Credit: Ryan Duggan

Bill Heirens, infamous as Chicago’s “Lipstick Killer,” is the longest-serving inmate in the Illinois prison system. He’s been behind bars since the age of 17, when he confessed to three gruesome murders that dominated the news headlines throughout the summer of ’46.

Housed at Dixon Correctional Center, the 82-year-old Heirens can’t get out of bed or bathe himself, and his cataract-plagued eyes have left him unable to read. He has severe diabetes and gets shots of insulin twice a day, along with a cocktail of other medications. Nurses constantly change bandages on his legs, where diabetic sores weep fluids. They say he is beginning to show signs of dementia.

Last year, he collapsed while inching his way down the hall, grasping the handrail, and was sent by ambulance to UIC medical center, where he stayed for four days. Though he is clearly too frail to injure anyone, the state will pay $73,000 this year to keep Heirens behind bars, feed him, and treat his ever-expanding list of ailments. All told, the Illinois Department of Corrections spends roughly $428 million a year—about a third of its annual budget—keeping elderly inmates behind bars.

Bill Heirens
Bill HeirensCredit: Jessica Pupovac

The number of older prisoners has expanded sixfold over the past 20 years, to 5,868 today. That segment of the prison population is growing faster than others, too. Inmates over 50 used to represent 5 percent of the state’s prison population. In a decade that’s grown to nearly 13 percent. If the trend continues, the number of prisoners over 50 will double by 2020. National numbers mirror the Illinois trend.

Meanwhile, the graying prison population has placed new demands on an already burdened prison health system, forcing medical workers to provide care that sometimes doesn’t meet IDOC’s own standards. Health care costs are rising, largely because of the complexity of treating older prisoners with a constellation of diseases. And taxpayers foot the bill for unionized corrections officers to guard inmates who would have trouble making it beyond the infirmary doors without a wheelchair or stretcher.

“We have many offenders who would probably do better outside of the system,” says Dr. Louis Shicker, medical director for the corrections department. “If they are terminal or incapacitated and not at risk to commit a crime, the IDOC is not the place for them. We need to be concentrating on people who are dangerous to the community and need to be locked up.”

State statistics show older inmates are much less likely to commit new offenses when released. Nearly 30 percent of IDOC prisoners under 50 return there within three years of release. That number falls to just 3.6 percent for those between 70 and 79. None of the 13 individuals over the age of 80 released from Illinois prisons in 2006 have committed crimes since.

Credit: Jessica Pupovac

Heirens lives with a dozen other aging inmates in the infirmary at Dixon, 102 miles west of Chicago. Two columns and a grove of trees grace the entrance to Dixon’s sprawling 462-acre campus, which looks more like a boarding school than a prison. To reach the geriatric ward, I pass through a series of security checkpoints. In the outer lobby, a female correctional officer studies my driver’s license and looks through my bag. She waves her hand, ushering me through the metal detector, where another guard, a large man, stands and watches. A few seconds later, an administrator and I are buzzed into a small corridor flanked by two heavy metal doors. A man behind thick bulletproof glass takes my ID, photocopies it, and hands it back. Another guard escorts me inside the fence to the medical complex.

We board an old, dingy elevator to the third floor, where another glass-enclosed guard station harbors a collection of walkie-talkies and shackles, along with two officers monitoring security cameras. They look at my host’s badge and my ID and eventually buzz us into the unit.

It’s surprisingly quiet for a prison ward that houses 82 inmates. Three- and four-man cells line the hall. In one room, an inmate in thin blue pajama pants and a white T-shirt sits at the edge of his bed, watching television and coughing violently. A cellmate—a gaunt old man wearing a navy blue stocking cap and a large hearing aid—stands at the door, leaning on his metal cane and watching the occasional traffic in the hall. A third cellmate with oily gray hair lies in his bed, peering at a word search book through thick-rimmed glasses. The fourth lies idle in bed, his blanket covering his entire body, including his head. Two men hobble down the hall, which is illuminated only by the light streaming through the glass windows of the cells. One grasps a metal handrail. The other uses a cane.

