(emotional music) - [Cynthia] I raised four kids, worked for 30 years with one company.

And when you've done that all your life, and then you hit rock bottom, and you're trying to get back up, it's kinda hard, because the rest of the world looks at you different.

- [Expert] For those who can't shake the idea that these folks are morally deficient, I would ask them, you know, do you have a relative who's an alcoholic?

Everyone's got a relative who's an alcoholic.

Are they homeless because of it?

Do you have a relative who's made a bad business decision, who's gone through a divorce?

You know, who's even broken the law maybe, right?

Are they homeless because of it?

And most of the time, the answer is no.

- [Expert] The reason that I spend all of my days working on housing and homelessness, even though I spent so many years training to be a physician, is that I realize that there is no medicine as powerful as housing.

When people are homeless, everything else falls apart.

People are exhausted, they don't get any sleep, they are highly likely to be sexually assaulted, physically assaulted.

- This is hard.

This is so hard.

I don't wish this on nobody.

I really don't.

I've never hurt anybody, or caused any harm on anybody in my life.

For me to have to suffer the way I've had to suffer, and I suffer.

- [Narrator] Major funding for "Aging Matters" is provided by the West End Home Foundation, enriching the lives of older adults through grant making, advocacy, and community collaboration.

The Jeanette Travis Foundation, dedicated to improving the health and wellbeing of the Middle Tennessee community.

The HCA Healthcare Foundation, on behalf of Tristar Health.

Additional funding provided by Jackson National Life Insurance Company, the Community Foundation of Middle Tennessee, and by members of NPT, thank you.

- Hello, kings and queens.

I see we got my celebrities coming through.

I'm on the streets, but I'mma put it like this, if it wasn't for "The Contributor," which I work for, and people will say that's homeless, they're just a bunch of drunks.

They're a bunch of drug heads.

They can go get a job.

It is a job.

This is not no easy task, being out here on a corner trying to sell paper to people.

But at the same time, it's a job.

And be honest with you, it's a job that I love, because I get to meet beautiful people.

- [Customer] This is very good!

They get an A plus from me.

- Thank you, queen, thank you, king.

Y'all be blessed, be safe, thank you.

- [Narrator] Shawn's been selling "The Contributor" since 2010.

It's a local street newspaper featuring articles about people experiencing homelessness.

By selling the paper, he not only earns money, but he's also connected to friends and services.

- [Shawn] I ended up without a home, 'cause I just got out of prison.

And I don't drink, never have.

I don't do drugs, never have.

It's just one of those unfortunate moments that you just, when you've been locked up so long, you don't know what to do.

(somber music) - People come to us, they don't even need to have ID, right?

They come to us, they experience training, but then we bring them into the community, right?

So, as they sell the papers, and we tell everyone, take the paper, because when they sell out, that glimmer of hope.

Like this may work, right?

Then they come back, and we start developing a relationship with them, and now we have this whole other department called the Cover Team, where we, you know, we housed seven people last week, right?

So, we apply them for housing, we connect them to food stamps, we connect them to SOAR, which is SSDI or SSI.

And we start surrounding them with resources to help lift them out of homelessness.

- [Shawn] Hello, kings and queens, whoop, whoop!

I see that you with my bodyguard!

Right now, "Contributor" is helping me get an apartment.

They helped me get a voucher, and I'm looking for a place to stay right now.

- [Narrator] The housing choice voucher, often referred to as a Section 8 voucher, provides a way for people with very low incomes to rent housing for 30% of their wages, but only one in four eligible families receive federal rental assistance.

Without access to an affordable apartment, people risk becoming homeless.

And for aging adults, street life takes a toll.

(emotional music) - [Shawn] Woo, woo.

At 52, it's hard.

I mean, it's not, your body's not the way it used to be when I was young.

Like I was saying, I stay out here every day, all day, because number one, I love my job.

Number two, it put a roof over my head, even though it was a motel.

But I'd rather be at a cheap motel than sleeping on the ground.

- Guys, care to buy a paper?

Only two dollars, folks.

- [Cathy] And these are the guys I worry about the most, because as they get older, and their health starts to age, you know, you have a bad week, you can't pay $300 that week, and it's not like the hotel's gonna let you stay.

I mean, you could be there for 10 years, and they'll still boot you out, so those are the vendors I really worry about.

And so, we have a lot of vendors who are senior citizens, who are over 60.

- [Margot] The fastest growing group of people experiencing homelessness are older adults.

It's estimated that people experiencing homelessness who are 65 and older will triple between 2017 and 2030.

- [Narrator] Based at the University of California San Francisco, Dr. Margot Kushel has been studying homelessness for more than two decades.

