SANTA MONICA, Calif. — Their bodies were found on public benches, lying next to bike lanes, crumpled under freeway overpasses and stranded on sun-kissed beaches. Across Los Angeles County, vulnerable people died in record numbers last year, averaging five homeless deaths a day, most in front of the world around them.
287 homeless people breathed their last breath on the sidewalk, 24 died in alleyways and 72 were found on the sidewalk, according to data from the county coroner. They were a small fraction of the thousands of homeless people across the country who die every year.
“It’s like the death toll in wartime in places where there’s no war,” said Maria Raven, an emergency room physician in San Francisco who co-wrote a study of homeless deaths.
An epidemic of deaths on the streets of American cities has accelerated as the homeless population ages and the cumulative number of people living and sleeping outdoors has shortened life. The wider availability of fentanyl, a particularly fast-acting and dangerous drug, has been a major contributor to the rising death toll, but many homeless people are dying young from treatable chronic diseases such as heart disease.
More than ever, being homeless in America has become deadly, especially for men in their fifties and sixties, who usually make up the largest group of despair. In many cities, homeless deaths have doubled during the pandemic, a time when finding medical care has become more difficult, housing costs have continued to rise and public health officials have been busy fighting the coronavirus.
Austin, Denver, Indianapolis, Nashville and Salt Lake City are among the cities where officials and homeless advocates have said they are alarmed by the rising number of deaths.
The crisis is most acute in California, however, where about one in four of the country’s 500,000 homeless people lives.
The process of counting homeless deaths is tedious and involves cross-referencing homeless databases and death reports. But based on data from a handful of California’s 58 counties that report homeless deaths, experts said 4,800 is a conservative estimate for the last year.
In Los Angeles County, the number of homeless people grew 50 percent from 2015 to 2020. Homeless deaths have risen much faster, up about 200 percent over the same period to nearly 2,000 deaths in the county last year.
“These are deeply lonely deaths,” said David Modersbach, who led the first public study of homeless deaths in Alameda County across the San Francisco Bay Area.
In some cases, bodies go undetected for hours. Others are not picked up at the morgue despite efforts to reach family members. In San Francisco, where people sleeping in cardboard boxes, tents and other makeshift shelters are a common sight, the body of a homeless man who died in a traffic lane last spring lay more than 12 hours before it was recovered. “The guy was lying here dead and no one noticed,” said a cardboard sign left at the scene.
Those who sleep on the street speak of the physical wear and tear, multiple untreated illnesses, and the loneliness of being surrounded by pedestrians who ignore you.
Billy, a New Jersey metalworker and carpenter who now sleeps in the narrow streets behind Venice Beach in Los Angeles, is constantly reminded of his previous jobs. At 50, he’s in chronic pain from a tree-cutting accident, which he treats with a jumbo bottle of Aleve he keeps in his backpack.
He overdosed on heroin twice, revived himself with the drug naloxone both times, and watched friends disappear around him.
“I can name 30 or 40 people who have died from drug overdoses and most of them were in my demographic,” said Billy, who didn’t want his last name released because he said it would put his three adult children in embarrass.
A Los Angeles County Department of Health study found that homeless people are 35 times more likely to die from drug or alcohol overdoses than the general population. They are also four times more likely to die from heart disease, 16 times more likely to die in a car accident, 14 times more likely to be murdered, and eight times more likely to die by suicide.
California, awash with cash from pandemic budget surpluses, has poured record amounts into tackling homelessness. Gov. Gavin Newsom last year announced a $12 billion homeless package that included funds to build 42,000 new housing units.
Los Angeles County voted overwhelmingly in 2017 to increase its sales tax and projected to generate $3.5 billion for homelessness programs over 10 years. Since then, the county has hosted 78,000 people.
But county officials say they can’t keep up: While 207 homeless people find shelter every day, 227 people become homeless every day, the county calculates.
