A view of high walls and a barbed wire fence at a penitentiary In North Carolina, there are currently almost 500 people over 65 who are eligible for parole. Most are men, and nearly half are Black. Photo by Larry Farr / Unsplash

The North Carolina prison environment can be a boiling cauldron of chaos, violence, and hardships without sufficient staff members to bring the mixture’s temperature down. While the situation presents serious difficulties for a young and healthy incarcerated person to navigate, these obstacles exponentially increase for the elderly with chronic illnesses

I work with some of these aging individuals as an incarcerated orderly. An orderly is selected based on heightened criteria like education level, undergoes standardized training, such as bystander CPR certification, and has been assigned a patient in the chronic illness housing unit. I am often asked why I choose to work in this field when other jobs are easier and have better benefits. 

The answer is complex.

My day starts early with a check-in with my first patient prior to breakfast. I push him in his wheelchair to chow calls (meal time), medication calls, and all appointments, and I bring him his change of clothes. If another orderly is unavailable, I cover his patient also. When someone is incontinent and has an accident, I clean the affected area. I’m on call 24/7. For this, I get paid $1 a day

My job isn’t comparable to any free-world medical career, as no one out there shares a home with 12 patients and seven co-workers that’s half the size of a basketball court. Such a unique arrangement builds bonds, so it isn’t some random patient who passes away but a friend. This gives me a desire to serve my gated community, blunt the carceral impact from my patients and help them preserve the best quality of life possible. 

But my rationale goes deeper. I fundamentally disagree with incarcerating the elderly who have chronic illnesses. Maybe COVID-19 and the deaths that followed in here cemented my thoughts. Maybe it was seeing two of my friends over 65 years old serve more than 20 years before dying in here with less than five years left on their sentences. Maybe observing patients struggling to get dressed, get to the bathroom and get to the shower — day in and day out — is the reason. 

In the end, I’m an orderly for all these reasons and because I cannot wrap my head around continuing to incarcerate those incapable of trimming their own fingernails. 

Whether the people are elderly and blind, paralyzed, have AIDS, congestive heart disease, terminal cancer, degenerative spine disease, dementia, Alzheimer’s, cirrhosis of the liver or a combination of these health conditions, North Carolina prisons have a bed ready. Unfortunately, these conditions in the older incarcerated population may not even qualify for medical release under current North Carolina law. As anyone in prison knows, it’s really easy to get in and nearly impossible to get out.

But this may change.

A prison yard, surrounded by high walls and monitored by a guard tower. For the incarcerated elderly population, getting out of prison to spend their last days with family is a top priority. Photo by Larry Farr / Unsplash

Currently, the Senate budget proposes to expand the state’s medical release statute by reducing the threshold for release to age 55 and changing eligibility to “medically incapacitated” from the current bar of “permanently and totally disabled, terminally ill or geriatric” and “incapacitated to the extent that the inmate does not pose a public safety risk.” If this change is enacted, nearly 2,000 additional incarcerated older adults may be eligible for medical release.

According to volumes of studies by experts, these individuals who have aged out of crime no longer pose a danger to society, and the sheer cost of keeping them in prison is staggering. Many have loved ones who will provide housing and care, yet, here they are having to serve years in a violent place of stabbings, rape, gang wars, overdoses, neglect, callousness, and madness. Without intervention, many will die in here like so many before them. Will the budget pass with the Senate’s proposal? Will qualified individuals actually get the chance to die free with their loved ones? Well, only time can tell. However, my experience of over 22 years in prison reveals one certainty: Prison is no place for old men.

Photo courtesy of James Kelliher.

James Kelliher is an incarcerated writer in North Carolina. Kelliher works as an orderly assisting incarcerated patients with chronic illness in the medical unit of Pender Correctional Institution in Burgaw. After earning degrees from Ohio University and Adams State University, he’s currently pursuing his master’s degree in business administration.


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  1. And what will happen to them once they are released? Will they simply be put on the street with no home and nobody to care for them? Sadly, this often is the case in your neighboring State of Tennessee, when the cost of keeping someone incarcerated rises due to debility or chronic illness.