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In 1985, Mr. Jackson (name and some features changed to protect patient identity) and another man got into a fatal drug-fueled fight; Mr. Jackson received an “indeterminate prison sentence” (7 years to life) for unintentional murder. In prison, he became sober, engaged in rehabilitative programming, became a mentor guiding young men in distress, and assumed if he followed the rules, he would one day return home. Yet, despite 10 parole board appearances, an unblemished prison record, and letters of support from staff, Mr. Jackson was repeatedly denied his freedom. His wife of 60 years died alone, and at age 86 he died in prison hospice after four decades of incarceration. Mr. Jackson's story is not uncommon. Nor is Mr. Bertch's (see Figure 1). Between 1990 and 2013, the US prison population nearly doubled while the number of incarcerated adults aged 55 or older increased by 750%. This aging of the prison population has occurred during an era of “mass incarceration,” in which decades of racially biased sentencing laws resulted in a disproportionate number of Black or Latino people in prison. These “tough-on-crime” policies (including the indeterminate sentence Mr. Jackson received) are coupled with exceedingly low parole release rates (also plagued with racial bias), as parole boards—largely staffed by retired law enforcement—often deny parole for people convicted of a violent crime regardless of their current behavior or low risk assessments. Mass incarceration and overcrowding have culminated in massive COVID19 outbreaks in prisons; over 400,000 incarcerated people have been infected with COVID-19 and at least 2500 died. COVID-19 infections in prisons also have fueled outbreaks in surrounding communities, making the need to end to mass incarceration even more urgent for our public health. Older adults confer a profound strain on correctional healthcare systems. Cognitive impairment and dementia are disproportionately common, and other geriatric syndromes (e.g., incontinence, falls, and functional impairment) are present at relatively young ages, a state referred to as “accelerated aging.” Difficulty performing everyday prison activities, such as getting on the floor for an alarm and climbing onto a top bunk, cause older adults to be impaired who would be independent in the community, and put them at risk for victimization. Geriatric challenges (such as not hearing staff orders) can lead to inadvertent rule violations adding more prison time. Meanwhile, we are paying a high price for this population, as incarcerated older adults generate up to nine times the cost of incarcerated younger adults. Yet there is