ʻIAEA, Hawai'i — Christian Alameda used a cane to get out of bed in his cell at Halawa Correctional Facility in Honolulu. He has been recovering in the prison's medical infirmary since a stroke in January left the right side of his body virtually paralyzed.
In February, Hawaii's parole board granted parole to the now 52-year-old, allowing inmates to receive early parole to seek medical care for serious conditions.
But without a long-term care facility willing to take him, Alameda hasn't been able to leave.
In June, at least three other prisoners who had been granted release to attend to their medical needs were living indefinitely in the infirmary after long-term care facilities were unwilling to accept them, primarily because of their criminal records, the state parole authority said.
“This is a challenge across the country,” said Molly Crane, an attorney with FAMM, which advocates for equity in prison policies.
All states allow compassionate release of prisoners, although Hawaii is the only one that does not have a specific law and is based on internal policy. Prisoners who typically qualify for compassionate release are unable to care for themselves or are terminally ill and may need an assisted living facility, nursing home or hospice.
But many long-term care facilities across the country refuse to accept those prisoners, leaving them incarcerated for months (or years) after they are granted freedom.
In Rhode Island, a study found that nursing home denials spiked after they were told a patient was coming from prison. In Colorado, inmates with high medical needs stayed an average of 200 days after being granted parole, due to refusals from long-term care facilities. And in New York, prisoners who were granted parole sued the state when they couldn't be placed in nursing homes.
President Donald Trump's signature, the One Big Beautiful Bill, further tests the ability of long-term care providers to move people out of incarceration. Inmates do not qualify for Medicaid, so parolees often must apply after they are granted release. The law, enacted last summer, reduces the period in which facilities can get retroactive reimbursements for new Medicaid patients from three months to just 30 days before applying. That means facilities risk not receiving payment for new Medicaid patients whose applications are not submitted within the reduced deadline.
The Centers for Medicare and Medicaid Services “encourages providers and beneficiaries to prioritize timely submission of applications to maximize coverage,” said CMS spokesman Timothy Foster.
'The risk is too high'
Most nursing homes across the country already have a waiting list for new residents, according to a 2024 report from the American Health Care Association and the National Center for Assisted Living. Those waiting lists are another obstacle to achieving prisoner placements, said Bob Merce, a former attorney who advocates for the compassionate release of prisoners.
“We tell nursing homes that most of the people we're talking about can't hurt anyone,” Merce said.
Some of the prisoners housed in the Halawa infirmary in June were unable to walk or dress themselves. A man couldn't remember what his illness was. Another with brain cancer could not coherently answer questions.
Sean Sanada, CEO of Hawai'i Health Systems Corp.'s O'ahu region, oversees the region's two state-funded long-term care facilities, Leahi Hospital and Maluhia. Sanada said the health system has reviewed dozens of compassionate release referrals but has never accepted any of them.
Sanada said the facilities do not discriminate based on a resident's origin. His main concerns, he said, were the safety of his staff and the lack of resources to properly care for the patient.
“The risk is too high in most of those cases,” Sanada said.
Violent incidents in long-term care facilities are well documented. A 2024 study looking at 14 assisted living facilities found that in just one month, 15% of residents experienced resident-on-resident aggression.
When long-term care facilities refuse to accept inmates who have been granted compassionate release, state taxpayers foot a larger bill. The annual cost of incarcerating a person in Hawai'i with complex needs is up to eight times the average $112,505 it costs to house a person in prison, according to FAMM. By comparison, the average Medicaid reimbursement for a long-term care patient at a Hawai'i Health Systems Corp. facility is about $135,000 a year.
According to FAMM, four states (Connecticut, Georgia, Massachusetts and Vermont) contract with nursing facilities to accept prisoners who are granted compassionate release.
iCare Health Network's MissionCare Health, which operates nursing homes for people leaving prison, won contracts in three of those states. David Skoczulek, iCare's vice president of business development and communications, estimated its rates are $100 to $350 per day more per patient than average nursing home rates in the states where they operate.
In Hawaii, the corrections department determines recommendations to send to the parole board, which decides whether to grant release. Inmates granted early parole may be released to family members who agree to care for them or to a long-term care facility.
Corey Reincke, director of the Hawaii Parole Authority, said that in his 24-year career he could not remember placing anyone in a long-term care facility without the family intervening, such as by contacting the facilities themselves.
“Probation has to find a facility that can meet their medical needs and is also willing to accept them,” Reincke said. “That's where we hit the roadblocks.”
For a parolee, Reincke called more than 100 nursing homes, he said, but all refused to accept the patient for safety reasons. According to a 2024 state report, while Hawaii's long-term care facilities use about 80% of their bed capacity, labor tensions make it difficult to maintain even those levels.
Hawaii Prisoner Shelter: Family
Last year, Paul Kupihea, 69, died in a hospital five days after the state granted him compassionate release to his family. He died before he could catch a flight to his native island.
In July 2025, Lahela Kruse, the mother of Kupihea's son, received a call from a Honolulu hospital informing her that his condition had become serious. By then he had been diagnosed with an incurable form of cancer and had been in and out of hospital while still in custody.
Kruse and her daughter flew to O'ahu to see him and were shocked to see how sick he was. His daughter agreed to take him into her home in Hilo, on the island of Hawaii, despite not having had a relationship with him for most of her life.
“She knew he was sick,” Kruse said. “I told her that, but she didn't know the seriousness of it. I really didn't know.”
His daughter's willingness to take him in caused his compassionate release. But Kruse said the notification about Kupihea's illness came too late.
FAMM's Crane has been working to expand compassionate release laws in states to allow more prisoners to qualify and strengthen transparency in the process. Hawaiian lawmakers have tried for years to pass compassionate release bills, but none have been successful.
Crane said without a law outlining a formal process and who qualifies, even family support isn't enough. Inmates may still face life-threatening delays, he said.
“The absence of a compassionate release statute means that people who need compassionate release languish and even die in prison,” Crane said.
In Alameda's cell, there were two beds about 3 feet apart, with a seatless metal toilet in the corner and a window facing a concrete wall. The smell of bleach permeated the room. Alameda said she hoped to see her daughter soon. She recently turned 5 years old.
“I made some mistakes in my life,” said Alameda, who has been incarcerated since 2024 for drug possession, driving a stolen vehicle and bail jumping. “I tried when my daughter was born, but I know I will change, because she needs me to get me out of here.”
Mercé, the former prosecutor, is still trying to find a place for Alameda, who committed no violent crimes. Merce became aware of the struggles of prisoners through his work as a trial attorney. He said he has helped about 15 prisoners leave Hawaii correctional facilities for medical treatment.
He said he has seen cases where people have waited years to get out.
“The ones that stick with me, though,” Merce said, “are the ones I never found placements for.”
