When criminologist Stephanie Jerstad’s former client, a registered ‘sex offender’ died waiting to find a long-term care facility in Illinois that would accept him, she dedicated her dissertation research to studying if facility-level characteristics matter in explaining organizational policies for the admission of persons on the sex offender registry. This issue intersects with public health, social justice, and human rights, requiring a closer examination of legislative, institutional, and societal factors.
Jerstad’s workshop at the PARSOL 2024 Fall Conference explored the challenges associated with long-term care access for aging individuals with criminal histories, highlighting the restrictive policies and misconceptions that exacerbate these barriers, emphasizing the need for ethical and evidence-based approaches to care. This article highlights her research and findings as presented.
The Problem of Access
The denial of long-term care for individuals with sexual harm convictions has created a public health issue of growing concern. Stories from across the country illustrate the severity of the problem. For example, a 76-year-old man in Illinois was denied admission to over 200 long-term care facilities due to his registry status. Unable to find placement, he died in the hospital. Such cases demonstrate how existing policies can have devastating consequences, particularly for those in advanced age who require specialized medical support.
This exclusion arises from legislative barriers, institutional risk aversion, and pervasive societal stigma. Many facilities refuse to consider applicants with any criminal histories, citing potential liability and community concerns, even when such individuals pose minimal risk. This is especially true for individuals with sexual offenses.
Legislative and Regulatory Barriers
Twelve states, along with select areas in Florida, have implemented laws dictating how long-term care facilities should handle individuals on sex offender registries. These laws, passed largely between 2005 and 2010, emphasize restrictive measures, including:
- Mandatory Notifications: In some jurisdictions (not Pennsylvania), facilities must inform staff, residents, and sometimes the public about the presence of an individual with a criminal history.
- Registry Screening: Admission processes often disqualify individuals based on registry checks, regardless of health status or age.
- Segregation Policies: Some states mandate that residents with criminal histories be housed separately or under heightened supervision. In Pennsylvania, no more than five individuals designated sexually violent predators (SVPs) may live in one facility.
- Residency Restrictions: In some states proximity to schools, parks, or daycares often disqualifies facilities from admitting individuals on registries. While this does not apply to Pennsylvania, if someone is on parole or probation, their release conditions may contain these kinds of restrictions.
Such measures are frequently justified as protective but effectively act as exclusionary practices. For instance, Illinois requires detailed disclosures about an individual’s criminal history to staff and other residents, a policy that further stigmatizes and isolates this population.
Impact of Misconceptions and Risk Aversion
A significant driver of these restrictive policies is the misconception that individuals with sexual harm convictions are highly likely to re-offend. Research indicates that the recidivism rates for this population are among the lowest of all criminal groups, particularly as individuals age. After age 60, the likelihood of re-offense drops to nearly zero. Despite these findings, public perceptions—shaped by media portrayals and societal fears—continue to depict this group as perpetual threats.
Institutional policies often reflect these unfounded fears. Many facilities cite risk management and liability concerns as reasons for denial. Administrators are particularly wary of potential lawsuits or negative publicity, especially in cases where they are required to disclose the presence of residents with prior convictions.
Interestingly, some studies suggest that facilities are more concerned about residents with cognitive impairments, such as dementia than those with criminal histories. Evidence shows that individuals with conditions like Alzheimer’s are more likely to exhibit inappropriate sexual behavior due to their illness. Yet, facilities remain focused on excluding those with past convictions, even when there is no evidence of ongoing risk.
State and Facility-Level Factors
Certain state and facility characteristics significantly influence whether individuals with criminal histories can access care:
- Punitive State Policies: States with strict residency restrictions, civil commitment laws, or high incarceration rates are more likely to enforce exclusionary practices in long-term care.
- Facility Ownership: Nonprofit facilities are far more likely than for-profit ones to admit individuals with criminal histories. Nonprofit organizations often approach admissions holistically, considering the individual’s health needs and overall circumstances rather than solely their criminal record.
- Administrator Backgrounds: Facilities led by administrators with nursing or healthcare experience are more likely to accept applicants based on their medical needs. Conversely, those with business backgrounds tend to prioritize risk management and liability, resulting in more exclusionary policies.
Broader Ethical and Public Health Implications
The denial of long-term care access raises critical ethical questions. Regardless of their past, every individual deserves humane treatment and healthcare access. By excluding individuals with criminal histories, particularly those who are elderly and frail, facilities contribute to a public health crisis that disproportionately affects vulnerable populations.
There are also significant implications for social justice. Denying access to care perpetuates cycles of marginalization and reinforces stigma, often exacerbating the very conditions that policies aim to address. Individuals on registries have already served their sentences and reintegrated into society, yet they continue to face lifelong discrimination due to outdated and overly broad registry requirements.
Additionally, policies that deny care based on past convictions often need to account for the aging process. As people age, their health deteriorates, and their risk of re-offense diminishes. Ignoring these factors creates a system prioritizing punitive measures over evidence-based approaches to care.
Research Findings on Long-Term Care Exclusions
Research reveals that the current exclusionary practices are rooted in myths rather than data. For example:
- Recidivism Rates: Individuals with sexual harm convictions have recidivism rates between 5–15%, with rates dropping significantly after age 60. This is far lower than for other offender groups.
- Time Since Conviction: Most facilities do not consider the time elapsed since an individual’s offense. A conviction from decades earlier is treated like a recent offense, even when the individual has demonstrated rehabilitation and good behavior.
- Universal Exclusion: Many facilities deny admissions without distinguishing between the severity or circumstances of the offense. This one-size-fits-all approach fails to consider the unique circumstances of each individual.
Potential Solutions & Next Steps
Addressing this issue requires a multifaceted approach that balances public safety with ethical care. Potential strategies include:
- Legislative Reform: Revisiting registry laws and long-term care policies to reflect evidence-based practices rather than fear-driven measures. This could include removing lifetime registry requirements for low-risk individuals or creating pathways for removal based on rehabilitation and time offense-free.
- Data Collection and Advocacy: Gathering comprehensive data on the number of individuals affected by these policies can strengthen advocacy efforts. Clear evidence of the scale of the problem is essential for driving legislative and institutional change.
- Education and Awareness: Dispelling myths about recidivism and risk through public awareness campaigns can help reduce stigma and foster more compassionate policies. Facilities and policymakers must be educated about the realities of risk and the ethical implications of denial.
- Collaboration with Nonprofit Organizations: Nonprofit facilities have demonstrated greater willingness to admit individuals with criminal histories. Expanding partnerships with these organizations can provide immediate relief while broader reforms are pursued.
Conclusion
The exclusion of aging individuals with criminal histories from long-term care represents a critical intersection of public health, social justice, and human rights. Current policies, driven by myths and societal stigma, deny essential care to a vulnerable population and perpetuate cycles of marginalization. By prioritizing evidence-based approaches, fostering dialogue, and enacting meaningful reforms, it is possible to create a system that balances safety with compassion and dignity. Addressing this issue is a matter of public health and a testament to the values of equity and humanity that underpin a just society.
