STEVE INSKEEP, HOST:
Many years ago, a Simon and Garfunkel album incorporated the sounds of interviews with senior citizens. A woman on tape said bluntly: God forgive me, but an old person without money is pathetic.
RENEE MONTAGNE, HOST:
For some seniors, it's just reality, and we report next on seniors who are homeless.
INSKEEP: The homeless population in this country is aging. People stand for hours. They may sleep in the cold, and when they get sick, they may have nowhere to go.
MONTAGNE: And there's growing alarm about what the means. NPR's Pam Fessler has this report.
PAM FESSLER, BYLINE: It's 4:45 a.m. in downtown Baltimore, Maryland, a chilly 25 degrees out, and dark.
And there's a rat. There is a rat crossing the street.
The first of several that scuttle by as bundled-up men with backpacks and duffle bags begin to emerge from an unmarked door next to a parking garage. This is the city's overflow homeless shelter. These men have to be out of here by 5:00 before office workers start to arrive downtown.
UNIDENTIFIED MAN #1: Real coffee today, pastries.
FESSLER: A few men grab Styrofoam cuts of black coffee as they head out. It's all they're likely to have for a while.
PAUL BEHLER: There's really not much still until about 7 o'clock when my storage locker opens up. I drop off my night clothes and change.
FESSLER: Paul Behler is 59. When he smiles into the cold air, you can see that his front teeth are missing. Behler's been homeless a year and a half after he lost his job as a concert piano tuner.
BEHLER: I've lost everything I had.
FESSLER: What's left is stored in rental space for a few bucks a month. No one here likes to carry too much. Things get stolen, and the bags are heavy. Behler says some days he feels like he's 70.
BEHLER: Haven't got to 80 yet, thank the Lord.
FESSLER: How do you feel today?
BEHLER: Sunday I had to put myself in the emergency room for severe tendonitis.
FESSLER: You hear that? The emergency room. It's a frequent destination for the homeless, here and in every city in America. 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 old when you're homeless. The life expectancy is only 64.
The news is this age group is growing fast. By some estimates, more than half of single homeless adults are 47 or older, and the cost to society for health care, social services is about to mushroom. Some of the homeless men here are now off to their regular jobs as cooks or handymen. Others head to a nearby health clinic, which opens at 7:30.
UNIDENTIFIED MAN #2: Yes. How you do?
FESSLER: About a dozen people have spent the night here, sleeping on the concrete steps. The clinic is something of a safe haven run by a nonprofit called Health Care for the Homeless. Everyone gets to come inside, at least for awhile.
UNIDENTIFIED WOMAN: You have an appointment with the doctor today?
UNIDENTIFIED MAN #3: No, ma'am.
UNIDENTIFIED WOMAN: You don't have an appointment today?
UNIDENTIFIED MAN #3: No, ma'am.
FESSLER: Here, as in similar clinics across the country, a growing percentage of homeless patients are age 50 and older. And nurse Yvonne Jauregui says many of them are in pretty bad shape by the time they arrive.
YVONNE JAUREGUI: Their priority isn't to get preventive care. It's to, you know, make sure there's a, you know, roof over their head and food in their stomach. And getting their teeth cleaning is 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.
FESSLER: Which makes treatment a lot more difficult. And 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 shelters. Medication is often stolen. Those with serious foot and leg problems sometimes can't even get to the doctor.
JAUREGUI: They are prone to having a lot of foot issues. Plus, it's like their primary mode of transportation.
LINWOOD HEARNE: I can't balance myself. I can't walk well. I'm getting very forgetful.
FESSLER: Sixty-four-year-old Linwood Hearne and his wife have been homeless for four years, sleeping most of that time under the highway across from the clinic. He's fairly typical.
HEARNE: 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: We're looking at a group of people who are sort of prematurely reaching old age.
FESSLER: Dennis Culhane of the University of Pennsylvania says the growth in the aging homeless population is due largely to one group: younger baby boomers, those who came of age in the '70s and '80s amid back-to-back recessions and a crack cocaine epidemic. He says they're almost twice as likely as others to be homeless.
CULHANE: 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 30, 35 years.
FESSLER: And now they're getting old. 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 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.
CULHANE: It's cheaper to have them in housing than it is to have them be homeless.
TONY SIMMONS: This one on Charles and 20th, have you all tried that one yet? The high rise?
FESSLER: But getting housing isn't easy when you have limited means. Tony Simmons, 51 and also homeless, is trying to help Linwood Hearne and his wife find a place to live. Simmons suggests that Hearne check out a nearby subsidized senior complex.
SIMMONS: You can actually go into the building and put in an application. And here's the trick: always look at the mailbox. If you see eviction notices, then there's apartments that are available. It's a bad way to look for it, but that's how I find them.
FESSLER: Like lots of people living in the streets, Hearne has a history marred with mistakes. He was evicted from public housing years ago because he stabbed a neighbor in a fight. That's hard to believe today. He seems so frail. Hearne says he's already served his sentence and shouldn't be condemned to life - or maybe even death - on the street.
Hearne and his wife take me outside.
HEARNE: Take your time, baby.
FESSLER: They want to show me where they've slept for much of the past four years. Hearne hobbles with his cane across a four-lane road, breathless as he tries to avoid getting hit by a car.
HEARNE: I made it.
FESSLER: In front of us, under the highway, there are blankets, bags and mattresses stacked along a cement wall, and a few white buckets used as urinals. About two dozen people sleep here every night.
HEARNE: I know it looks terrible, but this was our home. We shouldn't have to live like this.
FESSLER: And with that, he stops and leans over to pick something up off the ground. It's a penny.
HEARNE: A penny a day keeps the doctor away, right?
FESSLER: Is that true?
HEARNE: That's what they say.
FESSLER: Well, what they really say is it's good luck. And maybe it worked. Three weeks later, Health Care for the Homeless found Hearne and his wife a new place to live. That leaves the city with about 4,000 other homeless residents. Pam Fessler, NPR News.
MONTAGNE: Hear about one couple trying to deal with aging while living outside in a tent later today on ALL THINGS CONSIDERED. Transcript provided by NPR, Copyright NPR.