Her research exposes the extreme perils of homelessness among older adults.

- You know, there are these studies that look at what you would expect from someone in their seventies and eighties in terms of their memory, or their ability to walk, or their, how often they fall, things like that.

And what we found was that the folks in their early fifties who were homeless really looked like people in their seventies and eighties in the general population.

We found an incredibly high mortality rate.

Almost 1/3 of our participants, you know, have died within five to 10 years of being in the study.

(walker rattling) - [Cathy] A lot of our vendors who have even worked their way into housing with us, as they've gotten older, you'll see that being homeless really took a toll on their health.

So, they'll end up dying prematurely.

We've had a rough year.

We've probably had eight vendors this year pass away.

- [Margot] So many of the folks that we study who are homeless have paid into the social security system their whole lives, but they're not gonna live long enough to be able to draw that money back out.

I think we've left our older adults without a safety net, and we've done so just at the time where we have this calamitous housing situation where there's not enough housing.

(somber music) - I got sick, and had to leave the carnival show I worked for, which I worked for for 30 years, and when I got here, the apartment I got, it just ate through my savings, and I ended up just, I went to the women's mission, wasn't there 45 minutes, I had to leave.

Another homeless lady was trying to get up on my bed, and steal my dirty clothes, and it woke me up, and I lost my temper.

And I'm one of them people, I'm not staying there where I'm gonna end up getting in trouble, where I'm somewhere trying to get help.

So I got my stuff, and I left, and I went out in the woods, and made me a camp.

(ice clinking) It's more challenging at being 54 and homeless, and having medical issues, because first, I have no insurance, no job to pay for anything.

So, I had to be able to prove to the hospital that I'm homeless, I have no income, so I could get their indigent care, which covers a lot of the stuff I need, except for medication.

- [Narrator] Until recently, Cynthia was an active vendor for "The Contributor," which was her sole source of income.

But health issues made worse by chronic homelessness have prevented her from working.

- The issues I'm facing now is, I'm waiting now to get a surgery, 'cause I've had a drain tube in my gallbladder for almost six weeks now, and I got to get the surgery done, but with unsanitary conditions, you can get an infection around that wound area.

And so, I left my camp to come stay with a friend temporarily.

I can at least have a better chance of no other infections set in.

- [Narrator] But having temporary shelter versus a home of your own are two different things.

Her friend is living in Section 8 housing, and the lease forbids both long-term guests and pets, making eviction a real threat to both her, and her roommate.

- You gotta lay down if you want a biscuit.

I have an emotional support animal, which helps me with a lot.

My high blood pressure issues, stress, my anxiety issues.

And it's kinda hard.

People are like, oh, well we don't want no animals at all.

And you can still show 'em the letter from your doctor stating that I'd benefit from having her.

And they still, it's no, and I mean, it's either be able to stay with a friend, or be out there in the elements with this going on, where I can pick up an even worse infection in my system.

And it's just, it's like, every day it's, you know, you don't know what's gonna happen, from one minute to the next.

(somber music) (rain pattering) - I deal with this daily.

It's wet sometimes, and you know, it's not always the best circumstances, but it's better than where I just come from.

But now, since we've been here at, City Roads, and with our caseworkers, we have, starting to get a helping hand here.

- [Narrator] Dave and Terri are a married couple from Madison, a suburban neighborhood in northeast Nashville.

After a series of personal tragedies, they're now experiencing homelessness for the first time.

- [Terri] Well, we had lost our home to a fire, and- - [Dave] Yeah, we had a home, and we lost- - My husband was, he, David almost lost his life in that fire.

He had smoke inhalation, and was hospitalized for several days.

Things never really got back, financially, right after that.

And when he lost the use of his leg, we moved in with our good friend, who, when he passed, and we were basically just out, out in the street and not even camping skills, you know, before this.

- Yeah, never been camping, either one of us in our life.

- No, no, no, you know, I mean- - And they literally told us to get outta the house, and we rolled, she rolled me down the street.

- Does that help any?

- That always helps.

- A little bit?

- Yeah.

- You know, whether people were first homeless before 50 or after 50, there was trauma that led to their homelessness.

People don't choose to be homeless.

- Well, I was a barber for about 22 years in Old Hickory, and we had some tragedy, quite a bit of tragedy when we lost our first child.

He was 19, his name was Patrick, and he drowned in a swimming accident in 2012.

It was really hard on us all.

I lost the ability to even go back to work at the time.

So, that was the beginning of the end, really, so to speak.

In 2020 in April, we lost our daughter, Ashley Nicole, to an accidental fentanyl overdose.

She was a beautiful young woman.

