If aging is not for sissies, that's especially true if you're homeless. You can be on your feet for hours, or forced to sleep in the frigid cold or seriously ill with no place to go. But, increasingly, the nation's homeless population is getting older. By some estimates, more than half of single homeless adults are 47 or older.
And there's growing alarm about what this means — both for the aging homeless and for those who have to foot the bill. The cost to society, especially for health care and social services, could mushroom.
As in many cities across the country, there are plenty of homeless people in Baltimore, Md., — about 4,000 by the latest count. In the early morning hours, dozens of bundled-up men, carrying backpacks and duffle bags, emerge from an unmarked door next to a parking garage downtown.
This is the city's overflow homeless shelter for men, and the residents need to be out by 5 a.m., before office workers start to arrive downtown for the day.
Paul Behler, 59, says he's been homeless for about a year and a half, ever since he lost his job as a concert piano tuner and restorer. Behler says some days he feels like he's 70 years old.
"Haven't got to 80 yet, thank Lord," he laughs. Still, he says he had to go to the hospital emergency room recently because he had a bout of severe tendonitis and couldn't walk without a cane.
The emergency room is a frequent destination for the homeless in every city across the U.S. The list of ailments for those living on the streets is long — blood clots, chronic pain, exposure, diabetes. It's even longer for those in their 50s and 60s, which is considered elderly when you're homeless. The life expectancy is only 64.
On a recent chilly morning, some men head from the Baltimore shelter to their jobs, as cooks or handymen. Others go to the city's day shelter to get warm.
Still others head to a nearby clinic, run by a non-profit group called Health Care for the Homeless, which opens at 7:30 a.m. About a dozen people spent the night outside the clinic sleeping on the concrete steps. It's something of a safe haven.
Here, as in similar clinics across the country, a growing percentage of patients are 50 and older. Nursing services coordinator Yvonne Jauregui says many of them are in pretty bad shape by the time they arrive.
"Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach," she says.
Jauregui notes dental care as an example. She says it's not a priority at all. "It's until, 'I can't chew because my tooth hurts so bad and the tooth needs to come out' — that's when we see them," she says.
And that makes treatment a lot more difficult. There are other challenges for the homeless. Diabetics have nowhere to refrigerate their insulin. They're not allowed to bring syringes needed for such medication into homeless shelters. Medication is often stolen. And sometimes those with serious foot and leg problems can't get to a doctor.
"They are prone to having a lot of foot issues," says Jauregui. "Plus, it's like their primary mode of transportation."
Sixty-four-year-old Linwood Hearne is a case in point. He and his wife have been homeless for four years.
"I can't balance myself. I can't walk well. I'm getting very forgetful," Hearne says. "I have prostate cancer I have a lot of mental problems that's going on with me. I'm a paranoid schizophrenic. I suffer from manic depression."
Dennis Culhane, social policy professor at the University of Pennsylvania, says individuals like Hearne are increasingly common.
"We're looking at a group of people who are sort of prematurely reaching old age," says Culhane, who's done extensive research on demographics and homelessness.
He says the growth in the aging homeless population is due largely to one group — younger baby boomers — those born between 1955 and 1965. He notes that they came of age in the late '70s and '80s, amid back-to-back recessions and a crack cocaine epidemic. Culhane says individuals in this age group are almost twice as likely as those in other age groups to be homeless.
"These are folks who have been living on the margins, in and out of jail, in and out of shelters, in and out of treatment programs for the last thirty, thirty five years," he says.
Culhane says people are just coming to grips with what that means. A few communities have started to build special housing for the elderly homeless. Baltimore and other cities are also trying to get those most likely to die on the streets into permanent supportive housing. But funds are limited.
Culhane and other experts say it's going to cost a lot more to do nothing. "It's cheaper to have them in housing, than it is to have them be homeless," he says.
But getting housing isn't easy for those with limited means. And Hearne, like lots of people living in the streets, has a history marred with mistakes.
He was evicted from public housing years ago because he stabbed a neighbor in a fight. But he says he's already served his sentence — a three-year probation — and shouldn't be condemned to life, and maybe death, on the street.
Hearne and his wife have slept outside for much of the past four years, mostly under a highway across from the Health Care for the Homeless clinic. There are blankets, bags and mattresses stacked there, along a cement wall, and a few white buckets used as urinals. About two dozen people sleep there every night.
"I know it looks terrible, but this was our home," Hearne says. "We shouldn't have to live like this."
With that, he leans over to pick something up off the ground. It's a penny.
"A penny a day keeps the doctor away, right?" he asks. "That's what they say."
What they really say is that it's good luck. And maybe it worked. Health Care for the Homeless later found Hearne and his wife a new place to live.