Nursing home availability for incarcerated persons granted compassionate release

As incarcerated individuals age, prison systems often struggle to provide appropriate long-term care. Compassionate release policies can address this gap by allowing seriously ill or aging individuals to transition to community-based care. Many nursing homes, however, are reluctant to admit individuals recently released from prison. This study examined how incarceration status affects nursing home admission decisions.Using a statewide secret shopper methodology, researchers contacted all 74 licensed nursing homes in Rhode Island. Callers first inquired about bed availability for a standardized model patient, then disclosed the patient would be arriving from prison under compassionate release. Responses before and after disclosure were categorized and analyzed using ordinal regression.Of 74 facilities, 61 (82.4%) were reached. Before disclosure, 52.5% reported bed availability within one month; this dropped to 26.2% after incarceration was mentioned. Complete rejections increased from 9.8 to 44.3%. Facilities were 3.41 times more likely to downgrade admission status after disclosure (OR = 3.41; 95% CI: 1.76-6.70; p < 0.001). For patients with serious criminal offenses, the rejection rate reached 70.5%, and the odds of rejection increased to 11.39 (95% CI: 5.48-24.65; p < 0.0001). Facility size was not associated with rejection likelihood.Incarceration and criminal history significantly reduce access to nursing home care, even when medical need and payment ability are constant. These findings highlight the need for policy and system-level interventions to reduce stigma and increase care access for aging individuals eligible for compassionate release.