included in our data, as it was not spent on an individual who is formerly incarcerated. The unpaid caregivers reported spending an average of 15 hours a week (M = 19.7, median = 15) on caring activities (Table 2). A few caregivers mentioned taking time off work to assist their care recipients, though they willingly did so, as care recipients infrequently had others to help with their needs. Criminal justice system involvement may have damaged old relationships and individuals may seek to avoid potentially negative influences upon release and cut ties with past acquaintances. Research indicates that many individuals who have been incarcerated lack support from family and friends, and some report having no social support whatsoever (LeBel et al., 2015; The Urban Institute, 2012).

Local programs assisting older adults postincarceration with transportation, home maintenance, employment, and housing access—might alleviate demands on both paid and unpaid caregivers. Awareness of available programs is essential. Our reentry resource guide was created with this intention—to inform caregivers of the many resources available in Central NC. Similar guides or handbooks could be developed to aid caregivers elsewhere. Further research could determine what information would be most relevant for inclusion.

While not unique to older adults, stigma—a known hurdle faced by individuals who have experienced incarceration—was identified by caregivers as a challenge further complicating their efforts to support reentry. Many caregivers reported struggling to help their care recipient find housing or employment, as some landlords would not rent to, and some employers would not hire, individuals who have been incarcerated. In times of economic insecurity, some caregivers mentioned helping their care recipients pay for basic necessities. This model is unsustainable, as few caregivers have the financial means to assist their care recipients long term. Despite their need, individuals with convictions may be ineligible for public assistance, yet their age and lack of up-to-date occupational skills make them among the most vulnerable (Visher & Mallik-Kane, 2007). Housing and employment policies which do not perpetuate discrimination for this population could reduce caregivers’ burden.

Our interviews revealed that many caregivers are concerned about how they will assist their care recipients with age-related and end-of-life needs. The need to plan ahead is especially imperative given the likelihood of poorer health status among those who have been incarcerated. Many caregivers themselves are advancing in years and worry their age-related physical and financial limitations may affect their future caregiving abilities. Expanding state and local burial assistance programs may remove this responsibility from caregivers.

Some of our participants highlighted the stress caused by strict application deadlines when assisting care recipients with obtaining services, such as health insurance or nutrition assistance. Individuals, many of whom have existing physical and mental illness, may miss enrollment windows while incarcerated and face lengthy gaps in benefit coverage upon release. During the prison-to-community transition, maintaining continuity of care is challenging even with insurance, and lack of planned mental health care may result in increased emergency department visits and suicides (Frank et al., 2013; Pratt et al., 2006). Facilitating enrollment in Medicare, Medicaid, and social service programs for those who are incarcerated should be part of broader efforts to better prepare and support individuals ahead of community reentry, thus removing this responsibility from caregivers and potentially reducing crises, such as health emergencies or food insecurity.

Caregivers in our study noted care recipients often lack organizational and social skills, such as time management and interpersonal communication skills, as well as more practical abilities like applying for a driver’s license or opening a bank account. For older adults who are reentering the community, a lack of familiarity with technology, particularly computer related, is another significant hurdle that caregivers attempt to address. While many technological barriers can be overcome through training, other impediments may require more complex solutions, such as increased education and skill development during incarceration. Caregivers are front and center in their care recipient’s negotiation of the complex processes aforementioned.

To the best of our knowledge, this study is the first to explore the needs of caregivers of older adults reentering the community postincarceration; however, we note limitations. Our participants were from one geographic area and available community resources differ across regions. Despite a relatively small sample, we reached thematic saturation related to the study aims. Although we had anticipated most participants would be friends or family members of care recipients, our wide recruitment resulted in six working professionals, two community volunteers, and only three friends or family members. Despite our efforts, we had great difficulty recruiting potential participants who were friend or family caregivers. We conducted four informational sessions about our study at two local transition support programs in addition to reaching out to more than 100 professionals and volunteers working in three counties, emphasizing our desire to reach this population. It is possible that friend or family caregivers may be more schedule burdened than professional or volunteer caregivers. Family caregiver schedule burden, in the context of advanced age, is a previously noted factor (Burton et al., 2012). In addition, some bias may have been introduced from the convenience sampling within the local reentry community, resulting in a more homogeneous group of participants.

