When the letter arrived in Westil Gonzalez’s prison cell saying he had been granted parole, he couldn’t read it. In the 33 years he had been locked up for murder, multiple sclerosis had taken much of his sight and left him reliant on a wheelchair.
He had a clear sense of what he would do once he was freed. “I want to give my testimony to some young people who are out there, getting guns,” said the 57-year-old Mr. Gonzales in a recent interview. “I want to save one person from what I’ve been through.”
But six months have passed, and Mr. Gonzalez is still incarcerated outside of Buffalo because the Department of Corrections has not found a nursing home that will accept him. Another New York inmate has been in the same void for 20 months. Others were released only after suing the state.
America’s aging prison population is growing, in part because more people are serving long sentences for violent crimes. Nearly 16 percent of inmates were over 55 in 2022, up from 5 percent in 2007. The percentage of inmates over 65 quadrupled over the same time period, to about 4 percent.
Complex and costly medical conditions require more nursing care, both in prison and after an inmate is released. Across the country, prison systems trying to release inmates convicted of serious crimes often find themselves with few options. Nursing home beds can be hard to find even for people with no criminal records.
The cost of inmate medical care is rising — in New York, it has risen to just over $7,500 in 2021 from about $6,000 per person in 2012. Even so, those who work with the incarcerated say the money is often not enough to keep up with the growing proportion of elderly prisoners who have chronic health problems.
“We see a lot of unfortunate gaps in care,” said Dr. William Weber, an emergency physician in Chicago and medical director of the Medical Justice Alliance, a nonprofit organization that trains doctors to work as expert witnesses in cases involving prison inmates. With inmates often struggling to get specialized care or even copies of their own medical records, “things fall apart,” he said.
Dr. Weber said he was recently involved in two cases of seriously ill inmates, one in Pennsylvania and the other in Illinois, who could not be released without a nursing home placement. The Pennsylvania inmate died in prison and the Illinois man remains incarcerated, he said.
Almost all states have programs that allow for the early release of inmates with serious or life-threatening medical conditions. New York’s program is one of the most extensive: While other states often limit the policy to those with less than six months to live, New York’s program is open to anyone with a terminal or debilitating illness. Nearly 90 people received conditional medical licenses in New York between 2020 and 2023.
But the state’s nursing home occupancy rate hovers around 90 percent, one of the highest in the nation, making it especially difficult to find spots for inmates.
The prison system is “competing with hospital patients, rehabilitation patients and the general public who require skilled nursing for the limited number of available beds,” said Thomas Mailey, a spokesman for the New York City Department of Corrections and Community Supervision. He refused to comment on the case of Mr. Gonzales or the medical conditions of any other inmate.
Released persons remain in custody until the end of their initial period of imprisonment. Courts have previously upheld the state’s right to set conditions on the release of prisoners to protect the public, such as prohibiting parolee sex offenders from living near schools.
But lawyers and medical ethicists argue that parole patients should be able to choose how they receive their care. And some noted that the medical needs of these inmates are not necessarily being met in prison. Mr. Gonzalez, for example, said he did not receive glasses, despite repeated requests. His illness has caused one of his hands to curve inward, leaving his ragged fingernails digging into his palm.
“While I sympathize with the difficulty of finding placements, the default solution cannot continue with incarceration,” said Steven Zeidman, director of the criminal defense clinic at CUNY Law School. In 2019, one of his clients died in prison weeks after being granted medical parole.
New York does not release data on how many inmates are waiting to be placed in the nursing home. A 2018 study found that, between 2013 and 2015, six of 36 inmates granted medical parole died before a position was found. The medical parole process moves slowly, the study found, sometimes taking years before an inmate is even interviewed for possible parole.
Finding a nursing home can prove difficult even for a patient with no criminal record. Facilities have struggled to recruit staff, especially since the coronavirus pandemic. Nursing homes may also be concerned about the safety risk of someone with a prior conviction or the financial risk of losing residents who do not want to live in a facility that accepts ex-prisoners.
“Nursing homes have concerns, and whether they’re reasonable or not, it’s very easy not to get or not to return that phone call,” said Ruth Finkelstein, a professor at Hunter College who specializes in policies for the elderly and reviewed legal filings in The request of the Times.
