color stock photo of an elderly person's hands cupped upwards sticking through prison bars
(via iStock)

It’s an unusually cold day in Miami. The 45 degrees F temperature has every incarcerated person at Everglades Correctional Institution bundled up under blankets, long johns, thin state-issued jackets, and class-A uniforms. The elderly population here feels it the most. They have to use their walkers and canes, stand in long lines, and await their daily dose of medication, all with little to no relief from the cold, all at the mercy of prison staff whims.

Michael, a 57-year-old serving a life sentence, says prison staff often don’t give him the medication he desperately needs to manage nerve damage in both legs resulting from a back injury. 

“They had me take water pills, cholesterol pills. Medications that don’t even address nerve damage,” Michael, who is only using his first name for safety, said.

Michael’s story isn’t unique within the Florida criminal legal system. Florida has one of the largest elderly populations in prison throughout the country. According to the Florida Department of Correction (FDOC) annual report FY 20-21, while the number of older adults decreased by 3.6%, the percentage of older adults in the prison population increased from 26.8% in 2020 to 28.2% in 2021. Florida has the third largest elderly population in prison, behind Texas and California. 

“A prison that looks like a nursing home is a public safety failure,” says Molly Gill, vice president of policy at Families Against Mandatory Minimums (FAMM). 

This increase of older adults in prison has led to a massive increase in health care and housing costs, with particularly dire consequences for older incarcerated people who have spent decades under Florida’s abolished parole system. With a life sentence and no set criteria to be paroled, the health of aging incarcerated people is now in a crisis, facing an array of chronic and often life-threatening conditions such as cancer, respiratory problems, other illnesses, and high levels of stress. 

Tony, a 55-year-old with a life incarceration sentence, says he often sees an ambulance at the facility “three-to-four times a week,” not in response to violence, but for an elderly incarcerated person suffering from any number of ailments that could be addressed with medical treatment that’s been made unavailable to those who are incarcerated. 

“[It’s] a medical system that sentenced us to an early grave,” Tony, who is only using his first name for safety, said. “We’re just waiting our turn to die in here.” 

A “revolving door” of private health care providers

Laurette Philipsen knows very well the experiences that elderly people have in prison. She was 54 when sentenced and served over eight years before being released. She realized how bad the health care system was when she entered prison.

“You can put in a sick call to be seen by medical, and it could be weeks before you have seen a nurse,” she says. 

While incarcerated, Philipsen also developed stage 3 kidney disease. Although a doctor noticed her kidneys were malfunctioning and ordered more tests, Philipsen still had to wait months for the tests to be ordered, enduring a sudden switch in care when her doctor was replaced by a third-party vendor that further complicated her ability to get treatment.

Philipsen was lucky—she managed to survive and, after her release, eventually became the communications director at Florida Cares Charity, which aims to improve the lives of those who are incarcerated. But many other incarcerated elderly aren’t as fortunate. 

According to the Correctional Medical Authority, of the 450 people who died in Florida prisons between 2021-22, 354 of those people were elderly, and 133 of those people were men 70 and over. Incarcerated people aged 50 and older accounted for 97,594 of the 297,868 sick calls and emergency encounters in prison facilities, as well as 54%, or 25,444 out of 46,710, of the total  enrollments in chronic illness clinics. Among Florida’s elderly incarcerated population, 8,081 have visual impairments, 1,610 have hearing impairments, 3,101 have physical impairments, and 6,512 have developmental impairments.   

Either give us a death sentence or give us a release date. We have given you our life, what more can we give?


Incarcerating older people also costs about three times as much as incarcerating younger people, mostly due to health care costs. Between fiscal years 2015-16 and 2019-20, inmate health care costs increased by 36%. According to the FDOC annual report for FY 2020-21, older incarcerated people accounted for 60.5% of total hospital admissions and 68.7% of total in-patient hospital care.

