Aging Homeless Population Booming

So where does he go, this aging veteran, now that his legs and kidneys don't work and everything he owns fits inside the pair of pajama pants tied to his wheelchair?

John Knight, 60, spends his days wheeling to dialysis treatments, soup kitchens and the freeway ramp where he begs for change. A hospital has become his primary residence, but he sometimes scours the city for "a hole to climb into before it gets dark."

"I have one thing on my mind — that's to eat, sleep and stay out of the way," said Knight, a former manual laborer who has been homeless for nine years.

Older men like Knight once made up a comparatively small share of the nation's homeless. But researchers say seniors now represent its fastest-growing segment, byproduct of an aging Baby Boom generation.

University of California, San Francisco, researchers who tracked the city's transients found that between 1990 and 2003, their median age rose from 37 to 46 — aging at a rate much faster than the nation as a whole. Those 50 or older represented 11 percent of the participants at the beginning of the study and 30 percent at the end, according to Judith Hahn, the lead author.

Hahn and her colleagues found similar trends in Los Angeles, St. Louis, Pittsburgh and New York.

That has implications for governments, which may find housing the chronically homeless is cheaper than treating the health problems exacerbated by aging on the streets.

Without regular medical care, conditions such as hypertension and diabetes easily can degenerate into strokes, blindness and other infirmities that require more intensive treatment, if not around-the-clock inpatient care.

But Hahn noted another finding of their research that gave hope: While the homeless population is aging, it is not growing.

"If it's a static population, it's something you can solve," she said. "Something can be done right now for the people out there who really need help and are going to become more and more expensive to the system."

Margot Kushel, an internist at San Francisco General Hospital who specializes in treating homeless adults, already sees the ramifications of untreated disease in her patients. Many are in their 50s and 60s but have the bodies of people in their 70s and 80s, she said.

SF General often admits homeless people for illnesses that would have gotten them a prescription, bed rest and a follow-up appointment if they were properly housed, Kushel said. Expecting someone to recover from pneumonia or follow a diabetes-restricted diet while sleeping on the sidewalk "creates an almost absurd situation," she said.

"It's heartbreaking, not to mention immoral, to discharge a debilitated 60-year-old with heart failure to the street, knowing they would be exposed to all the elements," Kushel said. "We can perfect our medical treatments as much as we can, but it's not addressing the problem."

People older than 65 generally don't wind up on the streets or in shelters because they qualify for Social Security and Medicaid, said Stephen Metraux, an assistant professor at Philadelphia's University of the Sciences who studies homelessness.

But those slightly younger, like Knight, don't yet get retirement benefits. Baby Boomer homeless also include Vietnam veterans suffering with psychological effects. And they are living with the legacy of government efforts to close state-run mental institutions and last-resort, single-occupancy hotels, according to Metraux.

"This is not the first time this has happened," he said. "There was a relatively sizable population of hobos and tramps that exploded during the Depression. The postwar economy allowed a lot of those homeless men not to be homeless anymore. Those that were left were on skid row, got older and died."

San Francisco and other cities are creating permanent housing with onsite health and social services geared toward chronically homeless seniors. Such facilities often have case managers who can help residents apply for benefits, or nurses who can check vital signs, dress wounds and monitor blood-sugar levels.

Dennis Ragar, 66, was homeless for three or four years before he moved into the Raman Hotel, San Francisco's newest city-subsidized hotel specifically for homeless seniors.

A former truck driver who suffers from diabetes and needs a hip replaced, Ragar pays $470 a month to rent a room. He says it's better than a shelter, yet not the retirement he looked forward to in his youth.

"I thought it would be a lot better than this," he said.