By Rachel Crumpler
A 60-bed acute long-term care unit in the Central Prison Healthcare Complex houses some of the most medically fragile — and staff-intensive — men in state custody. All require help with many activities of daily living such as feeding, toileting, walking, bathing and dressing.
They lie in beds behind locked doors as nurses and other staff scurry from room to room providing care. Many doors are plastered with yellow signs warning of “fall precautions.” Other signs instruct “puree trays only” and “aspiration precautions.”
Another sign warns medical staff not to enter without a correctional officer — a reminder of the mixed custody levels housed there, complicating care.
On March 4, when NC Health News toured the unit, the average age of the men was 65. The oldest was 89.
Some arrived at the medical unit after strokes, severe heart failure, end stage kidney disease or other serious medical events. Others simply grew old and too infirm for regular prison housing.
Of the 45 sentenced men, many have years left on their sentences. One-third — 15 men — are sentenced to die in prison, according to data from the N.C. Department of Adult Correction provided to NC Health News.
Another 12 patients in the unit were county “safekeepers” — people awaiting trial or sentencing who are too medically complex to be in local jails. Those people are transferred to the state prison system, which has greater medical capacity.
Many patients remain for months — sometimes years — when their chronic illness or severe disability prevents sufficient recovery to return to regular prison housing. The average length of stay is 279 days — about nine months — according to the Department of Adult Correction. One man has been in the unit for more than 1,400 days so far.
In 2025, 21 new patients were admitted to the long-term care unit.
Prison officials expect demand for these long-term care beds to continue to swell as North Carolina’s prison population of more than 32,000 people grows older, bringing greater health care needs — and ballooning costs.
In the past decade, the number of incarcerated people age 70 and older has increased 300 percent. More than a quarter of the state’s prison population is now 50 or older.
This demographic shift presents a growing challenge; demand for long-term care beds is already outpacing capacity.
Not enough beds
Since opening in 2023, the long-term care unit has stayed full, Arthur Campbell, chief medical officer at the N.C. Department of Adult Correction, told NC Health News during a tour this month.
“It has been tremendous having that facility within our footprint,” Campbell said. “But it’s still over capacity. It was full essentially when we opened it, and it’s remained that way.”
State lawmakers voted in 2015 to convert former mental health care space at Central Prison into 60 long-term care beds, split between two 30-bed units. Renovations cost $6 million.
Even so, demand often exceeds available space.
“We have more [people] than we can actually put in there,” N.C. Department of Adult Correction Secretary Leslie Cooley Dismukes told lawmakers in January. “We have people [in the general prison population] who probably should be in there.”
That leaves the N.C. Department of Adult Correction paying to place a handful of people in a private long-term acute care facility in Greensboro for around-the-clock care. Five people were placed there on March 4, Campbell said.
The cost is steep: about $150,000 per patient per month. The total tally for 2024 was about $8.6 million. In 2025, the department paid more than $6 million to admit just 16 patients.
Some of these patients require services — such as ventilator support — that the prison system is not equipped to provide. Others are sent because there is too little space at Central Prison, the only one of the state’s 55 prisons with a dedicated long-term care unit.
“If we had more space and could open up more beds inside or could expand our long-term care facility on the inside of Central Prison, then we would not have to send those individuals to the external contractor for the long-term care beds,” Dismukes told lawmakers in December.
The cost for caring for these aging and sick men has actually declined. Before the department opened its own long-term care unit, it cost roughly $22 million annually to house such folks in the private facility, Campbell said. Still, the department maintains a contract with the private care facility to house the overflow of people in the state’s custody who need long-term care.
“We’ve secured basically an entire floor of that facility,” Campbell told lawmakers. “Our officers have to staff that floor. It’s a secure floor, and that’s where we place these patients.”
During a March 4 tour, Chad Lovett, hospital director of the Central Prison Healthcare Complex, told NC Health News three beds in the prison’s long-term care unit were empty — but they wouldn’t stay that way for long.
For women, there is no dedicated long-term care unit. Instead, they are housed in the 38-bed infirmary unit at the North Carolina Correctional Institution for Women Healthcare Complex in Raleigh, where they receive a similar level of skilled nursing services, Campbell said. As of March 19, seven such patients had been there for four to six months.
Staff shortages limit expansion
Campbell and Lovett said they would like to expand long-term care capacity within the prison system to reduce the number of patients sent to outside facilities.