There is also the issue of privatized health care. As the country’s third largest state prison system, Florida’s contract for health care services represents a significant opportunity for private health care providers. Philipsen says that after former Gov. Rick Scott’s election, he brought in a third-party vendor, and health care standards in the FDOC deteriorated. Inmate deaths also rose from 35-40 a year to over 400 a year. The FDOC has since gone through many private health care companies, including Wexford Health Sources Inc. and Prison Health Services Inc. Today, Centurion of Florida LLC provides health care for the FDOC. 

The current contract with Centurion is a cost-plus model for profit in which Centurion is reimbursed for the actual cost of medical care and paid an additional 11.5% of program costs to cover administration and profit. The contract was capped at $421 million annually for three fiscal years from 2019-22. Pharmacy services are not included in the contract and are managed directly by FDOC. 

The continual switch of health care companies working with the FDOC due to former Gov. Scott’s policy change hasn’t gone unnoticed by the public. A 2022 ABC Action News investigation highlighted “serious concerns surrounding basic health care in the state prison system, which have led to taxpayers footing the bill for millions of dollars in lawsuit settlements.”

“It’s like a revolving door of private medical providers,” says William Thomas, criminal justice strategist at Society First. “They get sued, they get kicked out of the state. Then comes the next one; they get sued and kicked out of the state.”  

Housing conditions are also exacerbating health issues for elderly incarcerated people. Executive Director of Florida Cares Denise Rock described how prison staff have confiscated canes and wheelchairs from incarcerated folks and how sleeping on the top bunk can be dangerous. 

“That’s a safety hazard for [elderly people],” says Rock. “There are no ladders to get them up and down to those bunks, so they have to jump on and off of them [risking injury].”

Additionally, mold, air pollution, dust, and pests are commonplace in prisons and can trigger asthma. More than 1 in 6 older adults in prisons across the country have been diagnosed with asthma, which also puts people at higher risk for hospitalization from COVID-19 and can be especially dangerous for older people. In short, Wanda Bertram of the Prison Policy Institute says that years in prison and terrible health conditions age a person in ways that life outside of prison does not. 

“A 55-year-old in prison who’s been there for several years is probably older in physical health terms than someone who has not been incarcerated for several years because of the way prison ages you.”

Stacking the deck against parole

The state of elderly care in Florida prisons isn’t new. In 1999, a Florida legislature report found a 377% increase in incarcerated people 50 and over since 1982. A 2014 article from the Journal of the American Geriatrics Society found that since 1990, the U.S. prison population has doubled, while the population of incarcerated people 55 years and older has increased over 500%. From 2000-10 alone the number of people 55 and over increased 181%. Both the actual number of older incarcerated people and the percentage of the total prison population they constitute are likely to increase further in the next three years. The FDOC estimates an increase of 8,798 inmates from 2021, bringing the elderly population percentage up to 34.1% of the total prison population by June 2026.  

Many experts point to the war on drugs and how Florida structured its sentencing laws in response as a contributing factor to the increase of people 50 and over in prison. In 1983, Florida enacted statewide sentencing guidelines, including eliminating parole eligibility for most offenses, and established guidelines for the Parole Commission to release the remaining eligible incarcerated candidates on parole. Eventually, Florida eliminated parole in 1995, and, as of May 2022,  there are 3,670 incarcerated people who are still eligible for parole consideration. 

“Florida has more life sentences than 30 other states combined,” says Thomas. “We have 13,600 lifers without parole.” 

Florida’s two-strikes law also contributes to the aging Florida prison population. The law, similar to former President Bill Clinton’s three-strikes law, states that those who commit a felony offense will have life in prison without the possibility of parole. The Truth in Sentencing Act additionally states that a person must serve at least 85% of their sentence regardless of whether or not they demonstrate that they have rehabilitated. 

