December 20, 2013

On March 17, in a Local Opinions commentary, “Hospice behind bars,” I advocated for the creation of a program to allow inmates at Jessup Correctional Institution to provide end-of-life care to their dying peers. Such a program would benefit both the patients, many of whom now face death scared and alone, and the caregivers, who would have a way to serve others at a time of profound need.

The initial response to my piece was encouraging, and we have made significant progress to a true hospice program. But one hurdle blocks our way. Here is an update:

Two days after my commentary appeared, Jessup Warden John Wolfe told me that his superiors at the Maryland correctional department agreed on the need for a hospice. By week’s end, Wolfe’s administration had created a palliative-care group, made up of medical, mental health, faith and social work personnel at the prison. This panel was instructed to create a hospice program that could serve inmates throughout the state.

In July, the prison psychologist asked me to get 10 volunteers from the Inmate Observation Aide (IOA) corps to act as hospice providers. IOA inmates are trained to watch suicidal prisoners to keep them from harming themselves. As the IOA clerk at Jessup, I got the volunteers, and we started our work.

Our first patient suffered from terminal cancer. He needed attention and care that the overworked and understaffed nurses could not provide. Our volunteers were able to be with him for 12 hours each day, in three four-hour shifts. We were told that patients don’t need a 24-hour hospice, but we could see that was not the case.

Many times, hospice volunteers had to complain to nurses about unchanged diapers, dirty bedding or the need to bathe, shave and feed the patient. For the most part, the nurses on the morning and evening shifts responded to our requests. But the night and weekend nursing crews are so severely understaffed that nurses routinely neglect this basic caregiving — that is, until a hospice volunteer arrives at 6:30 a.m. and starts complaining.

This generally has been the pattern with the patients who come to us.

Our hospice volunteers can do more than sit and watch, but until we get the training we need we are legally barred from providing basic care such as hand-feeding or bathing.

After my commentary appeared, the Hospice of the Chesapeake offered to provide companionship training at no charge to the state, and we’re hopeful that the training can be arranged soon. Companionship is an important part of hospice, and our presence at the bedsides of these dying men is a step forward. But the need is greater. We want to take some of the burden off the nurses. At a widely praised hospice program at the notorious supermax Angola prison in Louisiana, inmate volunteers provide basic personal care such as washing, feeding and dressing patients or changing soiled diapers. Why not train us to perform these tasks, too?

Maryland’s prison population is aging. Prisoners given long sentences in a tough-on-crime era are entering their declining years. Without a significant increase in resources, the prison nursing staff will be unable to meet the demand.

With training, we can offer some things even a skilled nurse cannot provide. Although the nurses are sympathetic to their patients, they cannot be empathetic. Prisoners are ideal caregivers for dying inmates. We have a shared experience. We understand what it’s like to spend decades behind bars. We know how heavily death looms.

We are close to our goal, but now we need public support. Prisoners don’t have much clout with state corrections officials, but corrections officials have shown that they do pay attention to the public.

If it can be done in Louisiana, it can be done in Maryland. All it will take is for Maryland residents to let it be known that they believe that incarcerated citizens, despite their crimes, deserve compassionate care and dignity at the end of their lives.

The writer is serving two life terms at Jessup Correctional Institution. He is a founder and director of the Extra Legalese Group, an incorporated prisoners think tank.