The Unseen Barrier: Compassionate Release Denied as Long-Term Care Facilities Shun Formerly Incarcerated Patients
Christian Alameda, a 52-year-old inmate at Halawa Correctional Facility in Honolulu, struggles to rise from his prison bed, relying on a cane for support. The right side of his body remains largely paralyzed following a stroke in January. While his medical condition qualified him for compassionate release in February, a decision granted by Hawaii’s parole board to allow early probation for severe medical needs, Alameda remains incarcerated. The reason: a critical shortage of long-term care facilities willing to accept him, a predicament shared by at least three other prisoners in Hawaii as of June. These individuals, like Alameda, have been granted release to address serious health issues but are now indefinitely confined to the prison infirmary due to their criminal backgrounds, according to the state parole authority.
This complex and often heartbreaking situation highlights a nationwide challenge, as articulated by Molly Crane, an attorney for FAMM, an organization advocating for fairness in prison policies. "This is a challenge across the country," Crane stated, underscoring that while every state offers some form of compassionate release, the post-release placement of medically vulnerable individuals is a persistent hurdle. Hawaii, notably, operates under an internal policy rather than a specific statute for compassionate release. The individuals who typically qualify for such programs suffer from debilitating conditions, terminal illnesses, or an inability to care for themselves, necessitating placement in assisted living centers, nursing homes, or hospice care. However, a significant number of these facilities nationwide refuse to admit former inmates, leading to prolonged incarceration, often for months or even years, beyond their officially granted release dates.
The Growing Crisis of Post-Release Placement
The reluctance of long-term care facilities to accept individuals with criminal histories is not a new phenomenon, but its impact has become increasingly pronounced. In Rhode Island, a study revealed a dramatic surge in nursing home rejections once a patient’s correctional background was disclosed. Similarly, in Colorado, prisoners with extensive medical needs faced average delays of 200 days after parole approval, solely due to denials from long-term care centers. The situation in New York reached a point where prisoners granted parole were compelled to sue the state in pursuit of nursing home placements.
Adding another layer of complexity is recent federal legislation. President Donald Trump’s "One Big Beautiful Bill Act," enacted last summer, has further strained the capacity of long-term care providers to accommodate individuals transitioning from incarceration. A significant barrier arises from the fact that prisoners do not qualify for Medicaid. Consequently, parolees must navigate the often lengthy application process for Medicaid benefits only after their release. The new law dramatically reduces the reimbursement window for facilities taking on new Medicaid patients, shrinking it from three months to as little as 30 days prior to application. This financial uncertainty creates a substantial risk for facilities, which may not be reimbursed for providing care to these individuals if their applications are not submitted within the narrowed timeframe.
Timothy Foster, a spokesperson for the Centers for Medicare & Medicaid Services (CMS), acknowledged the issue, stating that the agency "encourages providers and beneficiaries to prioritize timely application submission to maximize coverage." However, this directive does little to alleviate the immediate predicament faced by individuals like Christian Alameda.
"The Risk Is Just Too High": Fear, Resources, and the Bottom Line
The challenges extend beyond regulatory hurdles. Most nursing homes across the nation already grapple with lengthy waiting lists for new residents, a reality documented in a 2024 report by the American Health Care Association and the National Center for Assisted Living. This pre-existing strain on capacity exacerbates the difficulties faced by formerly incarcerated individuals seeking admission. Bob Merce, a former attorney and advocate for compassionate release, often finds himself reassuring potential facilities. "We tell the nursing homes that most of the people who we are talking about cannot hurt somebody," Merce explained, a plea that often falls on deaf ears.
The individuals languishing in the Halawa infirmary paint a stark picture of medical vulnerability. Some are physically unable to walk or dress themselves. One man could not recall his own diagnosis, while another, battling brain cancer, was unable to articulate coherent responses. Sean Sanada, the O’ahu Region CEO for Hawaii Health Systems Corp., which oversees state-funded long-term care facilities Leahi Hospital and Maluhia, confirmed that while his system has reviewed numerous compassionate release referrals, they have never accepted any. Sanada emphasized that his facilities do not discriminate based on an individual’s origin, but rather cite staff safety and resource limitations as primary concerns. "The risk is just too high in most of those instances," Sanada stated.
The concern for safety is not unfounded. Violent incidents within long-term care facilities have been a documented issue, with a 2024 study observing 14 assisted living facilities finding that 15% of residents experienced aggression from other residents in a single month. This backdrop of resident-to-resident violence contributes to the hesitance of administrators to admit individuals with a history of incarceration, regardless of their current medical condition or lack of violent offense.
