Dying Homeless on the Streets of Los Angeles County
The reality of Los Angeles County’s
homelessness crisis is a body count
Nearly four persons a day died homeless on the
Streets of Los Angeles County during 2020
Furthering the Integration of Street Outreach and
Street Medicine is Imperative to Save Lives
This report is based on publicly accessible data from the County of Los Angeles Department of Medical Examiner-Coroner (ME-Coroner) related to homelessness.
Acquired data from the Public Services Division revealed that 1,374 persons, whom the ME-Coroner examined in 2020, were noted as “indigent – homeless” under “type of residence” because the person did not have an established residence or the person was found in a location that suggested homelessness such as an encampment, field, park, alley, and sidewalk.
This report focuses on 1,360 persons who were adults age 18+. Of the 1,360 adults, as noted in the chart below,
- 17% or 232 were female and 83% or 1,128 were male;
- 96% were Black, Hispanic/Latino, and White—25% or 346 were Black; 37% or 505 were Hispanic/Latino; and 34% or 462 were White;
- 3% or 36 were youth age 18 – 24; 45% or 610 were under age 50; 55% or 750 were age 50+; and 19% or 256 were age 62+.
Chart 1Mode of Death
The mode or manner of death for the 1,360 adults is classified in four ways, as noted in the following chart:
- More than half (59%) or 802 adults died by accident;
The most common cause of death by accident was multiple or mixed drug toxicity, including cocaine, ethanol, fentanyl, heroin, methadone, and methamphetamine. The next common cause was blunt force trauma that included multiple injuries and head injuries. Other accidents included infections, septic shock, smoke inhalation, environmental exposure, sudden cardiac death, and drowning.
- More than one-fourth (28%) or 378 adults died by natural causes;
Natural causes involved cirrhosis, diabetes, heart disease, hepatitis C, HIV/AIDS, hypertension, metastatic cancer, respiratory failure, and a wide range of other illnesses and diseases.
- 5% died by homicide; and
- 4% died by suicide.
Table 1 provides a breakdown of the four modes of death by gender, the three largest race/ethnicity groups, and age categories.
The total column notes the number of persons in each subpopulation. Each of the four modes of death columns lists the number, and related percentage, of persons for each subpopulation. For example, 638 or 57% of the 1,128 males died by accidents and 164 or 71% of the 232 females died by accidents.
- A greater percentage of females (71%) died by accidents than males (57%);
- A greater percentage of males (30%) died by natural causes than females (19%);
- Nearly all adults (70 of 76 or 92%) who died by homicide were male;
- A slightly larger percentage of women (4%) than males (3%) died by suicide.
- A greater percentage of Blacks (63%) died by accidents than Whites (60%) and Hispanic/Latinos (56%);
- A greater percentage of Whites (30%) died by natural causes than Blacks (26%) and Hispanic/Latinos (26%);
- A lesser percentage of Whites (2%) died by homicide than Blacks (6%) and Hispanic/Latinos (9%);
- A lesser percentage of Blacks (1%) died by suicide than Whites (4%) and Hispanic/Latinos (4%).
- The percentage of adults that died by accidents decreased by age—72% of youth age 18 – 24 died by accidents; 69% of adults under age 50; 51% of adults age 50+; and 39% of adults age 62+;
- The percentage of adults that died by natural causes increased by age—3% of youth age 18 – 24 died by natural causes; 11% of adults under age 50; 42% of adults age 50+; and 56% of adults age 62+;
- The percentage of adults that died by homicide decreased by age—19% of youth age 18 – 24 died by homicide; 9% of adults under age 50; 3% of adults age 50+; and 1% of adults age 62+.
- A greater percentage of adults under age 50 than age 50+ died by suicide—5% of adults under age 50 died by suicide and 2% age 50+.
The data reveals that the predictions made not too long ago are unfolding in Los Angeles County. “Aging Trends in Homeless Populations” was published in May 2013; “Surge In Homeless Deaths Expected Over Next Decade Unless We Act” was published in January 2014; and “Death on the street: America’s homeless population is growing older and sicker: Half the country’s adult homeless are now 50 and over” was published in April 2016.
Street Outreach and Street Medicine Efforts
Street Outreach Efforts
Street outreach identifies and engages people living homeless in unsheltered locations, including encampments. Effective street outreach also engages persons who no longer seek assistance.
Effective street outreach efforts also include the use of harm reduction principles, including non-judgmental, non-coercive provision of services and resources. Street outreach workers allow for multiple opportunities to say “no” and make repeated offers of assistance as necessary throughout the engagement process. While working on connecting persons to appropriate temporary and/or permanent housing, outreach workers provide critical, life-saving resources such as food, water, clothing, blankets, and other necessities.
Street Medicine Efforts
Los Angeles County hospitals, public health departments, and private homeless service agencies are increasingly sending trained health practitioners into homeless encampments in a quest to improve health outcomes for individual homeless people.
Street medicine efforts involve providing health care to the sickest people living homeless on the streets where they are looking to remove barriers that make them more ill and more likely to die, such as scheduling appointments, finding transportation to a clinic, picking up prescriptions, and paying for their treatment.
Effective street medicine efforts prevent minor health conditions such as cuts and infections from becoming life-threatening and significant health conditions such as heart and lung problems from resulting in death.
Furthering the Integration of Street Outreach and Street Medicine Efforts
Furthering the integration of street outreach and street medicine efforts can end homelessness for persons who are languishing while living on the streets and likely to die by focusing the integrated efforts on geographical locations such as cities, districts, neighborhoods, and places.
The acquired data from the LA County ME-Coroner includes the city, zip code, place, and address in which each person died. For example, of the 1,360 adults who died, 656 died in the City of Los Angeles, 80 in Long Beach, and 34 in Lancaster. Two contiguous zip codes in the City of Los Angeles that had a significant number of persons who died were 90013 and 90014, which cover much of Central Los Angeles and Skid Row. Sidewalks and tents were the places where two-thirds (67%) of persons died.
A closer look at the data pertaining to Long Beach shows that half (50%) or 40 of the 80 persons died homeless in two zip codes—25 or 31% of persons died in zip code 90813 and 15 persons or 19% died in zip code 90806. Places included alley, hospital, hotel/motel, park, parking lot, street, underpass, and vehicle.
In Lancaster, more than half (56%) or 19 of the 34 persons died homeless in one of the cities six zip codes, which is zip code 93534. More than one-fourth (27%) or nine persons died in zip code 93535. Places included the desert and vehicles.
Effective street outreach coordinates efforts between a wide-range of public and private service providers involving mental health, substance use, and healthcare providers including street medicine.
Furthering the integration of street outreach with street medicine is imperative because lives can be saved. Street outreach workers can help ensure that street medicine care is provided to those persons languishing alongside streets and who are most vulnerable to illness, injury, and death. Also, coordinated efforts can intentionally focus on saving lives within the geographical areas with high concentrations of persons dying while homeless, such as zip codes and specific places within zip codes.