Denied for old crimes: The complex challenge of long-term care for America’s aging sex offenders
Admission was repeatedly denied despite professional evaluations of his appropriate behavior during a preceding hospital stay of more than 30 days. He also needed so much assistance with daily activities that he would have been physically incapable of assaulting anyone, Jerstad said.
As thousands of Americans are added to registries each year and more of them age into needing long-term care, patients and providers are left to wade through an increasingly complex healthcare access issue without much formal guidance.
In some states, nursing homes within close proximity to a school, park or daycare center cannot legally admit sex offenders. In another 12 states, there are specific communication and notification rules for nursing homes.
But the federal government is mute on when to accept or deny sex offenders.
Last year, there were nearly 800,000 Americans on a sex offender registry, an increase of nearly 43,000 since 2019. Many states also have expanded the list of offenses that land someone on a registry, and lengthened the time on the registry as a sentencing tool.
In states without clear rules, it can be hard for providers to understand their rights and responsibilities when it comes to both this would-be patient population and their current residents and staff.
“Long-term care providers are called to serve diverse populations with compassion, safety and dignity. Complex and sensitive situations, such as those that are on state sex offender registries, make this difficult to navigate,” Kierstin Reed, CEO of LeadingAge Nebraska, told McKnight’s Long-Term Care News.
“While these individuals may be legally entitled to receive care, their presence in a congregate setting raises significant considerations for resident safety, staff preparedness, community perception, and regulatory compliance.”
Growing need for care
In many states, experts said, uncertainty has led nursing homes to adopt policies excluding anyone on a sex offender registry. In many cases, nursing homes also restrict admission for anyone ever convicted of a sex-related crime, whether they’re on a registry or not.
Facilities look at possible admissions of sex offenders “more as a risk and a liability issue, but the risk is so minimal,” said Jerstad, PhD, an assistant professor of criminology at Millersville University in Pennsylvania.
In Jerstad’s state, there are about 26,000 individuals on the registry, and about 19% of the population is 65 or older. That means there are already about 5,000 senior offenders there, and of those, Jerstad points to statistics showing about 56% will eventually require long-term care.
“We’re not talking about just a handful of people. We’re talking about thousands of people. It’s affecting them, it’s affecting their families who can’t take care of them,” she said. “It’s a public health issue. It’s a medical ethics issue, and it’s a social justice issue. We’re denying access to treatment and healthcare solely based on their prior criminal history. They can go to the hospital just fine. They can go to urgent care just fine. They can have home health come in. They can go to a rehabilitation hospital just fine.”
What makes an offender?
The expansion of crimes that can land someone on sex offender lists has created a lack of understanding among providers, who may envision any offender as unable to be rehabilitated, Jerstad said. But state by state, laws vary, and some minor crimes can carry a 25-year or lifetime registration requirement.
In Indiana, for example, urinating in public was considered a lewd act and could require sex offender registry up until 2010. Teens in consensual relationships but convicted of statutory rape without the protection of Romeo and Juliet laws also could be placed on a list.
“We’ve just widened the net to throw all these people into the same category, and the majority of people who have sex offenses, they’re not sexually violent predators,” Jerstad said.
Explaining that to other residents — and their families — makes this an incredibly difficult situation for nursing home leaders to handle, however.
iCare Health Network has several MissonCare nursing homes designed to accommodate judicially involved patients, including many listed on sex offender registries. The organization also accepts some patients convicted of sex crimes at its regular nursing homes on a case-by-case basis, and only after using the same lengthy review process it imposes at its specialized campuses.
“It’s definitely the most stigmatized thing you could imagine and sometimes more than any other crime, even if that’s something most people would consider even more egregious,” said iCare’s David Skoczulek, vice president of business development and communications.
“People use their imagination on what a sex offender means and what they’ve done,” he added. “It catches many people in this net [but] there’s a stark difference between somebody who’s had a recent crime with violence against someone they don’t know … versus somebody whose crime is 30 years old and was sexual assault but it in a very specific circumstance.”
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