When the Nursing Home Resident in the Next Room Is a Convicted Criminal

Before Kenneth Bryan Holcomb shot and killed a homeless man in San Mateo County in 1992, he had been in prison for burglary and drug dealing. While he was serving a 22-years-to-life sentence for the murder, he fractured his spine during a fight, which left him a quadriplegic, unable to walk, dress or bathe himself. Mr. Holcomb speaks with some difficulty, although he is able to see and hear, Patrick Sparks, his lawyer, said during a medical parole hearing last September. Yet Mr. Sparks said that his client retained “the capacity in his mind for dangerousness,” a transcript shows.
 “Not to say that he’s the Godfather or anything, but he’s a pretty dangerous guy,” he said. Even so, the California Board of Parole Hearings found that because of Mr. Holcomb’s disabilities “the conditions under which the inmate would be released will not pose a reasonable threat to public safety.”

Today Mr. Holcomb lives in the Idylwood Care Center, a private 172-bed nursing home in a leafy suburban neighborhood in Sunnyvale, near a park and a private school. He and three other medical parolees from the California Department of Corrections and Rehabilitation — murderers, drug dealers and burglars, ranging in age from 40s to 70s — are watched by medical staff instead of by prison guards. The four are among the first 29 prisoners to be granted medical parole under a 2010 California law intended to save the state tens of millions of dollars in medical and guarding costs for permanently, medically incapacitated prisoners. Some of the parolees are bedridden, while others can be moved by wheelchair, and officials said that the parolees posed no threat to others.

Yet the medical parole program is raising concerns among the state’s long-term care ombudsmen, who investigate complaints from residents of nursing homes.

“There are worries involved in putting prisoners in with the regular population of frail seniors, but there is a lot of risk involved in putting them in with psych patients,” said Wanda Hale, who visited the Idylwood Care Center as the program manager for the long-term care ombudsman program at Catholic Charities in Santa Clara County. “My concern is that there is a lot of potential for problems. They just haven’t happened yet.”

The nursing facility in Sunnyvale received its first medical parolee from the Department of Corrections in August. They are all forbidden from leaving the Idylwood premises, except in a medical emergency, and they are confined to a 22-bed locked unit that they share with seven psychiatric patients.

“These medical parolees are both physically and mentally incapacitated,” said Larry Kamer, a spokesman for the nursing home, which is operated by Crestwood Behavioral Health of Sacramento. “In fact, in all but one case, they’re not even alert.”

One parolee’s interactions with staff have raised concerns, however. Peter Post, a medical parolee at another facility, “allegedly made indecent gestures to female nurses at a San Diego area long-term care facility” soon after arriving there in November, according to the state’s Department of Corrections and Rehabilitation. The Board of Parole hearings determined that Mr. Post was still eligible for medical parole.

Facilities that care for medical parolees are not required to inform other patients or their families about the parolees. The ombudsmen receive no formal notification when medical parolees are transferred to facilities in their region.

Other homes in California that accept medical parolees include Magnolia Special Care Center in El Cajon in the San Diego area and San Fernando Post Acute Hospital in Sylmar in Los Angeles, parole hearing transcripts show.

“Are these nursing homes that are caring for older adults being turned into mini-halfway-houses for parolees?” asked Joe Rodrigues, the state long-term care ombudsman. “Are you going to end up in a situation where the parolees could in theory outnumber the older residents of the facilities who are not parolees?”

Despite the intimacy of the nursing home setting, prisoners’ advocates see no threat to public safety in housing the medical parolees with other patients. The parolees “are profoundly disabled,” said Steven Fama, a lawyer with the Prison Law Office, a nonprofit public interest law firm in Berkeley. “As such, they would pose no danger to the public, near or far. We are talking about people who are incapable of performing the basic activities of daily living, and in some cases even knowing where they are.” The 29 inmates who have been granted medical parole so far will save the state more than $19 million annually, according to Joyce Hayhoe, director of legislation for California Correctional Health Care Services. Before medical parole was created, such inmates were cared for in prison hospitals or local hospitals or nursing homes while under constant guard.

“To have comatose patients guarded 24 hours a day by two prison guards by the side of the hospital bed is just crazy,” said Senator Mark Leno, the author of the medical parole law. “That’s what this is addressing.”

As an incentive for private nursing homes to accept the parolees, the state can offer to pay as much as 30 percent more than the Medicare fee schedule for their care. The state is also eligible for reimbursement from the federal government for some of the patients’ medical care, from programs like Medi-Cal, Medicare, veterans’ benefits and Social Security. The patient’s assets may also be garnished to offset medical costs.

Mr. Holcomb could end up paying for a portion of his own care.

After a brawl at Salinas Valley State Prison in June 2000, prison doctors determined that Mr. Holcomb was faking his injuries, when in fact he had fractured his neck. Mr. Holcomb contended that the misdiagnosis might have contributed to his permanent paralysis, and he later sued prison officials and doctors — one of whom was stripped of his medical license — and accepted $950,000 in a settlement.

California Correctional Health Care Services is applying on Mr. Holcomb’s behalf for MediCal coverage, which involves assessing his assets. “At that point, we’ll be able to figure out if there are assets there, and if so what steps are necessary to get them,” Ms. Hayhoe said.

At the Idylwood Care Center, patients’ rooms have two beds and a shared bathroom, although the medical parolees live singly at the moment. There are television sets in the rooms, but no telephones. One cellphone for the unit allows the staff to track the calls the parolees receive.

“These folks are no different from other patients from a clinical standpoint,” said Mr. Kamer, the Idylwood spokesman. “If you looked at these patients, you wouldn’t be able to tell” who is on medical parole, he said.

There is no requirement that facilities keep their medical parolees in a locked unit, and some, including Magnolia Special Care Center, do not. “Let’s say someone is comatose,” Mr. Leno said. “Does it matter to you, if you’re in the next bed, if this person came out of prison or not?”

Advocates for residents of nursing homes wonder how the program will change the mix of patients in facilities.

“When you’re looking to place a loved one, I think you’d be surprised if you heard about prisoners on parole,” Ms. Hale said. “It wouldn’t be a good selling point to you.”