A Prison Hospice Program for the Living and the Dying

Most people who die in prison die alone. Programs like the one at California Medical Facility aim to prevent that.

Allan Krenitsky, an incarcerated hospice worker, cares for a dying inmate at California Medical Facility.

A Prison Hospice Program for the Living and the Dying

Most people who die in prison die alone. Programs like the one at California Medical Facility aim to prevent that.

Mario Koran

Photographs by Dru Donovan

Mario Koran, who has written for The Times about serving time in jail, spoke with more than a dozen current and formerly incarcerated people to understand their experiences with death behind bars.

• Nov. 6, 2025

Gerrard Hite is circling the path that winds around the garden, pointing out the plants he has nurtured under a merciless California sun. He knows the name of each one in this 4,000-square-foot garden, their history, even their names in Latin. He moves casually but with purpose, pausing to gently scoop up a branch of a Mexican sage bush.

This one, he explains, is special: It attracts the hummingbird, the symbol for hospice and the reason he and others who tend to the dying wear pins of them on their shirts.

Image

Gerrard Hite tending to an artichoke plant. What started as a patch of concrete outside the unit has turned into a 4,000-square-foot garden, offering respite to dying patients and those caring for them.

Mr. Hite is incarcerated at California Medical Facility in Vacaville, Calif., a medium-security penitentiary within the state’s sprawling prison system. Most of the 2,144 men who live here require specialized medical care. Some are dying in the facility’s hospice unit. Others, like Mr. Hite, have volunteered to look after their peers in their final days. For them, the unit, and the garden in particular, offers something rare in prison: a sense of purpose and connection.

“When you get outside these walls, when you’re released, you breathe fresh air, freedom air, which is different than the air in here,” said Mr. Hite, who has been locked up for 48 years. “But in the garden, you get a little piece of that free air.”

Image

In addition to a clinical staff, the 17-bed hospice unit employs social workers, psychologists and a chaplain. Inmates referred to as pastoral care workers are trained to provide end-of-life care.

The hospice unit at California Medical Facility was built in 1993 in response to the AIDS crisis and demands for more humane care. It was the nation’s first licensed hospice program in a prison. It has since become a model for others around the country.

In addition to a clinical staff, the 17-bed unit employs social workers, psychologists and a chaplain. Some inmates, referred to as pastoral care workers, are trained to provide end-of-life care, helping to bathe patients, clean wounds, change dressings, handle oxygen tanks and assist in whatever other duties nurses request.

But they also provide companionship, the kind that a family member might: doing puzzles, writing letters and simply spending time with them. Despite their training, pastoral care workers make only about 24 cents an hour — nearly 75 percent less than the wage for men who sweep the floors of the prison. (Those workers make $1 an hour.) But more than one pastoral care worker said their duties on the unit were more important than making money.

Image

Puzzles serve as both an activity and a decoration throughout the hospice unit.

Image

Eric Anderson, a pastoral care worker, sitting vigil for a patient.

“If they didn’t pay me anything at all, I would still do this,” said Jerry Judson, who has worked on the unit for the past six years and is the lead technician, responsible for ordering and organizing supplies. “This work has helped bring me back to humanity.”

Image

“If they didn’t pay me anything at all, I would still do this,” said Jerry Judson, who has worked on the unit for the past six years. “This work has helped bring me back to humanity.”

Until 2018, the unit’s garden was little more than a slab of concrete topped by a corrugated roof and ringed by a chain-link fence — a patio that looked out onto a courtyard of hardpan dirt.

It has since become the unit’s centerpiece: A place where staffing meetings happen, where families reunite for the first time in decades, where men are wheeled out in their hospital beds for one last look at the world.

Dr. Joseph Bick, the prisons’s former chief medical executive and the driving force behind the garden, said that in a place surrounded by death, he wanted to create something restorative, not just for the dying, but also for the volunteers and staff members devoted to their care.

Image

When building the garden, Dr. Joseph Bick, right, asked patients what they missed most. One request, among others, was to simply remember what it felt like to touch grass.

What the garden eventually became started with a question to residents: What did they miss? Feedback poured in. They wanted to hear running water and some sort of motion — inspiration for the trickling fountain and the swinging bench where pastoral care workers rock idly in the shade.

They wanted something else, too: to remember what it was like to touch grass, something some inmates hadn’t done for decades. One day, Dr. Bick recalls, he was planting a tree when he saw a hospice patient approach the garden in his walker. He was near the end. He flipped off his sandals, raised his hands to the sky and gave praise for the simple act of being able to stand in grass.

A Crisis Decades in the Making

Image

When a patient nears what is expected to be his last 48 to 72 hours of life, a pastoral care worker is assigned to sit vigil so that no one dies alone.

Just as the general population in the United States is aging, so too is the population of people who are in prison — only faster. In 1991, incarcerated people over 50 years old made up just 3 percent of the U.S. prison population, according to a 2025 report by the University of Texas at Austin and the American Civil Liberties Union. Researchers predict that by 2030, that number could reach as much as 30 percent. This is, in part, a result of policy choices: Sentencing practices from the tough-on-crime era of the ’80s and ’90s have kept people in prison longer.

At the same time, a growing body of research suggests that prison conditions accelerate the body’s aging process, reducing life expectancy by two years for every year behind bars. And with states already spending two to five times as much on incarcerated individuals older than 50 compared to other age groups, a rapidly graying population will further strain the prison system’s ability to care for those in their custody.

One way to address this is compassionate release, which allows people to be released early if they meet certain criteria, such as age or terminal illness. But the process and criteria vary widely by state, and logistical barriers are often so high that people can’t get through them, said Dr. Michele DiTomas, medical director of the hospice unit at California Medical Facility.

