County’s 2021 Domicile Unknown report details deadliest year on record for homeless Multnomah County residents
Multnomah County’s Domicile Unknown report found at least 193 Multnomah County residents died while homeless in 2021 — the deadliest year on record since the county began compiling the yearly report in 2011.
The number of deaths recorded in Domicile Unknown reports, which aggregates and examines Multnomah County Medical Examiner data, increased each of the last four years, from 79 in 2017 to 92 in 2018, to 113 in 2019, to 126 in 2020 to 193 in 2021. In total, the reports recorded 962 homeless Multnomah County resident deaths since 2011. The count may not capture all deaths among the homeless population, as the medical examiner does not investigate cases of individuals hospitalized for 24 hours or longer prior to natural death.
The report, compiled by Multnomah County and co-published by Street Roots advocacy, found homeless residents face increased risks of violence, exposure to elements, and substance and mental health disorders.
The report shows despite accounting for only 2.6% of the county population when quadrupling the county’s 2022 Point-in-Time Count of 5,228 people (the county’s suggestion for a more accurate count), homeless residents represented 20% of all Multnomah County homicide victims in 2021. Additionally, “domicile unknown” deaths accounted for 12.5% of all deaths assessed by the medical examiner — a proportion that had remained steadily around 9% for the previous five years. The medical examiner “investigates and determines the cause, circumstances and manner of sudden, unexpected, violent or suspicious deaths.”
“Deaths that meet criteria for medical examiner investigation are often premature by definition,” the report’s executive summary concludes. “That said, looking at homeless deaths in aggregate over the course of a year paints a picture of potentially preventable deaths on our streets.”
Key findings
In addition to extreme vulnerability to violence, homeless residents also face an increased risk of various health issues and, in general, face more health problems and a lower life expectancy.
According to the report, the majority of deaths — 125 — were “accidental,” with 96 deaths being related to drugs or alcohol and the “majority of the remaining individuals died from trauma.”
Among the 41 “natural deaths,” at least 18 were linked to complications from drug and alcohol abuse. Other causes noted included “hypertensive cardiovascular disease, congestive heart failure, hemorrhage and unspecified disease.”
More than half — 107, or 55% — of people in the report died in outdoor public spaces, such as parks, sidewalks and encampments. Another 43 people died in hospitals, 12 people died in hotels, motels or shelters, 11 people died in cars or campers, 10 people died inside a dwelling and nine people died in “outdoor private” locations, or oudoors on private property.
More men died than women — the report documented 147 male deaths and 46 female deaths but did not note any statistics for nonbinary homeless people.
The report found the average age of death among homeless Multnomah County residents was 48 years old for men and 46 years old for women — three decades younger than the average age of death in the United States.
Native American and Alaska Native people, as well as Black people experiencing homelessness, were again overrepresented in the yearly report when compared to overall county demographics. Black people composed 10% of deaths — nearly double their percentage of the county’s overall population. American Indian and Alaska Native people accounted for 5% of deaths, despite making up 1.5% of the county population.
Deaths among homeless Asian Multnomah County residents and homeless Hispanic Multnomah County residents each comprised 2% of the total deaths.
White people were slightly underrepresented when compared to county demographics — 76% of deaths while representing 79% of the county’s overall population.
COVID-19
The report found at least two homeless people died from COVID-19 in Multnomah County in 2021. A third person died due to complications from chronic alcohol abuse but tested positive for COVID-19 posthumously.
COVID-19 deaths in 2021 may have been undercounted, according to the report, offering two potential reasons.
“An individual was hospitalized for 24 hours or longer prior to a natural death. These deaths are not investigated by the Medical Examiner,” and “The young average age of people who died while experiencing homelessness suggests that this is a young population. Risk of death from COVID-19 increases with age.”
The 2020 Domicile Unknown report found no homeless Multnomah County residents died from COVID-19. A Street Roots analysis of 2021 sweeps found city practices were potentially at odds with CDC guidelines after county officials helped the city craft expanded criteria to increase sweeps in the months following the delta variant surge. County officials emphasized the decision to expand sweep criteria was ultimately that of the city when Street Roots published the story in October 2021.
