This French Nursing Home Accepts Inmates Others Won't

Medscape

6 hours ago

Like the general population, France's prison population is aging. In 2019, nearly 2600 inmates were over the age of 60, and close to 500 were over 70. According to the French Prison Administration Directorate (DAP), 115 of these individuals were classified as dependent, and 430 were living with physical disabilities.
Despite these needs, very few healthcare facilities in France are equipped to accommodate older, dependent former inmates. Currently, only two nursing homes accept individuals with a history of incarceration. One of them is the Saint Barthélemy nursing home in Marseille, affiliated with the Saint John of God Foundation. Its director, Olivier Quenette, spoke with Journal International de Medecine (JIM) , a Medscape Network platform, about the challenges and responsibilities involved in caring for this particularly vulnerable group.
How did your nursing home come to care for individuals coming out of the prison system? Is there a link to the philosophy of the Foundation that supports your facility?
It happened by chance. We were approached by a family member of a 61-year-old man who had just been released from prison and had no housing solution. We agreed to take him in.
The Foundation's philosophy is to support the most vulnerable — those who are invisible or without options. We're committed to unconditional acceptance, so we responded positively to what was, in this case, an urgent request.
Did the idea of accepting incarcerated individuals develop gradually from there?
Absolutely. In 2005, we visited the Saint John of God facility in Austria, which had created a correctional unit within a hospital. That inspired us to consider the needs of aging people in prison. We started to study the issue and built relationships with the prison system to understand how it works — its language, procedures, and requirements — to be able to integrate these individuals appropriately.
How many incarcerated or formerly incarcerated individuals do you currently care for? What is their legal status?
As of our latest count in June 2024, we had admitted 29 people, including two women, with ages ranging from 54.5 to 89.7 years — an average age of 69.9. Fourteen were on modified sentences with judicial oversight, three were on parole with electronic monitoring, and seven had medical sentence suspensions. Only one was released without support.
How do you ensure anonymity for residents with a history of incarceration?
We've chosen to uphold a right to be forgotten. What matters to us is that the individual has either served their sentence or is in the process of doing so. We do not share the reasons for a resident's incarceration with the care team. This is an ethical decision. It's up to the resident to disclose their background, if and when they choose.
Naturally, in today's digital age, media reports about certain cases are easy to find. We've encountered such situations. But after more than 15 years of admitting former inmates, this is no longer a sensitive issue within our facility. We treat each person as an individual — not as someone defined by a past offense. Others may choose to look into a resident's background, but for us, it holds no greater weight than any other part of their personal history. We treat it as confidential, much like medical information.
Are there specific medical characteristics that distinguish incarcerated or formerly incarcerated residents from others in your facility?
Our nursing home has a somewhat specialized profile; we primarily care for individuals who have experienced homelessness or who live with mental health conditions. Of our 245 beds, the majority are occupied by residents with nontraditional or complex life histories. The current average age is 74, and approximately 60% of residents are men. Most are enrolled in public social assistance programs.
One of the key challenges with formerly incarcerated residents is helping them unlearn institutional behaviors developed in prison and relearn how to live independently. We recognized early on that this group requires more frequent and intensive psychological support, as they tend to experience higher levels of anxiety. This is particularly true for younger residents, especially those under the age of 65, who also benefit from more structured daily activities.
To support their reintegration, we offer paid, meaningful activities that carry therapeutic, occupational, and social value within the facility's community. We also maintain close collaboration with correctional social workers (known in France as CPIPs, Conseillers Pénitentiaires d'Insertion et de Probation), who visit monthly to meet with both the former inmates and staff.
We've successfully supported the reintegration of several former residents; four have transitioned to independent living. These transitions always take place following a period of judicial supervision, but each resident leads the process, and we provide support every step of the way.
What psychological and psychiatric support do you provide?
Some residents have psychiatric conditions. We rely on private psychiatrists who also care for our other residents, and we ensure follow-up. Our in-house psychologists work closely with these individuals, especially during the admission period and the first few months. Some residents are also under mandatory psychiatric follow-up ordered during incarceration.