Image

Jane Littleton visiting her husband, Ray Littleton, and sharing tomatoes from the unit’s garden.

Image

Hummingbirds are the symbol for the hospice facility and the reason pastoral care workers wear pins of them on their shirts.

Dr. DiTomas, known around the unit as a tenacious advocate for compassionate release, recalled how, not so long ago, the approval process was convoluted and often took longer than a person had left to live.

Image

Dr. Michele DiTomas, medical director of the hospice unit at California Medical Facility, is known as a tenacious advocate for compassionate release.

“There’s so many places where that system historically fell apart,” said Dr. DiTomas, who helped create a statewide tracking system so that family members can check the status of compassionate release applications and see where they are stalled.

But a series of policy changes over the last decade has helped streamline the process. Dr. DiTomas said that California now approves about 100 people a year for compassionate release, up from around 10.

There are, of course, those opposed to compassionate release who believe that incarcerated people should serve their full sentences, whether or not they are dying. Dr. DiTomas acknowledged this. But she also noted that not all victims favor extreme or harsh sentences. “Victims aren’t a monolith of what they want, and many victims don’t want to see that person’s family suffer as well,” she said.

The Ministry of Presence

Image

Dr. DiTomas noted that not all victims favor extreme or harsh sentences. “Victims aren’t a monolith of what they want, and many victims don’t want to see that person’s family suffer as well,” she said.

While the data is murky, it’s estimated that less than 5 percent of all state and federal prisons in the United States offer hospice programs. Most people who die in prison stand a good chance of dying alone — a fate described by current and former inmates as worse than death itself.

“You’re away from everything that’s meaningful to you and feel isolated, anonymous, invisible,” said Fernando Murillo, who spent 24 years in California prisons, including six as a pastoral care worker at California Medical Facility. Today he works as a program manager for the Humane Prison Hospice Project, an organization that uses a curriculum influenced by the one at California Medical Facility to train palliative care workers at other prisons.

At California Medical Facility, as a patient nears what doctors expect to be the last 48 to 72 hours of his life, a pastoral care worker is assigned to sit vigil so no one dies alone. At a staff meeting in July, the Rev. Keith Knauf, a chaplain at the prison and one of the longest-tenured employees on the unit, shared an update on two patients, both of whom had woken up bewildered and frightened, calling out for help. In each case, they were soothed when they saw a pastoral care worker by their side, and fell back asleep.

Image

According to the Rev. Keith Knauf, only two people at the hospice unit have ever chosen to die alone. Both were practicing Buddhists who refused morphine and wanted to be mindful of the entire death process.

Mr. Knauf said that when it comes time to sit vigil, it isn’t about what a person says or does to comfort those who are dying. It’s about simply being with them. On the unit they call it the ministry of presence.

To Allan Krenitsky, a pastoral care worker, accompanying patients during their final moments is one of life’s great honors — one he wasn’t always prepared to appreciate. He was just 23 years old in 1988 when he shot and killed a man in his Los Angeles home. Mr. Krenitsky was convicted of murder and sentenced to life without parole.

He didn’t expect to last long in prison. He had been diagnosed with hepatitis C and H.I.V. — essentially a death sentence in the late ’80s. He recalled in gritty detail the segregated unit where he and others with the virus were confined and how they were ostracized. But he also remembered how they cared for their cellmates, changing their diapers or helping them bathe.

Image

Before he became a pastoral care worker, Allan Krenitsky had cared for other patients with H.I.V.

Image

Confined to a segregated unit, he and others with the virus cared for one another, changing diapers and helping people bathe.

“That left an impression on me,” he said. “We understood that one day the people around you would take care of you just like you’re taking care of people now.”

Image

Mr. Krenitsky, a trusted leader on the unit, has proved talented at engaging patients’ memories and comforting them as they approach their last breath.

Ultimately, Mr. Krenitsky grew up in prison. Medications improved. He started reading and went to college. He married a woman who had been a pen pal and started a family from behind bars. But he still knew deep down that he would one day die in prison.

And then, this year, came the unthinkable: A call from Gov. Gavin Newsom telling Mr. Krenitsky his sentence had been commuted and he would go in front of the parole board. His hearing is scheduled for this month.

If he’s released, Mr. Krenitsky won’t come out unscathed. He wears a black patch where he lost an eye to infection. But with his easy way and lilting southern drawl, he has become a trusted leader on the unit and proved talented at engaging patients’ memories and comforting them as they approach their last breath. For him, it’s atonement.

“It haunts me, but I can never take that back,” he said of the killing. “But I can try to be a decent person for the rest of my life.”

Image

Mr. Judson with a patient in the garden. When it comes time to sit vigil, it isn’t about what a person says or does to comfort those who are dying. It’s about simply being with them.

One day this summer, as the late morning sun poured down on the scorched grass on the hills that seem to stand sentry over the prison, the garden was abuzz with activity. Employees wrapped up a staff meeting and collected their things. Pastoral workers swayed on the swinging bench. Mr. Judson, the lead technician, sat by a man who had been wheeled out in a hospital bed, holding his hand.

Mr. Hite, the head gardener, held a fistful of weeds. He takes pride in knowing that the hours he puts into the garden are in service of others, particularly the patients.

“I think people can see life and death in the plants,” he said. “It’s solace to their souls to be able to see and be part of that.”

Image

Mario Koran is an investigative reporter for Wisconsin Watch and lives in Milwaukee. He examined the Wisconsin Department of Corrections as part of The Times’s Local Investigations Fellowship.

Advertisement

SKIP ADVERTISEMENT