.Santa Cruz’s Homeless Die Much Younger Than Everyone Else. Why?

The first time Kenzie spent the night outside, she was 5 years old.

She was with her mother and siblings—six people in a five-seat station wagon parked on the second story of a downtown Santa Cruz parking garage. They stayed up listening to the radio until the car battery died.

“It was cold, and we were definitely hungry, and it was definitely difficult on my mom,” remembers Kenzie, who asked us to withhold her last name to protect her privacy.

Standing near her tent by the shoulder of Highway 1, Kenzie’s wearing a leopard-print top and a knit 7-Eleven beanie with her hair in a ponytail. She hasn’t been able to shower lately, and her hair is dirty, so she wants to keep it out of her face, she says.

Kenzie, a 29-year-old ovarian cancer survivor, has had a number of bouts of homelessness and a host of health problems to go along with them—including sciatica and blood clots, both of which she partially attributes to sleeping in awkward positions in her car in recent years.

“On top of that, the lack of sleep, having to be outdoors. And dude, this is not any life for a woman out here,” she says. “It is scary and sketchy and fucked in every way. It’s exhausting. You can’t get very healthy food very often. You can’t get support to stay safe from any abusers.”

In a multitude of ways, homelessness is a huge health risk. Statistics compiled by Santa Cruz County routinely show that local homeless residents die at least 22 years earlier on average than the county’s housed residents do. Housing Matters and the Santa Cruz County Homeless Persons’ Health Project (HPHP) will host the county’s 22nd annual Homeless Memorial on Friday, Dec. 18, at 10am. In compiling figures for this year’s report, HPHP found 77 confirmed homeless deaths, more than in any year in the past 22 years.

Some of the official causes of death include factors like suicide, substance abuse or heart attack.

But Joey Crottogini, the health center manager for HPHP, says many of the biggest health risks are much more basic. They include things like not having a phone or not getting daily mail, not having a stable address where friends or social workers might be able to follow up with them.

“Those are just critical needs for someone to survive in 2020,” he says. “A lot of folks we see have had a lot of trauma in their lives, and so being able to build rapport and build relationships with them is the most important thing, so we can provide care to them. Once we provide that trust, we can provide that care. A lot of times, it’s difficult. If you’re living outside and you’re constantly moving around, it takes a certain service provider to be able to provide you.”

FULL SERVICE

This year’s homeless memorial will be unlike those in years past.

For starters, the gathering will happen via webinar, and guests must register online on eventbrite.com. The event will be marked by the notable absence of Housing Matters Boardmember and past Board President Claudia Brown, who died of cancer earlier this month.

Friends and colleagues remember Brown for the clarity with which she spoke about both short-term challenges and long-term policy objectives. Housing Matters Executive Director Phil Kramer will honor Brown in his remarks at Friday’s memorial. Kramer says Brown showed a knack for cultivating honest dialogue, without ever losing sight of who she was fighting for—those suffering for lack of a safe, warm place to call home.

“She had this incredible patience—her wisdom in her ability to listen and synthesize. She really took time to understand where people were coming from. And that included stakeholders and leaders in the community and neighborhood groups and our own staff, who have a really hard job,” says Kramer, who also has fond memories of Brown talking him into taking on his role at the shelter campus—then called the Homeless Services Center—in 2015.

Brown always made herself available to talk. I spoke to her several times over the years, including once in 2017 when I sat down with a large group of shelter staff and boardmembers to chat generally about issues surrounding homelessness for a story I was working on at the time. Brown sat quietly through 20 minutes of rambling from myself and others in the room about the struggles that both create and result from homelessness.

Then, Brown pushed back against the broadness of my questions and the discussion in a way that stuck with me.

“There’s no such a thing as ‘the homeless population,’” Brown told me. “Homelessness is something people pass through. One person might have experienced domestic violence. Another might have gone through a serious illness. Getting that right is important.”

BACK TRACK

In tracking local homeless deaths, HPHP saw a 33% increase in homeless deaths this year compared with the previous year. The total came out to 77, an average of 1.4 per week.

HPHP administrative aide David Davis, who compiled the report, found that homeless people died at more than five times the rate of housed county residents over the past year. The average age of homeless people who died was 55.2 years old, 23 years younger than the county’s average housed resident who passed away. Only four of the homeless who died made it to age 70.