And once on the road, mental health, substance abuse, and general medical well-being can spiral out of control. Mr Modersbach said he was struck by the number of homeless people dying from disease outside of hospitals or other clinical settings.
“Dying from heart disease, liver disease, respiratory disease — alone — is pretty shocking,” he said.
Of the 809 homeless deaths in Alameda County between 2018 and 2020, a quarter were due to drug overdoses, half were due to heart attacks, cancer, strokes and chronic diseases, and the remainder were due to accidents, suicides and homicides, according to the study. At least three homeless people froze to death in Sacramento County last year.
A major difference among today’s homeless population is the graying of the destitute.
Margot Kushel, a physician who specializes in homelessness care, has tracked the rise in the median age of homeless people in the San Francisco Bay Area from their mid-30s three decades ago to their mid-50s today.
But even that increase in age doesn’t tell the full story of her vulnerability, she said. Homeless people in their 50s present with geriatric symptoms: difficulty dressing and bathing, vision and hearing problems, urinary incontinence.
“Poverty puts a lot of strain on the body,” said Dr. cuddle “Fifty is the new 75.”
A quarter of the homeless people she began studying nine years ago are now dead. The median age at death was 63 years, well below the average US life expectancy of 77 years.
Across California, the majority of homeless deaths are male, particularly black males, who die on the streets at a rate well in excess of their percentage of the total population. In Los Angeles County, men account for 67 percent of homeless people but 83 percent of homeless deaths. In San Francisco, men in their 50s have the highest rate of overdose deaths of any age decile.
Keith Humphreys, a Stanford psychologist, said the issue of death and despair in older men is underappreciated and understudied. He said society should ask the question, “Can we help men not die so much?”
David Brown, 59, a former bus driver and fast-food worker in San Francisco who is currently enrolled in a Salvation Army rehabilitation program, describes the circumstances that brought him onto the streets as a lifetime’s accumulation of suffering. The knee problems from cramming his big body into the bus driver’s seat. The type 2 diabetes. He was serving his sentence for burglary. A lifelong struggle with alcoholism and substance abuse.
At the time of the crack epidemic in the 1980s, so many friends were dying in street shootings and overdoses that he felt completely abandoned.
“I don’t have anyone in my life,” he said.
Pamela Prickett, a sociologist who has studied death certificates in Los Angeles, said one measure of male isolation is that male bodies are twice as likely to be dumped in the morgue as females. The number of unclaimed corpses, which has increased since the 1970s, is highest in males in their 40s and 50s.
“There are more people who don’t marry or divorce and don’t remarry,” Ms Prickett said. “That’s how we find a lot of loners.”
Vivek Murthy, the US surgeon general, said he saw a pattern of men who were ill-equipped to deal with “triggers” in life, such as illness and the loss of a job or spouse.
“As men get older, they tend to be less good at building and maintaining relationships,” he said. “If people don’t have a safety net of community and strong, healthy relationships, they’re much more likely to struggle with substance use disorders, mental illness and homelessness.”
Ivan Perez, 53, is philosophical about what caused his life to spiral out of control. His wife’s miscarriage and their broken marriage. A marijuana habit that ruined his stockbroker career. Jail time for being attacked while high. gambling.
“When you’re alone, you have no excuse to say, it’s my wife’s fault, it’s my mother’s fault, it’s society’s fault,” Mr. Perez said.
For the past few months, he’s been sleeping on the street in a tent near the North Hollywood subway station. The soundtrack to his life, he said, was the hiss of trucks driving past his tent and the roar of street sweepers.
“There’s a certain posture you adopt when you’re homeless,” he said. “You lose your dignity.”
His goal, he said, is to live as long as his father, who died at 54.5. He’s not far away.
Mr. Perez recalled the hopes he had when he was younger of becoming an actor or playwright.
“I was trying to do everything right and it blew my mind,” he said.
“What a rough deal this life has become.”
Susan C. Beachy contributed to the research.