California finally is making headway in reducing numbers in overcrowded prisons – enough to get the federal courts to say that the end of federal receivership "appears to be in sight."

But to get California prisons back under state control, the state will have to provide a credible plan by the end of April for tackling the other major problem in the prison system: An aging inmate population.

A new report issued last Friday, "Old Behind Bars: The Aging Prison Population in the United States" by Human Rights Watch, puts the California situation in national perspective.

In 1990, California state prisoners age 55 or older were a manageable 2.1 percent of the prison population. In 2009, they were 7.1 percent – taking up 38 percent of prison medical beds.

By 2019, the state expects older prisoners to be 15 percent of the prison population. California either has to find a way to house frail, ill people behind bars – or review sentencing and release policies to figure out how reduce the growing population of older prisoners without risking public safety.

Dealing with geriatric populations behind bars is costly, especially since prisoners are not eligible for federal health insurance programs for the elderly – Medicare and Medicaid. The state picks up the tab.

In addition to normal prison security costs, the state has to deal with the ailments of the old – mobility impairments, hearing and vision loss, dementia, illnesses that are chronic, disabling and terminal. Prisoners may not be able to climb into an upper bunk or up stairs, change their clothes or clean up their cells when they have an "accident" and soil themselves.

As the report notes, prison systems also have to deal with a population that has an "accelerated aging process." A 50-year-old, for example, may be frail and riddled with disease, more like someone in their 60s.

Keeping these older inmates in prison costs a lot more than incarcerating a healthy 25-year-old.

To get out from under the receivership, California will have to craft a comprehensive strategy for dealing with older prisoners. What is causing the growth in the elderly inmate population? What are the characteristics of elderly inmates? What are other states doing to address issues of an aging inmate population?

Perhaps most important, what other solutions are worth pursuing to avoid overwhelming in-prison expenses for elderly inmates?

For Human Rights Watch, treatment of elderly prisoners poses legal and constitutional issues. But for all Californians, it should also raise cost-benefit issues.

We have to ask ourselves, are we willing to bear the cost of keeping old, frail offenders in prison – or can we find more cost-effective solutions? That is the task that state officials have to address before going back to the federal judge in April.

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