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Medical care for baby boomers is high at jail

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AMES, ANN MARIE
August 19, 2012

— When Rock County Sheriff Robert Spoden was a criminal justice student in the mid-1980's, he was told the baby boomer peak would come and go earlier in jails and prisons than in other facilities.

In his 25-year career in jail services, Spoden has since learned that prediction was wrong. The number of jailed baby boomers has gone up and not come down, he said.

In Spoden's experience, those boomers who are crime-prone aren't slowing down. They have become an expensive group to house at jails around the country, including the Rock County Jail.

"Unfortunately, they're not young any more, and their lifestyles are catching up with them," said Spoden who is 49 and was born at the tail end of America's baby boom.

The baby boomers are defined by the United States Department of Health and Human Services as those people born between 1946 and 1964. That makes them between 48 and 65 years old.

They aren't the only segment of the jail's population with complex health needs, but they are a big segment, Spoden said. The increasing complexity of inmates' health conditions was part of the reason the county in 2010 expanded the medical facility at the jail as part of a $5.7 million jail renovation.

The Rock County Jail's data system doesn't track the historical ages of inmates seen at the jail's medical facility, said Cmdr. Erik Chellevold, who is head of correctional services at the jail. He took a headcount for The Gazette on a recent day and found that of eight people in the jail's medical facility, five were baby boomers.

It's common that baby boomers who have lived lives prone to committing crimes have, "for years abused their bodies with alcohol or drugs," Spoden said.

"That abuse is taking a toll," he said.

Many inmates are diabetic and require insulin. Others need to be taken several days a week to local facilities for kidney dialysis. Some inmates need adaptive tools such as canes, oxygen tanks or sleep apnea machines.

Some go through drug or alcohol withdrawal when they are admitted to jail. Many have poor mental health, Spoden said.

"People are coming in with sensitive medical issues that we just didn't see in years past," he said.

They take a host of medications, Spoden said. The jail provides prescription medication for inmates who can't buy it from an outside pharmacy. The jail's coverage includes medication for depression or other mental illnesses if it is prescribed.

"Back when I was on patrol, if someone would have told me I would be dealing with these kinds of medical issues someday as sheriff, I never would have believed them," Spoden said.

"It's just expensive"

Medical expenses are the second-largest slice of the jail's annual budget, according to jail data.

The only thing more costly is staff salary and benefits, which take up about 90 percent of the jail's $10.946 million annual operating budget.

The county in 2011 budgeted $757,334 for physician services. The next biggest expense at the jail is boarding for inmates, budgeted at $531,929 last year.

The county's current contract for medical services is with Advanced Correctional Health Care and is good through 2013. Started in 2009, the contract cost was by far the lowest offered the county in that round of bidding, Chellevold said.

Advanced Correctional's bid at the time was in the ballpark of the $750,000 or so the county had been budgeting for the service.

That cost likely won't be around forever, Chellevold said. He suspects the next round of bids might be higher.

"There's a reason the others were around $1.2 million," Chellevold said of the previous bidding round. "It's just expensive."

"Like a small hospital"

For years, the county got by with using Rock County personnel to administer medical care to inmates. However, as the jail population kept climbing into the early part of the first decade, jail staff couldn't keep up.

Although he's seen the change as it happened, it still surprises Spoden to see the variety of medical needs that come through the door.

"It's amazing from my perspective, to see the day-to-day services we provide," Spoden said.

When Spoden started working as a corrections officer at the jail, one nurse, who would have been a county employee, took care of a small number of minor concerns. Often, the nurse dealt with cuts and bruises inmates got from fighting just prior to or during arrest, he said.

"To go from that to where we are today " Spoden said. "It's like a small hospital we have here within the confines of the sheriff's office."

Ups and downs

On one hand, giving up the mountain of paperwork involved with providing medical services has been a good reduction in labor and hassle for jail administration, Chellevold said.

One downfall of having an outside contractor provide medical services is that it has limited the county's involvement in purchases. The current contract includes a tool to motivate the provider to keep costs at a minimum, Chellevold said.

The contract includes a pool of $50,000 for outside services such as hospitalization or dialysis. By statute, the county is allowed to pay hospitals and other providers the same rate a Medicaid client would pay, Chellevold said.

If money is left in the pool, 90 percent of it goes back to the county. The contractor can keep 10 percent as a bonus.

Inmates pay a $7 copay to see a nurse. If the nurse refers the inmate to a doctor, that visit is free.

The county was paid $5,649 for inmate copays in 2011, according to county data.

Managing costs

Since Spoden took office in 2007, he has focused on developing alternative programs that give inmates the opportunity to do community service instead of jail time. He also has increased the number of inmates ordered to stay at home on GPS monitoring bracelets.

Those programs, along with the Huber work-release program, do more than reduce the housing costs at the jail. They reduce medical costs, too, Spoden said.

People who are on the bracelet and serving their time at home are expected to cover their own medical expenses, Chellevold said. They therefore reduce the pressure on the busy medical facility, Chellevold said.

"If all the people that were out there on the bracelet right now were in here, we'd be busting at the seams," he said.



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