The ward, which houses inmates who can’t walk well, is one of three caring for older prisoners at Dixon. Another, Unit 26, serves inmates who, despite their ailments, can get around on their own. The last is the infirmary, which was originally intended to treat acute illnesses and injuries. In recent years it’s increasingly become home for chronically ill and dying inmates—the “permanently placed,” as prison staff call them.

Though inmates on the three wards speak dismissively of the prison’s medical units, they’re actually among the lucky few who are able to secure beds there. Dixon is 62 percent above capacity, and staffers say they have a particularly difficult time squeezing inmates into the elderly units and are constantly reshuffling cell assignments. “Spacing is an issue, availability of beds—huge issue,” said Amber Allen, Dixon’s health care administrator.

Dixon’s medical wards have been short on nursing staff for as long as she can remember. “When I began, we had a lot more [nurses] than we have now, but now we’re doing more with less and that’s not just nursing. That is every department. That’s everywhere.”

The medical building at Dixon Correctional Center
The medical building at Dixon Correctional CenterCredit: Jessica Pupovac

And budget concerns mean that doctors and nurses increasingly must skimp on care.

“We’re working with outdated equipment. We’re working with old methods. We don’t have the latest technology,” she told me. Bandaging tape is in short supply. “They’ll be like, ‘Be careful, because this is all we’ve got for the next two weeks,” she says.

When Allen started at IDOC, she was accustomed to changing her patients’ dressings while wearing sterile gloves to limit the chance of infection. But Dixon staffers are unable to follow the policy because there’s not enough money to buy the special gloves, she says.

Because serving time accelerates the aging process, and because inmates are often in poor health when they arrive, IDOC classifies prisoners over 50 as elderly. While keeping a younger inmate behind bars costs taxpayers about $17,000 a year, older inmates cost four times as much. They frequently need to leave the prison to see specialists, and each trip can involve a strip search, a prison van, and a crew of guards. They often rack up overtime making the drive to distant hospitals.

During one such trip Heirens took to UIC, his arm was shackled to the bed. “He couldn’t have gotten out of his bed if his life depended on it,” says Dolores Kennedy, the program director at Northwestern’s Center on Wrongful Convictions and Heirens’s longtime advocate. Even so, she says, a guard watched him for the entire four-day stay.

Adding to the financial drain is the cost of treating seriously ill inmates in a setting that’s designed for security rather than medical care. “I don’t think they get the best care in our system,” says Dr. Shicker. “We do the best we can with what we have, but some things are just meant for a nursing-home setting.” Providing nursing-home care to the state’s sickest prisoners would cost about $57,000 a year, according to the Federal Interagency Forum on Aging-Related Statistics. That’s an annual savings of $16,000 per inmate.

For inmates who don’t need nursing-home care, the savings would be even greater, says prison reform activist Bill Ryan. “If you released just ten reformed, elderly people from the system, we’d save the state $700,000. How many teachers can you hire for $700,000, or a million dollars, even? . . . I think we’ve got an overall sense of values that are upside down.”

Betty Finn, the sister of one of Heirens’s victims, is convinced the expenditures are justified.

“The court has said he’s supposed to spend the rest of his life in jail,” she told me. “It sends a message that if you commit these horrendous crimes that you should fulfill your sentence. Life in prison should mean life in prison. . . . If it protects one life it is worth it.”

Two major legislative decisions drove the expansion of Illinois’ older prison population. The first came in 1977, when the General Assembly did away with indeterminate sentencing. Under that system, an inmate might receive a sentence of 20 to 100 years, with parole eligibility after 11 or 12 years. The parole board would decide how much time he actually served. But critics argued that the parole board was overly generous, and some said the process was biased in favor of white prisoners.

Under the new legislation, the average time served rose. But the changes didn’t address a provision that allowed an inmate to receive one day off his or her sentence for each day of good conduct.

