Federal, state, and local governments are not doing enough to save the lives of homeless Americans. Homeless persons die at least 12 years earlier than other Americans, on average, and have a mortality rate four to nine times higher than those who are not homeless. Over the past five years, thousands of homeless people have died, including an estimated 2,000 in 2013 and 2,700 in 2016.
Over the past five years, reports in Sacramento and Santa Barbara, California, Colorado, Georgia, Oregon, Washington, and Washington D.C. stated that homeless persons have died from homicide, blunt force trauma, motor vehicle accidents, cardiovascular disease, cancer, diabetes, chronic obstructive pulmonary disease, suicide, drug and alcohol use, respiratory diseases such as bronchopneumonia, infectious diseases, skin infections, gangrene, and sepsis, and hypothermia and exposure to cold. In Santa Barbara, CA, Atlanta/Fulton County, GA, and Portland/Multnomah County, OR, the average age of death of homeless persons was between age 41 and 53 and in Denver, CO and in Sacramento, CA, the majority of these individuals were less than age 61.
Exposure to cold weather is fatal because it can lead to hypothermia, a lowering of the core body temperature to less than or equal to 95°F that can result in death or exacerbate health conditions such as cardiovascular and respiratory diseases, or frostbite, which is bodily injury caused by freezing and can lead to loss of feeling, permanent injury, and amputation. Over the past five years, at least a hundred homeless people have been reported to have died from hypothermia, frostbite, or exposure to the cold as the table below and our recent factsheet show and there are likely many more homeless people who have died from being out in the cold and have not been reported in newspaper articles, government reports, and other sources.
Exposure to cold weather can cause hypothermia at temperatures below 50°F and exposure to wind or rain or sweat can increase heat loss from the body and exacerbate the effect of cold temperatures to cause hypothermia and frostbite. These life-threatening weather conditions occur in most, if not every, state in the nation. In just the past five years, homeless people have died from hypothermia, frostbite, or exposure to the cold in at least thirty-four states, including the District of Columbia. As the table shows, some homeless people died when the temperature and wind chill were above 40°F on the day and the day before they were found.
Hypothermia is particularly deadly and difficult to avoid once homeless people are out in cold weather because once a person’s body temperature is lowered, his or her thinking and judgment become sluggish and impaired and they cannot perceive their need to avoid cold weather and for shelter or medical care.
Unfortunately, many homeless people do not have access to a shelter from life-threatening cold weather conditions. One-third of the people (176,000 of 549,000) who are homeless on a given night are without shelter and most surveyed states and localities provide access to shelter and winter services for homeless people only after temperatures are low enough to lead to hypothermia and frostbite. For example, one-third (17 of 50) of reporting areas that use temperature as their cut-off for providing services only provide shelter and winter services when temperatures are 25°F or below.
To protect homeless people from life-threatening cold weather, federal, state, and local governments must apply Housing First principles and develop and fund affordable housing, permanent supportive housing for chronically homeless people, bridge or transitional housing, emergency shelters and day shelters, and other housing opportunities.
Housing First, which is the approach of providing housing to homeless people and then providing services, such as counseling for mental health and substance abuse, more quickly provides housing and therefore can help prevent the exposure of homeless people to life-threatening cold weather.
With the demand for affordable housing far exceeding the supply and a major cause of homelessness is the lack of affordable housing, building more affordable housing will allow homeless people with income to obtain housing and escape exposure to life-threatening cold weather.
As approximately one-third (56,000) of the 176,000 unsheltered homeless people are chronically homeless with a mental or physical disability and consistently homeless for one year or more and with permanent supportive housing being associated with decreased homeless deaths, more permanent supportive housing can help prevent the exposure of homeless people to life-threatening cold weather.
As bridge housing has been shown to be effective in providing homeless veterans with short-term stays before moving to a planned permanent housing intervention and being assigned to transitional housing has reduced the post-traumatic stress disorder symptoms of adults with children compared to those assigned rapid rehousing assistance or no special assistance when assessing long-term impacts, residing in transitional housing should not be a barrier to obtaining permanent supportive housing for any homeless person and bridge housing and transitional housing should be provided to move homeless people out of cold weather and prevent the exposure of homeless people to life-threatening cold weather.
As emergency night and day shelter offers basic safety off the streets and reduces exposure to cold weather during the night and day, more emergency shelter and day shelter capacity is needed as a last resort and available to all and some type of housing or shelter must be provided to those who have been consuming alcohol or drugs so that no homeless person is exposed to life-threatening cold weather.