Some people involved in such cases said New York jails often do little more than a cursory search for nursing care.
Jose Saldana, director of a nonprofit called the Campaign to Free the Elderly in Prison, said that when he was incarcerated at Sullivan Correctional Facility from 2010 to 2016, he worked in a department that helped coordinate parole releases. He said he often reminded his supervisor to call nursing homes that didn’t get it the first time.
“They would say they had too many other responsibilities to stay on the phone,” said Mr. Saldana.
Mr. Mailey, a spokeswoman for the New York Department of Corrections, said the agency had multiple parole teams looking for placement options.
In 2023, Arthur Green, a 73-year-old dialysis patient, sued the state for parole four months after being granted parole. In his lawsuit, the lawyers of Mr. Green said they had secured a nursing home placement for him, but that it lapsed because the Department of Corrections filed an incomplete application at a nearby dialysis center.
The state found a place for Mr. Green a year after his release date, according to Martha Rayner, an attorney who specializes in prisoner release cases.
John Teixeira was paroled in 2020 at age 56, but remained incarcerated for two and a half years as the state searched for a nursing home. He had a history of heart attacks and took daily medications, including one given through an IV port. But an assessment by an independent cardiologist concluded that Mr. Teixeira did not require medical attention.
Lawyers for the Legal Aid Society in New York sued the state for his release, noting that during his wait, his port became infected repeatedly and his diagnosis progressed from “advanced” to “end-stage” heart failure.
The Department of Corrections responded that 16 nursing homes refused to accept Mr. Teixeira because they could not manage his medical needs. The case was settled three months after the lawsuit was filed, when “the judge put significant pressure” on the state to find a suitable placement, according to Stefen Short, one of Mr. Teixeira.
Some sick prisoners awaiting release have had trouble getting medical care inside.
Steve Coleman, 67, has trouble walking and spends most of the day sitting. After 43 years in prison for murder, he was granted parole in April 2023 and has remained incarcerated as the state searches for a nursing home that could coordinate with a three-times-weekly kidney dialysis center.
But Mr. Coleman has not had dialysis since March, when the state ended a contract with his provider. The prison offered to transfer Mr. Coleman to a nearby clinic for treatment, but he declined because he finds the transfer protocol—which includes research and flower shacks—painful and invasive.
“They say you have to go through a film investigation,” he said in a recent interview. “If I get paroled, I can’t walk and I go to a hospital, who could I hurt?”
Volunteers at the nonprofit Parole Prep Project, which helped Mr. Coleman with his parole application, they received a letter from Mount Sinai Hospital in New York in June, offering to provide him with medical care and help him return to the community.
Still imprisoned two months later, Mr. Coleman sued for his release.
In court filings, the state argued that it would be “unsafe and irresponsible” to release Mr. Coleman without plans to cover his medical needs. The state also said it contacted Mount Sinai, as well as hundreds of nursing homes, about placing Mr. Coleman and never heard back.
In October, a court ruled in favor of the prison system. Describing the situation of Mr. Coleman as “very sad and disappointing,” New York State Supreme Court Justice Debra Givens concluded that the state had a reasonable reason to keep Mr. Coleman after his release date. Ms. Rayner, attorney for Mr. Coleman, and the New York Civil Liberties Union appealed the decision on Wednesday.
Fourteen medical ethics experts have sent a letter to the prison advocating for the release of Mr. Coleman. “Forcing continued incarceration under the guise of ‘good interest,’ even if well-intentioned, ignores his autonomy,” they wrote.
Several other states have come up with a different solution for people on medical parole: seeking the business of nursing homes that specialize in housing patients turned away elsewhere.
A private company called iCare in 2013 opened the first such facility in Connecticut, which now houses 95 residents. The company operates similar nursing homes in Vermont and Massachusetts.
David Skoczulek, iCare’s vice president of business development, said these facilities tend to save states money because the federal government covers some of the cost through Medicaid.
“It’s more humane, less restrictive and cost-effective,” he said. “There is no reason for these people to remain in a corrections environment.”
