Part two of a two-part series
By R.G Dunlop
Special to NKyTribune
‘Public safety comes first,’ before costs
Both supporters and opponents of releasing elderly inmates from custody before their sentences have been completed typically agree that the costs of incarceration are a relevant consideration.
John Rees, former Department of Corrections commissioner, said older, infirm inmates could be cared for in a more cost-effective way in nursing homes where, he said, Medicare and Medicaid would assume most of the expenses.
In the state’s prisons, “KDOC pays 100 percent of the medical bills,” Rees said, “whereas in nursing homes, the federal government would pick up 70 percent. It’s a win for the taxpayer, because Medicare and Medicaid pick up most of the costs. It’s still taxpayer money, but not a burden on the taxpayers of Kentucky.”
Prisons are required to provide medical care to inmates following a 1976 U.S. Supreme Court ruling that “deliberate indifference by prison personnel to a prisoner’s serious injury or illness constitutes cruel and unusual punishment” and violates the Constitution.
Medicaid is a joint federal-state program that helps cover the cost of medical services for low-income people, including many prison inmates. The federal government’s share of Kentucky’s Medicaid expenses for the current fiscal year is 71.4 percent.
Federal law typically bars the use of federal Medicaid funds to pay for an incarcerated inmate’s health care, except when the inmate is in a “medical institution” (usually a hospital) for at least 24 hours. Otherwise, the state is responsible for the inmate’s health care costs.
Individuals on probation or parole, under home confinement, or living in halfway houses generally are not considered “inmates” under federal law, and thus are eligible for Medicaid benefits.
The state said it did not have records showing the total annual cost of operating the Nursing Care Facility (NCF) or the Daily Assisted Living Unit (DAL) at the Kentucky State Reformatory, where many older and/or infirm inmates are housed. The state also said it had no records showing the total annual of incarcerating each inmate living in the two units.
Sixteen inmates at KSR are at least 80 years old, state records show.
Overall, KSR’s per-day cost to incarcerate during the 2025 fiscal year was $158.40, the third-highest among the 14 state’s adult correctional institutions. Only the Kentucky State Penitentiary, which houses death-row inmates, and the Blackburn Correctional Complex, had a higher per-day cost. The penitentiary’s per-day rate was $167.07; Blackburn’s was $159.82. The overall state average per-day rate was $116.41.
During the 2022 fiscal year, Kentucky spent more than $355 million on adult correctional institutions, according to the state Department of Corrections’ 2022 annual report.
KDOC expenses include some of the cost of providing off-site medical care to inmates. State records show that the 101 inmates who died in custody from January 2020 until October 7 of this year made a total of at least 2,350 trips from prison to medical appointments and admissions to hospitals – all referred to in the records as being “out on medical” – during their incarceration.
Most of the trips (approximately 83 percent) were for brief periods of time, just a few hours, for outpatient care, which generally is not covered by Medicaid. Some if not all of the cost of those trips would have been borne by the state.
Approximately 16 percent of the 2,350 out on medical trips for inmates involved hospital stays, some lasting a week or more. Medicaid could have offset a portion of those expenses when eligible inmates were confined for 24 hours or more in a “medical institution,” including a hospital.
Some of the 101 inmates made few if any out on medical trips. At the other extreme: Parramore Sanborn, who was out on medical approximately 240 times between 2008 and his death at KSR in December 2020 at the age of 75.
Sanborn had spent more than 36 years in prison, first at the Kentucky State Penitentiary and later at KSR, for a 1983 Henry County murder and for kidnapping, rape, and sodomy.
While some of Sanborn’s out on medical trips involved hospital stays of several days or more, which would have been partially covered by Medicaid, many of the trips were completed on the same day, saddling the state with at least some if not all of the cost.
Between February 2010 and his September 2021 death at KSR at the age of 77, inmate Don Reed was out on medical approximately 102 times. As with Sanborn, some of Reed’s out on medical trips involved hospital stays of several days or more. But most lasted less than a day, at state expense.
Reed was serving a life sentence for a Magoffin County murder and had been in custody for more than 14 years when he died.
Prior to his August 2023 death at KSR, 78-year-old Larry Bruner had been out on medical approximately 96 times beginning in May 2004. All but 14 of those trips were for appointments lasting just a few hours and presumably mostly if not all at state expense.
Bruner was serving a life sentence for sodomy and sexual abuse committed in Jefferson County in 2002. He had been incarcerated for more than 20 years.
In response to a request for documents showing the cost of every “out on medical” reference for each of the 101 inmates who died in state custody, as well as who paid the cost of each trip for each inmate, the Department of Corrections said it did not have “any existing records responsive to your request.”
Westerfield, the former legislator, said he thinks the cost of incarceration is a relevant consideration, but that “it’s secondary to public safety and victim concerns.”
“We don’t question whether or not it costs too much to house folks while they’re awaiting trial for murder,” Westerfield said. “We don’t question whether or not it costs too much for law enforcement to do their jobs every day. We make it. Cost is important. We do examine the cost of law enforcement. We do examine, very frequently, the cost of corrections.
“Cost is very important. I’m not saying it’s unimportant. I’m just saying it is a secondary interest after public safety.”