She was 14 months older than her brother, who tragically, 14 months later, committed suicide himself.

Austin took his life, after his sister.

So well, we have Jessica Lynn remaining, and bless her heart, she's also having a very difficult time with things.

- I'm sorry.

(Dave crying) - I really understand that the experience of being homeless is a traumatic experience, and for a number of people, they need to have a, I'm gonna call it a program of recovery, From that trauma.

Nashville will tell you that we have a housing first approach, which is that we move folks into housing, and then we help them deal with the traumas and stuff that they've gone through.

Unfortunately, we don't have enough housing to move folks into.

- [Narrator] According to a 2021 report by Metro Nashville's Affordable Housing Task Force, Nashville needs to add more than 52,000 housing units by 2030 in order to keep up with a growing demand.

And nearly 70% of those units need to be affordable to those with extremely low incomes, many of whom are already unhoused.

(traffic rumbling) - So that's where the need, I think, for transitional living spaces, like we're running here out of our church building, are important, because they at least provide a way to get somebody out of this experience of being on the streets, into a place where they have a warm bed, and a place to take a shower, and eat a good meal, and generally have a better standard of life.

(keys clacking) (emotional music) - [Narrator] Jay Voorhees is the lead pastor at City Road Chapel in Madison.

Along with free showers and laundry services, his church is also home to the Mobile Housing Navigation Center.

It provides transitional housing to 15 people as they move toward permanent housing.

While Terri's been living inside, David is making due with less.

- [Jay] So, in that particular case, Terri's husband, David was in a wheelchair, he was handicapped, and our facility is not handicap accessible.

We wish we had an elevator to the third floor, we don't.

And so, because there were no other housing options in Nashville that would work for him, we chose to allow him to pitch a tent on our property, so that he could be in close proximity to her.

In their case, I think they both were starting to look at physical limitations, and just the whole reality of getting older.

And were like, yeah, we got, something's gotta change.

- So I know he's down there, I know he's safe, and it's kind of romantic.

Unfortunately, in our time out there on the street, and not having a home, and both of us having some significant physical problems, and pain, developed an issue with drugs.

Not that there's any excuse in the world for, but we were using drugs to numb the pain of physical pain, and the abandonment issues, and just the trauma of being out there in itself.

So, this program offered us the opportunity to participate in the methadone program, and it's been everything for us, as far as changing the way that we think, the way that I think about just life in general, getting up every morning is new, and something to look forward to today.

- People often think that homelessness is about substance use.

It's about drug problems, alcohol problems, mental health problems.

But, that is not what causes a region, or an area to have more homelessness.

You go to a state like West Virginia, a state I know, and I love, West Virginia does really poorly on measures of mental health and substance use.

They have some of the lowest homelessness in the country.

Why?

They don't have a lot of pressure on their housing markets.

If you look at what drives homelessness, what drives rates of homelessness, it's explainable by the amount of housing you have for your extremely low income households.

(emotional music) (birds chirping) - [Narrator] When we last saw Cynthia, she and her dog, Sassy, were staying at a friend's apartment, while Cynthia was waiting to have surgery.

She'd hoped that by having a clean, dry place to sleep, she'd stay well, but that hope was short-lived.

- [Cynthia] Me and my roommate kind of got into it.

He has some problems of his own.

And with some people, especially at his age, you have to overlook 'em, and just go on your way, and do what you're gonna do.

(monitors beeping) Hey.

- Hey, you doing okay?

- Yeah.

I had my gallbladder removed last Friday, and then I had to go back to camp on Saturday to sleep in a tent, because I had nowhere else to be.

And then early Monday morning, I had a severe pain that went across the whole top of my stomach, and it knocked me on my knees.

- [Narrator] Within days of the original procedure, Cynthia is back at the hospital, experiencing complications.

- I was so scared to death, because you don't know what you're facing out there.

With just having the surgery, I'm sore, and I can't really move to protect myself very good.

It's hard.

I mean, you never know what kind of germs you're gonna pick up out there anyway, as it is.

And then when you got stitches and stuff in you, it's easy to pick up anything anywhere.

- [Narrator] The prospect of returning to the street after having surgery is daunting, but individuals like Cynthia often have nowhere else to go.

Safety net hospitals like Nashville General provide essential medical care for people experiencing homelessness, but hospitals are designed to treat patients, not house them.

In fact, studies show that for older adults, prolonged hospital stays can increase the risk of infection, and disrupt care due to bed shortages.

For both patient and provider, the lack of options is agonizing.

(emotional music) (birds chirping) - It hurts to be sent out when you're hurting, and they can obviously see that you're in pain, and they're just like, well, you gotta go.