Lovett, who once served as CEO of the private long-term care facility used by the department, said providing the care inside the prison system is significantly less expensive.
But key gaps remain. The department cannot provide ventilator support, though Lovett said he would like to see the ability added at Central Prison. People who need intensive speech, occupational or physical therapy — such as after a stroke — also end up at the community facility because the department cannot provide that level of care, Campbell said.
A major barrier to expansion is chronic staffing shortages among prison health care workers and correctional officers, who provide security on medical units and transport incarcerated patients for medical care. The shortages stem from years of vacancies, low pay and high turnover.
Dismukes told lawmakers in January that the department employs 4,979 correctional officers statewide but needs 9,682 officers to fully staff all posts across North Carolina’s prisons — a shortfall of 4,703 people, or an overall vacancy rate of nearly 49 percent.
Medical staffing gaps are also significant. Most critically, Campbell said 74 percent of registered nurse positions are vacant as of March 19. To help fill gaps, the Department of Adult Correction relies heavily on contract workers who are more expensive than employees.
North Carolina’s starting salary for correctional nurses — $58,898 — is the lowest among neighboring states and well below the average registered nurse starting salary of $75,446 among Southeastern states, according to N.C. Department of Adult Correction analysis.
Staffing shortages have been a constraint for years. They even delayed the opening of Central Prison’s long-term care unit. Renovations concluded in March 2019, but the unit did not accept its first patients until early August 2023, after yearslong delays caused by funding and staffing challenges.
Lovett said long-term care capacity is also limited by the loss of some infirmaries and step-down units — places where people could keep recovering before returning to general prison housing — many of which were closed during the COVID pandemic when staffing levels plummeted.
The units — which department officials are working to rebuild — help move patients out of long-term care beds once they stabilize. However, with fewer of those options, patients stay in long-term care beds longer.
“As staffing levels increase and beds reopen out at our other facilities, we have the ability to move patients through our system — and that is a huge piece of [capacity],” Lovett said.
Additional staffing could also allow the department to open more infirmaries and create more specialized units, such as memory care, which could ease pressure on long-term care bed space, Campbell said.
Advocates push for medical release
With long-term care beds full and staffing stretched thin, some advocates are pushing for greater use of early medical release.
They argue that allowing more medically fragile people to leave prison could reduce department health care costs — for which taxpayers ultimately foot the bill — and also give people the opportunity to spend their final days with family. People granted early medical release are not simply set free; they stay under state supervision until the date upon which they would have been released.
A 2018 report by the now-defunded Program Evaluation Division at the N.C. General Assembly found that average health care spending for an incarcerated person age 50 or older is typically four to five times higher than for younger prisoners — costing the prison system an estimated $27,748 more per person each year. Evaluators said modifying early medical release criteria could help lower prison medical costs.
Years later, in 2023, lawmakers expanded the eligibility criteria. Despite this, few people are released each year.
In 2024 — the first full year with the new eligibility criteria — the North Carolina Post-Release Supervision and Parole Commission granted early medical release to four people out of a statewide prison population of about 32,000 people. In 2025, 13 people were released, according to data obtained by NC Health News.
Campbell, who determines whether applicants meet the law’s medical criteria, said the majority of people admitted to the department’s long-term care unit are automatically ineligible due to their convictions, including murder and offenses that require placement on the sex offender registry. Of the 45 men in the unit on March 4, Campbell said that 37 of them were statutorily prohibited.
Reviewing long-term care patients — along with oncology patients and those with prolonged hospitalizations — for possible early medical release is now part of the department’s process, but Campbell said few qualify.
Advocates say the state’s early medical release program is not being used to its full potential and are pushing for more people to be considered.
Molly Crane, a fellow at the national nonprofit FAMM who is focused on reforming compassionate release from prison and has helped people apply for medical release in North Carolina, said the state’s early medical release law lacks a clear definition of what qualifies as “incapacitation.” In most states, she said eligibility is assessed using activities of daily living — such as eating, breathing, toileting and walking — and how many tasks a person is unable to perform independently. North Carolina is an outlier for not using this standard, she said, which can make it unclear why someone does or doesn’t qualify.
“DAC could be making greater use of the law by defining the terms,” Crane said.
As the Department of Adult Correction faces rising health care needs, most of the aging, medically fragile population will stay in prison, putting increased pressure on the prison medical system.
“It’s not coincidental that as the population is aging, our health care costs are also increasing,” Campbell said.
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