homeless deaths report

8/10/2019 Homeless Deaths Report

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Sacramento County

Homeless Deaths Report:2002 2013 & a 2014 update

Homeless Memorial Wall: Loaves & Fishes

Dia de Los Muertos - Day of the Dead - Altar, Loaves & Fishes, 2013

December 19, 2014


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Principal author , Bob Er lenbu sch, Execut ive Director , Sacramento Regional

Coal i tion to En d Homelessness

Homeless Management Informat ion System [HMIS] d ata: Manj i t K aur; Review

draft : Ryan Loo fbourrow and Michele Watts; App endix II, And rew Geurkink

Pr imary data source, Sacramento Coun ty Coroner, Kimber ly Gin

Data analysis and mappin g b y Eduard Pol tavskiy, PhD Student, Epidemiolog y

and B ioStat is t ics, Univers i ty o f Cal i fornia, Davis w ith su pervis ion b y Dr. Ol iv ia

Kasirye, Publ ic Heal th Off icer , Sacramento County Department of Heal th &

Human Service

Sacramento County Department o f Health & Human Services, Pr imary Heal th

Division , Sandy Dam iano, PhD, Deputy Directo r, and Marcia Jo , JD/MPA Prog ram

Manager, Heal thcare for the Homeless Program, provided h eal th care informat ion

and reviewed this report


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Sacramento County Homeless Deaths Report: 2002 2013 & a 2014 Update Page 1

January 1, 2002 June 30, 2014

604 deaths of people experiencing homelessness

Or 1 person every 7 days for the past 12.5 years


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DedicationIn m emory o f al l the people exper iencing h omelessness

Who have died in our comm uni ty

The names of the 556 Coroner reported homeless deaths from January 1,

2002December 31, 2013, the date of their death and their age at their

death are listed in alphabetical order by last name in

Appendix II of this report.We hope that this publication not only provides a proper and dignified

memorial to their death, many in an untimely manner, but provides a

catalyst for change fueling the political and community will to find

solutions to end homelessness in our community and prevent the tragic

deaths of Sacramentans who have fallen on hard times.

We release this report on December 19, 2014, declared Sacramento City &

County Homeless Memorial Day by the Sacramento City Council &

Sacramento Board of Supervisors.

National Homeless Memorial Dayon or around December 21 annually - is sponsored by the

National Coalition for the Homeless, National Health Care for the Homeless Council

and the National Consumer Advisory Board


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TABLE OF CONTENTS

CHAPTER PAGE NUMBER[S]

I. Executive Summary 9 - 12

II. Results:

A. Number of Coroner reported

homeless deaths

B. Demographics

[1] Age

[a] Number of lost years due to

untimely deaths

[2] Gender

[3] Race/ethnicity

[4] Race/ethnicity & Gender

[4] Veteran status

[5] Marital statusC. Seasonal distribution

D. Day of the Week distribution

E. Location and Geographical

distribution

F. Manner & Cause[s] of death

[1] Manner of death

[2] Underlying causes of death

[3] Violent deaths

[4] Underlying causes by gender

[4] Underlying causes by race

G. Use of homeless services

[1] Clinic attendance

[2] Homeless Management

Information System [HMIS]

[a] Number in HMIS

[b] Self-identified issues

[c] Program type

[d] Number of times accessing a

program

[e] Date last seen by program

before deathH. Law enforcement

13 - 47

13 - 14

15

16

16 - 17

1819

19 - 20

21

212224

24

25 - 29

30 - 31

31 - 33

33 - 36

37 - 39

39 - 41

42

42

42

43

43 -- 44

44

444546 - 47


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Chapter Page Number[s]

III. Comparison of Homeless

Population Deaths to General

Population

A. Mortality rates per 100,000

B. Racial/Ethnic composition

C. Suicide rates

D. Homicide rates

E. Alcohol/drug related

F. Alcohol/drug related deaths by

race/ethnicity

G. Age distribution

48

48 - 49

50

50

50 - 52

5152

53

IV. Policy Recommendations 54 - 62

Appendix I:Methodology

Appendix II: Names of homeless

people who passed away: June 2002

June 2013

Appendix III: Distribution of Homeless

Deaths by Year, Gender, and Race

Appendix IV: Number of Homeless

Deaths by Marital Status &

Race/Ethnicity

Appendix V: Homeless Deaths byUnderlying Manner and Cause and

Race/Ethnicity

Appendix VI: Overview of Health

Status of Homeless People

Appendix VII: Program Type: Shelter

Appendix VIII: Program Type:

Transitional Housing & Permanent

Supportive Housing

63 - 65

66 - 91

92

93

9495

9697

98

99


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Index of Tables and Figures

Figure/Table Page Number

Table 1: Number of Homeless Deaths by

Year: 20022013 & 2014 Update

13

Figure 1: Number of Homeless Deaths 2002 -2013

14

Figure 2:Homeless Deaths by Age Category 15

Table 2:Years of Potential Life Lost: All; Race;

Gender

16

Table 3: Homeless Deaths Mean Age by

Gender: 20022013

17

Figure 3: Homeless Deaths by gender on an

annual basis: 20022013

17

Figure 4:Distribution of Homeless Deaths by

Race/Ethnicity: 2002 - 2013

18

Figure 5: Distribution of Homeless Deaths by

Race/Ethnicity: Jan.June 2014

19

Table 4: Homeless Deaths by Race/Ethnicity:

2002 - 2013

20

Table 5: Homeless Deaths by Race/Ethnicity

& Gender: JanJune 2014

20


Marital Status: 2002 - 2013

21

Figure 7: Distribution of Homeless Deaths byYear and Season: 2002 - 2013

22

Figure 8: Overall percentage of deaths by

each season: 2002 - 2013

23

Table 6: Seasonal Distribution of homeless

deaths by gender: 2002 - 2013

23

Table 7: Seasonal distribution of homeless

deaths by race/ethnicity: 2002 - 2013

24


Day of Week: 20022013

24

Figure 10: Geographical distribution ofHomeless Deaths: 20022013 & 2014

26

Figure 11: Sacramento County: Emergency

Shelters; Transitional Housing & Permanent

Supportive Housing

27


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Table 8: Homeless Deaths by Location

Category: 20022013

28

Table 9: Homeless Deaths by LocationCategory: JanJune 2014

29

Figure 12:Distribution of Homeless Deaths by

Manner of Death: 20022013

30


Manner of Death: JanJune 2014

31

Figure 14: Underlying Cause of Death of

Homeless People: 20022013

32

Figure 15: Underlying Cause of Death of

Homeless People: JanJune 2014

33

Table 10: Top 5 Causes of Death: 2002 2013

33

Table 11: Top 5 Causes of Death: JanJune

2014

34

Table 12: Violent Causes of Homeless

Deaths: 20022013

35

Figure 16: Percentage of Violent Causes of

all homeless deaths: 2002 - 2013

35

Table 13: Violent Causes of Homeless

Deaths: JanJune 2014

36

Figure 17: Percentage of Violent Causes of

Homeless Deaths: JanJune 2014

36

Table 14: Homeless Deaths by Underlying

Cause of Death by Gender: 2002 -2013

37


Cause by Gender: JanJune 2014

38

Table 16: Top 5 Causes of Homeless Deaths

by Gender: 2002 2013

38

Table 17: Top 3 Underlying Cause of

Homeless Death by Gender: JanJune 2014

39

Table 18: Homeless Deaths by Race/Ethnicity:

20022013

40


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Table 19: Underlying Cause of Death by

Race/Ethnicity: 2002 - 2013

40


Cause and Race/Ethnicity: JanJune 2014

41

Table 21: Clinic Attendance by Homeless

Status: 2002 -2013

42

Table 22: Clinic Attendance by Homeless

Status: JanJune 2014

42

Table 23: Self Identified Issues upon

Entering Program: 20022013

43

Table 24: Program Type: 2002 -2013 44

Table 25: Number of Times accessing a

homeless program

44

Table 26: Timeframe between last seen in a

program and death: 2002 -2013

45

Table 27: Law Enforcement: Number in

Custody: Jan 2002June 2014

46

Table 28: Length of time form Custody

Release date and date of death: Jan 2002

June 2014

47

Table 29: Mortality Rates Per 100,000:

General Population vs Homeless Population in

Sacramento County: 20072009

48

Figure 18: General Population vs Homeless

Population by Race/Ethnicity

49

Figure 19: Suicide: General Population vs

Homeless Population

50

Figure 20: Homicide: General Population vs

Homeless Population

50

Figure 21: Alcohol & Drug-Relarted Deaths:

General Population vs Homeless Population

51


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Figure 22: Alcohol & Drug-Relarted Deaths

by Race: General Population vs Homeless

Population

52

Figure 23: Age Distribution: General

Population vs Homeless Population:

Sacramento County: 2010

53

Table 30: Self-Identified Condition in 2012

homeless survey

96

Figure 24: Distribution of Medical Conditions:

2012 Survey of Homeless People

97

Photo Credit: The cover photo of the Day of the Dead Altar, Loaves & Fishes, 2013

was taken by Paula Lomazzi, Executive Director, Sacramento Homeless Organizing

Committee [SHOC]


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I. Executive Summary

Goal: To suppo rt the communit ies und erstanding o f the tragedy that befal ls

Sacramentans facing hom elessness and imp lement recommendat ions to p revent

the unt imely deaths of people exper iencing homelessness in our co unty.