The Financial Strain on Taxpayers and the Search for Solutions
The inability of long-term care facilities to accommodate prisoners granted compassionate release places a significant financial burden on state taxpayers. According to FAMM, the annual cost of incarcerating an individual with complex medical needs in Hawaii can be up to eight times the average cost of housing a person in prison, which is approximately $112,505. In contrast, the average Medicaid reimbursement for a long-term care patient at a Hawaii Health Systems Corp. facility hovers around $135,000 annually. This disparity highlights the economic inefficiency of keeping medically fragile individuals within the correctional system.
Innovative models exist in other states. Connecticut, Georgia, Massachusetts, and Vermont have implemented contracts with nursing facilities specifically to accept prisoners granted compassionate release. iCare Health Network’s MissionCare Health, for instance, has secured such contracts in three of these states, providing specialized care for individuals transitioning from correctional facilities. David Skoczulek, iCare’s vice president of business development and communication, estimated that their per-patient daily rates are $100 to $350 higher than average nursing home rates in their operating states, suggesting a willingness to cover the increased costs associated with this specialized population.
In Hawaii, the correctional department makes recommendations to the parole board, which ultimately decides on compassionate release. Upon approval, prisoners can be released to family members who commit to their care or to a long-term care facility. However, Corey Reincke, head of the Hawaii Paroling Authority, noted that in his 24-year career, he cannot recall a single instance of a prisoner being placed in a long-term care facility without direct family intervention, such as families proactively contacting facilities themselves. "Parole has to find a facility that can meet their medical needs and is also willing to take them," Reincke stated. "That’s where we’re hitting the roadblocks." Reincke recounted one instance where he contacted over 100 care homes for a parolee, with each facility ultimately declining due to safety concerns. Compounding this issue, a 2024 state report indicated that while Hawaii’s long-term care facilities operate at approximately 80% bed capacity, workforce shortages make it challenging to maintain even these utilization levels.
Hawaii Prisoners’ Refuge: Family and the Lingering Hope for Change
For many, family remains the only recourse. Paul Kupihea, a 69-year-old man, died in a hospital five days after Hawaii granted him compassionate release to his family. He passed away before he could make the journey to his home island. In July 2025, Lahela Kruse, the mother of Kupihea’s child, received a call from a Honolulu hospital. Kupihea had been diagnosed with an incurable form of cancer and had been receiving intermittent medical care within custody. Kruse and their daughter traveled to O’ahu to see him, only to be shocked by his severe condition. Despite a fractured relationship, their daughter agreed to take him into her home in Hilo, on Hawaii Island. "She knew he was sick," Kruse recalled. "I told her that, but she didn’t know the severity of it. I didn’t truly know." Kupihea’s daughter’s willingness to care for him was instrumental in his compassionate release, but Kruse lamented that the notification of his critical illness came too late.
FAMM’s Molly Crane has been actively campaigning for the expansion of compassionate release laws across states, aiming to increase eligibility and improve transparency. Lawmakers in Hawaii have made repeated attempts to pass legislation formalizing compassionate release, but these efforts have thus far been unsuccessful. Crane contends that without a clear statutory framework outlining the process and eligibility criteria, even robust family support may prove insufficient. Prisoners continue to face potentially life-threatening delays. "The absence of a compassionate release statute means that people who need compassionate release languish and even die in prison," Crane stated.
In Christian Alameda’s stark prison cell, the reality of his confinement is palpable. The small room, equipped with two beds, a basic toilet, and a window offering a view of a concrete wall, is permeated with the smell of bleach. Alameda, who has been incarcerated since 2024 for drug possession, driving a stolen vehicle, and jumping bail, expresses a deep desire to see his daughter, who recently turned five. "I made some mistakes in my life," Alameda confessed, his voice tinged with regret. "I tried when my daughter was born, but I know I’ll change, because she needs me out of here."
Merce, the former attorney, continues his efforts to find a suitable placement for Alameda, who has no history of violent offenses. Merce’s advocacy stems from his experiences as a trial lawyer, during which he has assisted approximately 15 individuals in transitioning out of Hawaii’s correctional facilities for medical care. He has witnessed cases where individuals have waited years for release. "The ones that stick with me, though," Merce reflected, his voice heavy with emotion, "are the ones that I never found placements for." The case of Christian Alameda, and countless others like him, underscores the urgent need for comprehensive solutions to bridge the gap between compassionate release and access to essential long-term care.
