From the September 1999 San Francisco Street Sheet:

Homeless Deaths Rise 57 Percent

Last winter, the body of a 55-year-old male was found lying on a sheet of metal in a South of Market alley, five blocks from the large but capacity-filled homeless shelter known as MSC-South. He was still wrapped up in the plastic garbage bags he had fashioned into a makeshift sleeping bag to keep warm. He had died from cardiomyopathy, a chronic heart condition.
The remains of G.M., a 42-year-old male, were found by gardeners at Golden Gate Park inside a sleeping bag within a pup tent. And J.W., a 46-year-old male war veteran , was found last February in an unnamed doorway by a passerby, "cold, wet, mumbling ." At San Francisco General Hospital, where he died, he was found to have an 80 degree F. core temperature.

These three cases were part of a study released last month by the San Francisco Department of Public Health (DPH), which identified a total of 157 homeless persons who died in the City in the preceding 12 months, a figure that was later raised to 163. This was 57 percent higher than the previous year, and the largest total since the City began keeping records in 1987.

The average age of those dying homeless was 42.3 years, compared to 68 years for all San Francisco residents.
Poverty and the living conditions of homeless people increase their risk of early death. Many of the deceased leave behind a well-documented record of the failure of health services and social services, both public and private, to reach those most in need.

Since 1987, the deaths of at least 1,273 homeless San Franciscans have been recorded. The purpose of the annual count is so that each person may not only be remembered, but may teach us where the system has failed and what we, as a city, must do to prevent further deaths.
The official total is an undercount, as not all homeless deaths are referred to the DPH's Medical Examiner. However, those deaths that have been documented provide accurate data to help to guide community and public health efforts to prevent these premature deaths among homeless persons.
W.J., a 52-year-old male, died in his wheelchair from a drug overdose, the day before he was to move into housing. He was a client of the City's Homeless Death Prevention Team, who believe that W.J. would have lived if only they could have gotten him into housing right away. Instead, he had to live on the streets for months with diabetes.

Lack of affordable housing has increasingly become an insurmountable barrier for low-income people in San Francisco. Low vacancy rates, exorbitant rents, and loss of public housing units have exacerbated the homeless problem. At the same time, without permanent affordable housing, it is exceedingly difficult for homeless people to manage their health issues, such as diabetes, mental illness or addiction.
J.C. committed suicide at the age of 30 by hanging himself . He had written to his mother and in his journal he was depressed because he was homeless and could not get into a substance abuse treatment program.
In the study period of Dec. 1, 1997 to Dec. 1, 1998, there were 86 recorded deaths from drug overdoses and alcohol abuse among people not fortunate enough to have a place to live.

In comparison to past years, almost twice as many people who were homeless at the time of death died from illicit drug overdose. Substance abuse is a growing health problem, which manifests itself in our City's most vulnerable population. San Francisco has been dubbed the "drug death capital" of California, with drug death rates triple the statewide average. There continues to be a shortage of substance abuse treatment; on average, there are 1,200 people on the waiting list every day for treatment.
R.B. died at the age of 32 at the Mission Rock Shelter from a heroin overdose. He had cerebral palsy, and was deaf. According to shelter residents he had been trying to ask for help earlier in the evening, but staff could not understand what he was saying. After breakfast he was found dead kneeling next to his bed by shelter residents.

Heroin overdose, alone or in combination with other drugs, was the cause of 62 homeless deaths in 1998. ODs have exploded over the past two years, and appear to be steadily climbing. Heroin continues to be widely available at a cheap price and high levels of purity in San Francisco. One form of proven medical treatment, methadone, is almost impossible to obtain if you cannot pay for it yourself. In fact, there are at least 500 people on waiting lists for methadone treatment alone. The City is moving towards helping to alleviate this problem by having methadone available by prescription through physicians. This will help, but hundreds of free slots are needed.

C.A., a 53-year-old man, was found in the bushes near McDonald's, dead of an enlarged heart. He had been living in Golden Gate Park during the sweeps last year. His heart medications were confiscated along with his winter gear.

Eighty-six deaths occurred during the six-month span of December 1997 to May 1998, the months of El Nino. This is different from past years, where the number of deaths among homeless people would not rise in the winter months. Even though shelter beds were increased during El Nino, many people still could not access shelter beds, and were exposed to the elements.

Increased efforts by the police department to sweep homeless people from familiar areas make it extremely difficult to provide services through outreach, since clients cannot be found. When an opening occurs in a substance abuse program , or in housing, the individual often loses the opportunity.

While the City estimates that there are 12,000 to 14,000 homeless people each night in San Francisco, the City has fewer than 2,000 shelter beds.
The location of where homeless people die, and where they reside, is important information that the DPH Homeless Death Prevention Team can use to determine where their resources should be targeted.
This year, 38 deaths occurred in the South of Market, double the number for the previous year. Eleven people died inside shelters, while in past years, only about half a dozen people did.

K.H. was a 34-year-old women who was staying at A Woman's Place shelter. Ten minutes after she left the building, she was found face down with dirt and blood on her face. She had died from bronchial asthma.
Shelters have long been recognized as temporary Band-aids to homelessness, at best. Individuals staying in shelters often have less privacy than they do staying outside. In addition, they may be exposed to other health risks, by living in cramped quarters, sometimes with hundreds of people. The high number of deaths in shelters calls for more appropriate training and medical support for shelter staff.

DPH has developed a Homeless Death Prevention Project, which includes research, advocacy and direct services through outreach components. The project is based on a Coalition on Homelessness proposal to decrease the large numbers of preventable deaths that occur each year. Outreach to those at risk of death must continue to ensure adequate medical care, and workers must be able to access necessary resources on behalf of homeless people.

A memorial service is held each December for homeless people who have died. Last month's service took place on a bitterly cold day at Civic Center Plaza, where nearly 100 people gathered in a circle to light candles, recite prayers and sing together. As each name was read aloud, a bell was sounded, clanging solemnly for an instant, then fading away in the night air. But those in attendance heard the message: every person should be honored, and every death should be mourned.

back   top