Note: Please see Appendix I for discussion of the methodology of this report.

Below is a summary of the signi f icant f indings of this study as wel l as

recommendat ions:

RESULTS:

Number of Coroner reported homeless deaths: There were 556 Coroner

reported deaths of homeless people from January 2002 December 2013 and

an additional 48 for the first six months of 2014, which is 1.7 times higher thanthe same period in 2013. The total is 604 deaths, or roughly one death per

week, every week for a 12 year period.

Demographics:

Age: 69.4% where between 4059 years old;

Number of lost years due to untimely deaths: Using 75 years of age as the

life expectancy national average, overall, the lives of the homeless people

was cut short on average by 34% [25 years years]; This was higher for

African Americans [35%]; women [37%] and Hispanics [39%];

Gender: The overwhelming majority of the homeless deaths were male

(87%); Race/ethnicity: The majority of homeless deaths were Caucasian ( 69%),

with homeless people of color [African American; Asian and Hispanics]

comprising 31% of the homeless deaths;

Veteran status: 9 % of the homeless deaths were Veterans, with 55%

being post-Vietnam veterans.

Marital status: 90% of the homeless people were never married; divorced

or widowed;

Seasonal distribution: homeless deaths were spread relatively equally [roughly

25%] across the four seasons;

Day of the Week distribution: 48.5% of homeless people died either on Friday,

Saturday or Sunday;

Location and Geographical distribution: 38% died outside [roads, parks,

alleys etc.]; 35% in a hospital and only 10.6% inside [friends home; board and

care; jail or shelter]. Overwhelmingly homeless people died in the downtown

area and along the transit corridors [freeway and light rail transit corridors];


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Manner and Cause[s] of death:

Manner of death: 40% were accidents, while only 29% died of natural

causes; 5% suicides and 5% homicides.

Cause[s] of death: alcohol and drug induced deaths was the leading

cause of death [28%], followed by violent deaths [22%] blunt force head

injuries, gun shots, stabbings or hangings.

Of note:

Cardiovascular disease: the proportion of cardiovascular deaths

was higher in women [17.8%] than men and by race/ethnicity it

was higher in African Americans [18.1%] compared to either

Caucasians [11.3%] or Hispanics [3.9%];

Internal disease: the proportion was higher in women [4.6%]

compared to men and in African Americans [5.3%] compared to

Caucasians [3.9%];

Infections: the proportion was higher in Hispanics [7.8%] than in

Caucasians [5.5%] or African Americans [5.3%];

Injury: the proportion was higher in Hispanics [23.5%] than in

African Americans [21.3%] and Caucasians [16.3%];

Wounds: the proportion that died from wound injuries was higher in

men [4.6%] than in women [2.7%] and by race/ethnicity was higher

in Hispanics [13.7%] than African in Americans [7.4%] and

Caucasians [2.5%].

Use of Services:

Clinic attendance: 62% of the 556 decedents had at least one contact with

County Healthcare for the Homeless staff at some point in theirhomelessness, while 38% had no contact with County health staff.

Homeless Services: 32% [178 out of 556] decedents were found in the

Homeless Management Information System [HMIS] database.

Self-identified issues: almost 40% [38.7%] self-identified a disability, half

[51.1%] a substance abuse issue and roughly 16% a mental health issue.

11% identified a chronic health issue, with almost 82% failing to respond

with an answer.

Type of program: 90% of homeless people accessed a combination of

winter shelter and emergency shelters for the time permitted;

Number of times in a program: The range was from 1 time to a high of 20

times, with the average being 3 times. The majority [58%] was between 1-

2 times, while three fourths [76%] were between 1-5 times. 94%

accessed one or more programs between 110 times.


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Time between last program and death: 11% passed away less than a

week after exiting a homeless program, with 3 homeless people dying a

day after they left a program. Almost one in five passed away between 1

day and 4 weeks of exiting a program. Almost half [48.9%] died between

1 day and 6 months of exiting a program, while two thirds [68%] died

between 1 day and 1 year of exiting a program. The average timeframe

between exiting a homeless program and a homeless persons death is

371 days.

Law Enforcement: 80% of the decedents had been in custody [county jail] in

2013 -2014 compared to 77% in 20022013.

Comparison of Causes of Death of Homeless to General Population:

Mortality rates per 100,000: The estimated death rates for the homeless

population [2007 - 2009] were about 2 - 3 times higher than for the general

population in Sacramento County;

Racial/Ethnic Composition: Differences were identified in racial/ethnic

composition of the deceased in the general vs the homeless populations

of Sacramento County in 2010 including slightly higher for Caucasian

homeless people [73.9% compared to 70.9%]; and much higher for

African American homeless deaths [19.6% compared to 11.5%];

Suicide rates: The suicide rate for the general population was constantly

below 2% but fluctuated between 2% and 12% for the homeless

population;

Homicide rates: The homicide rate for the general population was

constantly below 2% for the general population but fluctuated between 2%

and 12% for the homeless population; Alcohol and Drug related deaths: The percentage of alcohol and drug

related deaths was 5-7 times higher than in the general population.

Age distribution: The homeless population had a much higher percentage

of deaths in age groups from 25 - 74 years compared to the general

population, peaking at the 55 - 64 year old group.


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Sacramento County Homeless Deaths Report:

20022013 & a 2014 update

Policy Recommendations supported by findings of report

Recommendation: County Coroner establish a Homeless Deaths Review Committee, similarto review panels for children & youth and victims of domestic violence

Policy Recommendations FindingsExpand the Sacramento City & County Affordable

Housing Trust fund to create more affordable

housing

604 homeless deaths over 12.5 years: 1

death every 7 days

Support for housing first approach, but were

housing is lackingincrease the capacity of

crisis response system to serve more homeless

people through a variety of means including rapid

rehousing and year round emergency shelter

75% of the homeless deaths were in

Spring; Summer & Fallevenly

distributed across seasons

48.9% died within 1 day6 months of

leaving a homeless programFund a Weekend Drop in Center to provide a safe

location for homeless people

Almost 50% [48.5%] of the deaths were on

either Friday, Saturday or Sunday

22% died of blunt force injury; gun shots;

stabbings or hangings

Increase funding for alcohol & other drugs and

mental health treatment programs - Refund VOAs

free treatment on demand program

28% died of alcohol/substance abuse

induced deathsthe leading underlying

cause of death

Expand funding for Respite Care facilities Homeless people are routinely discharged

to the streets by local hospitalsmany

need a respite care facility to recover from

sur eries etcIncrease funding for nurse street outreach

program

38% of the homeless decedents never

visited a County health care clinic

Continue outreach, enrollment and navigation

services for homeless people on MediCal or other

plans

14% died of cardiovascular disease; 5% of

infection; 4% internal disease and 1% of

diabetesmany deaths preventable with

access to preventative health care

Ensure full enrollment of homeless people on

CalFresh & full implementation of Restaurant

Meals Program

Almost 50% [48.6%] of homeless people

died of poor health conditions [high

blood pressure etc.] which are related to

poor nutrition

Free or subsidized transportation for homelesspeople

Lack of transportation is a major barrierto access health care as well as

substance abuse & mental health

treatment programs

Full implementation of CA Public Utilities

Commission LifeLine Program free cell

phones for homeless & low-income people

Cell phone access would give homeless

people greater access to follow-up health

care appointments as well as employment

and other a ointments


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II. Results:

A. Number of Coronersreported homeless deaths:

One death every 7 days for 12 years

There were 556 Coroner reported deaths of homeless people from January 1, 2002

December 31, 2013 and an additional 48 for the first six months of 2014 for a total of

604 deaths. See Table 1 below for the number of deaths year by year and Figure 1 for

a year by year graph.

Table 1:

Number of Homeless Deaths by Year: 20022013

With a 2014 update

YEAR FREQUENCY PERCENT CUMULATIVE

FREQUENCY

CUMULATIVE

PERCENT

2002 32 5.76 32 5.76

2003 36 6.47 68 12.23

2004 44 7.91 112 20.14

2005 47 8.45 159 28.60

2006 46 8.27 205 36.87

2007 41 7.37 246 44.24

2008 55 9.89 301 54.14

2009 45 8.09 346 62.23

2010 46 8.27 392 70.50

2011 61 10.97 453 81.47

2012 43 7.73 496 89.21

2013 60 10.79 556 100.00

Total 556 - - 100.00

1/2014-6/2014 48

Total 604 - - -


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Figure 1:

Number of Homeless Deaths: 20022013

Nu

mberofHomelessDeaths

2014 Update: There were 48

homeless deaths in the first six

months of 2014, compared to 29

homeless deaths in the first six

months of 2013, or an increase

of 1.7 times in the first six

months of 2014 over the first

6 months of 2013.

