High Dependency Unit (HDU), Rimutaka Prison - a first in New Zealand
A 78 year old male struggles out of bed. He has trouble breathing and has dementia. He requires 24-hour care, is unable to toilet or dress himself and has difficulty understanding simple instructions. He is a prisoner in the High Dependency Unit at Rimutaka Prison, and will not be eligible for parole until 2019.
In response to the increasing health needs of prisoners, in 2012 the Department of Corrections, Ministry of Health and Hutt Valley District Health Board, worked together and set up the country's first ever High Dependency Unit (HDU) at Rimutaka Prison.
The New Zealand population is aging, and so is the prison population. Between 2000-2009 there was a 94% increase in the number of prisoners aged 50 years and over.
There are 8,600 people in prison, 1,195 of whom are 50 years and older, with 94 people being 70 years and older. A history of drug and alcohol use, violence, lack of adequate medical care and deprivation can take its toll on an individual's health, so that a 50 year old prisoner often suffers similar health problems to someone 10 years older.
An ageing prison population brings with it increased health issues. Heart disease, arthritis, cancer, hypertension, prostate problems, diabetes, and dementia are on the rise, as is the number of prisoners who, while not elderly, have significant health needs.
The 20-bed HDU caters for people with physical disabilities and neurological disorders. Most of the residents are in their seventies or eighties, with serious medical conditions that mean they need help with daily activities such as showering, toileting and eating. They have single-person rooms, which resemble hospital rooms more than prison cells.
The HDU features Health Services staff supported by a custodial team. There is a dedicated registered nurse at the unit, as well as healthcare assistants who provide 24 hour care.
The team works closely with the local district health board to ensure they are providing levels of care equivalent to those outside the prison. The Hutt Valley DHB provides excellent support to the unit with assessments of patients with particular health needs and education sessions for health staff on those needs. In addition, the occupational therapy service and palliative care team visit the unit to assess patients, to familiarise themselves with the unit and see how they can provide further support. Health appointments can be delivered in the unit, which means that the need for transport to hospital clinics is reduced.
At present, there are 18 men in the unit. The HDU provides a safe and secure environment where people can be supported to either transition out of prison or age with dignity within the prison.