Every year for the annual homeless vigil, the Clark County Coroner’s office determines how many homeless people died, who they were, and in most cases, how their lives ended.
Figuring out why they died can be a far more complicated question. While often connected to medical, mental health or substance abuse conditions many homeless people face, the nearly 200 deaths this year also illuminate the barriers homeless people confront when accessing services.
“A lot of these are preventable deaths,” says Merideth Densford Spriggs, the founder of the homeless service and outreach nonprofit Caridad. “I think as a whole, providers, and I’m including myself in that, should have a renewed sense of urgency. Essentially, three people die at our work every week. What are we doing about it?”
In Southern Nevada, the Clark County Coroner reported 192 people died in 2018 who were either identified as homeless or transient, a 47 percent increase over the 131 deaths reported in 2017. There were 139 deaths in 2016, and 148 in 2015. The last time the number of those who died was in double digits was 2013.
On any given night, nearly 6,100 people experience homelessness in Southern Nevada according to the 2018 Homeless Census conducted in January.
On Dec. 13, as the sun began to set over Foremaster Lane, off Las Vegas Boulevard in the heart of the homeless corridor, a crowd gathered to light candles, bow their heads in a moment of silence and pay respects to those listed.
Thomas Randle El, who with his now-deceased wife Linda founded the organization Straight from the Streets, has organized the Homeless Annual Candlelight Vigil for the last 23 years. Many cities host remembrance events to coincide with the National Homeless Persons’ Memorial Day — it is Dec. 21 this year.
Here in Southern Nevada, death came in different ways for people living on the streets. For 61-year-old Michael Lawhead, it was a subarachnoid hemorrhage, a brain bleed, in an unidentified Las Vegas shed. A 24-week-baby boy, the youngest on the coroner’s report who was listed without a name, died at Sunrise Hospital due to congestive heart failure.
For the majority listed, their deaths were connected to the inability to access adequate health care, substance abuse treatment complications and a lack of options that offer respite from the dangers being on the streets — in other words, a leading cause of homelessness deaths is homelessness itself.
Kathi Thomas Gibson, the director of community services with the city of Las Vegas, says as people stay on the streets longer, they become less resilient, which takes a toll on their health.
Health care is always an obstacle, but the number of homeless individuals reporting chronic health conditions increased from about 30 percent to 41 percent, according to the homeless census.
About 21 percent surveyed said since becoming homeless they’ve had a medical need arise but were unable to get it taken care of. “Homelessness is rough on the body and can exacerbate any health issue,” says Michele Fuller-Hallauer, Continuum of Care Coordinator with Clark County Social Services.
That played out in about 50 health-related deaths such as pneumonia, cancer, sepsis, cardiovascular disease and heart failure documented by the coroner this year — there could be more considering there are numerous cause-of-death results pending.
There are various barriers to getting needed medical care. “It’s not an easy system for people to navigate,” Thomas Gibson says. “Folks have to figure out transportation and how to manage their appointments.”
Fuller-Hallauer adds if people are struggling with where to eat and sleep, managing medical needs isn’t a priority.
The number of homeless relying on emergency rooms for medical care increased from 53 percent in 2017 to 73 percent this year. Reliance on free, community clinics for medical needs fell from 7 percent to 3 percent in the last year. “They are only going to the hospital when it is really, really wrong and not for preventative care,” Thomas Gibson says.
Densford Spriggs adds that people are often considered healthy enough to leave the hospital but still not well enough to survive living on the streets. “They are released too fast and slip through the cracks,” she says.
The city wants to open a health clinic off Foremaster Lane — Thomas Gibson says it’s about 18 months out and the city still has to select a developer to convert the building into the facility. “This way people can literally walk off the streets and get the health care they need,” she says.
But accessing health care for medical problems is just one component. “(Southern Nevada) has a mental health crisis and there aren’t enough treatment beds or licensed professionals,” Thomas Gibson says. “We’ve seen substance abuse issues increase across all populations, including the homeless.”
An estimated 39 percent of the homeless reported having a drug or alcohol problem according to the 2018 census. “Substance abuse can be the cause of homelessness but can also be the response to homelessness,” says Fuller-Hallauer.
Drug overdose, such as methamphetamine intoxication, was cited as the cause of death in about 50 cases.
Due to income, mental health status, disabilities or other factors, many on the streets should qualify for government assistance, which could help them gain not only medical care and treatment, but financial support. Randle El says many don’t have proper identification, which often hinders people from accessing most services.
Also, applying for and then receiving benefits such as Social Security Disability or Social Security Income can be a lengthy bureaucratic process, and advocates who work to connect homeless people with benefits note that sometimes people start the process but then can’t be found.
The lack of health care or treatment for mental health and substance abuse issues is just one problem. Sometimes, just being on the streets can be deadly.
About 64 percent of the homeless population is unsheltered according to the 2018 census — in a recently released US Department of Housing and Urban Development report, the agency notes Nevada has one of the highest unsheltered populations.
Another 20 deaths resulted from blunt force trauma, stabbings and gunshot wounds, though only six were categorized as homicides — the manner of death, or how the death is classified, is still being determined in some cases. Densford Spriggs says some of the trauma deaths could be from accidents due to living in unsafe or uninhabitable environments such as abandoned buildings or along the railroad tracks.
The cause of death is still pending or undetermined in at least 22 deaths. Most of the manner of deaths were ruled as an accident or natural, with eight cited as a suicide and 28 are as unknown, undetermined or pending.
While addressing the underlying issues that contributing to these deaths, the solution to dealing with many of these deaths comes back to the lack of housing.
“Once someone doesn’t have to worry about where to lay their head at night, doesn’t have to worry about safety, then they can start addressing other areas in their lives,” Fuller-Hallauer says. “That’s when they can start getting a handle on substance abuse issues and mental health. Housing is the crux to address this issue.”