Older offenders pose unique and costly problems for correctional systems already struggling to cope with outdated and overcrowded facilities. Many States are faced with an increased number of aging prisoners who need acute or chronic medical care. It is estimated that elderly prisoners suffer from an average of three chronic illnesses and frequently need such corrective aids and prosthetic devices as eyeglasses, dentures, hearing aids, ambulatory equipment, and special shoes. Correctional systems are faced with making necessary adjustments to accommodate the special needs of aging inmates. Issues of increasing concern include providing special diets and 24-hour nursing care, building new facilities or altering old ones, and restructuring institutional activities. A nationwide survey of special policies, programs, and facilities for elderly inmates in U.S. prisons found that most States did not have specific written policies on elderly inmates. All inmates, however, including the elderly, were screened in the admission process. Housing and work assignments were made in accordance with inmate health, security considerations, and family location. Although most States did not have policies based strictly on age, they provided compassionate leave for inmates who were terminally ill or not capable of physical functioning in the correctional system. A significant number of States routinely housed older inmates apart from the general population and offered them unique programming and services. The impact of rising medical costs on the provision of correctional services in U.S. prisons is discussed, as well as research and policy implications of elderly inmate needs. 24 references and 1 table