Nearly a decade after Multnomah County launched Oregon’s first and only effort to count homeless deaths, state lawmakers are considering whether to take the initiative statewide.
Sen. Deb Patterson (D-Salem), with co-sponsor Sen. Wlnsvey Campos (D-Aloha), has proposed legislation requiring that death reports include the housing status of decedents. If that person was determined to be homeless at the time of death, the report would have to note “domicile unknown.”
That term has been the title of Multnomah County’s annual homeless deaths report since 2011, when it became the first jurisdiction in Oregon to formally track how many people died homeless. In its inaugural year, the county tallied 47 people who died on the streets. In 2019, the most recent year for the report, 113 people had died homeless, bringing the nine-year total to 643.
“In Oregon, we have no state database to examine mortality data for people who died while unhoused,” Patterson said about the urgency for Senate Bill 850. “It is important that we collect data on the age, gender and cause of death for these Oregonians, as well as the aggregate numbers, in order to know how best to prevent these deaths and provide needed services. In addition, those who have died deserve to have their stories counted.”
Patterson said the bill was inspired by a conversation with Jimmy Jones, executive director of Mid-Willamette Valley Community Action Agency in Salem, which serves people in poverty across 11 counties. His agency runs the ARCHES program, the primary direct service program for people experiencing homelessness in the region.
“I told her no one really knows how many people are dying outside,” Jones told Street Roots. “Even nationally, there are some jurisdictions that gather this information, but there’s no consistent statewide policy anywhere that I know of in which the number of people passing away outside are documented.”
The advantages of such documentation include lead information to plan and design systems to prevent deaths, Jones said.
Jones spoke of a man he knew who died homeless. Brian was a client at ARCHES, and a simple case of frostbite became a MRSA or staph infection. He lost his foot, then part of his leg, and then an MRSA infection began consuming his remaining foot and attacked his face. His life was a cycle of hospitals to hotels and ultimately back to homelessness, Jones said. Brian died Feb. 11, before he was scheduled to go back into the hospital.
“If we had the systems in place, not only here locally but statewide and nationally, we’d have a much better means to prevent these sorts of, gruesome, painful — basically he had to sit there while his body was rotting away around him. It’s just intolerable that in a nation as rich as this that we have this sort of thing happening on a regular basis.”
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Jones said he hoped tracking homeless deaths statewide will bring into better focus the life and death conditions on the street.
“There’s a vast gulf in understanding among the public and policymakers as to what the conditions (that) people living outside (in) are like,” Jones said. “They believe that there are systems and resources out there for anybody that’s willing to engage with them, without understanding how those systems and resources might actually conspire — not deliberately but just in their existence — to actually make it impossible for somebody to exit the condition of homelessness once they’re in a chronic state and have been so for a while.”
When Multnomah County started counting homeless deaths, it had to add the “domicile unknown” field in its database. In 2019, the Oregon state medical examiner also added the field to note people who were possibly homeless at the time of death.
But simply checking a box isn’t enough to provide complete and accurate information.
Senate Bill 850 does not define what “homeless” would mean, and existing government definitions vary under various agencies. Nor does it detail what kind of rigorous fact-checking is needed to determine a person was actually homeless — a task that could be a strain on smaller communities with limited resources.
Paul Lewis is the former Multnomah County health officer and was involved in the creation of the county’s “Domicile Unknown” report, along with County Commissioner Deborah Kafoury’s office and Israel Bayer, then-executive director of Street Roots.
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In Multnomah County, Lewis said, death investigators painstakingly track down all information available to determine if a person is homeless under qualifications set by the federal bureaus of Housing and Urban Development and Health and Human Services. Only after such vetting is a person’s housing status recorded as “domicile unknown,” Lewis said.
“For the death investigation you could classify someone is possibly homeless,” Lewis told Street Roots. “To verify that they meet the HUD or HHS definition of homeless typically takes substantial additional work.”
Testimony on Senate Bill 850 at a March 29 hearing before the Senate Committee on Health Care was all in favor of the initiative, with several noting the high level of need for basic homeless services. DJ Vincent, director of Church in the Park, which runs a collaborative navigation center in Salem, said accurate numbers will help the community plan for the future.
“Tracking this data enables analysis for making more informed decisions, helps identify trends, gaps, and service needs, and enables more accuracy, efficiency, collaboration, and transparency,” Vincent stated in his submitted testimony.
The National Health Care for the Homeless Council, an arm of the federal Health Resources and Services Administration, has identified 68 cities and counties that recorded the deaths of people experiencing homelessness in 2018, but not on a standardized basis. The figures were drawn up from a combination of news accounts, public records requests, medical examiner and coroner reports, and stories from community members. Those jurisdictions reported a combined 5,807 people who died homeless in 2018. The NHCHC, however, estimates that number could exceed 46,000, and the gross discrepancy in the figures illustrate the need for consistent and thorough counts.
Multnomah County is one of about a dozen jurisdictions, including King County, Washington, Los Angeles and New York City, that conduct an annual report through the medical examiner’s office. In most of these communities, according to the NHCHC, the numbers of homeless deaths have been on the rise. Los Angeles, for example, homeless deaths doubled from 518 in 2014 to 1,038 in 2019. The average age of death consistently ranges from the mid 40s to lower 50s.
Poor health is among the leading causes of homelessness, but it is also a byproduct. Most health conditions among people experiencing homelessness are a combination of physical and behavioral health issues, according to the NHCHC. The group outlines numerous aggravating factors to health among the unhoused, including stress and communicable diseases from shelters, inability to properly maintain medications or sustain a healthy diet, and worsening behavioral issues such as mental health conditions and substance use disorders. And on the streets it’s difficult to keep wounds from injuries or surgery clean or get needed rest and recuperation.
Patterson said she read through Multnomah County’s Domicile Unknown report and was struck by the personal stories of the people who struggled “to find a path to lives of community and dignity.”
“We are not only failing to protect and support those who are unhoused, but we aren’t even collecting basic information that could be key to helping our state better support other houseless individuals,” Patterson said. “We are all Oregonians, and each person must be treated with dignity and respect.”
“Right now, it’s really convenient not to know,” Jones said. “If people don’t know, it’s easier to sort of turn your head. Knowledge compels action, and it creates the perception that there’s some responsible party for allowing this to happen.”