Stanislaus County doesn't track homeless death causes. Is knowing the data helpful?

Sep. 27—Unlike other California counties such as Sacramento, Stanislaus cannot provide data from its records systems on when and how homeless people die.

The coroner most frequently listed natural causes in a sample of about 30 homeless deaths The Bee compiled by hand-searching records, but stakeholders shared different perspectives on whether comprehensive data can help reduce homelessness.

If the county began tracking homeless death causes, said Stanislaus County Supervisor Terry Withrow, the effort would not achieve the goal of housing people. Withrow serves on the Stanislaus Homeless Alliance and said he doesn't know if the group has discussed tracking the issue because officials recognize experiencing homelessness shortens people's life expectancy.

"Just knowing what they're dying of doesn't help us get them off the streets," Withrow said. "We know they're going to end up dying if they stay on the streets long enough."

Based on how homeless people interact with county services from behavioral health to law enforcement, Withrow said they can die from violence, drug overdose, suicide and untreated illnesses related to not seeing doctors regularly. The county tries to provide services to these at-risk people, Withrow said, which helps prevent deaths.

Tracking homeless death causes likely will not tell the county anything new, Withrow said. Even if data showed a particular issue such as drug overdoses as a leading cause, he said, the county already has programs, including an opioid coalition.

The county tracks overdoses and suicides in general, but information on homeless deaths can help inform strategies specifically around mental health and substance abuse, said Ruben Imperial, director of Stanislaus County Behavioral Health and Recovery Services. Imperial identified the Community Assessment Response and Engagement (CARE) team as one strategy his department participates in that mitigates homeless deaths. The recently expanded team connects homeless people with health care, housing, substance abuse and other services.

By assessing homeless mortality data, health departments and policy makers may also decide if they need to change approaches, said Sharon Rapport, director of California state policy for the Corporation for Supportive Housing. Officials may further identify geographic hot spots and devote more resources to specific communities, Rapport said.

"Any data can and should be used to address homelessness," Rapport said. "We know from lots of best practices across the country that data does inform good policy. So, to the extent that we're missing data, that does stand in the way of driving the best policy we can reach to move the needle on homelessness."

Sample shows snapshot of Turlock homeless deaths

The coroner lacks software programs to separately maintain homeless death records, Deputy County Counsel Elizabeth De Jong said in a response to The Bee's public records request. The county declined to hand-search records because it would be a burden on the office, which investigated about 4,000 deaths in 2020 alone.

But the We Care Program provided lists of names from candlelight vigils the nonprofit has held to honor Turlock homeless people who died in the past four years. Shelter manager Debbie Gutierrez compiled the lists from word of mouth among clients and homeless service providers, so she said they do not include every death.

By hand-searching coroner death records from about 2017 to 2020 for the 60 full names listed, The Bee found data for 28 homeless death cases. The average age of death was 51 and 71% were men. The most deaths, 12, occurred in the fall while summer accounted for half as many.

Homeless deaths related to weather are common in other parts of the nation, but Rapport said it seems most deaths in California are not due to heat or cold based on available data. More than half of California counties do not track of deaths of people experiencing homelessness, Rapport added. In counties tracking the data, such as Sacramento and Los Angeles, Rapport said most fatalities occur because health deteriorates rapidly on the streets.

In the sample of Turlock deaths, the coroner most frequently listed natural causes, which made up 29% of the 28 cases. Among the reported natural causes were heart problems, liver failure, pneumonia and poverty. Unspecified accidents and drugs each accounted for 18% of homeless deaths.

Car or train accidents, suicide and gunshot wounds respectively made up 14%, 11% and 7% of cases. Records showed the cause of one 2020 death was still pending.

Linda Murphy-Julien, executive director of the United Samaritans Foundation, said the limited sample reflects issues the nonprofit sees in Turlock. Comprehensive data on homeless deaths and causes would not hurt, Murphy-Julien said, but she questioned why the county does not track it already.

At the same time, the representative on the Stanislaus Community System of Care said she prioritizes how the group can support homeless people here now.

"I'm an advocate for education and looking for help and support," Murphy-Julien said. "I know that we've got it. We don't have it perfect and we can't save everyone, but boy, let's try to save the next one."

California, others work on homeless mortality tracking

The county vital records department likewise cannot pull homeless death information from its database, but the state is developing a system to track homeless death records, said Health Services Agency spokesperson Elizabeth McCuistion.

The California Department of Public Health is updating its electronic death registration system to add a question regarding whether people experienced homelessness, the department said in an email. The updated system will also staff completing death certificates to indicate whether people were sheltered, unsheltered or in an institution.

Adding the data will allow the department to better monitor the public health crisis of homelessness in California, the department said. County health departments will be able to access local data, too. The state has worked on the update since early 2020 and estimates it will go live in mid-2022.

Nationwide, about 30 counties and cities currently track homeless deaths, said Katherine Cavanaugh, consumer advocacy manager for the National Health Care for the Homeless Council. The council partners with another organization to organize Homeless Persons' Memorial Day, which is when Turlock holds annual vigils. Oregon also recently passed a law to record homelessness on death reports, Cavanaugh said, and the requirement begins next year.

Homeless mortality information is limited, but Cavanaugh said collecting the data is an important accountability measure.

"These are humans that we've failed," Cavanaugh said. "These people who pass away to homelessness, these are policy failures and systemic failures. It's important for us to really be understanding how and why people pass and were they involved in services, did they have these connections to case managers or support before their deaths, so we can be changing interventions for people in the future."

The council published a homeless mortality data toolkit explaining how to develop and improve efforts to collect and review the information. The guide can be found on the council's website at nhchc.org.

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