Offenders in some Missouri prisons are breaking down walls — emotional walls. They’re demolishing the barriers they’ve spent years building while inside a prison cell. But it’s only at the end of their sentence, the end of their life, that those walls finally crumble. And they crumble with a fellow inmate by their side.
It’s all part of the Missouri Department of Corrections (MODOC) Hospice Program, which started in 2015, where offenders are trained to provide end-of-life care for their peers.
Deloise Williams, assistant division director of medical services at MODOC, said Missouri prisons have anywhere between eight to 10 hospice patients each month. But the fact that they’re prisoners doesn’t change the kind of care they’re getting.
“People are people are people,” she said. “I know what that person did because they are in prison. That's not my focus. The focus is not on who that person is, what that person has done and their life, but the focus should be, ‘How can I provide care and comfort to that person to make this a more natural process?’”
In the two hospice care rooms located in the infirmary at Jefferson City Correctional Center (JCCC), offenders live out their final days. There’s not much to look at: two small paintings of a snowy landscape, a bulletin board for photos of family and a single, narrow window just under the ceiling with a view of a fence and barbed wire.
Kevin Dyal has been an inmate at JCCC for 18 years and is a volunteer in the hospice program. He sits with his peers, reads to them, writes letters for them, and he helps them come to terms with death.
One patient’s death struck a chord with Dyal. He said the man wasn’t able to eat well. It was a man he had known for years. Although the man had been in a bad mood for days, on this particular day, Dyal saw his spirits lift as he took him through the halls of the hospice unit. And there was cake.
Dyal mixed the cake with Kool-Aid so that his patient could enjoy the treat. But when Dyal left for a few minutes to tend to another patient, something happened.
“I come back, and he's looking at me, and he grabs my hand and holds my hand and starts doing hiccupping,” Dyal said.
Minutes later, the man was dead, and Dyal was terrified the man had choked on the Kool-Aid/cake concoction. But it was a heart attack that was the official cause of death.
“That was a hard one for me. And luckily, I had other hospice guys who were right there who were trying to comfort me because I was not in a very good head right then,” he said. “It was sad for me.”
Dyal is serving a life sentence for second-degree murder.
He’s one of more than 250 volunteers who help with hospice care in Missouri prisons, ensuring inmates don’t die alone.
Prison hospice programs are becoming more common as inmate populations age. According to 2014 data from the U.S. Department of Justice, the mortality rate in Missouri prisons increased by 70 percent within a 13-year period. Most of those deaths are caused by cancer. Thus, the need for end-of-life care increased.
CEO of the Missouri Hospice and Palliative Care Association, Jane Moore, said she saw that need and wanted to act on it.
“At that point in their life, whatever they were there for, they’re not going to be a danger to society at that point by any means,” she said. “Many of them can’t even get up, they’re bed bound at that point because they’re at the end of life.”
According to 2012 data from the National Prison Hospice Association, there were about 75 prisons in the United States with access to hospice care, and out of those 75, about half use prisoners as volunteers. Louisiana and Maine are two of the states with a similar program, and Moore designed Missouri’s off of the program in those states.
But the program wasn’t easy to start. Moore first went to MODOC with the idea back in 2013, but the Hospice and Palliative Care Association didn’t train the first group of volunteers until 2015.
Moore said the implementation of the program took so long because of the back and forth between MODOC and the Hospice and Palliative Care Association. They slowly ironed out small details like how much information could be disclosed in journaling and how much the inmates could touch one another.
“We had to go back and manage some of the areas where we do a lot of touchy-feely stuff in hospice,” she said. “So we had to figure out how do we work that? I mean, how much can we do? Can they touch somebody’s hand?”
The Missouri Hospice and Palliative Care Association has trained prisoners at 12 of the 21 Missouri prisons. There are plans to train offenders at another Missouri Prison in early 2018 and to add dementia training to the curriculum.
Moore said the association underwrites what it does for MODOC when it comes to training the offenders. Doctors and nurses volunteer their time to spend a day with criminals and teach them about end-of-life care.
“This was our sort of gift, being part and parcel and being on board with this idea that it would be a really great program to put into place,” Moore said. “We volunteered all our time, we volunteered the organization and all of the work.”
Dyal is no stranger to death. He was convicted for assisting in the murder of his stepmother, and during his time behind bars, he’s helped his friends die peacefully. But despite all the death, he still volunteers. He still reads to his peers who are at the end of their life; he still writes for them; he still feeds them cake.
“What I like now is to know that someone is not dying in the worst place you can die — alone. No one there for you; no one to care for you,” Dyal said. “That's what I enjoy from hospice.”