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Abstract
The number of older inmates in US correctional facilities is increasing and with it
the need for quality palliative health care services. Morbidity and mortality are
high in this population. Palliative care in the correctional setting includes most
of the challenges faced in the free-living community and several unique barriers to
inmate care. Successful models of hospice care in prisons have been established and
should be disseminated and evaluated. This article highlights why the changing demographics
of prison populations necessitates hospice in this setting and highlights many of
the barriers that correctional and consulting physicians face while providing palliative
care. Issues specific to palliative care and hospice in prison include palliative
care standards, inmate-physician and inmate-family relationships, confidentiality,
interdisciplinary care, do-not-resuscitate orders and advance medical directives,
medical parole, and the use of inmate volunteers in prison hospice programs. We also
include practical recommendations to community-based physicians working with incarcerated
or recently released prisoners and describe solutions that can be implemented on an
individual and systems basis.