“If you had good behavior or indicated where you got your GED or college degree, those things would [whittle] down your sentence in other prisons,” says Delvin Davis, a senior policy analyst specializing in decarceration and criminal legal system reform at the Southern Poverty Law Center. “But when you have an 85% requirement, you could take as many classes as you want and be on your best behavior as possible, it doesn’t help you beyond that 85%.” 

Older adults in prison are feeling the toll of staying in prison for 25, 30, or 40 years. Byron, a 59-year-old who is only using his first name for safety, says the system of incarceration needs to change and that the method of incarceration is only getting worse. 

“Either give us a death sentence or give us a release date,” Byron said. “We have given you our life, what more can we give? We have changed, we’ve done all the programs. Now you have created life with no parole or no possibility for release.”   

“Our barriers are [those with] a stake in the prison system”

For years, advocates have tried introducing bills to the state legislature attempting to reform sentencing based on medical release and release based on an incarcerated person’s advanced age. So far, the state of Florida has killed each one. The problem is that both the state legislature and the governorship are currently under Republican control, and Florida Republicans have steadfastly refused to consider any reform or mitigation around sentencing and parole.

“We have a Republican legislature that believes that tough on crime is the way to be,” Florida state Rep. Dianne Hart said in an interview with Prism. “They have not been interested in releasing people at all.”

Tough on crime is a brick wall on criminal justice issues.

Delvin Davis

Former state Sen. Jeff Brandes notes that when there is movement to change sentencing laws, it’s almost always to further increase the already severe standards. 

“The challenge in Florida is that there has been little appetite for any type of sentence reduction proposals,” Brandes said. “Even when Florida voters allow the legislature to reduce sentences, the legislature still hasn’t enacted a policy that would be retroactive to reducing sentences on existing laws.”

In the 2022 midterm elections, Republicans throughout the country funneled money into “tough on crime” television ads, including $40 million in September, which many activists say is the biggest hurdle when it comes to any form of criminal justice. 

“Tough on crime is a brick wall on criminal justice issues,” says Davis. 

Advocates and activists still have several options to address the needs of an increasing elderly incarcerated population in the state. Many, like Philipsen, believe that releasing older people from incarceration is an immediate and crucial need.

“People who have been incarcerated since a very young age and serving these long existential sentences don’t get out of prison until they are well into their 60s,” Philipsen said. “They have no opportunity to work for 10 years and be able to collect Social Security.” 

Even some lawmakers agree that the removal of older adults from prison must happen. Brandes has suggested removing sentences from the war on drugs era, like the two-strike law. 

“We could have a provision for elderly inmates,” he said. “There is no reason why the state should hold on to the elderly inmates who are unlikely to commit any crimes.”

Other advocates like Thomas point out that even if more older people are released from incarceration, they still need a better support system to help them reintegrate into their communities and society. Organizations like Society First, Thomas says, seek to open “reintegration centers and incorporate accountability and responsibility within the communities themselves.” 

But most crucially, older incarcerated people say that this system keeping them imprisoned well into advanced age is doing great harm to their quality of health. They need the current sentencing system to change, whether that means bringing back parole, instituting conditional medical release, passing a ballot initiative, or something else. Otherwise, more and more older incarcerated adults will suffer as they age.

But for now, Florida isn’t just committed to its especially harsh sentencing laws—it’s doubling down on them. In 2018, the FDOC built a 598-bed residential mental health continuum of care program at Wakulla Correctional Institution to house the elderly. And elderly incarcerated people aren’t surprised by this response. 

“Our barriers are our lawmakers, the governor, and all the private companies that are bidding to get a stake in the prison system,” said Molina, a 59-year-old incarcerated person who is only using their first name for safety. “As long as these private [companies’ lobbies] keep coming in and paying them, we’re never going to get any sentencing reform for life sentences in Florida.”

Khawla Nakua is a freelance reporter. She covers stories on voting rights, criminal justice, religion and Muslim communities.

Anthony Cobb is an incarcerated journalist at the Everglades Correctional institution in Miami, Florida. He's also a nonfiction writer.