Relief is more about logistics
Wanda Bertram, communications strategist for the Prison Policy Initiative, said the question of whether to release older people from custody “unfortunately is often more about logistics than about philosophies around retribution.”
“Most importantly: If elderly prisoners are released, where will they go?” Bertram said. “A lot of nursing homes refuse to take people with felony convictions, and often, elderly incarcerated people don’t have living relatives who can take them in. They are also much less employable, and exiting prison after decades means they are almost certainly coming home to live in poverty.”
Rees, Schept, and others agreed that finding places for older inmates to live in the community can be challenging, especially if their crimes involved violence including sex offenses.
“Would you put your mother in a nursing home with Jeffrey Dahmer?” the late Rodney Ballard, a former state Department of Corrections commissioner, said in an interview prior to his death last July. (Dahmer, an American serial killer and sex offender, killed and dismembered 17 men and boys between 1978 and 1991, according to Wikipedia and other sources.)
“Where does that 80-year-old inmate in a wheelchair go?” Ballard said in the interview. “Some people think we in corrections don’t have a heart, but we don’t want to release that person to the street, to nowhere.”
An example of the obstacles faced in finding a place for older sex offenders: The calls went everywhere across Kentucky: To hospitals, to nursing homes, to rehabilitation centers; 252 calls in all. And still more were made beyond the Commonwealth: To Ohio, Indiana, Tennessee, Florida, and West Virginia.
But each time someone answered one of the calls from the Department of Corrections and others, the response was invariably the same: No. We will not accept Michael Kennedy.
Kennedy had been convicted in 1997 on 209 counts of having sex with minors, and was sentenced to 60 years in prison.
After being paroled in 2017, Kennedy lived without incident for several years at a Lexington hotel. But in October 2022, when a nurse at the adult care center Kennedy was attending saw him dressed in only his underwear and “visibly disheveled,” he was hospitalized and diagnosed with brain dysfunction, according to court records.
Thus began the exhaustive efforts by state officials and members of Kennedy’s family to try and find a place for him to live that was safe not only for him but also for the other residents.
When those efforts came to naught, Kennedy’s sister, Betsy Kennedy, told the state in February 2023 that there was “no choice” but to return him to the Kentucky State Reformatory. And that’s where Michael Kennedy spent most of the rest of his life until he died in April 2024. He was 65 years old.
“There is no place for an elderly sex offender to live,” said Elias Kang-Bartlett, an attorney with the state Department of Public Advocacy and who represented Kennedy. “It’s something legislators need to address. The problem is shedding light on the issue. A lot of people don’t know, or don’t care.”
State building new medical center at Blackburn
The state is overseeing construction of a new medical center at the Blackburn Correctional Complex, a minimum-security prison in Fayette County, according to Hall, the state Justice and Public Safety Cabinet’s spokesperson.
“The primary goal of the new facility is to transition inmates with medical needs from the Kentucky State Reformatory,” Hall said. “Upon completion, the $208 million secure medical facility will contain a unit comparable to a nursing home, and treatment areas for severe and debilitating illnesses such as cancer and kidney disease.”
Hall said construction of the first phase of the medical center is expected to be completed next spring.
But Rees, the former KDOC commissioner, said he doesn’t “think it solves the problem. It’s still a prison, and it’s still medical expenses in a prison,” he said. “The only solution would be if Medicare and Medicaid started paying for inmates, and that’s not gonna happen.”
If finding the proper place for older, infirm inmates can’t be readily solved by the new medical facility at Blackburn, here are some other possibilities to help address issues related to their release from custody:
“Another option (more expensive than parole, but less expensive than the current practice) would be to establish a minimum security, perhaps community-based, (Department of Corrections) senior facility, essentially an assisted living /nursing home for DOC inmates,” said Preston of the Department of Public Advocacy.
“If a dedicated facility was created that, from the start, is designed to be only available to residents who meet certain physical/mental criteria and to deliver medical/palliative care in a non-correctional setting, that would be substantially cheaper,” Preston said. “Yes, occasionally some old guy may put on his pants and make a run for it, but then they could be returned to a more secure facility, having forfeited their right to be housed in a more comfortable place.”
Attorney Belzley suggested paying inmates “a fair wage for their work while incarcerated” and letting them deposit the money in an interest-bearing account “for use to fund their reentry” after release from custody.
And Westerfield, the former legislator, suggested consideration of so-called “second-look” laws that allow a court, or some other judicial-related authority to review a person’s sentence after so many years “based on rehabilitation, age, or other changed circumstances.” More than a dozen states have adopted some form of that approach.
Those with an interest in addressing matters pertaining to older, infirm inmates serving long prison sentences generally agree on one thing: Bringing about change won’t be easy.
“If health care facilities don’t want them and there’s no family to keep them, that’s really tough,” said Schept, the EKU professor. “It’s a reflection of society, and also an indictment of the absurdly long prison sentences that Kentucky and others have on the books. A life sentence is essentially a death sentence.
“I don’t know that there’s a neat and clean policy solution, but keeping them incarcerated while they age is not the right solution.”
See Part I: Growing Old in Prison here