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Homeless Deaths in Santa Clara County,Ca Aretrospective Study 2011-2016

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Homeless Deaths in Santa Clara County,Ca Aretrospective Study 2011-2016 HOMELESS DEATHS IN SANTA CLARA COUNTY, CA A RETROSPECTIVE STUDY 2011-2016 HOMELESS DEATHS IN SANTA CLARA COUNTY, CA A RETROSPECTIVE STUDY 2011-2016 STUDY Retrospective Data for 2011-2016 Published August 2017 PROJECT IDEA, STUDY DESIGN, DATA ANALYSIS: MICHELLE A. JORDEN, MD, CHIEF MEDICAL EXAMINER SANTA CLARA COUNTY MEDICAL EXAMINER-CORONER’S OFFICE STUDY DESIGN, DATA COLLECTION AND ANALYSIS: KARIN WELLS, BA, STUDENT INTERN FOR THE CHIEF MEDICAL EXAMINER SANTA CLARA COUNTY MEDICAL EXAMINER-CORONER’S OFFICE Retrospective Homeless Study, Santa Clara County Medical Examiner-Coroner Office 2011-2016 TABLE OF CONTENTS INTRODUCTION………………………………………………………………………………………………………………………………………….4 DEFINITIONS AND CLASSIFICATIONS…………………………………………………………………………………………………………………4 HOMELESSNESS LOCATION STRESSORS MENTAL ILLNESS SEASONS MANNER OF DEATH CAUSES OF DEATH YEARLY STATISTICS…………………………………………………………………………………………………………………………………..…9 2011………………………………………………………………….………………………….8 2012…………………………………………………………………………….………………14 2013…………………………………………………………………………………………….20 2014…………………………………………………………………………….………………27 2015…………………………………………………………………………………………….33 2016…………………………………………………………………………………………….39 SUMMARY AND CONCLUSIONS…………………………………………………………………………………………………………….………47 RECOMMENDATIONS…………………………………………………………………………………………………………………………………58 REFERENCES……………………………………………….…………………………………………………………………………………………..59 ACKNOWLEDGEMENTS…………………………………………………………………………….…………………………………………………60 2 Retrospective Homeless Study, Santa Clara County Medical Examiner-Coroner Office 2011-2016 TABLE OF FIGURES LOCATION OF DEATH FLOWCHART……………………………………………………………………………………………………….…………6 2011 GRAPHS AND TABLES…………………………………………….………………………………………………………………….……9-13 2012 GRAPHS AND TABLES……………………………………………………………………………………..…………………………...15-19 2013 GRAPHS AND TABLES………………………………………..………………………………………………………………………...21-26 2014 GRAPHS AND TABLES……………………………………..…………………………………………………………………………...28-32 2015 GRAPHS AND TABLES………………………………………..………………………………………………………………………...34-38 2016 GRAPHS AND TABLES…………………………………………………..……………………………………………………………...40-45 TOTAL HOMELESS DEATHS GRAPH………………………………………………..……………………………………………………………..47 2011-2016 TOTAL GRAPHS AND TABLES…………………………………..…………………..………………………………………..47-57 3 Retrospective Homeless Study, Santa Clara County Medical Examiner-Coroner Office 2011-2016 INTRODUCTION This is a retrospective study of homeless deaths in Santa Clara County encompassing the years 2011 through 2016. It is the goal of this study to define homelessness as used by the Santa Clara County Medical Examiner-Coroner’s office, as well as illuminate trends in homeless deaths over the previous six years. Each year was analyzed separately for the following variables: decedent demographics; cause and manner of death; location of death; medical history; the presence and use of drugs; veteran status; and motor vehicle related deaths. The yearly data was compiled to demonstrate trends across the six year period. It is hoped that these data and trends presented in this study of homeless deaths will inform policy discussion and help identify service gaps for this vulnerable and growing population. DEFINITIONS AND CLASSIFICATIONS HOMELESSNESS: Homelessness is not well defined but according to the Centers for Disease Control and Prevention (CDC), the homeless can be defined, on a general level, as those who do not have customary and regular access to a conventional dwelling or residence.1 The Santa Clara County 2017 Homeless Census and Survey defined homelessness based on the definition used by Housing and Urban Development (HUD) and states that an individual is considered homeless if they are “living in a supervised publicly or privately operated shelter designed to provide temporary living arrangement,” or are living in any type of makeshift living space not normally designed for habitation. This definition does not include individuals living in hotels or motels.2 Any case falling under the jurisdiction of the Medical Examiner requires a medicolegal death investigation to render cause and manner of death. During the course of the Medical Examiner-Coroner investigation, the decedent will be positively identified and address of residence and next of kin notification will be determined, among many other demographics. A decedent is assigned into the homelessness category if the circumstances of the death occurred in an environment to suggest homelessness (e.g. homeless encampment) or was known to be homeless and/or public record searches do not identify a valid living address. In almost all cases, irrespective of this study, people who knew the decedent, such as family and friends, are further interviewed by the Medical