2002 - 2013: The average number

of homeless deaths per year, 2002

2013, was 46.3.

However, there were 60 homeless

deaths in 2013, which represents

an increase of 39.5% or 1.4 timesthe number in 2012.

2002 03 04 05 06 07 08 09 10 11 12 2013


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B. Demographics

[1] Age:

Figure 2 below shows the adult age range of the homeless deaths by age category.

69.5% of the decedents were between the ages of 40 - 59.

Figure 2:

Homeless Deaths by Age Category: 2002 - 2013

Age Categories


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A : Number of lost years due to untimely death:

Using 75 years of age as the life expectancy national average, overall, the lives of the

homeless people were cut short on average by 34% or about 30 years. However, for

Hispanics, their lives were cut short by 39% and for homeless women 37%. [Table 2

below]

Table 2:

Years of Potential Life Lost Using 75 years: All; by Race; by Gender:

2002 - 2013E.

Total Life

Expectancy

Total Years

of Life

Total Years

of Lost Life

Lost Years

%

All 40,875 27,002 13,873 34%

Race

Asian 825 559 266 32%

African

American

7,050 4,578 2,472 35%

Caucasian 28,275 18,908 9,367 33%

Hispanic 3,825 2,322 1,503 39%

Other 900 635 265 29%

Gender

Male 35,325 23,490 11,845 34%Female 5,400 3,429 1,971 37%

[2] Gender:

Overwhelmingly the homeless decedents are male, however, the percentage of

homeless women who died was significantly higher in 2013 [21.7%.] than in the

previous eleven years [See Table 3 below]. Figure 3 below shows the percentage of

deaths of homeless men and women on an annual basis.


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Table 3:

Homeless Deaths Mean Age by Gender: 2002 - 2013

AGE All

Gender Min Max Mean Median N %

Female 23 80 48 48 73 13.3%

Male 19 81 50 50 477 86.7%

6 people have missing data about age or/and gender

Figure 3:

Homeless deaths by gender on an annual basis: 20022013

[3] Race/ethnicity:

2014 Update:

Gender: In the first 6 months of 2014, 25% were homeless women and 75% homeless

men.

Age range:

The ages for homeless women ranged between 3361 years old with the average

age being 48.7. 75% were between the ages of 4059.

The ages for homeless men ranged between 20 82 years old with the average

age being 48.5 years old. 62.2% were between the ages of 4059.

Thus, in the first 6 months of 2014, the percentage of homeless women was the highest it has

been 25% - in the 12.5 year span, with homeless men dying at a slightly younger age on

average [48.5 for 2104; 50 years old for 20022013.]


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[3] Race/Ethnicity

Figure 4 shows that over two-thirds of the homeless deaths were Caucasian, however,

approximately one-third are people of color, disproportionately higher than their

percentage in the general population.

Figure 4:

Distribution of Homeless Deaths by Race/Ethnicity: 20022013

2014 Update: As Figure 5 below depicts, for the first 6 months of 2014,

56.3% of the homeless decedents were Caucasian, significantly lower than

the 69% for 2002 2013 while homeless people of color comprised

43.7%, significantly higher than the 30.1% in 20022013. In the first

six months of 2014 the distribution by race was 18.8% African American,

12.5% Hispanic, 8.3% Asian and 4.2% Native American.


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Figure 5:

Distribution of Homeless Deaths by Race/Ethnicity: JanuaryJune 2014

[4] Race/Ethnicity and Gender:

Overall, homeless women of color are a slightly higher percentage 35% - compared to

their male counterparts 30%. This is especially true for homeless African American

women25% - compared to 16% for homeless African American men. The reverse is

true of Hispanic homeless men compared to Hispanic homeless women 10%

compared to 3% respectively. [See Table 4 below].


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Table 4:

Homeless Deaths by Race/Ethnicity & Gender: 20022013

RACE

AfricanAmerican

Asian Caucasian Hispanic NativeAmerican

All

N % N % N % N % N % N %

Gender

Female 18 25% 2 3% 48 66% 2 3% 3 4% 73 13.3%

Male 75 16% 9 2% 333 70% 49 10% 11 2% 477 86.7%

All 93 17% 11 2% 381 69% 51 9% 14 3% 550 100%

See Appendix III for Homeless Deaths by Year, Gender and Race/Ethnicity:2002 - 2013

Table 5:

Homeless Deaths by Race/Ethnicity & Gender: JanuaryJune 2014

RACE

African

American

Asian Caucasian Hispanic Native

American

All

N % N % N % N % N % N %

Gender

Female 2 16.7% - - 9 75% - - 1 8.3% 12 25%Male 7 19.4% 3 8.3% 18 52.8% 6 16.7% 1 2,8% 36 75%

All 9 18.8% 3 6.3% 27 56.3 6 12.5% 2 4.2% 48 100%

2014 Update: Table 5 shows the first six months of homeless

deaths by race and gender. Juxtaposed to 20022013, the trend

above is the reverse. 47.2% of the men were people of color -

to 30% in Table 4, while only 25% were women of color - to 35%

in Table 4


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[5] Veteran status:

50 or 9% of the decedents were veterans and all were male. 6% [three] were WWII era

veterans, while 38% [18] were Vietnam era veterans. The majority, 55% [26] veterans

were post-Vietnam era veterans, or in their 50s.

[6] Marital status:

As Figure 6 indicates, almost three-fourths of the homeless decedents were never

married, divorced or widowed, with almost half of this being never married. Only about

10% [9.4%] of the homeless decedents were married at the time of their death.

Figure 6:

Distribution of Homeless Deaths by Marital Status: 2002 - 2013

Appendix IV : Number of Homeless Deaths by Marital Status and Race: 2002 2013

2014 Upate: The marital status pattern identiifed in Figure 6 above is very

similar for the first 6 months of 2014, for divorced [27%], never married[39.6%] and widowed [4.2%]. However for married homeless people,

the percentage was nearly double for 2014, 20.1% - to 9.4% in 2002

2013.


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C. Seasonal distribution:Figure 7 indicates that the homeless deaths are fairly evenly disributed across the four

season with approximately 25% of the deaths accuring in each of the seasons.

Figure 7:

Distributon of Homeless Deaths by Year and Season: 2002 - 2013

Figure 8 is the overall percentage of deaths by each season, which shows are very

even distribution of homeless deaths over the four seasons, or roughly 25% per season.


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Figure 8:

Overall percentage of deaths by each season: 2002 - 2013

A. Seasonal distribution by gender and race/ethnicity:

Gender: Generally, less homeless women died in the winter while more homeless men

died in the winter. Summer was a season of high percentage deaths for both homeless

women and men. [See Table 6 below].

Race: In terms of race/ethnicity, the Fall season was the deadliest season forhomeless African Americans and Hispanics, followed by Summer, while for homeless

Caucasians, Summer was also the deadliest season, followed by Winter. [See Table 7

below].

Table 6: Seasonal distribution of homeless deaths by Gender: 2002 - 2013

Gender

Female Male All

N % N % N %

SEASONWinter 13 2.4 126 23.2 139 25.6

Spring 18 3.31 112 20.6 130 23.9

Summer 21 3.87 121 22.3 142 26.2

Fall 20 3.68 112 20.6 132 24.3


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Table 7: Seasonal distribution of homeless deaths by Race

2002 - 2013

D.

Day of the Week distribution:

Almost half [48.5%] of the homeless deaths were on Friday, Saturday and Sunday,

presumably when fewer services are open. [Figure 9 below]. This is also true

regardless of gender and race.

Figure 9:

Distribution of Homeless Deaths by Day of Week: 20022013

Race

African

American

Asian Caucasian Hispanic Other All

SEASON N % N % N % N % N % N %

Winter 20 3.7 4 .7 100 18.4 12 2.2 3 .6 139 25.6

Spring 19 3.5 5 .9 94 17.3 9 1.6 3 .6 130 23.9

Summer 26 4.8 0 0 143 18.7 11 2 4 .7 143 26.2

Fall 29 5.3 2 .4 81 14.9 19 3.5 2 .4 133 24.4


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E. Location and geographical distribution

Geographical distribution: Figure 10 shows the geographical distribution of the

homeless deaths in Sacramento County. Of the 556 deaths from 2002 - 2013, 308

death locations had an exact address match, with eight locations having three deaths ormore at their institution.

As Figure 10 illustrates, the homeless deaths in 20132014 follow the same pattern as

reported in the 2013 homeless deaths report. The deaths are disproportionately located

in the downtown area and tend to follow transportation corridors, including the

interstates and light rail.

