Mr. Long Term Care
Let Care be our Long Term Commitment
I can safely say that the purchase of my LTC insurance was the wisest and most forward-thinking, financial decision of my life. - Mr. LTC

Do your know someone who required or will soon require long term care?
"After age 65, Americans have more than a 70% chance of needing some form of long-term care."
-American Society on Aging

"An estimated 12.1 million Americans need assistance from others to carry out everyday activities."
- As noted on

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An Interview with Margaret Ratcliffe

by Mr. LTC

Toward its mission to "reach and uplift" the American people, Volunteers of America is offering the GRACE (Guiding Responsive Action for Corrections at End-of-Life) project to elderly inmates, who comprise the fastest growing, most costly sector of America's prison population. The ultimate goal of the GRACE Project is to achieve community hospice standards in end-of life care for inmates. Volunteers of America, one of the nation's oldest, largest, and most comprehensive nonprofit human service organizations, annually helps over one million people lead productive lives and avoid incarceration. We spoke with Margaret Ratcliffe, Vice President of Services for Volunteers of America.

Mr. LTC: Margaret, how long have you been with Volunteers of America?

MR: I've been with Volunteers of America for twenty years.

Mr. LTC: Where were you before Volunteers of America?

MR: I was the director of an Area Agency on Aging in New Orleans.

Mr. LTC: And what, exactly, are the services over which you preside for Volunteers of America?

MR: The services group assists affiliates to develop programs in any kind of a variety of program areas. We work on new developments.

Mr. LTC: How did you become involved in the GRACE project?

MR: We got into it because Volunteers of America has been involved in correction programs over 100 years. Because of that, when we have been interested in special populations in corrections, such as the elderly, people with disabilities, women with children, we are also involved with services for these populations. Programs such as this grew out of our interest in corrections and older inmates.

Mr. LTC: What kinds of problems do older inmates in correctional facilities have?

MR: Largely, we deal with end-of-life care. The project has dealt with terminally ill people who are not old, of course; it's not limited to the elderly. About a third of deaths in correctional facilities are HIV and AIDS-related.

Mr. LTC: What do you hope to accomplish through GRACE?

MR: We're trying to work hard to have resources to help the states respond to the fact that they have a population that's growing old and dying in prison, The hope for the project is to pull together all the information and techniques to share.

Mr. LTC: Where would you like to see GRACE going?

MR: Where we'd like to go is to come up with some less institutional approaches (to incarceration). Compassionate release has been declining. Most states have a very hard time even to have these older, very ill inmates released.

Mr. LTC Why is this?

MR: It takes so long to work through the system that many die before they're able to complete the process, or they only have a few days to live. Given that we have so many prisoners, it seems a shame to tie up a secure space with these inmates. We'd like to have a way to have more individuals in secure programs that are more community based - smaller, closer to the inmates' families.

Mr. LTC What kind of distances are we talking about?

MR: For example, the Federal. Bureau of Prisoners has an outstanding Hospice program in Texas for women who are terminally ill. It's the only program in the country, though. So if a woman is a federal offender, and she wanted to be in the Hospice unit, that's the only place she could go. Even in the states where special units have been created, there's a distance problem.. Probably the comprehensiveness of the care is a lot higher than if you have one patient here and one there. The downside is that it's far from relatives.

Mr. LTC: What's blocking the kind of change you'd like to see?

MR: I think the institutions are taking the inmates they have and trying to do the best things possible. Whether they have a handful of patients or a larger number.the states could look at offering more community-based programs. It would necessitate working to be sure that it fits with the sentencing.

Mr. LTC: What do you think gets in the way?

MR: It's very hard to believe that somebody has changed their life drastically or that this person is no longer potentially harmful. I think more releases could be possible, so they're appropriate, I believe it's possible to find some way to do it. Electronic monitoring might be a possibility. Or, if someone's in a wheelchair, they're not going to go too far too fast. But (there are other factors); there might still be victims' families who are going to have a say in what happened.

Mr. LTC: What has impressed you with end of life care programs in correctional facilities?

MR: I've learned from working with Departments of Corrections that they have a hard balancing act. I've been very impressed with the quality of the people we've worked with who are in the correctional health services. They've identified these problems themselves and started working in the answers. It wasn't some bureaucratic decision to start these programs.. Sometimes it's been the chaplain, a medical person, or the assistant warden who had a family member who benefited from Hospice. One of the most remarkable aspects is that where inmates have been able to volunteer as hospice volunteer. It's been most inspiring.

Mr. LTC: Where are there such programs?

MR: Oregon has a terrific program with inmate volunteers. They started very carefully, and really built up their way of doing it. The Women's Prison in Texas also uses volunteers. They have a wonderful warden. One that has gotten a lot of national recognition is in Louisiana. Louisiana is a state with large numbers of people incarcerated with long terms. One prison has about 7,000 people. They expect that 85% will never leave, because it's maximum security. That may be one reason that they've had such success with this program; the inmates who are the volunteers are gaining a lot from this personally. A lot of inmate volunteers are lifers - it allows them to give back in some way, they say. It's very transformational.

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