“We do not see the correlation (Street Roots is) asserting,” Cody Bowman, Wheeler’s communications lead, said when asked if the mayor was concerned the 2021 change in sweep policies may have contributed to COVID-19 deaths.
Bowman said Wheeler’s top priority is to “get Portlanders stabilized, better connected to services, and into housing.”
“Portland has hundreds of unsanctioned camping sites spread out across the City of Portland, making it nearly impossible to connect this vulnerable population with support and services,” Bowman said. “Those who our outreach teams make contact with are offered an immediately available shelter bed, a ride to that shelter with their immediate belongings, storage for additional belongings, and other services.”
When asked if city sweep policies played a role in the first documented cases of homeless people dying from COVID-19 in Multnomah County, Julie Sullivan-Springhetti, Multnomah County communications director, said she wasn’t sure if she knew the answer.
“But if you look at both years, aggressive County policies to increase social distancing and masks in shelters, open isolation motel rooms for people with symptoms, and prioritize vaccination houseless community members with clinics that offered incentives probably saved a lot of lives,” Sullivan-Springhetti told Street Roots.
Drug Use
The ongoing flood of fentanyl and methamphetamines continued to take a toll on homeless Multnomah County residents. Amphetamines, including methamphetamine, contributed to 93 deaths — almost half of all deaths — and represented the largest number of substance-related deaths.
Fentanyl, the potent opioid causing an uptick in deaths and addiction nationwide, was a “primary or contributing factor in 36 of the deaths,” the report found. Overall, “any opioid” was a primary or contributing factor in 57 deaths.
Exposure to the elements
People experiencing homelessness are vulnerable to extreme weather, facing both intense heat and freezing cold temperatures without housing and often without adequate resources to keep themselves warm or cool themselves.
In cases of severe weather, homeless populations rely on additional resources, in particular warming or cooling shelters, to help them survive increasingly severe weather conditions.
The heat dome that plagued the Northwest in late June 2021 led to several homeless deaths. During that time, the area faced a record-breaking three-day hot streak in which temperatures reached 108, 112 and 116 degrees. Four individuals died from heat exposure, or hyperthermia, while an additional person died of acute methamphetamine intoxication but also showed signs of hyperthermia. All five of these deaths occurred between June 27 and June 29, and accounted for 5% of the total deaths between April and September 2021.
In 2021, more homeless people died from cold than heat. Eight people died from cold exposure, or hypothermia — three more deaths than in 2020.
As Street Roots reported in January, county guidelines for warming shelters mean homeless Multnomah County residents rarely have access to warming shelters during the coldest months of winter.
“In practice, the guidelines mean even temperatures at or below freezing for an entire night won’t trigger severe weather shelters alone, nor would a forecasted nighttime low of 26 degrees without precipitation, nor would wind chills below 25 degrees,” Street Roots wrote at the time.
Homicide and violence
While homeless populations are front and center in many city debates regarding safety, homeless people are far more likely to be victims of violence rather than perpetrators. Indeed, homeless people accounted for 20% of all Multnomah County homicide victims in 2021.
As Street Roots reported in June, research from the National Healthcare for the Homeless Council found almost half of the homeless people surveyed — 49% for men and 48% for women — said they experienced violence while living homeless.
The most recent edition of the Domicile Unknown found a rise in violent deaths, noting “more people experiencing homelessness died of homicides than at any time since 2011.”
The report found 26 homeless deaths were classified as homicide or someone taking their own life. Of these, 13 homeless people died from homicides due to firearms in 2021 — more than double the number in 2020.
Notably, the report found that those homeless persons who died from homicide were “significantly younger than those dying by other manners of death,” though the report did not provide specific data.
The uptick in homeless death parallels an overall increase in homicides, the report found. According to the Portland Police Bureau, homicides rose 83% in the same time span.
In 2021 eight homeless Multnomah County residents took their own lives. This number also doubled from the previous year. Such deaths composed 4% of all homeless deaths in 2021.
Editor’s note: Street Roots advocacy co-publishes the yearly Domicile Unknown report in cooperation with Multnomah County. The Street Roots newspaper maintains editorial independence from advocacy efforts and was not involved in the compiling or publication of the report.
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