Additionally, comparing Figure 10 to Figure 11 [Sacramento County: Map of

Emergency Shelters, Transitional Housing and Permanent Supportive Housing], they

generally mirror each otherin terms of location of homeless deaths and the location ofemergency shelters, transitional housing program and permanent supportive housing.


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Figure 10: Geographical distribution of homeless deaths

20022013 and 2013 - 2014


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Figure 11: Sacramento County: Emergency Shelters, Transitional Housing &

Permanent Supportive Housing

Emergency Shelter Transitional Housing Permanent Supportive Housing


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Location: Table 8 below details the location of the homeless deaths by category. As

the table indicates, 45.6% of the deaths occurred indoors, with 77% [N=195] of the

deaths being in a hospital, divided fairly evenly between inpatient and the emergency

room [50.3% and 47.1% respectively.] 212 homeless people [38.1%] died outside, in a

field, alley, park or in a car.

Table 8: Homeless Deaths by Location Category: 2002 - 2013

Location Number % Category % total [N=556]

Hospital

Inpatient 98 50.3% 17.6%

EmergencyRoom

92 47.1% 16.5%

Other 5 2.6% .9%

Subtotal 195 100% 35%

Outside

Roadway/alley 106 50% 19.1%

Field 36 16.9% 6.5%

River 16 7.5% 2.9%

Car 15 7.1% 2.7%

Parking lot 14 6.6% 2.5%

Railroad 12 5.7% 2.2%

Park 13 6.1% 2.3%

Subtota l 212 100% 38.1%

IndoorsResidence

Friend 13 36% 2.4%

Other 23 64% 4.1%

Subtota l 36 61% 6.5%

Motel 13 22% 2.4%

Nursing home 4 6.8% 0.7%

Business 3 5.1% .5%

Jail 1 1.7% .18%

Shelter 1 1.7% .18%

Church 1 1.7% .18%

Subtota l 59 100% 10.6%

Other 90 100% 16.2%

Total 556 100.0%


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Table 9:

Homeless Deaths by Location: January 2014June 2014

Location Number % Category % total [N=48]

Hospital

Inpatient 8 47.3% 16.7%

EmergencyRoom

9 52.7% 18.8%

Other - - -

Subtotal 17 100% 35.5 %

Outside:

Roadway/alley 18 75% 37.5

Field 2 8.3% 4.2%

River - - -

Car 2 8.3% 4.2%

Parking Lot - - -

Railroad 1 4.2% 2.1%

Park 1 4.2% 2.1%`

Subtotal 24 100% 50%

Indoors

Residence

Friend 1 25% 2.1%

Other - - -

Subtotal 1 100% 2.1%

Motel 3 75% 6.3%

Nursing home - - -

Business - - -

Jail - - -

Shelter - - -

Church - - -

Subtotal 4 100% 3.9%

Other 3 100% 8.3

Total 48 100.0%

2014 Update: As Table 9 above indicates, while the overall locationpattern was similar in the first six months of 2014 contrasted to the

pattern in 2002 - 2013, there was one exception: a significantly higher

percentage of homeless people died outside [50%] in the first six

months of 2014 than in 20022013 [38.1%].


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F. Manner and Cause of death:

[1] Manner of deaths:

The manner of death is the cause of death indicated on the death certificate, whichincludes the following five categories: Natural, Accident, Suicide, Homicide, and

unknown.

As Figure 12 shows, only about 30% [29%] of the homeless deaths are natural, with

21% undetermined, leaving 50% of the deaths to Accidents [40%], Suicides and

Homicides [5% each].

Figure 12:

Distribution of Homeless Deaths by Manner of Death: 2002 - 2013


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Figure 13:

Distribution of Homeless Deaths by Manner of Death:

January 2014June 2014

[2] Underlying causes of death:

Figure 14 and Figure 15 below detail the underlying causes of death of homeless

people for 20022013 and January 2014June 2014 respectively.

Of note:[1] Of the 556 deaths of homeless people from 2002 - 2013, 18% [90 people] died

of injuries and blunt force injuries accounted for 84% of the injuries. Additionally,

4.7% [24 people] of the total died of wounds and 67% of these were gunshot

wounds. Overall, almost 23% of the homeless deaths were due to injury or

wounds, disproportionately blunt force injury, gunshot wounds, stabbings or

hangings. The percentage for the first six months of 2014 was roughly similar,

with 18.8% dying of injuries.

[2] Over a quarter (28%) of deaths were alcohol/drug related in 20022013 with a

significantly higher percentage, 35.4% in the first six months of 2014;

2014: As Figure 13 shows, there were signficantly higher percentage

of deaths by accident in the first six months of 2014 - to 2002 - 2013

[66.7% and 40% respecitvely].


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[3] 3% [2002 2013] and 4.7% [2014] of the underlying cause of deaths was

hypothermia/hyperthermia [body temperature goes below 95 degrees

Fahrenheit and heat exhaustion and heat stroke respectively];

[4] Despite the large number of homeless people living near the Sacramento River,

only 2% drowned in 20022013.

Figure 14:

Underlying Cause of Death of Homeless People: 2002 - 2013


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Figure 15:

Underlying Causes of Death of Homeless People: January 2014June 2014

Top 5 Cause of Death: Table 10 [below] identifies the five leading underlying causes

of death of homeless people from 2002 - 2013, while Table 11 [below] identifies five

leading underlying causes of death of homeless people for the first six months of 2014.

For both time frames, alcohol/drug induced deaths was the leading cause, followed by

injury.

Table 10: Top Five Causes of Death: 2002 - 2013

Underlying Cause[s] of death Percentage of homeless deaths

Alcohol/drug induced 28%

Injury 18%

Cardiovascular disease 13%Infection 6%

Wound [gun shot or stabbing] 5%


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Table 11: Top Five Causes of Death: January 2014June 2014

Underlying Cause[s] of death Percentage of homeless deaths

Alcohol/drug induced 35%

Injury 24%

Cardiovascular disease 17%

Hypothermia 4%

Wound [gun shot or stabbing] 4%

[3] Violent Deaths:

As Table 12 indicates, 124 [22%] of the 556 homeless deaths were violent deaths, with

79% being by injury, with nearly two-thirds [65%] being by blunt force, while 21% were

by wounds, either from gunshots or stabbings.

Figure 16 shows the overall percentage of violent deaths, with 15% of all 556 deaths of

homeless people being by blunt force injury.

2014 Update: As Table 11 above shows, significantly greater

percentage died of alcohol/drug induced deaths in the first six

months of 2014 to 2002 2013 [35% and 28% respectively]

presumably due to increased methamphetamine or meth use in

the community. 50% of the 16 deaths by alcohol/drug induced

deaths were meth overdose.

Additionally, a greater percentage died of injury [24%] and

cardiovascular disease [17%] - to the 2002 2013 [18% and

13% respectively]


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Table 12:

Violent Causes of Homeless Deaths: 2002 - 2013

Count % violent causes % total homeless

deaths [N=556]

INJURY

Blunt force 81 65% 15%

Trauma 17 15% 3%

All injury 98 79% 18%

WOUND

Gunshot 18 15% 3%

Stabbing 7 6% 1%

All Wounds 26 21% 4%

Total Violent

Causes

124 100% 22%

Figure 16:

Percentage of violent causes of all homeless deaths: 2002 - 2013


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Table 13:

Violent Causes of Death: January 2014June 2014

Count % violent causes % total homeless

deaths [N=48]

INJURY

Blunt force 8 72.7% 16.7%

Burns 1 9.1% 2.1%

All injury 9 81.8% 18.8%

WOUND

Gunshot 2 18.2% 4.2%

Total Violent Causes 11 100% 22.9%

Figure 17:

Percentage of violent causes of homeless deaths: January 2014June 2014

2014 Update: 2014 showed the similar pattern of violence, with a

higher percentage of blunt force death72.7% as well a gunshot

deaths18.2% to 2002 -2013 [65% & 15% respectively]


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[4] Underlying causes of homeless deaths by gender:

A greater percentage of homeless women died of both cardiovascular disease [17.8%]

and internal disease [6.8%] compared to their homeless male counterparts [10.7% and

3.4% respectively, while a greater percentage of homeless men died of injury [18.1%]

and wounds [4.6%] compared to homeless women [15.1% and 2.7% respectively]. [SeeTable 14 below]. Table 15 shows the Top 5 causes of death by gender.

