At 60 West in Connecticut, all 95 patient beds are full. Photo courtesy of iCare

A decade after it launched its first program for patients who had been released from the criminal justice system, iCare Health Network has become an in-demand resource on providing care for such complex patient populations.

With every bed full in each of its two existing nursing homes designed for judicially involved patients or those with complex behavioral health needs, the for-profit operator is now looking to expand to additional states with mission at the top of mind.

iCare is a long-time specialist in substance abuse disorder treatment and other behavioral needs. It first dabbled in caring for former prisoners at 60West in Rocky Hill, CT, where about one-third of the residents today are former prisoners. iCare leaders have seen demand grow for placements like the ones they offer in partnership with state officials in Connecticut and Massachusetts.

This month, Vermont officials announced they had selected iCare to launch the state’s first program, citing 100 state residents who are in hospitals, correctional facilities, or out-of-state facilities awaiting placement in a licensed nursing facility because of their “challenging and complex care needs and/or social or judicial history.”

And the need is growing from coast to coast.

The nation’s prison population, much like that of the general population, is rapidly graying. A 2022 Health Affairs study found that the proportion of older adults in the nation’s prisons rose from 3% to 11% between 1999 and 2016. By 2030, experts estimate older people will represent one-third of the entire prison population.

“We’ve had conversations over the past five years with at least seven states,” Dave Skoczulek, vice president of business development and communications, told McKnight’s Long-Term Care News Thursday. “Every state we’ve talked to is scrambling to figure out what to do with these folks that are aging in place, who are demented and very ill. There are cases where they’re actively dying, and the state would prefer, and the more humane thing would be, for them to be in a setting like ours rather than in a correctional facility.”

Skoczulek said interest is high across the political spectrum because nursing home placement of the right patients is seen as a more humane solution, but also the less costly one. In many cases, prison patients or those long ago confined to state mental hospitals are ready for release but cannot find anywhere to go. Sometimes, they remain in prison, are boarded in acute-care hospitals or remain in a behavioral institution even when they have physical or age-related needs that might require a nursing home level of daily care. In about 70 cases, states run in-prison hospice systems at a steep premium over the cost of external care.

Finding the right patients

iCare’s patients at the speciality facilities in Connecticut, Massachusetts, and eventually, Vermont, could be parolees; aged prisoners who’ve reached the end of their sentences; those released on compassionate grounds; or former state hospital patients who might have been ruled not guilty by reason of insanity but whose conditions have long been managed by medication and treatment.

The facilities they call home are very much designed as regular nursing homes, albeit with more oversight from state parole officials and in-house security monitoring round-the-clock entrances and exits. There’s an emphasis on recreation, rehab and patient rights, and the design is meant to be middle-of-the road and homelike.

“The leading edge for us is to be sure there’s a stigma-free environment. They may have a checkered past, but they’re human beings and they deserve humane care,” Skoczulek said. 

With the two existing buildings at 100% capacity, iCare also can be somewhat selective about how it determines a safe patient mix.

“The key strategy on ensuring the right residents come in is time. It’s making sure we’ve seen them for long enough, we understand their patterns and their needs, that they are reasonably stable, that we know what to expect with them,” Skoczulek said. “If they’re not right at that particular time, they may become right with more medication and more treatment, but [we know] not to rush that. They need to come in at the right time for them and the right time for us.”

Not for everyone

The sector is seeing other bidders for such placements, and while Skoczulek supports broader access, he notes the mini-sector isn’t one anyone can just jump into.

Medicaid add-ons and other funding support mechanisms approved by the states they’re in help to support the higher cost of caring for this specialty population, he added. But the care can’t be attempted as a money grab, especially given public perception about the residents and additional state partnership or regulatory scrutiny that comes with the territory.

iCare does not operate under federal waivers and must comply with all normal regulations for skilled nursing facilities. Staffing also requires a careful approach, although the uniqueness of the patient mix and the mission-driven sense of care allows iCare to recruit from unusual places. Among its staff in these buildings are former volunteers with the homeless, social workers, and those who’ve moved over from prisons.

Being sure workers know who they will be working with, though, is critical, Skoczulek added. So too, is carefully plotting out any state partnership and ironing out details on who will be referred, what the acceptable release mechanisms are and how the reimbursement will work.

“It definitely shouldn’t be done by guesswork,” Skoczulek said. “It should be done from a point where you’re embracing it, and you’re all in on it and you’re a good partner to the state and you understand what they really need and what these people really look like and what’s in their best interest.”