"This place was not designed for people aging and dying … we long for home, to see family in our last days.”
With those words, 69-year-old Sylvia Boykin, now wheelchair bound, described what it means to grow old inside a prison. She has been incarcerated at SCI Muncy for 34 years.
Her words capture a growing reality: prisons are increasingly housing people who are aging, ill, and approaching the end of life.
This issue matters. Here’s why in five key takeaways:
1. Prisons were not designed for people to grow old and die in them.
Pennsylvania has more than 7,500 people serving life sentences who are over the age of 55, an age considered geriatric in prison, where the conditions of confinement actually accelerate physical and mental decline far faster than life on the outside.
Prisons increasingly function as nursing homes and hospice units despite lacking adequate medical infrastructure and staffing. People wait months for eye exams. Routine preventative measures such as mammograms and colonoscopies are often delayed or unavailable.
2. It costs more than you think — and we're all paying for it.
Keeping one person at SCI Laurel Highlands, a state prison that now functions more like a hospital, costs over $100,000 a year. Pennsylvania spends $3.4 billion annually on its state prison system, and that doesn't include county jails. Two state prisons have dialysis units because demand is so high.
Beyond the budget, there are also hidden costs borne by incarcerated people and their families. A $5 medical co-pay — combined with in-prison wages of just 23 to 42 cents an hour — can prevent people from seeking necessary care. Families often absorb additional medical costs along with travel, phone calls, and commissary, adding strain to households that are already financially stretched.
3. Serious illness and chronic conditions are widespread and often undertreated.
Health needs inside prisons are growing. Studies show increasing rates of chronic illness and mental health conditions among incarcerated people, alongside significant gaps in care.
Despite the worsening mental and physical health of incarcerated people, a startling number have never received care in prison. About one out of seven people in state and federal prisons with at least one chronic condition reported not having been seen by a health care provider since they were incarcerated. Among people with a chronic mental health condition, one-third had not received any treatment.
4. The pathways out are barely open.
For people serving life sentences, there are only two pathways out: compassionate release and commutation. Both are extraordinarily difficult to access.
Compassionate release is a process in which the court can approve the release of someone in prison who is near death. Compassionate release has been granted in fewer than 70 cases since 2009. Commutation is a process in which the state parole board ends someone's sentence so that they can be released. Commutation requires a unanimous vote from the politically appointed parole board and can take three to five years just to move through the process. Many people apply multiple times over decades before any decision is reached.
5. Pennsylvania is at a legal and moral crossroads.
Taken together, these realities point to a system under growing strain and increasingly responsible for housing aging, ill, and dying populations, while still operating under policies designed for punishment rather than long-term care or release.
There is some progress on the horizon. A 2026 state Supreme Court ruling found mandatory life without parole for second-degree murder unconstitutional. For years, people were sentenced to die in prison for killings they did not commit or intend. Pennsylvania once led the world in rethinking punishment — grounded in the belief that people can change. This decision points us to that principle once again: justice must be proportionate, and people must have the opportunity to change.
More than 1,100 people serving life without parole could be impacted.
These issues were discussed in connection with a podcast launch event of Dying on the Inside on April 22, 2026. The conversation included moderator Cherri Gregg (WHYY’s Studio 2), Prison Monitoring Director Noah Barth of the Pennsylvania Prison Society, attorney Rupalee Rashatwar of the Abolitionist Law Center, Pennsylvania Representative Andre D. Carroll, and formerly incarcerated advocate Dannielle Hadley. Listen to the conversation in a special episode of the podcast here.