Table 14: Homeless Deaths by Underlying Cause by Gender:

2002 - 2013

Gender

Female Male All

Count % Count % Count %

Cause of Death

20 27.4 135 28.3 155 28%Alcohol-/Drug-Induced

Asphyxia 4 5.5 17 3.6 21 4%

Cardiovascular Disease 13 17.8 51 10.7 64 12%

Diabetes . . 6 1.3 6 1%

Drowning . . 13 2.7 13 2%

Hypo/Hyperthermia 2 2.7 17 3.6 19 3%

Infection 4 5.5 26 5.5 30 5%

Injury 11 15.1 86 18.0 97 18%

Internal Disease 5 6.8 16 3.4 21 4%

Other 1 1.4 16 3.4 17 3%

Unknown 11 15.1 71 14.9 82 15%

Wound 2 2.7 23 4.6 25 5%

Total 73 100.0 477 100.0 550 100%

"Drug" includes both legal and illegal drugs


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Table 15: Homeless Deaths by Underlying Cause by Gender:


Gender

Female Male All

Count % Count % Count %

Cause of Death

Alcohol-/Drug-Induced 5 41.7% 12 33.3% 17 35.4%

Asphyxia - - - - - -

Cardiovascular Disease 1 8.3% 5 13.9% 6 12.5%

Diabetes 1 8.3% - - 1 2.1%

Drowning . . - - - -

Hypo/Hyperthermia - - 2 5.6% 2 4.7%

Infection - - 1 2.8% 1 2.1%

Injury 2 16.7% 7 16.7% 9 18.8%

Internal Disease - - - - - -

Other - - 3 8.3% 3 6.3%

Unknown 2 16.7% 5 13.9% 7 16.7%

Wound 1 16.7% 1 2.8% 2 4.7%

Total 12 100.0 36 100.0 48 100%

Table 16: Top 5 Underlying Causes of Homeless Deaths by Gender:

2002 - 2013

Top FiveCauses ofDeath

Females Males All

1. Alcohol/druginduced: 27.4%

Alcohol/druginduced: 28.3%

Alcohol/druginduced: 28%

2. Cardiovasculardisease: 17.8%

Injury: 18% Injury: 18%

3. Injury: 15.1% Cardiovascular:10.7%

Cardiovasculardisease: 12%

4. Internal disease:6.8%

Infection: 5.5% Infection: 5%

5. Infection: 5.5% Wounds: 4.5% Wound [gun shotor stabbing]: 5%


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Table 17: Top 3 Underlying Cause of Homeless Deaths by Gender


Top ThreeCauses ofDeath

Females Males All

1. Alcohol/druginduced:41.7%

Alcohol/druginduced:33.3%


2. Injury: 16.7% Injury: 16.7% Injury: 18.8%

3. Cardiovascular

disease: 8.3%

Cardiovascular

disease: 13.9%

Cardiovascular

disease: 12.5%

Thus, the pattern of underlying causes of death in 2002 2013 and the first six months

of 2014 are very similar: alcohol/drug induced cause of death is the leading cause of

death regardless of gender with each gender having injury as a major cause of death.

[5] Underlying Cause of Death by Race/Ethnicity:

Table 18 identifies all the underlying causes of death by race while Table 19 highlights

the top three causes of death by race. As this table indicates, cardiovascular disease issignificantly higher for homeless African Americans, while alcohol/drug induced deaths

is high for all four races, as is death by injury and wounds. The latter cause of death is

a significantly higher percent for Hispanics than the three other races.


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Table 18:

Homeless Deaths by Underlying Cause and Race/Ethnicity: 2002 - 2013

Race

Asian Af Am Caucasian Hispanic Other All

Count

%

Count

%

Count

%

Count

%

Count

%

Count

%

Cause of Death

Alcohol-/Drug-

Induced

1 9.1 19 20.2 115 30.2 14 27.5 6 31.6 155 27.9%

Asphyxia 1 9.1 1 1.1 17 4.5 2 3.9 . . 21 3.8%

Cardiovascular

Disease

1 9.1 17 18.1 43 11.3 2 3.9 1 5.3 64 11.5%

Diabetes . . 3 3.2 3 .8 . . . . 6 1.1%

Drowning . . 1 1.1 9 2.4 3 5.9 . . 13 2.3%

Hypo/Hyperthermia 1 9.1 1 1.1 17 4.5 . . . . 19 3.4%

Infection . . 5 5.3 21 5.5 4 7.8 . . 30 5.4%

Injury 2 18.2 20 21.3 62 16.3 12 23.5 1 5.3 97 17.4%

Internal Disease 1 9.1 5 5.3 15 3.9 . . . . 22 4%

Other . . 3 3.2 12 3.1 2 3.9 . . 17 3.1%

Unknown 3 27.3 12 12.8 57 15 5 9.8 11 57.9 88 15.9%

Wound 1 9.1 7 7.4 10 2.5 7 13.7 . - 25 4.5%Total 11 100 94 100 381 100 51 100 19 100 556 100%

Table 19:

Top 3 Underlying Causes of Death by Race/Ethnicity: 2002 -2013

TopThreeCauses ofDeath

African American Caucasian Hispanic All

1. Injury: 21.3% Alcohol/druginduced: 30.2%



2. Alcohol Drug: 20.2% Injury: 16.3% Injury: 23.5% Injury: 17.4%

3. Cardiovasculardisease: 18.1%

Cardiovasculardisease: 11.3%

Wound: 13.7% Cardiovasculardisease: 11.5%


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Table 20:

Homeless Deaths by Underlying Cause and Race: January 2014June 2014

Race

Asian Af Am Caucasian Hispanic All

Count

%

Count

%

Count

%

Count

%

Count

%

Cause of Death

Alcohol-/Drug-Induced 3 9.1 4 20.2 7 30.2 3 27.5 17 35.4

Asphyxia - - - - - - - - - -

Cardiovascular Disease - - 4 66.7 2 23.3 - - 6 12.5

Diabetes . . 1 100 - - - - 1 2.1

Drowning - - - - - - - - - -

Hypo/Hyperthermia 1 50 1 50 - - - - 2 4.7

Infection - - 1 100 - - - - 1 2.1

Injury - - 2 22.2 5 55.6 2 22.2 9 18.8

Internal Disease - - - - - - - - - -

Other - - 2 66.7 - - 1 23.3 3 6.3

Unknown - - 1 14.3 6 85.7 - - 7 16.7

Wound - - 1 50 - - 1 50 2 4.7

Total 4 100.0 15 100.0 20 100.0 6 100.0 48 100.0

Note: Asian was not included since the number was

Only 11 which distorts the percentage of cause of death

See Appendix V: Homeless Deaths by Manner & Cause of Death by Race:

2002 - 2013

G. Use of homeless services:

This section identifies the decedents who used either the Sacramento County Health

Services compared the names of the decedents to their health care records to

determine if the person and/or homeless programs [as identified by the Homeless

Management Information System, H.M.I.S.]. These programs include emergency

shelters, including the Winter Shelter Program, as well as transitional housing programs

and drug treatment or mental health programs.

See Appendix VI: Overview of Health Status of Homeless People


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[1] Clinic Attendance:

The percentage of homeless decedents that had contact with the County Health Care

for the Homeless program is roughly the same in 2002 2013 and the first six months

of 2014, roughly 62% seen by the clinic [Tables 21 & 22 below]. This contact could

have been a public health screening for tuberculosis [TB] or a sexually transmitted

disease [STD], triage, immunizations, emergency dental service or for a medically

necessary health service.

Table 21: Clinic Attendance by Homeless Status: 2002 - 2013

County Clinic

Visit

All

No Yes

Homeless2002 -2013 212 344 556

Percentage 38.1% 61.9% 100%

Table 22: Clinic Attendance by Homeless Status: January 2014June 2014

County Clinic

Visit

All

No Yes

Homeless

2014 18 30 48

Percentage 37.5% 62.5% 100%

[2] Homeless Management System [HMIS]:

Number Identified in by HMIS: Of the 556 decedents, HMIS identified, 178 or

32%, as being served at some point in time by a homeless service provider

between from 2002 - 2013. This low percentage is due in large degree that the

HMIS system did not become a reliable source of information until 2005 as wellas most of the decedents utilized the Winter Shelter Program exclusively, which

is not designed to be part of the HMIS system.


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Self-identified Issues: When entering into the homeless delivery system the

Homeless Management Information System tracked the following issues as self-

identified by the homeless person upon entering a program. These included

disability; substance abuse; chronic health issue and mental health issue. Table

23 below indicates the number of homeless people that self-identified any, one or

more of the above issues. There is a lot of missing data, i.e., no answer,

ranging from 35% to 82%. Nevertheless, 35.9% self-identified a disability, half

[51.1%] a substance abuse issue and roughly 16% a mental health issue. 11%

identified a chronic health issue, with almost 82% failing to respond with an

answer.

Table 23: Self-Identified Issues upon Entering Program: 2002 - 2013

Issues Yes % No % No Answer %

Disability 71 35.9% 58 29.2% 69 34.8%

Substance

Abuse

91 51.1% 35 19.7% 52 29.2%

Chronic

Health

Condition

20 11.2% 12 6.7% 146 82.1%

Mental

Health

29 16.3% 62 34.8% 87 48.9%

Program Type: Table 24 below identifies the number of decedents seen by the

type of program [winter shelter; emergency shelter; transitional housing;

permanent supportive housing; affordable housing].

