North Carolina spends more than $230 million each year on medical care for prison inmates.
Elderly inmates cost the most, and they are also the fastest-growing segment of the prison population.
Now, the state has found a controversial solution -- releasing some elderly inmates who are ill, even if they have not served their entire sentences.
It is not uncommon at Piedmont Correctional Center to see wheelchairs. There are parts of the facility that look more like a hospital ward than a medium-security prison.
Willis Caddell is serving a life sentence there for a kidnapping conviction back in the 1970s. He is also very ill.
"You name it and I got it, everything but diabetes," the 78-year-old inmate said.
Caddell says he's had a quadruple bypass and a pacemaker put in while he's been in prison. Next to his bed is an oxygen tank to help him breath.
“They've already spent $3 million on me," Caddell said.
The latest available figures from 2010 show that 8 percent of the prison population – a total of 124,000 inmates -- nationwide are 55 or older, compared with just 3 percent in 1995.
Officials said the change in population is because of longer sentences that segment grew at six times the rate of the overall prison population.
Three years ago, North Carolina started a medical release program in which certain inmates who are disabled, terminally ill, or geriatric can be released before the end of their sentence.
"It has been rough," said 78-year-old Chester Ledford, who was released through the program.
He is living in an apartment in Morganton where neighbors said they had no idea about his lengthy criminal past, which includes convictions for breaking and entering, credit card theft and forgery.
"He's in bad condition. He can't do any harm but people who can do harm, that would be kind of dangerous," said neighbor Mary Torres of the release program.
The Department of Corrections has restrictions about who can be released. The inmates must be incapacitated to the point they do not pose a safety risk.
The cost savings are significant.
According to the state’s own research, health care costs for inmates older than 50 are four times greater than those of younger inmates.
However, the decision to release gravely ill inmates is not all about the bottom line.
"You have the compassion factor; you have the factor of budget; you have factor of you trying to help the families as much as you can," said Regional Director Todd Pinion.
Inmates with serious felonies like murders and sexual assaults are not eligible.
Charles Hodges, 71, has already served 15 years for a second-degree rape conviction. Because of his crime, he cannot get out early but isn't worried with 10 more years to serve.
"They seem to give me good attention. If I need to see a doctor, I get to see one," he said.
It has been nearly two years since Chester Ledford left prison after serving less than half of a nine-year sentence. He suffers from Parkinson's disease and spends much of his time in his apartment where he often thinks about the mistakes he made.