Examiner-Coroner Investigator, either during the initial investigation or days to weeks later prior to closure of the case to verify homelessness. In this study, each case file was reviewed, number of deaths verified, and variables analyzed by the Chief Medical Examiner Michelle A. Jorden, MD, Interim Chief Investigator Rosa Vega, and student intern Karin Wells. The circumstances of the death and absence of a validated living address provide further support that an individual does not have access to a specific enclosed living area with amenities. Homelessness was determined by the Medical Examiner-Coroner’s Office if both/either criteria 1 and 2 as stated below were present: 1) People living on the street Those living in some type of homeless encampment, indoor makeshift shelter (i.e. storage facilities, warehouses, garages, etc.), inside of a motor vehicle, trailer, or recreational vehicle (RV), homeless shelters (i.e. emergency housing consortiums, transitional housing), hotels and motels, or any type of funded housing where the decedent is not personally paying rent or currently on a lease and does not demonstrate a stable economic source of income. This category excludes individuals living in 4 Retrospective Homeless Study, Santa Clara County Medical Examiner-Coroner Office 2011-2016 converted garages, basements, and sheds, even if they are not paying rent as these housing situations are for the most part considered more stable and can include amenities. and/or 2) Public record searches do not identify a valid living address The authors take this opportunity to provide and unveil a more precise definition of homelessness using the above stated two criteria. LOCATION: Locations of death were separated into categories in order to illustrate the many types of areas where homeless deaths occur. It is the goal of these classifications to provide the reader the number of individuals dying in places where they lived and in which personal belongings were found, such as homeless encampments and other makeshift living areas both in- and outdoors, versus those dying in hospitals or care facilities. A classification of death outdoors was separated into two sub-categories to further distinguish between outdoor areas where decedents were living as evidenced by the presence of their personal belongings, such as homeless encampments, in contrast to areas where they did not appear to live, for example on the street without accompanying personal belongings. In some cases, there is overlap between these two outdoor distinctions. Therefore, determination of a makeshift living area supported by the individual’s personal belongings versus simply being found outdoors was determined by the descriptions in the investigative reports, as well as scene photographs. Indoor makeshift living areas include motor vehicles, trailers, RVs, storage rooms, outhouses, garages, and other nontraditional indoor living arrangements. Other locations of death include hospitals, emergency rooms, nursing homes, homeless shelters, hospice facilities, and other residences belonging to friends, family, or acquaintances. A homeless encampment in San Jose. Photo taken by Michelle A. Jorden, MD 5 Retrospective Homeless Study, Santa Clara County Medical Examiner-Coroner Office 2011-2016 Source: Santa Clara County Medical Examiner-Coroner STRESSORS: In this study, we also tried to identify stressors that occurred hours to days prior to death such as emotional stressors, physical and verbal altercations, medical stressors, and interactions with law enforcement. These events were categorized by the authors based on notations in the investigative reports. Emotional stressors included incidents such as recent breakups with family or with a loved one, loss of child custody, suicide attempts, 5150 holds, and evictions. Included in the medical stressor category were recent falls, visits to the emergency room, complaints of pain or illness, and those decedents found to have hair and/or body lice. Incidents involving law enforcement included recent arrests, releases from jail, active warrants, restraining orders, and being on parole. Source: Shutterstock 6 Retrospective Homeless Study, Santa Clara County Medical Examiner-Coroner Office 2011-2016 MENTAL ILLNESS: We have included in this study data on mental illnesses among the homeless decedents. This includes both medical and observational diagnoses found during the investigative process. Prior to late 2016, mental health history was either captured from friends and family interviews or was captured in the medical records. In late 2016, this Medical Examiner-Coroner’s Office was able to pass legislation allowing the Medical Examiner-Coroner’s Office to obtain mental health records for cause and manner of death determination, and verify mental health diagnoses. SEASONS: The season in which death occurred was determined
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