Article Content

In February 2008, Kathy Baxter, RN, director of patient services for Hospice Care of America of Rockford, IL, received a call from Captain Timothy Owens of the Winnebago County Jail. Captain Owens asked about the availability of hospice services for an inmate who had been diagnosed with advanced esophageal cancer and was beginning to experience rapid physical decline. Baxter assured Captain Owens that hospice is for anyone with a life-limiting illness.


The healthcare agency and the incarceration facility embarked on a complex but rewarding partnership that culminated in a peaceful death with comfort and dignity. It required that one inmate be given preferential treatment over others, a difficult concept from a logistical and psychosocial perspective for prison staff and inmates. Maintaining the security of many seemed incongruent with meeting the physical, emotional, and spiritual needs of one who was dying.


Championing the cause to incorporate comprehensive medical care into the secure environment of the jail system was nurse practitioner Sandra Nienaber, CNP. "How do you treat someone who has broken the law? You do the right thing for the right reason. You suspend judgment," she said.


Nienaber went out of her way to provide little things that made a difference in Inmate B's comfort and quality of life. In addition to administering medications under the supervision of the jail's medical director, Dr Eric Henley, she brought Inmate B popsicles, watermelon, peaches, and special sandwiches. However, she admitted that it was a challenging situation. "After I gave Mr B a pillow, I had four or five other inmates wanting pillows."


Following Nienaber's lead, security staff and inmates joined the hospice team in supporting Inmate B's needs. When hospice home health aide Valerie Murphy was not sure how to rebraid her patient's hair after a shampoo, another inmate in the medical unit explained how. A correctional officer adjusted a shower stall so the hot water would stay on for as long as necessary. Security staff provided a lockdown of other inmates and supervision during times of personal care.


Superintendent Andrea Tack admitted, "I don't know that we ever could have done anything like this in the old jail. Certainly, our population is aging just like the rest of the community [horizontal ellipsis] our senior inmate population is growing, and this is something we are going to have to face in the future. First of all, we are a correctional facility. Safety and security are number one, and sometimes, it gets difficult to find balance. But I think it's important to be willing to at least try and recognize the needs."


The Winnebago County Jail has been a pioneer, willing to adapt to a changing population with the increased aging of its inmates. Changes have addressed increased medical needs, along with diverse and sometimes opposing public sentiments concerning conditions and cost for inmates. In addition to taking care of the day-to-day priorities of housing the jail's population and equipping the staff-from administrative to the correction's emergency response team-Captain Owens is aware of his responsibilities to the taxpayers of Winnebago County.


Owens' 21 years of experience has shown him that one of the most cost-effective ways to provide the greatest level of safety and security is to emphasize rehabilitation of the inmates while they are incarcerated. He has learned that rewarding good and positive behavior decreases the need for additional security staff. And with this recent situation, he discovered that partnering with Hospice Care of America to share the burden of medical care for inmates at the end of their lives also saves local taxpayer dollars.


Before entering the hospice, Inmate B had become increasingly uncomfortable because of the spread of his cancer. Hospice nurse Lorna Sullivan was able to assist the medical staff at the jail with symptom management and provided the new medications he needed. Hospice also provided a low-air-loss mattress for his hospital bed in the medical unit and a wheelchair.


Hospice social worker Julie Sanderson was instrumental in developing a contingency plan when Inmate B could no longer perform self-care. The hospice team of nurse, home health aide, social worker, and chaplain required security clearance for unlimited access to the patient. This proved essential when, in the middle of the night, Inmate B was found collapsed with internal bleeding. Prison staff called the hospice, and Sullivan responded immediately. Inmate B was hospitalized at Swedish American Hospital according to the contingency plan in effect. There, all of his acute medical needs were met.


Mr B died peacefully and comfortably with dignity in April 2008 at a nursing facility. All interests of the individual and the community had been served without compromising the safety and security of the inmates and the public. Mr B received excellent medical care at the end of his life.


Captain Owens explained, "[Hospice Care of America] made it a lot easier for us. They helped us whenever we did a court appearance. They were there. They had knowledge in the case. I just wish we had other experiences that were as comfortable as this one."


Hospice Care of America was founded in 2004 in Rockford, IL, by Martha Johnson-Swagerty, RN. The company has opened its first satellite office in Pecatonica, IL, and is looking forward to an expansion further west. Swagerty-Johnson became a hospice nurse after the death of her twin sister from lung cancer, who benefited greatly from hospice care at the end of life.