See Appendix VII: Program Type: Shelter - a listing of all shelters.

We used the first time the person was seen and the last date the person was

seen by a program, hence each of the 178 HMIS entries had two records below,which is why the total number is double. Overwhelmingly, almost 90% [89.6%] of

homeless people accessed a combination of winter shelter [only open during

three winter months]and emergency shelters.


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Only about 6% entered either a transitional housing program, permanent

supportive housing program or affordable housing, in this case the Homeless

Prevention & Rapid Rehousing Program [HPRP].

See Appendix VIII: Program Type: Transitional Housing and Permanent

Supportive Housing

Table 24: Program Type: 2002 - 2013

Program Type Number % of total [346]

Winter Shelter 112 32.4%

Shelter 198 57.2%

Transitional

Housing

15 4.3%

PermanentSupportive Housing

[PSH]

5 1.5%

Affordable Housing 1 .3%

Missing information 15 4.3%

Total 346 100%

Number of times accessing homeless programs: Table 25 identifies the number

of times homeless people accessed one or more homeless programs. The range

was from 1 time to a high of 20 times, with the average 3 being times.

Table 25: Number of times accessing a homeless program: 2002 - 2013

Number of Times

Accessing

Program

Number % of total [178]

1-2 100 56.2%

3-5 35 19.7%

6-10 35 19.7%

11-15 3 1.7%

16-25 4 2.4%

Missing Data 1 .06%

Total 178 100%


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Date last seen before death: Table 26 shows the date last seen by a homeless

program and the timeframe after they were last seen and their death. Averaging

the 178 homeless between less than a week and 4 years, the average timeframe

between exiting a homeless program and a homeless persons death is 371

days.

Roughly one-third [31.5%] of the 178 homeless people died within one - three

months after they were last seen, while almost half [48.9%] within one - six

months and over two-thirds [68%] from one twelve months of last being seen

by a program and their death.

Table 26: Timeframe between last seen in a program and death:

2002 - 2013

Timeframe Last Seen to Death Number % of total

< 1 week 19 10.7%

12 weeks 6 3.4%

24 weeks 7 3.9%

13 months 24 13.5%

36 months 31 17.4%

612 months 34 19.1%

1 year2 years 15 8.4%

2 years4 years 20 12.2%

> 4 years 14 7.9%Missing data 8 4.5%

Total 178 100%


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H. Law Enforcement:

As Table 27 indicates, 80% [N=63] of the decedents had previously been in custody,

while only 20% had no previous custody record. This compares to 77% of the 501

decedents having been in custody in the 2002 2013 homeless deaths report.Cumulatively, from 20022014, 450 or 77.6%, of the decedents had been in custody.

Table 27: Law enforcement: Number in Custody:January 1, 2002June 30, 2014

Ever in Custody Number %

No previous

custody

16 20%

Previous custody 63 80%

Total 79 100%

Table 28 below identifies the amount of time between the last release date from custodyand the Coroners date of death. Similar to Table 26 above where 68% died betweenone twelve months after being seen by a social service program, almost 60% diedwith a year or less from being released from custody, with a third of that [21%] passingaway within a month or less of being released from custody.


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Table 28: Length of time from Custody Release date to date of deathJanuary 1, 2002June 30, 2014

Number of

Days/Months/Years

Number %

< 30 days 13 21%

3060 days 6 10%

6090 days 4 6%

3 months4 months 3 5%



6 months1 year 8 13%

Subto tal 35 57%

12 years 5 8%

23 years 5 8%

34 years 4 3%

45 years 2 3%

510 years 5 8%

1015 years 5 8%

1619 years 2 3%

Total 63 100%


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III. Comparison of causes of death of the homelesspopulation with the general population deaths

A. Mortality Rates for General and Homeless Populations

Estimated mortality rates for the homeless population in 2007-2009 [Table 29] are

about two to three times higher than for the general population in Sacramento County,

but lower than reported (four to nine times) by the United States Interagency Council on

Homelessness.

Table 29: Mortality Rates per 100,000: General Population vs. Homeless

Population in Sacramento County: 2007 - 2009

Mortal i ty Rate per 100,000 popu lation

Population 2007 2008 2009

General

Population

678 688 680

Homeless

Population

1,672 2,054 1,607

B. Racial/Ethnic Composition for General and Homeless Populations

Significant differences were identified in racial/ethnic composition of deceased in the

general and homeless populations of Sacramento County in 2010 [Figure 18]. There

were no deaths recorded among Asian homeless in 2010 comparing to 9.1% in the

general population.

About two third of all homeless deaths were Caucasians (73.9%) which was slightly

higher than the proportion of Caucasian deaths (70.9%) in the general population. Incontrast, the proportion of Hispanic homeless deaths (2.2%) was much lower than the

proportion of Hispanic deaths (8.6%) in the general population.

The proportion of African-American homeless deaths (19.6%) was also much higher

than the proportion of African-American deaths in the general population (11.5%).


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Figure 18: General population vs. Homeless Population by Race/Ethnicity

General Population

Homeless Population


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erce

tS

icie

PercentofHomicide

C. Suicide Rates for General and Homeless Populations

Figure 19 shows that the percent of deaths due to suicide was constantly below 2 % for

the general population, but was not so stable for the homeless population and ranged

from about 2% to 12% for the studied period.Figure 19: Suicide: General population vs. Homeless Population

D. Homicide Rates for General and Homeless Populations

Figure 20 shows the percent of deaths due to homicide was constantly below 2% for the

general population, but was not so stable for the homeless population and ranged

between 2% and 12% for the studied period.

Figure 20: Homicide: General population vs. Homeless Population


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Percentof

lcohol

rugRelated

eaths

E. Alcohol and Drug-Related Deaths for General and Homeless

Populations

Figure 21 shows that the percentage of alcohol and drug-related deaths was about five

to seven times higher than in the general population.

Figure 21: Alcohol and Drug-Related Deaths: General population vs.

Homeless population Sacramento County 2003 - 2010

F. Alcohol and Drug-Related Deaths by Race for General and HomelessPopulations

Figure 22 shows the racial/ethnic distribution of alcohol and drug related deaths over

the eight-year period. The proportion of alcohol or drug-related deaths among the

Asians was 2.7% in the general population and there was no alcohol or drug-related

deaths in the homeless population for this period. Alcohol and drug related deaths

among the Homeless Caucasians (76.7%) were slightly higher than for Caucasians in

the general population (71.3%). For the African-Americans, the proportions were about

the same in the homeless (10.7%) and the general population (11.0%) For the Hispanicpopulation, the proportion was much lower among the homeless population (9.7%) than

in the general population (12.7%).


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G. Distribution of Deceased for General and Homeless Populations in 2010

Figure 23 shows age distribution of deceased in the general and homeless populations

in 2010. The homeless population had much higher percentage of deaths in age groups

ranged from 25 to 74 years compared to the general population. The age distribution of

deaths had a peak at 55-64 year group for the homeless population compared to 85+

year group in the general population.

Figure 23: Age Distribution: General population vs. Homeless population:

Sacramento County, 2010

References

1. Kurteff Schatz M, Halcon E. Sacramento Homeless Count 2013. Count and

Survey Report. July 20132. Sacramento County Department of Health and Human Services. The Chronic

Disease Experience of Sacramento County Residents. April 2013

3. United States Interagency Council on Homelessness. People Experiencing

Chronic Homelessness. http://usich.gov/population/chronic. Accessed

11/10/2013

4. California Department of Public Health. Vital Statistics and Strategic Planning.

http://www.apps.cdph.ca.gov/vsq.Accessed 11/10/2013
http://usich.gov/population/chronic.%20Accessed%2011/10/2013http://usich.gov/population/chronic.%20Accessed%2011/10/2013http://usich.gov/population/chronic.%20Accessed%2011/10/2013http://www.apps.cdph.ca.gov/vsqhttp://www.apps.cdph.ca.gov/vsqhttp://www.apps.cdph.ca.gov/vsqhttp://usich.gov/population/chronic.%20Accessed%2011/10/2013http://usich.gov/population/chronic.%20Accessed%2011/10/2013


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IV. Policy recommendations

The Sacramento Steps Forward Health Care Committee, Sacramento Regional

Coalition to End Homelessness [SRCEH] Board of Directors and SRCEH Strategic

Advisory Board are making the following policy recommendations, based on ouranalysis of the data in this report. The policy recommendations are in priority order.

I. Affordable Housing & Emergency Shelter:

A. Affordable Housing : Expand the City/County Affordable Housing Trust

Fund to create affordable housing: increase the resources local ly to

signi f icant ly expand the Sacramento City/County Afford able Housin g Trust

Fund to s igni f icant ly increase the supply of affordable hou sing, especially

for tho se at or below 30%- 50% Area Median Inc om e [AMI] .

