Ernestine Edwards, 76, lives on $430 in monthly Social Security benefits, $44 worth of food stamps, and her wits.
Once the resident manager for a Northwest Washington apartment complex, Edwards has a heart ailment, high blood pressure and diabetes. Her illnesses make it difficult for her leave home, even to attend her church.
"I have three problems," said Edwards. "I am old, sick and poor."
Edwards, who lives alone in a tiny house in a low-income section of Prince George's County, is an example of the hundreds of elderly residents in the Washington area who are struggling to survive.
While the majority of the elderly have sufficient income to live independently with little or no assistance, officials say, many do not.
"Certainly we are delighted that a lot are comfortable, but that doesn't help this woman or others like her," said Sue F. Ward, director of the Prince George's County Department of Aging.
A report compiled for Ward's agency has concluded that about 27,000 seniors -- nearly half of the county's elderly -- could benefit from additional assistance and that 1,600 are in "almost desperate need of assistance."
And the problem does not stop at the county line, Ward said. "There isn't that much difference anywhere in the Washington area among the elderly who are poor."
The District has about 18,000 elderly persons with income below the poverty line, according to the D.C. Office on Aging. Montgomery County has about 20,000 elderly in need of assistance and about 1,000 in "desperate need," according to a recent study compiled for the county's Division of Elder Affairs. Local officials in Northern Virginia cite similar problems.
Many of these elderly do not have enough income for basic living expenses at a time when their health problems are growing and their physical abilities are diminishing, according to the Prince George's study.
The report -- based on a survey of 601 elderly Prince George's residents by Ecosometrics, a Bethesda research group -- also concluded that:
The number of Prince George's residents aged 60 and older is increasing four times faster than the county's overall population. The county's elderly population is growing more rapidly than that in some other Washington suburbs and faster than the national average.
The median household income of the Prince George's elderly was about $18,200 in 1986, about half the level for the county population as a whole. Median household income for the total county population was $34,100.
Even though income ranks as the number one problem for Prince George's elderly, about three-fourths own their homes. Jon E. Burkhardt, project director for the report, termed this finding "surprising."
Elderly Prince George's residents face a variety of problems including isolation, concern about crime, and difficulty in obtaining transportation, medical care and home repairs and in selecting and understanding health insurance policies.
These problems are familiar to Edwards, who agreed to be interviewed provided that she be identified only by her middle and last names and that her address be withheld.
"I live alone, and I don't want anybody to know where I live," she said. Before being photographed, she put on a wig, saying it would help conceal her identity.
Edwards takes 10 kinds of medication each day. She says she fears that she might lose her house to creditors as a result of unpaid medical bills. But settled in a big stuffed chair in her living room, with her dog Toy bouncing and barking, she tries to make the best of her situation.
The house is warm and tidy. Soft music plays from a small radio. And within arm's reach, she has a pile of crochet work, a telephone and a stack of library books.
This is Edwards' world almost all the time.
"I haven't been out of the house in three months," she said.
A friend picks up groceries and medicines for Edwards and drops them at her house. The county delivers a hot meal to Edwards five days a week as part of a program for low-income elderly. Mary Williams, a caseworker with the county Department of Aging, visits Edwards or telephones her on a regular basis.
Edwards insists that she does not mind the isolation.
"I'm not like most people," she said. "I don't even turn on the TV until 5 p.m. when the news comes on. The rest of the time I read or I crochet."
Still, Edwards gets upset about the ups and downs of the benefit system on which she depends.
When her Social Security benefits rise, as a result of a cost-of-living increase, she said, other benefits shrink, in part because of government formulas.
For example, food stamp allotments are reduced when a recipient's income rises. Edwards never seems to get ahead.
This month, her monthly Social Security check increased $12, from $418 to $430, because of a cost-of-living increase. At the same time, her monthly food stamp allowance dropped $8, from $52 to $44, as a result of her higher Social Security check.
Her net gain for the month was $4.
"They give you with one hand," Edwards said, "and take away with the other."
Edwards retired from the apartment job in 1977, three years after her only son died, and she took out a 30-year mortgage to buy the little house where she now lives. It is valued at $44,700, according to county tax records.
The triangular house has white-shingle siding and green-and-white window awnings.
The yard is enclosed with a metal fence. A cement walk leads to the front door.
"It's just a shack, but it's my shack," Edwards said.
Born July 27, 1911, near Howard University, Edwards was the oldest of three children. She graduated from Armstrong High School in Northwest Washington and married her high school sweetheart. Later, they were separated. For a time, she was a junior partner in a florist shop.
Today, more than half of Edwards' monthly Social Security check goes to pay her $238.78 monthly mortgage.
The balance of her income pays for electricity, heating oil, telephone service, food, medicine and minor home maintenance costs, such as repairing two porch steps.
After those expenses are paid, Edwards said, she has nothing left for medical costs that exceed her Medicare coverage.
As a result, she has been unable to pay a $1,000 bill she ran up when she had two heart attacks in 1986 and was in the Washington Hospital Center.
The hospital, responding to a federal directive to try to collect unpaid bills, turned the matter over to a collection agency.
"They keep mailing me things -- but I can't pay," said Edwards, pulling out a letter from the agency. The letter said she owes Washington Hospital Center a total of $1,006.50 for services received in 1986.
With Williams' assistance, Edwards applied to Medicaid for help in paying the bills. Medicaid agreed to pay $287.50 of Edwards' expenses, records show.
Her monthly income was too high for her to qualify for any Medicaid assistance beyond that amount, officials said.
In the meantime, the notices from the collection agency for the unpaid hospital bills continued to appear in Edwards' mailbox.
Edwards said the most frightening development came when she asked a Legal Aid office to help her appeal the Medicaid decision on her eligibility for additional assistance.
In a July 15 letter, the Legal Aid Bureau in Riverdale advised Edwards to work out a payment plan with the hospital because her house "could possibly be attached and sold by a creditor to satisfy bills which you owe."
"I didn't know they could take my house," Edwards said. But, she added, she does not know where she can get enough money to work out a payment plan.
Williams said that Edwards is so emotionally attached to her home that "it would be her death" to have to move.
After inquiries from The Washington Post, spokesmen for Washington Hospital Center said last week that the hospital and its collection agency have placed Edwards' account "on hold" so that no more collection notices will be sent to her while her eligibility for Medicaid or other assistance is being reviewed.
Hospital officials said that if Edwards is unable to qualify for additional Medicaid benefits, they will inquire about other possible sources of assistance for her.
Spokeswoman Mary Anderson said that Edwards may be eligible for help from the hospital's Needy Sick Fund, which was established to cover the working poor and others who fall through the cracks in the social service system.
Edwards has adopted a wait-and-see attitude.
"When it happens, it happens," she said. "So I try not to worry about it."