Between July of 2018 and June of last year, 404 people considered homeless in New York City died. Those deaths represent a 39 percent increase over the prior year, the largest year over year increase in a decade. They died in hospitals, shelters, outside the entrance of a building, on a subway car, in an abandoned building, and in a vacant lot. The majority of them were middle-aged men. Many were plagued by drug addictions, alcoholism, and heart disease.  

“Like across the country, the tragic deaths of our clients are driven by chronic health conditions due to decades of risk factors,” said Steve Banks, Commissioner of the Department of Social Services. “As opposed to safety within the shelter.”

The data on these deaths comes from an annual report mandated by city law. According to the report, the top five causes of death were drugs, heart disease, alcoholism, unspecified accidents, and cancer. More than a third were either living on the streets or somewhere else other than a shelter. 

To deal with serious health conditions, Banks said the shelter system is working with the city’s public hospital system to provide caseworkers whose job it is to connect the seriously ill with healthcare. He said the shelter system is also working with hospitals when they discharge patients so that the transition from hospital to a shelter can be more seamless.   

“The people that come to us and die reflect upstream factors in the healthcare system and many other systems, including jails and prisons,” he said. 

Not all deaths were due to chronic illness. Fifteen people also committed suicide, more than double the amount in fiscal year 2016. Three took their own lives inside a shelter. There were also 10 homicides, three more than the prior year. According to the city, none of them occurred inside a city shelter. But at the end of last year, during a time period not covered by the report, at least two people were killed inside a shelter. 

Drug addiction is prevalent among New Yorkers experiencing homelessness. And since 2016, the city said it trained more than 20,000 shelter staff and residents to use Naloxone, a drug that can rapidly reverse an opioid overdose. According to a spokesperson, Naloxone was used successfully 600 times during fiscal year 2019. But 103 homeless people still died of an accidental drug overdose, ten more than the prior year. The city argues only 31 of those deaths occurred inside a shelter, three less than the prior year. 

“We’ve been able to stop the increases in the numbers of overdose deaths,” said Banks. “And similarly we were very much focused on addressing death from exposure on the streets and we’ve been able to keep that flat as well.” Four people died from hypothermia, according to the report. 

Among the most vulnerable in the homeless system are infants; 17 died in fiscal year 2019, compared to 10 the prior year. The leading causes of death among babies were “congenital malformations,” sudden infant death syndrome, and the flu with pneumonia. One infant also drowned and another died while sleeping in unsafe conditions. The cause of death for seven infants still has not been determined by the city’s medical examiner. The city said no one issue was driving the deaths and when they occur, the city responds immediately to deter any future deaths such as by making sure all families have cribs so that babies sleep alone and not with their parents. 

Women also died more frequently—from 59 to 91 this fiscal year. 

Dr. Mitchell Katz, CEO of NYC Health +Hospitals, said that much like the men, women suffer from high rates of drug use. 

“What’s always been interesting about women who are homeless is how preyed upon they are,” he said. “That just fuels more addiction as an escape. It’s awful.”

The report states that 163 people who lived in a shelter died inside a hospital. Katz believes the overall increase in deaths is driven by an aging homeless population and easy access to cheap drugs. 

“You can now buy for $5 fentanyl more powerful than $50 worth of heroin would have been when I began my training more than 30 years ago,” he said.  

The city has been tracking deaths among the homeless to comply with a local law that was passed in 2005. Banks fought to get the law passed when he was a Legal Aid lawyer representing homeless advocates.

“Every year we use this report to make reforms,” he said. “The drivers of the numbers of deaths this year really reflect significant chronic health conditions.”

Cindy Rodriguez is an investigative reporter for New York Public Radio. You can follow her on Twitter at @cynrod.

This content was originally published here.

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