“Cardiac disease/failure” was listed as the most common known cause of death, having led to 15 deaths, followed by 10 people who died of substance abuse or an overdose. But 44% of all deaths were listed as “undetermined/pending.” The report identifies 82% of all homeless who died as being male.

Of the 77 total homeless deaths, 21 died outside and 22 died in the hospital. The rest died in skilled nursing facilities, temporary residences, shelters or under circumstances where such data was not yet available. Nine of the homeless people reflected in the report’s numbers died outside of the county, but were included because they were residents of Santa Cruz County.

Davis and his colleagues will count any homeless deaths that happen during the remainder of 2020 in HPHP’s 2021 report.

Different counties have their own ways of tracking the numbers. Some other counties, like Santa Clara County, will track if a person found dead was presumed homeless. That allows third-party-investigators like journalists to request the necessary information, look at the raw data themselves and crunch the numbers. Santa Cruz County’s coroner’s office does not track the numbers in the same way. County officials told me earlier this year they had no way to meet my requests for information on homeless death totals.

Instead, Davis compiles the numbers himself by staying in touch with the coroner’s office and searching the local death records, which he has access to as a county employee. He also looks through health and hospital records. He stays plugged in to the word from the local homeless community, and he looks up the name of nearly every single person who dies in the county in the Homeless Management Information System, to see if they appear and compares birthdays, when two names look similar, two see if they match.

Because of the work he puts in, Davis estimates that his count is more complete than those in most other counties, including Santa Clara County. Still, he estimates that even his count may undercount the true toll of deaths by about 10%.

Each year after the report is finished, the mood of the annual memorial is somber. Service providers read out the names of those who passed one by one.

Davis says the team does its best to acknowledge what the deceased went through during their life, including during their time being homeless. And they work to pay tribute to them.

“Some of the worst things are reading about where somebody died outside. It’s just the most horrible thing,” he says. “Dying outside and alone and cold should not happen. It’s just God-awful. We take solace and pride in doing everything we can for all of them, but it’s a systemic problem, and it’s not easy to overcome.”

CLINICAL APPROACH

If homelessness is the root cause of so many homeless problems, HPHP works to be as proactive as possible about managing the myriad symptoms that result from it—offering everything from mental health services to general care to acupuncture at its office on the Housing Matters campus.

The Covid-19 pandemic has dramatically reduced the number of patients that doctors can see on site, but clinicians have been going out to homeless camps to treat people where they are. HPHP also plans to operate a new recuperative care center at Housing Matters, as part of a proposed 120-unit permanent supportive housing complex that the Santa Cruz Planning Commission approved last month.

Other aspects of homeless-oriented services continue to move around as the seasons change. The county, for instance, recently moved its Benchlands encampment to DeLaveaga Park, given that the previous location at San Lorenzo Park was in a floodplain, a precarious location for the winter season. The county has been running regular shuttles to and from DeLaveaga.

In general, Crottogini, the HPHP manager, says there’s a lot of confusion around homelessness, partly because the concept can seem baffling on such a basic level. He recalls one time when his young son told him he had seen a dead guy on the sidewalk. Crottogini tried to explain to his son that the man was not dead. He was sleeping.

But adults can be awkward about homelessness too, he says.

The natural reaction to seeing people on the streets, he explains, is a pretty uncomfortable feeling. And when a society feels that discomfort collectively over the span of decades, it can cause feelings of fear or guilt, he says. People try not to look at the problem directly, try not to think about it—at least for as long as they can.

“When it gets to the point where it’s impossible to not confront because it’s so pervasive, that turns to anger,” he says. “And people don’t know how to direct that frustration and anger. Is it toward the government because they’re not providing the resources? It’s also just easy to say, ‘Well, they got themselves into this situation; it’s an individual problem.’ So they don’t even look at the community-wide or systemic issues of inequality and racism and other things that contribute to homelessness. One of the good things about the memorial is it brings it back to the human side. These are people. Anyone in this field that’s been here long enough, when you get to know the people, you see every single example of how somebody became homeless.”

The online Homeless Memorial will be 10am on Friday, Dec. 18. To register, visit bit.ly/2IxVKba. Questions about registration can be emailed to Andrea Feltz at af****@ho**************.org. Those staying in shelter at the Veterans Hall in Santa Cruz or in Watsonville, or at Housing Matters, will have an opportunity to view the event and share a remembrance story or poem.

This story was reported with support from the California Fellowship through the USC Annenberg Center for Health Journalism.