Roger Richardson has been in and out of jail throughout his adult life for various offenses, including drug possession, and most recently, violating his probation. Now 59, he hopes that being housed in a new unit for older adults at the Middlesex Jail & House of Correction in Billerica, Mass., will help him stay out for good once he’s released. The Older Adult Re-Entry (OAR) unit, created in collaboration with a team from Sargent, provides age-appropriate care for incarcerated adults aged 55 and older. It aims to prepare them for life outside prison walls by stimulating the mind and teaching skills for independent living. All residents are required to participate in occupational therapy and rehabilitation programming designed by the Sargent team—with the ultimate goal of reducing recidivism.

Richardson was invited to apply to the medium-security jail’s new unit in October 2024. “It’s been pretty good, you know?” he says. He describes the unit as “quieter, calmer, and more comfortable” than housing for the general population. And he’s enjoyed the programming, which includes foreign language classes, Alcoholics Anonymous meetings, and occupational therapy. “It’s helped me a lot,” Richardson says. “I’d definitely do it again if I had to—but hopefully, I never have to come back.”About 20 men, those incarcerated and those awaiting trial, live in the voluntary unit. While its windows still have grates and the door still locks from the outside, OAR is specially designed to meet the needs of older adults. There are no upper bunks, which can be difficult to climb into. The beds, arranged in neat rows, dormitory-style instead of in individual cells, are raised to make it easier for residents to get in and out. The unit also has padded rocking chairs to stimulate the brain’s balance systems, low-threshold shower stalls to prevent tripping, and directional signage on the floors to reduce the risk of falling.

At the March 21, 2025, opening ceremony and tour of the facility for government officials and the press, Middlesex Sheriff Peter Koutoujian said he and his colleagues believe OAR is the only unit in the country that combines specialized accommodations for older adults with rehabilitation programming.

“We are truly thrilled to be part of this innovative and groundbreaking project that is first of its kind in the United States,” Sargent Dean Jack Dennerlein said at the event. He believes that OAR will make a meaningful impact on the lives of those in the unit and the communities they return to after their release, as well as on Sargent’s students and faculty. Dennerlein said he hopes the unit can “pave the way for a more equitable and rehabilitative approach to corrections.”

A Growing Need for Specialized Care

Older adults are the fastest-growing demographic across the United States, including in its jails and prisons. The proportion of state and federal prisoners who are 55 or older is about five times what it was three decades ago. This trend is driven, in part, by longer life expectancy, harsher sentencing (in some cases), and the rising number of crimes committed due to economic hardship (stealing, for example).

Older incarcerated adults face higher rates of chronic diseases and victimization compared to the general prison population, making them the most costly group to house. Research also shows that incarceration accelerates the aging process.

In 2019, Koutoujian had the idea of creating an older adult reentry preparation unit, similar to other targeted units at the Middlesex facility, such as those for young offenders ages 18 to 24 and for military veterans. He and his team first consulted with UMass Boston’s Gerontology Institute and sociology department to conduct a needs assessment of the older population at the Middlesex facility. Older adults face specific challenges in jail, says the assessment’s coauthor Laura Driscoll (’99,’01), a UMass alum whose dissertation focused on her work on the project.

“Older adults tend to have worse hearing and vision issues, and they can’t always hear the instructions they are supposed to follow, or even be able to visually identify where they are supposed to go,” says Driscoll, a Sargent clinical assistant professor of physical therapy and a board certified geriatric physical therapist. “And they may not have access to the typical things that older people have, such as specialized meals, a walker, or a cane.”

The UMass team concluded that the Middlesex Jail’s aging population would greatly benefit from a specialized housing unit and accommodations.

In 2023, Shawn MacMaster, Middlesex assistant superintendent of program services, emailed Emily Rothman, a Sargent professor and chair of occupational therapy, to inquire about a partnership. He’d learned about BU’s best-in-the-nation occupational therapy program after a simple Google search. Rothman’s staff were thrilled by the invitation.

“We got a tour and drew up recommendations,” says Anne Escher (’08), a clinical associate professor of occupational therapy, who worked alongside Jennifer Kaldenberg (SPH’18), a clinical associate professor of occupational therapy, and Jennifer Keenan (CAS’07, Wheelock’12,’22), assistant dean of clinical education administration and community partnerships. “They took every single one.”

Five Pillars of OAR

Beyond the physical accessibility enhancements, OAR has five pillars: treatment, including AA meetings and substance use disorder programming; social enrichment, like games and puzzles; education, in the form of foreign language, life skills, and book groups; occupational therapy, to teach goal-setting and achievement, executive functioning skills, self-regulation, and healthy roles, routines, and habits; and health and nutrition.

Koutoujian says these pillars aim to reduce isolation, foster prosocial behavior, and promote cognitive health. Challenging the mind “is something we focus a little bit more on here than we do in other units, since this acts as a protective factor against cognitive decline,” he says.

The programs focus on creating healthy routines, managing stress, and using cognitive strategies, such as visual aids and routines to focus better and finish tasks, all aimed at setting the men up for success after leaving jail. There are workshops on digital literacy, financial planning, healthy living, effective communication, self-confidence, teamwork, and family reunification.

Over the last year, Sargent’s occupational and physical therapy students have also worked in the unit, helping with tasks like needs assessments, an exercise guide, and group therapy. In March 2025, Driscoll started an exercise program with the men on the unit, which Sargent students now help to lead.

A National Model

Before OAR opened, Sargent’s team trained the corrections officers on age-related changes and how to support these older residents.

“If someone seems not to be listening to you when you announce it’s time to hand out medicine, it might just be because they can’t hear you,” Keenan says. “So maybe just go over to them and calmly say, ‘Hey, did you hear that?’ If they start to act differently when the sun starts to go down, it could be a sign of dementia or a sign of general confusion.”

Team members say this training has been well-received by the Middlesex officers, which perhaps isn’t surprising. Research shows positive effects on correction officers who lead reentry programs and specialized units with a focus on rehabilitation—rather than a punitive approach.

Some of this has to do with stress levels. “If everyone is expecting violence [in a prison], then everyone is on edge all of the time,” Keenan says. “It raises people’s stress levels. But there is some evidence to show that having approaches like this, that are targeted toward the actual needs of the people living there, actually reduces the stress on the people who are running the unit too.”

Koutoujian believes OAR has the power to influence the future of corrections. “This unit is visionary,” he said during the tour. “This can be—and should be—a national model.”

STORY BY AMY LASKOWSKI
PHOTOS BY CYDNEY SCOTT AND JAKE BELCHER