Behind Bars: They're elderly or infirm – and in jail. What life in Changi Prison is like for these inmates

In this second of a three-part series on life in Changi Prison, CNA looks at how some elderly or infirm inmates are housed in assisted living cells.

SINGAPORE: Time waits for no one, even those behind bars. Age and infirmity catch up with you even when you are in prison.

While jail isn't a bed of roses for anyone, mobility issues that crop up with old age or ill health can make life in Singapore's prison system even harder than intended.

After a fall in prison in 2022, 48-year-old inmate Ska (not his real name), suffered a slipped disc and could not walk for three months.

"From one to 10, the pain was around eight," he told CNA in an interview facilitated by the Singapore Prison Service. "Really painful and ... I couldn't sleep. Each time I move, it was like pressure (on my back)."

Ska was diagnosed with lumbar spondylosisa, a degenerative spine condition. His medical officer told him it would take time, medication and physical therapy to recover.

After months of not being able to walk, his leg muscles felt stiff and weak. That set off alarm bells. "I can't let that happen, because I want to walk," he said.

Ska, who is serving a 14-year sentence for drug trafficking, resolved to be on his feet again. In November 2022, he moved into a special class of prison cells with assisted living to start his rehabilitation.

Instead of eight men to a cell sleeping on straw mats on the floor, here Ska sleeps on a plastic bed in a cell he shares with three others. The raised bed means he can lower himself onto it more easily.

He has access to a toilet seat, instead of a squat pan, and even a commode if he needs one. The toilet in the cell has anti-slip flooring to prevent falls, and grab bars on its walls that he can hold onto for support.

Outside his cell, Ska moves around in a wheelchair. Inside his cell, he is now able to shuffle short distances on foot, although his steps are still unsteady.

"I can't say (it's) comfortable, to be honest with you. You have to adapt," said Ska, who still holds out hope for a mattress to sleep on. But he believes the specially designed cell is "conducive" to his recovery.

Assisted living cells have been available to inmates in three of Changi Prison's correctional institutions – Institution A5 for men, Institution A4 for women and the Drug Rehabilitation Centre – since March 2016.

There are currently 60 to 70 inmates in assisted living across the three institutions. The assisted living cells have a total capacity of about 100 inmates, said Deputy Superintendent of Prisons Raymond Ong, officer-in-charge of the assisted living correctional unit in Institution A5.

"The decision to have such a unit stems from the growing concern (about the) ageing population within our correctional system," said DSP Ong.

The percentage of inmates aged 60 and above was 13.3 per cent in 2022, or 672 inmates out of a prison population of 5,038. This was a slight increase from 13.2 per cent, or 787 out of 5,945 inmates, in 2021.

The assisted living cells align with the prison service's emphasis on the welfare and rehabilitation of inmates, regardless of age or physical condition, said DSP Ong.

Inmates who hope to be assigned to an assisted living cell must be nominated by their correctional institution, and undergo a physical assessment by a prison medical officer on their suitability.

Mobility issues, and not age, are the primary consideration. At the same time, eligible inmates must be able to perform essential daily activities – like using the toilet, dressing and feeding themselves – independently in an assisted living cell.

This is to ensure the cells serve their intended purpose of providing care and support to those who genuinely need it, said DSP Ong.

Inmates in assisted living also work out through simple stretching and movement exercises with volunteers at the prison, some of whom have backgrounds in physiotherapy.

Years before entering jail, 63-year-old Tong (not his real name) injured his knee playing sports and in a traffic accident. His injury causes him to feel stabbing pain. He uses a walker to get around, and cannot walk for long distances.

Tong, who is serving 10 years for a sex-related offence, said he is grateful to the volunteers who have helped him with strength-building exercises for his muscles and joints.

"The idea is not to let your muscles deteriorate, but to let your muscles be alive again, or it will be more troublesome next time," he said in Mandarin.

Having learnt by heart the moves the volunteers taught him, he does warm-up exercises and physiotherapy exercises in his cell every morning, from the time he wakes up at 4am to about 6am.

Twice a week, during yard time, Tong also practises walking around the hard court on the advice of the volunteers.

The prison service is now exploring installing exercise equipment in the yard to help inmates with physical rehabilitation, said DSP Ong.

RELEASE IN OLD AGE

While still in prison, elderly inmates on the assisted living programme also receive throughcare support from case workers, who help to identify and meet the needs they are likely to have upon release.

This can range from determining if the inmates need mobility aids, to whether they have a place to live when they are out of prison.

Since August 2023, social services organisation Care Community Services Society (CCSS) has provided throughcare support through psychology-based group work and individual counselling to elderly offenders.

In prison, case workers meet the inmates for nine sessions in a group setting, and at least six sessions for individual counselling. After release, they meet another six times individually.

Case workers talk to inmates to understand their family and living situations upon release, and identify gaps in social support, housing, healthcare, employment and financial assistance.

As of end-March, the throughcare programme has supported four cohorts of offenders comprising 28 elderly inmates. Two offenders in the programme have been released from Changi Prison.

One inmate declined further assistance as he felt he already had the necessary peer support, said Mr Chan Soon Onn, a social worker and head of CarePrison at CCSS.

The second inmate was getting his case worker's assistance in applying for rental housing, the Community Health Assist Scheme, a public transport concession pass and SingPass renewal, as well as employment support and counselling.

"This same inmate has underlying health issues and recently received inpatient medical assistance at one of the restructured hospitals," added Mr Chan.

Elderly offenders face a set of unique challenges encompassing social isolation, their ability to carry out basic activities of daily living, and difficulties connecting to social services and resources, said Mr Chan.

Many elderly inmates are also repeat offenders. Going in and out of jail means their connection to family or a social network is likely to be poor. Some of their own kin may simply no longer be around.

One of the programme's aims is to connect the inmates to Active Ageing Centres near their homes. It is common for ex-offenders to have low confidence when it comes to navigating such resources, said Mr Chan.

During group work sessions in prison, they tackle this by giving inmates an introduction to the Active Ageing Centres and simulating what it would be like to walk into one and ask for assistance.

Instilling confidence in the inmates to prepare them for life outside prison looks different for each individual, and the case worker can play an outsized role.

Building rapport and trust between the inmate and his case worker is important, because for those behind bars, these interactions represent the possibility of reintegration in society at large, said Mr Chan.

"The goal of the case manager is to really help them to develop pro-social attitudes in order to regain their sense of meaning and what change is about." 

For both Ska and Tong, physical rehabilitation is part of a dream of having a better quality of life, and ultimately a better life, outside prison.

Ska, who has served about eight years of his 14-year sentence, is a keen musician who used to play the keyboard, guitar and drums before his injury.

He can still play instruments while seated, but is motivated to get better so that he has the strength to perform on stage as part of a band one day.

Tong, who has served more than four years, looks forward to the remission of his 10-year sentence and the possibility of finishing his recovery at home.

His goal is to be healthy and out of prison so he can help his family. "Family is very important to me," he said.