Inside the 60 West nursing home in Rocky Hill, two residents played solitaire to the sound of soul music. Others sat in wheelchairs beneath a simulation of rolling clouds, while one got a haircut in a barbershop decorated with Red Sox posters.
From the outside, the 95-bed, single-story facility set back from the road looks like any other nursing home. But many of the elderly and ill residents are paroled prisoners, and the home is being watched nationally as a potential game-changer for states grappling for ways to care for their aging inmate populations.
60 West is the first facility in the country to win approval from the Centers for Medicare & Medicaid Services (CMS) for federal nursing home funding — a designation that has national significance, experts say, because it's a new option for cash-strapped states looking for ways to care for growing populations of older and sicker inmates.
"Connecticut has tried to be innovative in our criminal justice reforms. This is one of them," said Michael Lawlor, the state's undersecretary for criminal justice policy and planning. "What we are doing is being copied in other parts of the country. It's this kind of innovation that helps reform the criminal justice system nationwide."
Tina Maschi, a Fordham University professor and former prison social worker who studies aging prisoners, said the state "responded to a difficult problem of caring for seriously, terminally ill prisoners, and [its approach] managed to survive, despite community pushback. This program is a role model."
In December, 60 West, a privately owned facility under contract with the state, was notified that CMS had reversed its 2015 rejection for federal certification and granted the facility the same status as thousands of other nursing homes across the country, making it eligible for federal funds — a development first reported by the website The Crime Report. CMS previously had ruled that paroled inmates did not meet federal guidelines.
Ailing inmates who qualify for nursing home-level care and who the state deems are not public safety risks are referred to 60 West. Medicaid covers half the cost of their care, which will save the state about $5 million annually.
Lawlor said federal approval is a boon to Connecticut, with an over-60 population that has increased by more than 40 percent from 2010 to 2016.
"There is a need for this type of facility in every state in the country," Lawlor said. "It's way more expensive to provide this care in the context of a prison. … If they are in a real nursing home, you get 50 percent [funding] from the feds; in prison, you get zero percent."
In addition to funding concerns, caring for the growing population of elderly prisoners is difficult because "prison infirmaries were not designed to serve chronically ill people or people who need hospice care," said Judith Dowd, director of health and human services for the state's Office of Policy and Management.
Although Connecticut's prison population decreased by more than 3,000 inmates between 2010 and 2016, the over-60 population increased from 301 to 426, according to December population counts posted on the state Department of Correction website. In 2010, inmates ages 46 to 60 made up just 16 percent of the prison population; that percentage inched up steadily to 19 percent last year.
As the number of elderly and sick prisoners rises, so, too, does the cost of their care. The annual price of care for an inmate increased from $4,814 in fiscal year 2010 to $5,201 in 2015, as more inmates required regular health care. In 2016, 27 percent of the prison population required health care, up from 20 percent in 2011. And most prisoners are on some form of medication: 56 percent in 2016, up from 40 to 45 percent between 2008 and 2010.
Many of the 60 West residents are on nursing-home-release parole, a form of parole the legislature created in 2013. To qualify, the correction department must determine that inmates are "suffering from a terminal condition, disease or syndrome" and "be physically incapable of presenting a danger to society."
These "offenders are so medically compromised, they don't have the physical ability to commit a crime," said Dr. Kathleen Maurer, the correction agency's director of health services.
The idea for a facility like 60 West began under former Gov. Jodi Rell. Inmates eligible for release often languished in prison, as nursing homes refused referrals from the correction department and the Department of Mental Health and Addiction Services, according to Lawlor.
In 2011, the Malloy administration sought a facility operator for 60 West, and SecureCare Options LLC submitted the winning bid. The facility started accepting paroled inmates in 2013.
But the process of gaining acceptance was anything but smooth.
Some neighbors opposed the facility, and the town of Rocky Hill filed a lawsuit against SecureCare, arguing that the nursing home violated local zoning regulations. The state Supreme Court tossed out that lawsuit, but others are still pending. The town of Rocky Hill filed a second lawsuit alleging a separate zoning violation, and two neighbors have a pending lawsuit alleging the facility has decreased their property values.
In the 3½ years since 60 West opened, state officials say, no criminal incidents have been reported. "There hasn't even been a workers' comp claim," Lawlor said.
Currently 72 residents live at 60 West: 45 were referred from DMHAS, which includes referrals from inpatient psychiatric units; 19 residents were referred from the correction department; and eight are from the community.
Diagnoses vary, and include dementia, brain injuries, HIV, cancer, Huntington's disease and psychiatric conditions, such as schizophrenia, depression, personality disorders and anxiety, said Diana Lejardi, a spokeswoman for DMHAS.
Jessica DeRing, the administrator of 60 West, said staff members know where the residents come from, so that they can accommodate their needs, but "they don't necessarily know their histories."
"From our end, these are nursing home residents," she said. "And they are here and we'll take care of them."
This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org)