At nearly 80 years old, Robert Cheeks kept falling in the shower. Inside the Alabama prison where he had spent nearly four decades behind bars, other inmates were the ones left to help him bathe.

“I’m thankful to be alive,” said Cheeks, speaking to AL.com after a nonprofit helped win his release. But Cheeks is an exception; few elderly and ailing prisoners are allowed to leave those prison gates.

Cheeks spent 38 years in Alabama prisons, sentenced to life in prison without parole for a robbery in 1984 where no one was hurt. “I accepted that (I’d die in prison) because I didn’t see a way out…. I accepted my fate.”

He was ordered to spend the rest of his life behind bars because of the state’s old “three strikes” law. Despite being elderly and sick, there weren’t many avenues left for him to have a shot at freedom—or at least, not dying in a prison infirmary.

Alabama spends hundreds of thousands of taxpayer dollars each year on keeping elderly people behind bars and is about to increase its healthcare spending this spring when a new billion-dollar contract goes into effect. The spending has prompted lawmakers and advocates to question how keeping aging, sick prisoners behind bars is really keeping Alabamians safe.

The older and sicker the inmates are, the more money the Alabama Department of Corrections has to spend, resulting in a strain on the already fraying prison healthcare system in a prison system already subject to a federal lawsuit over “decrepit conditions.”

“Our investigation revealed that an excessive amount of violence, sexual abuse, and prisoner deaths occur within Alabama’s prisons on a regular basis. Indeed, a review of a single week in Alabama’s prisons—a week in September 2017—provides a window into a broken system that too often disregards prisoners’ safety,” the U.S. Department of Justice said in a 2019 letter to Gov. Kay Ivey.

Just last week, a state legislative committee tried to tackle the problem when lawmakers on the Joint Prison Oversight Committee met Wednesday and lawmakers of both parties dug into why the state rarely uses the medical furlough option to let out some of those prisoners.

The program allows the prison commissioner “discretionary authority to grant medical furloughs for terminally ill, permanently incapacitated, and geriatric inmates who suffer from a chronic infirmity, illness, or disease related to aging, and who do not constitute a danger to themselves or society,” according to the prison system.

The prisons system’s November report showed that 27% of all Alabama inmates are 51 years old and older, and nearly one in 10 are over 60. That’s more than 2,500 inmates over 60. Of those over 60, more than 400 were serving life without parole sentences.

But as of November 2022, just seven people were entered into the medical furlough program. The year before, there were only three.

Over six years ago, the U.S. Department of Justice began investigating the state’s overcrowded, understaffed prisons for unconstitutionally dangerous conditions—a lawsuit that’s still ongoing. Since then, the average age of Alabama inmates has increased from 39 to 42 as of 2021.

There’s been a 15% increase in prisoners aged 60 and above, department data shows, while spending on medical services increased 65% over that same time—from $112.2 million to $184.9 million.

“I sure did think I would die in there,” Cheeks said. “That was their intention, for me to die in prison.”

Graying prison population

Cheeks won his release from prison last summer, after his lawyers from the nonprofit Alabama Appleseed Center for Law and Justice appealed his sentence. When asked how many older, sick men served time with him, Cheeks scratched his chin.

“It’s more than I can remember.”

Aging prisoners are now a fourth of the population in Alabama’s prisons—facilities the Department of Justice calls dilapidated and unsafe. In the last 50 years, Alabama’s prison population has exploded, but the state has also been keeping people longer and longer. Alabama’s general prison population grew by 607%, according to data gathered by Alabama Appleseed. But in the last 50 years, the state saw a 3,640% increase in inmates over the age of 50.

Cheeks told AL.com that the oldest inmate he knew of at Donaldson was a man nicknamed “Hen.” He was 88.

There are several reasons people like Cheeks and “Hen” are graying in prison, including the lack of retroactivity of prison reform laws enacted in the last decade and the fact that the system rarely uses options like medical furlough.

“We’ve got to find other ways to take care of this aging population including identifying those who are terminally ill, who are not a threat to public safety who can be better served outside of the facility,” said Rep. Chris England, D-Tuscaloosa, during Wednesday’s prison oversight committee meeting.

Mounting medical bills

In a 2021 report from the Alabama Department of Corrections, inmate healthcare “and other professional services” cost the department $221,765,318. That’s just over a third of the prison’s total expenditures and the most money the department spent on anything.

The state is expected to enter into a new contract for medical and mental health services for inmates in April. The $1.06 billion contract will cover four-and-half years through September 2027, costing a little over $250 million a year.

A 2012 special report from the department acknowledged the increasing amount of aging inmates, writing, “the major impact from the growth of the 50+ inmate population is the cost of ongoing health care.”

Cheeks spent just under 38 years behind bars before his 2022 release. He was diagnosed with cancer and other diseases while serving life imprisonment and had at least three surgeries in the last decade.

The now 80-year-old—who was released just weeks before his milestone birthday—spent the last two years living in the prison infirmary. And he wasn’t alone.

Last year, there were 4,262 inmate admissions to onsite prison infirmaries, the department’s data shows. State inmates accounted for another 1,356 admissions at private hospitals.

And who pays for these medical bills? Taxpayers.