How do you coordinate medical care and judicial monitoring — for example, for residents with electronic ankle monitors?
Their medical care is the same as for any other resident. With their consent, they are assigned a private physician who manages their care, appointments, and testing. We handle transport logistics if needed. One resident took 2 years before leaving the facility, so we support them in rebuilding autonomy.
Those with ankle monitors are allowed to leave their rooms during specific times, managed in coordination with their probation officer.
Nursing homes often report difficulties in hiring healthcare staff. Does your facility face these challenges?
The healthcare labor market in our sector is undeniably tight. We face recruitment challenges in certain roles, particularly when it comes to coordinating physicians — a difficulty reported by more than 30% of nursing homes in France. However, for nursing and nursing assistant positions, we are currently able to meet about 95% of our staffing needs. While we are not experiencing acute shortages, there is ongoing pressure, and we must continuously recruit to anticipate potential vacancies and ensure continuity of care.
Have your staff received specific training to care for current or former inmates? Have any raised concerns?
No specific training has been provided for caring for formerly incarcerated individuals. As I mentioned, we focus first on the resident's primary condition — whether that be mental illness, physical illness, or a state of dependency. In our experience, residents with severe psychiatric histories — particularly those recently discharged from psychiatric hospitals — often present greater care challenges than former inmates.
That said, we do offer targeted training on geriatric mental health, though not programs specifically focused on the needs of former prisoners.
Regarding staff concerns, we addressed them through discussions with our internal multidisciplinary ethics committee. We made a deliberate choice not to create dedicated units for former inmates. Instead, they are integrated across all units. This approach has worked well. Even during our initial admissions, there were some questions, but no significant issues arose.
In principle, any prisoner can be granted release for medical reasons or if they are over the age of 70. Is this law effectively applied?
Not at all. As I recall, this provision was introduced in 2014 by then-Justice Minister Christiane Taubira. But in reality, many incarcerated individuals over 70 are unable to access release because no care facility is available to receive them. So, despite being on the books, the law remains difficult to apply in practice.
Medical parole is granted by a sentencing judge, based on clinical evaluations. However, it only becomes a viable option if a long-term care facility is willing and able to admit the individual. According to the DAP, roughly 80-90 older inmates in France each year would meet the criteria for such release. That is a relatively small number considering the total nursing home capacity nationwide. But the fear of recidivism, especially involving individuals convicted of sexual offenses, remains the primary barrier to placement.
France currently has only two nursing homes that accept former inmates — yours and one in Cuiseaux. Should more facilities follow this model? What are the barriers?
In addition to the facility in Cuiseaux, a nursing home in the Ardennes began accepting former inmates 2 years ago, and the French Red Cross has also shown interest in participating.
Progress is being made, but it remains slow and limited. The biggest barrier is stigma: the fear that someone who has committed a crime may reoffend. Facilities are concerned about how families will react, whether there are safety risks for other residents, and what staff will think.
These fears continue to prevent many nursing homes from accepting former inmates. Yet these individuals are often seriously ill and no longer capable of living independently in a prison setting. In some cases, their living conditions behind bars may even be incompatible with basic human dignity.
In collaboration with the Ministry of Justice and the DAP, we've presented our model to national networks of nursing home directors to encourage broader participation. I've also met with two large foundations that have committed to supporting these efforts. The idea is starting to gain traction, but significant challenges remain.
For older, dependent inmates who remain in prison, what improvements are needed in their medical care?
At a minimum, prisons need architectural modifications to better accommodate individuals with physical dependency. In addition, access to in-home nursing services must be significantly improved within prisons and detention facilities.
While a few pilot programs exist, the response time for initiating care is approximately four times longer than in the general population. The main barrier is financial.
In my view, the most practical solution would be for every nursing home in France to commit to accepting at least one inmate per year. If just 90 facilities nationwide did so, we could resolve this public health challenge.
At our facility, for example, we currently house former inmates from Bapaume Prison near Lille. Before being accepted here, they were denied admission by 40-50 nursing homes in their local region.