You can't stay here.

I'm like, well, the only place I got to go is in the woods.

Now I'm out here, and I'm wounded, I'm very sore.

If somebody was to come in and try to attack, I couldn't help protect against nothing right now.

Come here, baby.

Oh, come here.

Mama been gone a while.

My dog Sassy is my protector.

She's very watchful over the camp.

She helps with my anxiety.

When I start having an attack, she's right there with me.

She's the big clown.

She's a goofball.

She's everything, she's everything.

(emotional music) - We live in a society that gives people very little margin.

And at the root of this crisis is the extraordinarily high cost of housing.

- [Narrator] 30% of the nation's homeless population and half the nation's unsheltered population live in California.

Many of these individuals are concentrated in prosperous cities like San Francisco, where the issue often dominates headlines.

- [Margot] San Francisco should be a cautionary tale for any other thriving city.

It's great to have great jobs, it's great to have people want to live there.

That's terrific.

But you need to create the housing for everybody.

Seniors who've spent their entire lives in San Francisco and Nashville shouldn't be forced out.

They should be able to stay near their community, their neighborhoods, their churches.

(people chattering) I think that no region of this country is immune to homelessness.

And what I would say to other places is, don't become like California, where it's worse.

It's worse because of our shortage of housing.

Do everything you can now to build, and create those deeply affordable housing units.

It's not enough just to create housing.

You need to create housing that is affordable to the lowest income households.

(emotional music) - [Cynthia] I'm down, because I've been working on getting housing for like, four months now.

And the Section 8 people, it takes so long for them to get back with you that it, you know, you get excited at first.

Okay, I'm on the list, here we go.

But then it, it's still nothing, and I'm like, okay, well I'm gonna end up spending the winter out here, and being cold, and freezing to death, because I don't have what it takes to be out here.

- [Narrator] While Cynthia worries about the coming cold, a more immediate threat emerges, and puts her in jeopardy once again.

- The doctor called me this morning.

The infection from my gallbladder, I guess, got into my blood, and I gotta be in the hospital for two days to get antibiotics to cure it up.

- [Narrator] And to complicate matters, her dog, Sassy, can't stay in the hospital.

- I have nobody to take care of her for two days, so I can get these antibiotics that I need, but I have to give her up if nobody will keep her for me.

(Cynthia sniffles) And I have no way of getting her back.

(Cynthia crying) Come here, baby.

- This is just really emblematic of just what types of struggles people go through when they're disconnected from the community, and they don't have insurance.

Imagine if she had been in housing, and she had neighbors that she knew, and she had a family that could support her, and she had health insurance.

The story's totally different, and she's not the only person like that out there.

There's so many people like that out there.

- [Shawn] Hello, kings and queens!

I see you with my bodyguard.

- [Narrator] While many people experiencing homelessness are cut off from society, selling papers for "The Contributor" keeps individuals connected to a caseworker, and a community.

It gives people like Shawn a voice, and Cynthia a fighting chance.

Sometimes having an advocate can make all the difference.

Just hours before Cynthia was released from the hospital, "The Contributor" was able to find her a place in a medical respite called Village at Glencliff.

(emotional music) - I think it's amazing that they have places like this that help people.

It's a little hard without Sassy, 'cause I'm used to her being at my side all the time, but she's with a good family that's taking care of her right now, so I can take care of my health, and I can get better, because without me being better, I'm not good for her.

- Cynthia is one of the very few that's fortunate enough, she's in a medical respite center, a housing unit that is for people experiencing homelessness, but there's like 11 of those units, and she's there as transitional housing until she goes into permanent housing.

And you know, the problem they have is because there's not enough permanent housing, that many people end up staying there, right?

So those units aren't available for other people being released from the hospital.

- [Narrator] Being unhoused is nothing short of catastrophic.

To survive, we need shelter that keeps us safe, dry, warm, and well.

That's powerful medicine.

And while it doesn't come cheap, we simply can't afford to go without it.

- Right there, temporarily.

I'm thankful, being blessed.

A lot of people out there fighting to help me get this fresh start, and I wanna make it happen myself.

(emotional music) (emotional music continues) - [Narrator] Major funding for "Aging Matters" is provided by the West End Home Foundation, enriching the lives of older adults through grant making, advocacy, and community collaboration.

The Jeanette Travis Foundation, dedicated to improving the health and wellbeing of the Middle Tennessee community.

The HCA Healthcare Foundation, on behalf of Tristar Health.

Additional funding provided by Jackson National Life Insurance Company, the Community Foundation of Middle Tennessee, and by members of NPT, thank you.

(gentle guitar music)