Tony Lithgow and Andrea Mayer have been living under a highway overpass in downtown Baltimore since last year. He's 49 and has been homeless on and off for eight years. She's 51 and has been homeless for 10 years.
Living on the streets has clearly taken a toll on the couple, both physically and mentally. While they're standing at a corner waiting for a free city bus to take them to a soup kitchen, Lithgow shouts at a passenger staring at them from a car stopped at the light.
"We're homeless!" he calls out to the man.
Mayer tries to get him to stop, but Lithgow is on a roll. His anger is palpable.
"You're one paycheck away," he says. "That's all they are. And they don't understand. That's all it was for us."
A growing number of the nation's homeless are reaching what's called "premature old age." Like Lithgow and Mayer, they're in their late 40s and 50s, but suffer from ailments more common for those in their 70s. Many will likely die over the next decade. This has posed 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.
Lithgow and Mayer say bad circumstances and bad decisions sent them spiraling from their middle-class lives and onto the streets.
"My husband died. I screwed up and I blew all the money," Mayer says. She adds that she was also very sick at the time and couldn't work. She suffered from Lyme disease, high blood pressure, memory loss and osteoarthritis.
Lithgow took care of his mother until she died of multiple sclerosis, and that cost him all of his savings. He says he worked as a cook and locksmith, but when the economy soured, he couldn't get a job.
Worsening Health Problems
Now they're homeless. Mayer's physical problems have only gotten worse and Lithgow has a bulging disc. You can see the pain on his face when he hikes a huge duffel bag onto his back. He carries all their essentials -- 75 pounds of clothing, toiletries, important documents and medication. This includes a dozen pill bottles, mostly for Mayer.
She's also in constant pain and needs to have both of her knees replaced. She walks with a cane she received from another homeless person, after hers was stolen.
"I don't feel safe without it," she says. "Because my knees buckle, you know ... by the end of the day, I'm in excruciating pain. Right now, I'm living on painkillers."
It might seem unusual for someone who's 51, like Mayer, to be so infirm. But it's extremely common if you're homeless: For those living out on the streets, 50 is old.
Aging Prematurely
"It ages you prematurely," says Nilesh Kalyanaraman, chief medical officer at Health Care for the Homeless, a clinic in Baltimore. Like similar clinics across the country, the Baltimore facility is seeing a growing number of older patients as the baby boom generation ages.
Kalyanaraman says people's health problems only snowball the longer they're outside, which makes treatment more difficult and expensive.
"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," he says. "Diabetes is more prevalent if you're homeless. It's harder to control."
Kalyanaraman says it's especially difficult to have a healthy diet when you're homeless.
When Mayer and Lithgow go to the United Church of Christ soup kitchen for dinner, the meal is heavy on the starch -- white beans, mashed potatoes with cut-up hot dogs, white hamburger rolls and a pastry.
Lithgow whispers to Mayer that the beans look a little scary. But they have little choice and know that people here mean well. They finish eating in about 15 minutes and tell the servers that they'll see them again next week.
Finding Work, Finding A Home
Lithgow is frustrated. He says he'd like to get a job, but doesn't want to leave Mayer alone outside. It's too dangerous. Mayer was punched in the face when they were robbed recently at a bus stop.
Lithgow thinks they could afford a small efficiency apartment -- using Mayer's Social Security disability payments -- but he says they don't have enough money for a security deposit.
"I got to get her off the street and I can't do it. Nobody's helping us. I'm tired. I'm tired. I'm exhausted," he says as his voice cracks. "This is not a joke anymore. I hurt."
Lithgow stands up. Andrea watches him walk away with a concerned expression on his face.
"I've never seen this, seen him so emotional," she says.
The Population
On any given night, more than 600,000 people are homeless in the U.S. By some estimates about a third are 47 or older -- almost half the single adults. And this group is 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, there was a crack cocaine epidemic and some of them never quite got on track.
After dinner, Andrea and Tony take another bus back to a small parking lot downtown under the interstate highway. This is where they sleep, as thousands of cars pass overhead. Their blankets, sleeping bags and everything else they own are hidden away -- at least that's what they hope.
"You know, we never know if we're going to be OK until we check the stuff. And it's usually the homeless ripping off the homeless," Andrea says.
Someone stole all their things -- including her dentures -- last fall, when Andrea had to be rushed to the hospital for emergency gallbladder surgery. She still has no teeth.
Baltimore and other cities are trying to get their homeless residents off the streets and into permanent supportive housing. But money is scarce and they've only scratched the surface.
'Living High Class' Compared To Others
Like other couples, Andrea and Tony prefer to sleep outside rather than in a city shelter, where they'd be separated. And in the parking lot, they've found an electric outlet to charge their phones and plug in a small heater.
"I mean, we're sort of living high class compared to what these people are living," says Andrea, referring to the dozens of others sleeping nearby on city streets. "We're warm at night. These people are freezing to death."
Exhausted, Andrea sits down on a bag and watches Tony proceed with their nightly routine. He takes some rope and attaches solar blankets to a street sign to form a makeshift tent. He then covers the ground with layers of blankets and sleeping bags.
"See, what I do is I put the heater in first. I turn it on and it gets nice and warm in here, while I'm putting it together," he says.
And the tent is pretty cozy inside by the time Tony is finished. Still, he says, this is no way to live. When Andrea was released from the hospital after her surgery, this is where she came to recuperate and where he changed her dressings.
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