More than 1,000 Women Died While Homeless on the Streets of Los Angeles County During the Past Five Years
Each Mode of Death was Categorized as an
Accident, Homicide, Natural Cause, or Suicide
HER (Homeless Engagement Response) Street Outreach
and Street Medicine Teams Need to Be Initiated,
Increasingly Integrated, and Intentionally Directed
Five women will likely die this week while living homeless on the streets of Los Angeles County and brought to the County of Los Angeles Department of Medical Examiner-Coroner (ME-Coroner) for examination. Another five women will likely die homeless the following week, and the week after that. This is exactly what happened in 2021 according to ME-Coroner mortality data.
This report is based on publicly accessible mortality data from the ME-Coroner. Acquired data from the Public Services Division reveals that 1,050 women, who were examined by the ME-Coroner between January 1, 2017, through April 30, 2022, were noted as “indigent-homeless” under “type of residence.” A person classified as “indigent-homeless” 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.
The number of women who died homeless while living on the streets increased from 146 women in 2017 to 255 women in 2021, representing an increase of 109 women or 75%. An average of three women died per week in 2017 and an average of five women died per week in 2022.
Between January and April of 2022, 85 women died homeless while living on the streets. At this rate, 255 women will die homeless during 2022 or approximately five women per week.
Homelessness, Death, and Trauma
Homelessness is much more than the absence of physical housing. Prolonged exposure to homelessness can be fatal. It is a tension-filled, trauma-filled, and treacherous condition that often results in loss of life.
Homelessness is a traumatizing and re-traumatizing experience for too many women who died while living on the streets. For many, their death culminated in a life full of trauma from the cradle to the grave.
Chronic illnesses overwhelm the last years of life for many women living on the streets. Managing chronic illnesses while living on the streets is a very difficult task for someone who is homeless and for supportive health care providers. Repeat visits as well as adherence to complicated medication regimens are necessary, including specific diets and physical routines.
Cognitive and functional impairments also advance dying on the streets. Cognitive impairments often involve problems with memory, processing information, and following directions and contribute to persons dying on the streets. Functional impairments make it difficult to manage daily tasks such as dressing, bathing, and toileting. Older women living on the streets often experience mobility impairments (e.g., the ability to walk) and deteriorating hearing and vision.
The next chart shows that
- 41 women or 4% were victims of homicide. The manner of homicide was gunshot wounds, stab wounds, blunt force injuries, or strangulation.
- 42 women or 4% committed suicide. Manner of suicide included blunt force trauma, gunshot wounds, hanging, and acute toxicity.
- 189 women or 18% died because of natural causes. Manner of natural causes included arteriosclerotic cardiovascular disease, complications due to diabetes and obesity, heart disease, hepatic cirrhosis, hypertensive cardiovascular disease, peritonitis, pulmonary embolism, sepsis and septic shock, and sudden cardiac arrest.
- 681 women or 65% died because of accidents. Manner of accidents included blunt force trauma, drug effects and toxicity from cocaine, heroin, methamphetamine, and fentanyl, multiple drug intoxication, and smoke inhalation.
Initiating, increasingly integrating, and intentionally directing HER (Homeless Engagement Response) Street Outreach and Street Medicine Team efforts will result in more lives saved by these teams.
HER (Homeless Engagement Response) Teams are defined as street outreach and engagement teams that identify and engage women living in abandoned buildings, encampments, make-shift shelters, tents, and vehicles and also living exposed and uncovered on sidewalks, in parks, and in parking lots and other places not meant for human habitation. They are also defined as teams particularly skilled at identifying and engaging women who are chronically homeless and languishing on the streets and who are increasingly vulnerable to illness, injury, and death.
Creating effective HER Teams involves ensuring that all team members are skilled at integrating a trauma-informed approach into their street outreach and engagement activities to help women obtain temporary and/or permanent housing. All team members should understand the premise that past and present trauma affects the ability of women languishing on the streets to overcome their homelessness experience.
Street medicine efforts involve providing health care to the most ill people living homeless on the streets. Their goal is 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 resulting in death.
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 the streets and who are most vulnerable to illness, injury, and death.
HER and Street Medicine Teams need to be skilled at integrating and implementing a trauma-informed approach into their street outreach and engagement activities. They should know that past and present trauma is affecting the ability of females languishing on the streets to connect and engage effectively in services.
HER and Street Medicine Teams understand that the lasting effects of trauma and the fear of being re-traumatized may cause too many women to live in a constant state of survival on the streets. This constant state of survival is likely to prevent them from taking the steps necessary to get off the streets, as counter-intuitive as it may seem.
HER and Street Medicine Teams should ensure that women living in a constant state of survival on the streets experience them as teams committed to safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues while helping each women take the necessary steps to obtain and maintain permanent housing.
The findings in this report adds to the urgency to carry out the recommendations included in Mortality among People Experiencing Homelessness in Los Angeles County: One Year Before and After the Start of the COVID-19 Pandemic.
The report detailed 20 recommendations that focused on
- Enhancing and expanding field-based substance use disorder and other health care treatment;
- Expanding and improving substance use disorder services;
- Expanding peer-based outreach through street-based syringe exchange and overdose prevention education;
- Expanding and enhancing county-contracted substance use disorder provider utilization of the Homeless Management Information System (HMIS) to improve coordination of care and housing-focused case management;
- Increasing investments in recovery bridge housing;
- Implement infectious disease protocols in encampments;
- Continuing annual surveillance of mortality among persons experiencing homelessness in LA County including a geographic analysis of traffic injury and homicide deaths, and review a subset of deaths in more depth; and
- Conducting analysis of administrative data records of deceased persons experiencing homelessness in coordination with County departments and academic partners, to reduce homeless mortality.
To read the report click here.