Rep. Jim Hill, R-Moody, a former circuit judge who also sits on the prison oversight committee, was clear about his feelings on the aging inmate population last week.

“I guess what I am concerned about as much as anything is if we have people who are incapacitated to the point where they are simply not a threat to public safety, and I can’t give you every single example, but people who are on dialysis, people who are on chemotherapy, people who are on hospice care…that are in a situation where they simply are not a danger,” he said. “If they are a danger, they are a minimal threat to public safety.”

“And we have them in prison, and we’re rolling them around in a wheelchair and we are giving them dialysis… if that can be shifted to Medicaid, then I think we are foolish if we do not do so.”

Who are the elderly people behind bars?

According to a report from Alabama Appleseed, assuming each of their seven recently freed clients who were all serving life in prison live only to the age of 70, those seven clients alone save the state over $2 million.

The state prison system could use the money it saves on aging inmate healthcare on other things, said Rep. England last week. He said the beds being taken up by those inmates could be freed up in a system that is overcrowded.

The committee discussed ways of shifting older, sick inmates to the prison’s medical furlough program and enrolling them in Medicaid or Medicare—therefore saving the state money and beds—and other ways to fix the aging prisoner problem. That conversation received bipartisan support during the meeting, but experts are unclear whether it would work.

Sen. Dan Roberts, R-Mountain Brook, echoed the calls to explore ways that aging and sick prisoners could receive federal care if released on medical furlough, saying he was “working on this very diligently.”

Prison system commissioner John Hamm said there are strict guidelines for the medical furlough program and “probably half” of those who applied have been furloughed in the year he’s been at the department, totaling seven. In response to Hill’s comments about the system being “foolish” for not trying another avenue, Hamm replied: “Understand, judge.”

England wasn’t convinced.

“That billion-dollar contract that we’re about to sign, it’s not going to work. It’s not,” he said. “We’re going to outpace the cost of care well before we reach the end of that contract… they won’t be able to afford to care for our aging population.”

Cheeks, who uses a walker, said his shoes and other belongings went missing when he was moved to the infirmary. When he was released from prison, his lawyers had to buy him shoes because all he owned were shower slides.

He received only one disciplinary action during his almost four decades in prison, and it was just a few years after he landed behind bars. For 30 years, he worked in the kitchen at Donaldson prison. He didn’t get paid, but he was allowed to make himself an extra sandwich or two.

His mother, sister, and one of his brothers all died while he was incarcerated.

But Cheeks got lucky—he got the help of a nonprofit legal center who took on his case and with Jefferson County District Attorney Danny Carr not objecting to his release, a judge let him out last year.

“I hate that I didn’t have the chance to be around my mother and help her,” he said. “Yes, (prison) robbed me in that sense.”

Robert Cheeks

There are several reasons people are growing old in prison, one being that not all reforms have been applied to people already serving time. It’s called retroactivity, and Alabama has opted to skip that step when working on prison reform.

One of those reforms was presumptive sentencing standards, which was first enacted in the state in 2013 but wasn’t applied to the people already behind bars. The sentence they would receive if convicted today for the same crime doesn’t affect the punishment they received or what they’re still serving.

Another example is changes to Alabama’s Habitual Felony Offender Act—often called the “three strikes” law. The act was amended in 2016 and reclassified some crimes, meaning that offenses previously considered as “strikes” don’t carry the same gravity they once did for people convicted today. That’s the law that meant Cheeks was sent to die in prison.

Under current Alabama law, according to Alabama Appleseed, Cheeks would have been eligible for parole in 1994. Instead, he slowly walked out of prison using his walker—and wearing his new shoes—in July 2022.

“The time seems to have crept up on me,” said Cheeks.

Recidivism rates are hard to measure due to variables like misdemeanors, parole revocations, state versus federal charges, and other factors. But according to a report from the ACLU, research shows that “most people have significantly outlived the years in which they are most likely to commit crimes” by age 50.

That report cited data showing arrest rates drop to nearly zero for people ages 65 and older, and that prisoners aged 50 and older are “far less likely to return to prison for new crimes than their younger cohorts.”

“Prison is a place that’s bad on your mind,” Cheeks said. “I had fear in me.”

But he kept his morale up by working hard, “minding my own business,” and writing to pen pals. Several of those pen pals have visited him in the nursing home where he now lives.

Cheeks talked about the violence he saw behind bars, persistent drug usage and more. But he also talked about the kindness of inmates who brought him things from the commissary while he laid in the infirmary for two years; who helped him get the courage to ask an officer for medical attention when he needed hernia surgery in 2018; and those who he wants to write letters to now, if only he can get his hands to stop shaking from his various health issues.

Now, Cheeks is learning how to live in the free world again. He visited the Birmingham Botanical Gardens, Red Mountain Theatre, and had his 80th birthday party at The Fish Market restaurant—a celebration that was the first of its kind he’s ever had. He’s looking forward to visiting the Birmingham Zoo when the weather warms up.

But his favorite part of being out of prison, Cheeks said, is taking care of himself. He only knew of one person to get out on medical furlough while he was locked up, and that man died the day after walking out of prison, Cheeks recalled.

“I was one of the lucky ones.”