As Sacramento Steps Forward points out in their 2013 Sacramento Countywide

Homeless County Report, housing programs are competing for scarcer funding at the

federal, state, regional and local levels. Current cuts to the Housing Choice Voucher

Program and administrative resources for public housing authorities due to

Sequestration will mean significantly reduced resources in this region, and may lead to

even greater increases in homelessness.Add to the negative impacts on affordable

housing with the abolishment of redevelopment agencies throughout California on

February 1, 2012, and a slow-down in the pipeline to develop permanent supportive

housing, a critical strategy for reducing chronic homelessness.

Thus, our community faces tremendous challenges in ending and preventing

homelessness, including lowering the number of deaths of people experiencing

homelessness, with few resources to create affordable and accessible housing.

Our recommendat ion to increase the resources to create affordable housing

local ly is to signi f icant ly expand the Sacramento City/County Affordable Housing

Trust Fund . Currently, the Trust Fund is funded by a commercial linkage fee, a fee to

builders of commercial buildings based on the square feet of the project. Given the

recession, very little commercial building was taking place and the Trust Fund shrank toless than $1 million in 2013. As of October 2014, the combined City/County Affordable

Housing Trust Fund is approximately $3 million.

The City Council and County Board of Supervisors needs to consider a range of

additional sources of funding for the Trust Fund to replace the tens of millions of

redevelopment funds that were lost annually.


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B. Emergency Shel ter :

1. We support the housing first approach. However, with a lack of

affordable hou sing un i ts, we recommend increasing the capaci ty of the

cr is is response system to s erve more homeless people through a var iety of

means including year roun d shel ter and rapid rehou sing. Finally , againgiven the lack of affordable housin g, we support Safety Options includ ing

supp ort ing the Safe Ground con cept and safe places for tents:

While we advocate for increased funding for housing and the housing first approach, we

have the immediate need to increase emergency shelter and safety options for the

roughly 30% of the Sacramento homeless population that is outside, often alone, and as

our report underscores, exposed to a high level of violence.

Given this, we recommend increasing the capaci ty of the cr is is respo nse system

to serve more homeless people through a var iety of means includ ing year roundshel ter and rapid rehousing.

Special note: Homeless people with pets and sex offenders:

Homeless People With Pets: We also recommend that our community removes the

significant barrier of denying shelter to homeless people with pets. Homeless people

with pets cannot access emergency shelters or currently Winter Shelter and thus are

forced to live outside with their pets or give up their pets, which are family to them.

Rather than this either/or option, we recommend creative solutions to allowing homeless

people with pets to access emergency shelters.

Sex Offenders or 290s: Although beyond the scope of our research for this report, we

do know that men and women who are registered sex offenders or 290s [the criminal

code in California] become homeless because their housing options are severely limited.

For example, they cannot reside within a 1,000 feet of a school. Thus, many become

homeless because the number of Single Room Occupancy [SROs] rooms has

decreased significantly in downtown Sacramento nor can they access emergency

shelters.

We recommend that Sacramento Steps Forward in th e f i rst quarter of 2015 hold a

communi ty forum on th is issue wi th the goal of f ind ing solut ions to hous inghom eless sex offenders in our commun i ty.


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Safety Options: We recommend the fol lowing to provide homeless people safe

places to be:

Safe Ground Concept: We support Sacramento Steps Forwardsrecommendation [2013 report above] Safe Ground as part of the solution to

ending homelessness by providing a pathway to self-sufficiency. Safe Ground

has been endorsed by both the Mayor of Sacramento and the Sacramento Steps

Forward and Continuum of Care Boards as a part of the solution to end

homelessness in Sacramento.

Safe places for Tents: In addition to support of the Safe Ground concept, we

also recommend the City and County locating safe places for people to have

their tent and their belongings as a way to provide a safe community for

homeless people.

2. Weekend Drop In Center:

A critical finding is that homeless people tend to pass away at a higher frequency on the

weekends, specifically Friday, Saturday and Sunday. Specifically, almost 50% [48.5%]

of homeless people died on Friday, Saturday and Sunday, presumably when homeless

programs are closed.

We recomm end a weekend Drop -In Center wh ere homeless people can be safe,

have access to a bathroom , shower, food, storage faci l i ty for food and medic ine,

barbeque pi t for cooking .

II. Health Care:

A. Increased fundin g for alcohol , other drugs and mental heal th treatment

services and prog rams:

1. Given the findings of this report, that 28% had deaths with

alcohol/substance abuse induced deaths as an underlying cause of their

death, we need to significantly increase the funding for alcohol and drugtreatment services and programs as strategy to help reduce preventable

deaths of homeless people. The County should refund VOAs

Substance Abu se Outreach & Treatment Program wh ich prov ided

free outpat ient dru g treatment services and treatment o n d emand.


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2. We also recommend that the Sacramento County outstat ion

embedded Alco hol and other Drugs [AOD] screening/assessment

and referral personnel in commun i ty based homeless programs th at

provide o utpat ient and resident ial treatment [suc h as Volun teers of

America, NextMove and WellSpace]. This will remove the

access/transportation barrier of having the sole access point for AOD

assessment and referral be at the County Adult System of Care located on

Power Inn Road.

3. Final ly we recommend the County provide a l is t of al l the

cl inics/providers who p rescr ibe Naloxone sinc e some cl inics have

implemented AB 635 which provides for fami ly members, direct

serv ice programs etc. to obtain a prescr ipt ion for Naloxone

[emergency drug o verdose treatment] . The County should also include

clinics that provide prescriptions for other medication assisted treatmentswhich includes Campral, Suboxone, and Vivitrol.

B. Expand fundin g for a Respi te Care faci l ity :

Currently, Sacramento County, three of the largest hospital organizations and Salvation

Army support the Interim Care Program (ICP) operated by Well Space Community

Clinic Inc. This community collaborative was developed after the media exposed the

need when many homeless patients were being discharged from hospitals with

extended health care needs but nowhere to properly rehabilitate.

Since 2004, hospital case managers coordinate the discharge of potentially homeless

individuals to ICP. Individuals being discharged from the hospital must be able to

conduct Activities of Daily Living with little assistance. Salvation Army secures at least

18 beds for ICP clients and Well Spaces medical and social worker staff monitors these

individuals and assist them with medical and psychosocial needs during their

recuperation at the Salvation Army Shelter.

Since this is not a medical facility and the Well Space staff are not on site 24 / 7 and

limited days and hour throughout the week; therefore, the Interim Care Program is not a

Respite facility and clients have limited health care service.


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We recommend expanding fu nding for a Medical Respi te mod el , which is shel ter

or sup por t ive hous ing wi th m edical suppor ts for those being discharged from

hospi tals. A medical respite would provide hospitals a discharge plan for people

experiencing homelessness who no longer need inpatient treatment but for whom

homelessness compromises their wellness. Medical respite may be an important

additional service, but without long-term housing options, a person leaving medical

respite is still homeless and still vulnerable

C. Increase fundin g for nurse street outreach with a pr ior i ty of out-stat ioning

nu rses at the Year Round Shelter sites as well as street outreach.

Outreach services can be defined many ways when discussing outreach for our

Countys homeless population. They are defined as navigators, paraprofessionals and

mental health worker, medical teams etc. All of these are important and productive in

their own way. Outreach has taken different forms within our community. We have

patient navigators, mental health outreach; faith based outreach, veteran outreach and

licensed nurse outreach.

For the period of this report, the Sacramento County DHHS Health Care for the

Homeless Program utilized two licensed nurses [note: which increased to 3 RNs in

2014] to go to shelters, parks, downtown hotels and other homeless service areas to

provide hands-on nursing assessment, treatment within their scope of practice.

They advocate for patients immediate health care needs with local health professionals

for urgent and acute problems. In addition, since they are part of the County safety netclinic, they have ability to retrieve clients medical records communicate with his/her

doctor and retrieve verbal orders as well as standing orders to treat client. The licensed

nurses ability to expedite care helps to promotes positive health outcomes and

prevents potential hospitalizations and costly emergency room [ER] visits.

Across the nation, we have homeless shelters and advocates helping the homeless

improve their current circumstance. The federal grant which supports health care for the

homeless grantees identifies outreach as its primary premise to the grant. Many of

these grantees conduct mobile medical outreach. This allows medical teams of doctors;

nurses and / or psychiatrist go to the homeless in areas they congregate and providehealth care services in non-traditional health care settings.

In Sacramento County, the emphasis is comprehensive primary care with enabling

services to assist homeless individuals to participate in health improvement activities,

such as transportation assistance and case management.


