By Thomas Goldsmith
Clanking security doors, pristine cells, wide halls and private spaces for medical visits all stand ready at the new long-term care facility at Central Prison in Raleigh.
The combined assisted-living and skilled nursing facility take up five floors and 32,930 square feet of former mental health care space, recently converted at a cost of $6 million. One of a kind in the state corrections system, renovations on the facility ended March 12.
But it’s empty, unoccupied by the faltering older inmates and those with chronic health-care needs — the people for whom the facility is designed. With the state budget at a standoff, there’s no staff or money to run the 46-bed center.
And that means its intended population will stay in sought-after prison hospital beds or in a general population cell for more than 15 months after its completion, even if proposed funding for 2020 makes it into the final budget.
“We are looking forward to the opening, being able to provide the health care in real time,” hospital director Chad Lovett said during a recent tour. “All of this is integrated to keep the health care within these walls as much as possible.”
Officials: Not luxury care
On the tour, a visitor to the Central Prison long-term care facility saw new cells with beds in a T-formation, an immersion tub where inmates can be moved in a chair for treatment, small eating and gathering spots on each of three floors, security and administrative space on two separate floors, and showers kept five degrees warmer than the surrounding space.
“None of this is a luxury,” said Department of Public Safety spokesman John Bull. “It’s a requirement under the courts to provide the community standard of care.”
The center will save taxpayers money on the cost of transporting inmates who need 24-hour care, or nursing care, from other prisons and lessen the workload on transportation staff, Bull said.
“The long-term care facility will focus on reducing developing medical issues through daily medical oversight and will be located next to Central Prison’s urgent care hospital for the more urgent needs that arise with this chronically ill offender population,” Bull said in an email.
How to spend less
Units in the Central Prison long-term care facility can hold patients at a variety of security levels, with an emphasis on placing them at the least secure level in which they can be effectively managed. Some are free to leave their cells and walk around their hall. More secure spaces can house inmates with infections, those who need isolation, or those who already live in the facility but have behavioral, medical or disciplinary problems.
Problems with acting out or other behaviors can have a variety of causes, prison officials said.
“A sinus infection can affect the brain,” explained Donald Mobley, associate warden for programs at the prison.
Legislators were looking for ways to reduce the cost of health care in the prison system when they approved the makeover of the former mental health space. The idea is that costs will be reduced by lowering the need to move offenders to other hospitals when their chronic physical or mental conditions get worse, prison officials said.
“Project consists of renovating a 33,000 SF five story detention facility into a security grade dormitory with adaptive features for an enfeebled inmate population,” read language in a Department of Public Safety request for bids that used outmoded language for people with mental or physical disabilities.
The state spends about 45 percent more on health care for inmates older than 50 than on those who are younger, according to a legislative Program Evaluation Division report. Among this older group, nearly three-in-four inmates have a chronic disease such as “cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma, and cirrhosis of the liver,” the PED report says.
Older inmates are sicker
“Currently they are in the regional medical center, or some are in general population,” Lovett said of the center’s eventual residents. “This will house 46 inmates and this is just half of the facility. We’ll be housing 46 more at some point.”
The largest age group in North Carolina prisons contains about 20,000 inmates between 21 and 40. Only around 6 percent, or 2,125, of the state’s male prison population of 34,919 is older than 61. About 200 inmates older than 60 live at Central Prison, but the long-term care center will also house people with chronic health conditions ranging from diabetes to COPD.
“They didn’t have good, healthy practices coming up,” Lovett said. “They’re not all old. You can have a person in his 40s who has ALS or Parkinson’s.”
Susan Pollitt, an attorney at Disability Rights North Carolina, pointed out that the state will not be inspecting the new facility in the same way that state or federal investigators monitor North Carolina’s adult-care homes or skilled-nursing facilities. That’s also true of hospital prisons, she said.
“A little team from DHHS does go into a random number of prisons a year,” Pollitt said. “They have an auditing tool that they use. The rules are very old, they date back to 1998.”
The new facility, like the current prison hospital, will be accredited by the American Correctional Association, Lovett said.
Multiple causes for delay
But the money to open the facility isn’t available.
In its version of the budget, the state Senate appropriated funds to begin at the beginning of the 2019 fiscal year on July 1. But the final conference committee budget the legislature sent to Gov. Roy Cooper delayed the long-term care facility’s estimated annual appropriation of $3.5 million to begin in July 2020.
Cooper vetoed that GOP-drawn state budget June 28. Since then a stalemate has continued meaning state spending continued at last year’s levels and funding for new projects has been placed on hold. Last week, a vote in the House of Representatives moved the state budget one step closer to passage.
(In late August the legislature approved separate bills to grant a pay raise for state employees, which Cooper signed into law on Aug. 30.)
“We were hoping to be open in June, but you have to have staff,” Lovett said. “I wouldn’t say I’m frustrated.”
Even if the budget had passed on time and the governor signed it, “We wouldn’t have been open in July,” Lovett said. “It would have been 90 to120 days out — might have been September or October.”
He did express confidence that even without the unit open, “we are meeting [inmates’] clinical and medical needs.”