In 1995 the Clinton administration developed a financial incentive for states to increase mandatory minimum sentences and eliminate “good time” credit for certain violent offenses. With victims’ rights groups protesting that inmates were getting off easy—and getting out early—the legislature took another run at sentencing policy.

The resulting Truth in Sentencing bill required everyone convicted of first-degree murder to serve their entire sentences. Inmates convicted of attempted murder, sex crimes and other violent crimes could earn a maximum of four and a half days of good behavior credit a month. Those serving time for the least serious felonies could continue to receive the one-for-one credit.

The two pieces of legislation were enacted 17 years apart. The first was introduced by Democrats; the latter was backed by Republicans but supported by many on the left. Observers say their provisions have combined to create startling and unintended effects.

When the Truth in Sentencing legislation was under consideration, the cost of caring for inmates who would die in prison never came up, says Dave Olson, chairman of the criminal justice department at Loyola University Chicago. Lawmakers assumed sentences would grow shorter as it became clear inmates were serving most or all of their prison terms. “People said there would be no impact,” he says.

Some legislators have tried to address the humanitarian implications, as well as the costs, of keeping older inmates in prison. In 2009 state representative Art Turner pushed a bill that would allow inmates over 50 to petition for early release if they compiled good prison behavior records and had served at least 25 years. The Fraternal Order of Police, victims’ rights organizations, and tough-on-crime politicians opposed the measure. It was shot down in the House, 83-32.

“It’s not a popular position to take,” says Turner, now retired. “Politicians don’t want to be realistic and look at it from the standpoint of what the purpose is of sending people to prison. Is it rehabilitation or is it punishment? Our tough on crime stance has had this effect of costing the state, and I think—no, I know—that there is no real justification for the cost when many of these guys have been rehabilitated.”

The sole choice available to terminally ill inmates who don’t want to die in prison is to seek clemency. It rarely works. “That process takes a long time, unless you have a hotshot lawyer working for you,” Dr. Shicker says. “The governor’s office is always afraid of the [political] climate.”

Last year, legislators created a task force to study sentencing policy in other states and revise Illinois’ guidelines. The Sentencing Policy Advisory Council, composed of law enforcement officials, criminal justice experts, and retired politicians, is set to make its recommendations by the end of 2012.

Meanwhile, the problem is getting worse.

“We’re on the tip of the iceberg now of what we’re going to see in terms of the graying of the American prison population,” says Ronald Aday, director of aging studies at Middle Tennessee State University.

Olson says demographics will ultimately force public officials to make a difficult choice.

The corrections department, he says, is “going to be providing geriatric care or care for people with substantial medical problems in an environment that is a very expensive environment to provide them in. . . . People aren’t going to be thrilled with the implications.

“We impose these sentences for the purposes of rehabilitation or retribution, and you get to the point where we have to ask how much this retribution is really worth. Are we willing to pay an enormously high amount when they are in prison with diabetes or cancer or other conditions?”

The looming costs are apparent in some plans IDOC is now considering. In addition to the geriatric unit at Dixon, IDOC officials hope to open a facility devoted to the care and supervision of elderly offenders with minor physical ailments as well as an enhanced, 200-bed medical center for prisoners in need of more intensive care. The medical center would also house the state’s first official dementia unit inside a prison. Although Dr. Shicker says it’s too early to put a price tag on the projects, a medical wing recently built in Arkansas similar to the one he described cost that state $60 million. But even if the state drums up the money to build better facilities, it’s impossible to escape the question of whether they’re necessary.

Since being locked up at the age of 17, Heirens (who steadfastly insists on his innocence) has lost both parents, his brother, and most everyone else he knew from his previous life. His life has passed him by, but he hopes that some of the prisoners he’s seen grow old with him will get a second chance. “A lot of us are too old to do anything anymore. All we’re doing is taking up room. . . . And the people don’t realize that there are all these taxes, that they are the ones who are paying for this. I don’t think they realize that they would have more for themselves if they didn’t have to pay so many taxes to keep people in prison.”

The author received a grant from the Soros Justice Fellowship program of the Open Society Institute to report this story.