End-of-life care, also known as palliative care, is a healthcare process that aims to improve the quality of life and reduce the suffering of those who are terminally ill. Being incarcerated can make this stage of life even more complicated. Age can take on a different meaning in the prison system, with people being considered “old” at the age of 50. People in prison are experiencing age-related health conditions earlier than those in the community.
Australia’s prison population is aging. Between 2009 and 2019, the proportion of older Australians in prisons (aged over 45 years) grew by over 78 percent to more than 9500 people.
Currently, to access specialist healthcare, those in minimum-security prisons are required to be transferred to maximum-security facilities. This can influence people’s decision to accept, decline or delay receiving treatment, as those in minimum-security prisons will potentially lose the comfort and familiarity of their cell and job.
Because of this, many people are not receiving timely medical care.
Once people in prison access the healthcare they need, there are still many systemic barriers that can negatively impact the delivery of care. For example, having security guards at all appointments and in hospitals can compromise the privacy of the patient and interrupt the healthcare being provided.
It’s also difficult for incarcerated people to have visitors while in hospital. All visitors must be on the patient’s Nominated Visitor List, and visits must be during hospital hours and are limited to 40 minutes.
Reform to palliative care in prison: what you need to know
The University of Technology Sydney, with the Department of Health and Aged Care, is working on reshaping palliative care in prison.
This five-year project is in its final stages, and has examined the current state of palliative care for people in prison, along with options to improve it.
Its suggestions include:
- Implementing education about palliative care
- Building connections with local palliative care teams
- Encouraging collaborations with correctional and justice health on local and national levels
- Continuing to conduct reviews to monitor the effectiveness of palliative care in prisons
There are some positive developments around keeping people comfortable and improving the standard of healthcare.
There are plans to expand the number of secure correctional wards in hospitals around the country, meaning that people receiving care will not have to be shackled to the bed.
One such ward has been running at St Vincent’s Hospital in Victoria for several decades, and one is expected to open in Brisbane specifically to provide palliative care for incarcerated people.
There are also changes designed to remove the need to transfer someone away from their cell into a foreign environment, or a higher security centre, to receive care.
At Port Phillip Prison in Victoria, doctors and nurses are delivering end-of-life care outside of the hospital, and guards are trained in palliative care delivery. Since this program began in 2021, just three patients have been transferred from the prison for palliative care.
In the ACT, guidelines for the delivery of palliative care are in place at the Alexander Maconochie Centre. According to this policy, those who need palliative care or who have been given 12 months to live or less must be given healthcare to the same standard as someone in the community.
People in the ACT prison will also be able to access a Complex Care Meeting which will see a developed medical care plan specific to their needs.
End-of-life care, also known as palliative care, is a healthcare process that aims to improve the quality of life and reduce the suffering of those who are terminally ill. Being incarcerated can make this stage of life even more complicated. Age can take on a different meaning in the prison system, with people being considered “old” at the age of 50. People in prison are experiencing age-related health conditions earlier than those in the community.
Australia’s prison population is aging. Between 2009 and 2019, the proportion of older Australians in prisons (aged over 45 years) grew by over 78 percent to more than 9500 people.
Currently, to access specialist healthcare, those in minimum-security prisons are required to be transferred to maximum-security facilities. This can influence people’s decision to accept, decline or delay receiving treatment, as those in minimum-security prisons will potentially lose the comfort and familiarity of their cell and job.
Because of this, many people are not receiving timely medical care.
Once people in prison access the healthcare they need, there are still many systemic barriers that can negatively impact the delivery of care. For example, having security guards at all appointments and in hospitals can compromise the privacy of the patient and interrupt the healthcare being provided.
It’s also difficult for incarcerated people to have visitors while in hospital. All visitors must be on the patient’s Nominated Visitor List, and visits must be during hospital hours and are limited to 40 minutes.
Reform to palliative care in prison: what you need to know
The University of Technology Sydney, with the Department of Health and Aged Care, is working on reshaping palliative care in prison.
This five-year project is in its final stages, and has examined the current state of palliative care for people in prison, along with options to improve it.
Its suggestions include:
- Implementing education about palliative care
- Building connections with local palliative care teams
- Encouraging collaborations with correctional and justice health on local and national levels
- Continuing to conduct reviews to monitor the effectiveness of palliative care in prisons
There are some positive developments around keeping people comfortable and improving the standard of healthcare.
There are plans to expand the number of secure correctional wards in hospitals around the country, meaning that people receiving care will not have to be shackled to the bed.
One such ward has been running at St Vincent’s Hospital in Victoria for several decades, and one is expected to open in Brisbane specifically to provide palliative care for incarcerated people.
There are also changes designed to remove the need to transfer someone away from their cell into a foreign environment, or a higher security centre, to receive care.
At Port Phillip Prison in Victoria, doctors and nurses are delivering end-of-life care outside of the hospital, and guards are trained in palliative care delivery. Since this program began in 2021, just three patients have been transferred from the prison for palliative care.
In the ACT, guidelines for the delivery of palliative care are in place at the Alexander Maconochie Centre. According to this policy, those who need palliative care or who have been given 12 months to live or less must be given healthcare to the same standard as someone in the community.
People in the ACT prison will also be able to access a Complex Care Meeting which will see a developed medical care plan specific to their needs.
Tips for navigating palliative care in prison from a former prison nurse in the UK
Accepting the end of life can be tough, and it is normal to feel a variety of emotions: sadness, fear, regret. It is normal to have concerns over not being with family, the fear of being alone, pain management, and what happens next.
Getting prepared early is your best chance to ensure your end-of-life care meets your needs.
1. Understand your rights
You have the same rights to healthcare as those in the community. The Australian Charter of Healthcare Rights is for everyone, and you are entitled to be seen by a nurse or doctor in the prison when you need.
2. Get your will sorted
It is your human right to have access to legal help – through Legal Aid or your own chosen service provider.
3. Create an advanced care plan
An advanced care plan enables you to make your wishes known about how you want to be treated. It allows you to plan your healthcare for the future, especially when you may no longer be able to communicate what you want. Think about your preferred medical treatments and care choices, your wishes in terms of organ donation, and your spiritual or religious preferences.
Try asking yourself these questions:
- What medical conditions do you already have?
- What feels different about your body? Stay aware of your body and speak up.
- Do you want a religious figure as part of your care plan?
Also try to keep your loved ones in the community aware of your health and plans.
Tips for navigating palliative care in prison from a former prison nurse in the UK
Accepting the end of life can be tough, and it is normal to feel a variety of emotions: sadness, fear, regret. It is normal to have concerns over not being with family, the fear of being alone, pain management, and what happens next.
Getting prepared early is your best chance to ensure your end-of-life care meets your needs.
1. Understand your rights
You have the same rights to healthcare as those in the community. The Australian Charter of Healthcare Rights is for everyone, and you are entitled to be seen by a nurse or doctor in the prison when you need.
2. Get your will sorted
It is your human right to have access to legal help – through Legal Aid or your own chosen service provider.
3. Create an advanced care plan
An advanced care plan enables you to make your wishes known about how you want to be treated. It allows you to plan your healthcare for the future, especially when you may no longer be able to communicate what you want. Think about your preferred medical treatments and care choices, your wishes in terms of organ donation, and your spiritual or religious preferences.
Try asking yourself these questions:
- What medical conditions do you already have?
- What feels different about your body? Stay aware of your body and speak up.
- Do you want a religious figure as part of your care plan?
Also try to keep your loved ones in the community aware of your health and plans.