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Finally, SRCEH will collaborate with the Sacramento County Primary Health Services

for the Health Care for the Homeless Program and Medi-Cal Managed Care Advisory

committee to develop a Homeless 101 Traininga training curriculum for the managed

care health plan providers, alcohol and drug providers, and local safety net providers

that do not have previous experience with the homeless population.

E. Nutr i t ion: Ensure ful l enrol lment on CalFresh and implementat ion of the

Restaurant Meals Program and all Certi f ied Farmers Markets accep t the EBT

card so that hom eless peop le as wel l as other low incom e people have

access to fresh frui t and vegetables.

While not directly related to the manner and cause of death, many of the poor health

conditions of homeless people, such a poor dental care, high blood pressure,

cardiovascular issues, and diabetes are directly attributable to poor nutrition.

The recommendations below are supported by the 2010 report by the SacramentoHunger Coalition, Hunger and Homelessness in Sacramento: 2010 Hunger & Food

Insecurity Report. The report is a survey of 112 homeless people at the 2010 Homeless

Connect event. Several key findings include:

53.2% currently do not receive Food Stamps [now called Cal Fresh] and 65.0%of respondents receiving food stamps report they only lasted between 2 3weeks per month;

Nearly 60.0% have no access to food storage facilities; while between 56.0% 84.0% have no access to any kind of cooking facilities;

Access to free food is limited, with even the most common source, sidewalk

giveaways, only being utilized by 49.9% of respondents; Over one third identify lack of storage and cooking facilities and transportation as

barriers to accessing nutritious food while over 25.0% state healthy food is notaccessible to them. Additionally, over 20.0% stated they cannot use their EBTcards at local Farmers Markets;

Greater availability of Farmers Markets, Community Gardens and BBQ areas inparks topped the list of programs respondents would like to see expanded in theSacramento region, with 75.0% 85.0% indicating interest in these.

We recommend that Sacramento County cont inue to be aggressive in their

enrol lment of el igible hom eless people [note: i f a person receives SSI they are

no t el igible for CalFresh] on to CalFresh, sti l l often referred to as Food Stamps .


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Add i t ional ly we recommend the County fu l ly implement the Restaurant Meals

Program [RMP]. The RMP is a program for homeless people, seniors and people with

disabilities to be able to use their EBT [electronic benefits transfer card] at participating

restaurants. Currently, there are only 42 participating restaurants in Sacramento

County, compared to over 1,200 in Los Angeles County, the latter due to aggressive

outreach by LA County. Sacramento County should automatically enroll homeless

people into the RMP instead of the current practice of applying. This is an unnecessary

barrier that could easily be removed by enrolling homeless people onto the program

automatically.

Final ly, we recommend th at al l Certi f ied Farmers Markets accept the EBT card so

that homeless peop le as wel l as other low incom e people have access to fresh

fruit and vegetables.

III. Transportation:

Subsidize transportat ion opt ion s for hom eless people:

Lack of transportation is a significant barrier for many homeless people seeking health

care, shelter, housing, employment and other benefits. We recommend that

Sacramento County provides free or subsidized transportat ion opt ions for

hom eless peop le including bus and l ight rai l passes.

IV.Free phones and charging station[s]:

We recommend ful l implementat ion in our communi ty of the CA Publ ic Util i t ies

Comm ission Li fel ine Program that al lows for the distr ibut ion of free cel l phon es

as wel l as recomm end charging stat ions in key, central locations fo r people to

charge their phon es.

We recommend full implementation in our community of the CA Public Utilities

Commission Lifeline Program that allows for the distribution of free cell phones [250

talk minutes and 250 text minutes per month] to qualifying homeless people [to qualify

your income has to be 135% or below of the federal poverty level]. Additionally, many

homeless people have cell phones but have no way to charge them, so we also

recommend charging stations in key, central locations for people to charge their

phones. We make this recommendation in the hopes of increasing the safety of

homeless people to be able to call for help in case of an accident as well seek

counseling if the person is considering suicide.


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V. Homeless Deaths Review Committee:

We recommend the County Coroners Office convene a Homeless Deaths Review

Comm ittee, simi lar to death review panels for chi ldren and y outh and vict ims o f

domest ic violence, compr ised of ident i f ied system partners with the goal to

cont inuous ly assess, moni tor and recommend improvements to communi ty

services and suppo rts for people exper iencing homelessness.


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Appendix I: Methodology:

Coroners Office:

This report is based on the report of deaths of people experiencing homelessness,

January 1, 2002December 31, 2013, as well an update on the first 6 months of 2014,as reported by the Sacramento County Coroners office. Note: the Sacramento

County: Homeless Deaths Report: 20022013 published in December 2013 was data

from June 2002 June 2013. So we could do a year-to-year comparison for this

report, we added the Coroners data for the first 6 months of 2002, the last six months

of 2013 and then added an update for the first 6 months of 2014.

The data in the Coroners report included: Name; Death address; Location type [i.e.,

hospital, field, parking lot, car etc.]; Date of death; Birthdate; Ethnicity; Marital status;

Causes[s] of death [A,B,C,D]; Manner of death; Indigent status; Body abandoned;

Homeless status.

Death Investigation is pursuant to the California Government Code Section 27491 for all

deaths meeting the jurisdictional requirements (of CaGov Code Sec 27491) occurring

within Sacramento County. Death investigation included the following: Death Scene

Investigation (when possible); Forensic Examination of remains (autopsy, external

examination and or medical record review); Forensic Toxicology analysis when

warranted/possible; Decedent Identification Confirmation; Follow-up

investigation/Interviews with all relevant investigative parties/stakeholders (law

enforcement, EMS, hospitals, reporting party, service providers, families, friends,

coworkers, etc.); Decedent Record review (medical records, criminal records, work

history records, military records, local/state/federal personal information database

records all inclusive)

As part of the overall investigation the Coroners office determines the decedents

address. The components included in this determination include the reporting partys

information, death scene investigation, interviews of friends and family and witnesses,

evidence found at autopsy that may confirm a homeless lifestyle and record checks.

This report is not a report of every homeless persons death over the decade, however

we feel confident that the report captures most of the deaths of people experiencing

homelessness and gives us a large enough database to be able to identify issues and

make recommendations for the future on how to lower the number of preventable

deaths of homeless people.


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Veterans Status:Veterans status was confirmed by the coroner contacting the county veterans services

officer who runs the decedents name for veterans status.

Health Clinic Status:The Sacramento County Health Services compared the names of the decedents to their

health care records to determine if the person ever had been a patient at the clinic. This

report shows whether or not the person had been seen by the clinic, but did not report

the reasons for the visit.

Homeless Management Information System:To determine if the decedent had ever been a guest or client of any of the Sacramento

County Continuum of Care funded homeless programs, the names of the decedents

were searched in the Homeless Management Information System [HMIS]. The HMISsystem goes back to 2003, so it does not include any information prior to that date. The

elements that were searched included: [1] First date seen by a homeless program; [2]

How many times seen by a homeless program; [3] Last date seen; [4] Self-assessments

including: physical disabilities, chronic health conditions, substance abuse and mental

health issues.

Law Enforcement:The Sacramento County Sheriffs Department compared the names of the decedents to

their database to see how many of the decedents had ever been in custody and length

of time in custody at any point during the period covered by this study.

Methodology for data analysis:Eduard Poltavskiy, PhD Student, Epidemiology and BioStatistics, University of

California, Davis, with oversight of the staff of the Department of Health and Human

Services, Public Health Division, Sacramento County, analyzed the July 2013 June

2014 data of homeless deaths provided by the Coroners Office, Sacramento County.

The data included full name, sex, date of birth, marital status, race/ethnicity, date of

death, place of death, manner of death, and cause of death. The study protocol used

SAS for data analysis. This study analyzed routinely collected administrative data, andso did not pose a significant risk to the privacy of the studied subjects.

We identified some published reports that provided estimates for the general andhomeless populations, racial/ethnic distribution of general population, mortality rates ordata from which mortality rates could be calculated among both the general public andhomeless population in Sacramento County. 1, 2


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Appendix II: Names of homeless people who passed

away: January 1, 2002December 31, 2013

Last Name First Date of Death Age

ABEL ROBERT 7/31/2007 51

ADAMS JAMES 7/9/2010 58

ADAMS-ZUNIGA ALEJANDRO 02/09/14 20

ALEXANDER LANETTE 02/12/14 54

ALIRES ALBERT 6/30/2004 50

ALLEN GERALD 2/16/2007 53

ALLEN KEITH 9/5/2011 45

ALMANZA ROBERTO 3/2/2005 49

AMBORD JOHN 10/7/2007 53

ANDERSON ROBERT 10/12/2003 46

ANDERSON KEITH 1/8/2013 59

ANGELES DANIEL 12/7/2011 61

ANGELICA CHRISTOPHER 12/18/2008 37

ANICHINI ERIC 01/27/14 45

APODACA DAVID 10/31/2009 43

ARATOLI STEVEN 02/08/14 32

homeless deaths report

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