But he remembers years past, before the open-heart surgery, before the lung problems and the high blood pressure, before he was taking around 16 medications a day, before he required oxygen and carried nitroglycerin.

"When I was 30, I could go out and play football, baseball," says Rice, now 70 and an inmate at the Utah State Prison. "Until I was about 55, I was very active."

Health care was not so important to him - and millions of other aging Americans - back then. Now, issues like Medicare, Medicaid and medication costs are top concerns for those over 55 who are struggling to afford medical care. But there is one important difference: Rice is a convicted sex offender serving a three-years-to-life sentence, meaning his health care is funded by taxpayers.

Within the past six years, the prison's over-55 population has increased by 67 percent, compared to an 11 percent increase in the overall population, said Richard Garden, a physician and director of the state Department of Corrections' Bureau of Clinical Services.

The oldest inmate is 97. He was sent to prison for one to 15 years in 2002 for second-degree sexual abuse of a child. "He's doing fine from a medical standpoint," Garden said.

The increase in aging inmates has brought about a sea change in the way the prison's health-care staff handles senior citizens. In an effort to keep costs down and provide better care, medical staffers are focusing more on preventative strategies.

"It's really kind of the big thing in prison medicine," Garden says. "If we can prevent a heart attack, it's a lot cheaper than treating a heart attack. Plus, you have a healthier, happier patient."

The prison spends about $500 yearly for an inmate under 55, compared to about $7,500 for those 55-plus, he says. But unchecked heart problems or diabetes, for example, can land an inmate in the intensive care unit of University Hospital for two weeks, costing the state $100,000. That funding flows through Corrections, which like most state agencies has been hit hard by budget cuts in recent years.

An additional problem: Prison inmates as a whole tend not to be as clean-living as some senior citizens on the outside have been. "They have a lifestyle that's somewhat reckless," Garden says. That lifestyle, all too often, omitted proper diet and exercise and included alcohol, cigarette and drug use. "Physiologically, these guys have led such a hard life."

Rice, a former smoker who has been in prison since 2001, knows. After his heart problems developed, "they told me to stop smoking and drinking," he says. "If I hadn't have quit, I wouldn't be alive today."

He participates in some of the new measures in place at the prison infirmary: A high blood pressure clinic and a Chronic Obstructive Pulmonary Disease clinic, among others. Inmates with the condition are seen by a doctor and undergo tests.

A nurse then meets with them to discuss items like diet and exercise, and flow charts keep track of their condition over time. Prison staff waive the usual $4 co-payment for inmates participating in the clinic.

"It's been pretty good," Rice says. "They're always bringing me over, doing tests. They could do more if they had more money. It's up to the Legislature."

He is housed in one of four 28-person dorms, solely for senior citizen inmates. "You should see the pill line in the morning," he says.

But the placement helps him feel safer. "There are some violent people in here. They keep those separate. We all seem to get along pretty good over there."

When he had his last heart attack, it was a fellow inmate who summoned help for him, he says.

About half of the over-55 population are sex offenders, said Corrections spokesman Jack Ford. The others were convicted of "serious [offenses] against a person," Ford said. "It's not a burglary or an auto theft."

Rice's only complaint, from a health standpoint: "The beds are very uncomfortable for people with bad backs."

The department, however, has far more pressing choices to make. Inmates who have lost a limb to diabetes, for instance, might need a prosthetic.

"That's a painful expense," Garden says. "We have a limited amount of resources. I've got a guy over here with heart problems who needs bypass surgery. How do you choose?"

And then there are those that no amount of preventative care will help. An inmate who is quadriplegic after a spinal injury has been living in the prison infirmary for two years, despite the fact it is neither staffed nor equipped to handle such long-term cases, Garden says.

Sometimes, such inmates can be given a "compassionate release" and are paroled to a nursing home or other care facility, or terminally ill inmates are given leave to die at home.

While Garden advocates such releases, he acknowledges they can be difficult decisions for the state Board of Pardons and Parole.

"Just because you have cancer doesn't mean you can't go out and harm someone," he said.

aebroughton@sltrib.com