LA GRANGE - Patrick O'Hara, a prisoner convicted of murder, is 69 years old and mostly confined to his bed. He is incarcerated in a sparkling-clean facility where nurses work behind steel cages and he gets oxygen from tubes in his nose while a television mumbles nearby.
He's one of 67 inmates in the Kentucky State Reformatory's nursing care facility, which costs state taxpayers more than $4.4 million a year. In a state grappling with $1.6 billion in budget cuts since 2008, some Kentucky lawmakers ask why it's worth keeping O'Hara and others like him behind bars.
The state legislature has approved a pilot program that requires Kentucky to parole some infirm inmates - excluding sex offenders and death row inmates - to private nursing homes where the federal government, through Medicaid, would pay most of the medical bills.
For the plan to work, inmates cannot be in prison. The federal government will not pay for inmates' medical expenses. But if the inmates are paroled to a private facility, they become eligible for Medicaid. Inmates who leave the nursing home would be returned to prison for violating parole.
The expanded program comes as many states are grappling with the cost of aging prisoners. Connecticut began paroling inmates to a private nursing home last year under a program officials say will save that state up to $5 million annually.
From 1995 to 2010, when the nation's prison population grew 42 percent, the number of inmates over age 55 quadrupled, according to a 2012 study by Human Rights Watch. From 2001 to 2008, state spending on inmate health care increased in 42 of 44 states surveyed by the Pew Charitable Trust and the MacArthur Foundation.
The geriatric prison population is swelling for multiple reasons, including longer prison sentences with no chance of parole and the fact that the huge population of aging baby boomers accounts for more arrests.
"It's not a crime wave, it's just there are more older people in that age category," said Ron Aday, a professor at Middle Tennessee State University and author of the book "Aging Prisoners: Crisis in American Corrections."
It costs $182 per day to care for inmates like O'Hara, while Kentucky's daily cost for an average healthy inmate is $50.
"That really isn't the mission of the department to provide nursing care for elderly folks," Kentucky Corrections Commissioner LaDonna Thompson said.
But it's not the mission of private nursing facilities to cater to ex-convicts, said Steve McClain, communications director for the Kentucky Association of Health Care Facilities. Kentucky nursing homes have among the highest liability costs in the country, according to a 2013 study from the American Health Care Association and Aon Global Risk Consulting.
"There's just a huge liability risk that our facilities have anyway, that they are not going to take this without a lot of thought and discussion," McClain said.
Kentucky already has a medical parole option, subject to the parole board's discretion. Since 2011, the department has released 12 inmates on medical parole. Of the 67 inmates in the nursing care facility, three have already been denied medical parole.
The new program, enacted as part of the state budget, requires the parole board to parole inmates if they meet certain conditions. Even then, however, they might not have a place to go.
O'Hara was paroled to a Louisville halfway house in December 2010 but stayed there only one day because his condition had deteriorated so much he needed full time care, prison officials said. Because no private nursing facility would take him, corrections officials say they had no choice but to revoke his parole and lock him up again.
"I got a parole, just have no place to go," O'Hara said.
That's where Carlo Musso sees opportunity. The Georgia doctor owns CorrectHealth, a company that provides prison medical services. Last year, Musso purchased an old prison in Milledgeville, Georgia, that he is converting into nursing facility for paroled inmates. Musso said he expects to hire about 200 people there.
"When we studied the problem, in many states we found much to our surprise that many inmates were past their parole date - but because they were so medically fragile they had no place to go," Musso said. "I don't know if you would want an individual who has a prior history of violent criminal past mixed in with your grandparents."
The Atlanta Journal-Constitution reported that Musso bought the Georgia prison for half of its appraised value and stands to make millions of dollars off the deal, which some have criticized.
"We responded to an open bid process ... and it's all above board," Musso said.
Musso has participated in some of Georgia's executions. In 2011, some anti-death penalty advocates asked for Musso's medical license to be revoked because they said he imported sodium thiopental from overseas without registering with state regulators. At the time, Musso said he was being targeted for political purposes.
Musso has hired Kentucky lobbyist Kim Nelson, who has introduced him to some Kentucky lawmakers. Kentucky House Speaker Greg Stumbo said he wants Musso to open a similar facility at the defunct Otter Creek Correctional Center in Wheelwright. The private, for-profit prison closed in 2012 after the state removed its inmates.
Stumbo said he has been trying to reopen the facility to create jobs for his district.
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