American criminal justice policy has resulted in growing numbers of older adults experiencing incarceration. These individuals’ complex physical, social, and psychological needs necessitate the development of tailored aging service delivery systems (Snyder et al., 2009). The necessity for such supports has become more urgent with the spread of the COVID-19 pandemic. The increased vulnerability of incarcerated populations to the novel coronavirus and the risk of correctional facility-associated community spread have resulted in widespread calls for decarceration (Franco-Paredes et al., 2020; Howell et al., 2020; National Academies of Sciences, Engineering, and Medicine, 2020). In light of these risks, the DOJ has authorized use of home confinement for older and medically vulnerable individuals currently incarcerated (Office of the Attorney General, 2020). We strongly recommend caregiver support be addressed in decarceration plans. In addition, public–private partnerships and dedicated caregiver support may assist successful community reentry and quality of life for these often-stigmatized individuals (Boucher et al., 2020).

This study has identified several challenges specific to caregivers, and these findings have informed the development of a resource guide for caregivers in Central NC. This guide, designed with input of local stakeholders, has been distributed to local reentry support organizations and others helping individuals who have been incarcerated transition back into society. The major topic headings of the guide are listed in Table 4, and the guide is included as a Supplemental File Online.

Table 4.

Resource Guide Contents.

Multiresource centers

Food and clothing

Housing and emergency shelter

Job-related

Legal

Medical care and physical health

Mental health and substance use help

Transportation

Outreach programs and supports that seek to reduce stigma regarding this population with landlords, employers, and benefits administrators could improve access to these critical services for individuals reentering the community. Skill development programs targeting this unique older population and led by individuals familiar with the tensions discussed herein would facilitate older adults’ ability to reacclimate to society following incarceration. Limiting social isolation and addressing serious illness needs—ubiquitous challenges for older adults—may improve the quality of life in this underserved population. Finally, a deeper recognition of the intersecting trust, trauma, and mental health issues faced by older adults who have experienced incarceration could inform interventions designed to improve reintegration in our communities. Frameworks, such as the Criminal Justice Involved Older Adults in Need of Treatment (COJENT), may serve as models for communities seeking to address older adults’ postincarceration needs (Metzger et al., 2017).

Our findings indicate that older adults face significant challenges when returning to the community postincarceration. Limited social support means that substantial caregiving duties often fall to volunteers or community-based professionals. Dedicated programs and policies supporting these individuals are imperative. Further research should explore reentry challenges from the perspective of older adults who have experienced incarceration themselves, as well as from their caregivers. Additional studies should also assess how length of incarceration and age upon release might affect the caregiving relationship or needed assistance.

Supplemental Material

sj-pdf-1-jag-10.1177_0733464821990511 – Supplemental material for “He Needed Just About Everything”: Caring for Aging Adults Postincarceration

Supplemental material, sj-pdf-1-jag-10.1177_0733464821990511 for “He Needed Just About Everything”: Caring for Aging Adults Postincarceration by Laylla B. Jimenez, Sarah H. Cross and Nathan A. Boucher in Journal of Applied Gerontology

Supplemental Material

sj-pdf-2-jag-10.1177_0733464821990511 – Supplemental material for “He Needed Just About Everything”: Caring for Aging Adults Postincarceration

Supplemental material, sj-pdf-2-jag-10.1177_0733464821990511 for “He Needed Just About Everything”: Caring for Aging Adults Postincarceration by Laylla B. Jimenez, Sarah H. Cross and Nathan A. Boucher in Journal of Applied Gerontology

Footnotes

Acknowledgements

The authors would like to thank all participants for their contribution to this study. We wish to thank the dedicated professionals in our area working in the reentry and justice-involved professions.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding was provided by the Sanford School of Public Policy at Duke University.

IRB Approval

This study was approved by Duke University Campus Institutional Review Board (approval number: 2020-0109).

ORCID iD

Laylla B. Jimenez

Supplemental Material

Supplemental material for this article is available online.

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