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A growing number of the nation's homeless are reaching what's called premature old age. They're in their late 40s and 50s, but suffer from ailments more common among people in their 70s. Many will likely die over the next decade. It's a challenge for communities trying to care for the homeless and could mean hundreds of millions of dollars in added costs, especially for health care.
Today on MORNING EDITION, NPR's Pam Fessler laid out these issues. And now she has this profile of one aging couple living under a highway overpass in downtown Baltimore, Maryland.
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PAM FESSLER, BYLINE: Tony Lithgow is 49. Andrea Mayer is 51. He's been homeless on and off for eight years. She's been homeless for 10. They've been a couple for much of that time. Today, they're on a corner waiting for a bus to take them across town to a soup kitchen, when Tony suddenly shouts at someone staring at them from a car stopped at a light.
TONY LITHGOW: We're homeless.
ANDREA MAYER: That's embarrassing. Why would you do that?
LITHGOW: Why, because he's looking. (unintelligible) We're homeless, right?
FESSLER: Andrea tries to shush him up but Tony's on a roll.
LITHGOW: You're one paycheck away. That's all they are. And they don't understand. That's all it was for us.
FESSLER: Living on the streets is clearly taking its toll. Tony's anger is palpable. This couple says both bad circumstances and bad decisions sent them spiraling from their middle-class lives into the streets.
MAYER: My husband died. I screwed up and I blew all the money. You know, I was sick.
LITHGOW: Been there, done this.
MAYER: You know.
LITHGOW: I took care of my mother. I mean she died from MS, and I took care of her.
FESSLER: Tony says that cost him all of his savings. He worked as a cook and a locksmith, but then the economy soured and it's been downhill ever since.
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FESSLER: Now, Tony is homeless and has a bulging disc. He looks strong but you can see it hurts him to hike a huge duffel bag onto his back. He carries all their essentials - 75 five pounds of clothing, toiletries, important papers and medication, including a dozen pill bottles, mostly for Andrea.
Andrea has bleached blonde hair and dark glasses and looks perfectly healthy, until she starts to walk. She suffers from osteoarthritis. She needs to have both knees replaced and is in constant pain. She also has high blood pressure and memory loss.
LITHGOW: After you, ladies.
FESSLER: Andrea steadies herself with a cane that she got from another homeless person after hers was stolen.
MAYER: I don't feel safe without it. I feel like, you know, like, because my knees buckle.
MAYER: You know, especially walking this. By the end of the day, I'm in excruciating pain. Right now, I'm living on painkillers.
FESSLER: It might seem unusual for someone who's 51, like Andrea, to be so infirm. But it's extremely common if you're homeless. Out here, 50 is old.
NILESH KALYANARAMAN: It ages you prematurely.
FESSLER: Nilesh Kalyanaraman is chief medical officer at Healthcare for the Homeless, a clinic in Baltimore. He says they're seeing a growing number of older patients here and across the country as the baby boom ages. And he says the problems only snowball the longer people are outside, which makes treatment more difficult and expensive.
KALYANARAMAN: If you're on the street, you're about three times more likely to have hypertension or cardiovascular disease. You're about 50 percent more likely to die from it as well. Diabetes is more prevalent if you're homeless. It's harder to control.
FESSLER: He says just try keeping a healthy diet if you're homeless.
Andrea and Tony are now waiting outside the United Church of Christ soup kitchen with about three dozen others, mostly men. The sun has set and it's freezing. Still, they like to get here at least an hour early, so Andrea can sit on the front steps instead of standing in line.
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FESSLER: Inside the church, dinner is served. Tonight, it's heavy on the starch: white beans, mashed potatoes with cut up hot dogs, white hamburger rolls and a pastry. Tony whispers to Andrea that the beans look a little scary.
LITHGOW: It wasn't worth coming out for this.
FESSLER: But what can you do? It's not like they have much choice and people mean well.
MAYER: OK, goodnight. See you next week.
UNIDENTIFIED WOMAN: OK, take care.
FESSLER: Tony is frustrated. He says he'd like to get a job, but doesn't want to leave Andrea alone outside. It's too dangerous. He thinks they could afford a small efficiency. She gets Social Security disability payments, after all. But they don't have enough money for a security deposit.
LITHGOW: I got to get her off the street and I can't do it. Nobody is helping us.
MAYER: And we're getting tired.
LITHGOW: I'm tired. I'm tired. I'm exhausted. This is not a joke anymore. I'm hurt.
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FESSLER: Tony stands up. Andrea watches concerned, as he walks away.
MAYER: I've never this, seen him so emotional.
FESSLER: On any given night, there are more than 600,000 homeless people in the U.S. By some estimates, about a third are age 47 or older, almost half the single adults. And the numbers are growing. Researchers say that's partly due to younger baby boomers, who are more likely than others to be homeless. They came of age in the late '70s and '80s, when the economy was especially bad and some of them never quite got on track.
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FESSLER: Andrea and Tony take another bus back to a small parking lot under an interstate highway.
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FESSLER: This is where they sleep, as thousands of cars pass overhead. Their blankets, sleeping bags and everything else they own are hidden away nearby, at least that's what they hope.
MAYER: You know, we never know if we're going to be OK until we check the stuff.
FESSLER: Someone stole all of their things, including her dentures, last fall when Andrea had to be rushed to the hospital for emergency gall bladder surgery. She still has no teeth.
MAYER: And it's usually the homeless ripping off the homeless.
FESSLER: Baltimore and other cities are trying to permanently house the homeless, but money is scarce and they've only scratched the surface.
Like other couples, Andrea and Tony prefer sleeping outside to using a city shelter, where they'd be separated. And here in the parking lot, they've even found an electric outlet to charge their phones and to plug in a small heater for the tent they make out of solar blankets.
LITHGOW: See what I do is I put the heater in first, and I turn it on and it gets nice and warm in here while I'm putting it together.
FESSLER: And the tent is pretty cozy by the time Tony is finished. Still, he says this is no way to live. When Andrea was released from the hospital after her gall bladder surgery, this is where she came to recuperate and where he changed her dressings.
Pam Fessler, NPR News.