Rising Hypothermia Deaths Among California's Older Homeless Population

In California, a troubling trend has emerged as the number of deaths from hypothermia, particularly among the older homeless population, has seen a significant increase. According to recent provisional data from the Centers for Disease Control and Prevention (CDC), hypothermia was identified as the underlying or contributing cause of death for 166 individuals in California last year, more than double the figure from a decade ago. This translates to an age-adjusted rate of 3.7 deaths per million residents in 2023, marking the highest rate recorded in the state in over 25 years.

Nationwide, the situation is similarly dire, with approximately 2,520 hypothermia-related deaths reported across the United States in the previous year, reflecting a 35% increase since 2014. The year 2022 was particularly severe, with around 3,500 fatalities attributed to hypothermia, many occurring during harsh winter storms that swept through various regions.

Experts attribute the rise in hypothermia deaths primarily to escalating homelessness rates, especially in California, which has the largest homeless population in the nation. The homeless demographic is particularly vulnerable to extreme weather conditions, as many older adults live outdoors and are directly exposed to the elements. While local governments have responded with temporary warming centers for those experiencing homelessness during cold nights, advocates stress the urgent need for more permanent housing solutions and programs aimed at preventing homelessness in the first place.

Leon Winch, a homeless individual near the state Capitol, expressed the challenges of staying warm as winter approaches. He noted the difficulty in finding dry places to shelter from the rain, as many areas are often monitored by private security that prevents him from seeking refuge. Hypothermia can occur at temperatures below 40 degrees Fahrenheit, but it is also a risk at warmer temperatures, particularly when conditions are wet.

City officials have established criteria for opening warming centers, such as when nighttime temperatures are expected to drop below 37 degrees for two or more nights within a five-day period. However, Winch expressed a lack of trust in the city, opting not to use the warming centers despite the frigid weather.

Data from the California Department of Health Care Access and Information reveals that homeless individuals accounted for 18% of hospitalizations and emergency room visits related to hypothermia between 2019 and 2023. Given that homeless Californians make up nearly 0.5% of the state's population, they are approximately 40 times more likely than the general population to require hospitalization for hypothermia.

Federal statistics indicate that more than two-thirds of California's 181,000 homeless individuals are unsheltered. Among those who have succumbed to hypothermia, older adults are disproportionately affected, with individuals aged 55 and over accounting for over three-quarters of hypothermia-related deaths in the state from 2021 to 2023. Margot Kushel, director of the University of California-San Francisco Benioff Homelessness and Housing Initiative, highlighted a significant increase in the aging homeless population, with the percentage of single homeless adults aged 50 and older rising from 11% in 1990 to nearly 50% today.

The rising fatalities attributed to cold exposure align with a broader trend of increasing deaths from heat exposure during summer months. Climate change is contributing to more extreme temperature fluctuations and severe weather conditions, which pose heightened risks for older individuals who may not be able to withstand such conditions. Projections indicate that the proportion of the homeless population aged 65 and older could triple in the U.S. between 2017 and 2030.

While hypothermia death rates are notably higher in California's rural, mountainous regions, the majority of fatalities occur in urban areas. Los Angeles County recorded 46 hypothermia-related deaths from 2021 to 2023, the highest in the state, though the death rate remained below the statewide average due to the county's large population. In contrast, Santa Clara, San Francisco, and Sacramento reported the highest hypothermia death rates among California's most populous counties, with Santa Clara experiencing a sharp increase from 11 deaths in the previous three years to 42 in the most recent data period.

Advocates argue that local governments are not providing sufficient permanent shelter options for the homeless population, nor are they offering enough temporary shelters during cold nights. Michelle Jorden, the chief medical examiner in Santa Clara County, indicated that while outreach teams have been deployed to encampments with supplies and warming centers have been established, the reason for the rising hypothermia death rate remains uncertain.

In Sacramento County, hypothermia-related deaths rose from 20 in the period from 2018 to 2020 to 34 from 2021 to 2023. Like many regions, Sacramento has enacted ordinances targeting homelessness and conducted sweeps following a Supreme Court ruling that granted cities more authority to manage homeless individuals on the streets. Kushel highlighted that nearly half of unsheltered homeless Californians have reported instances of local authorities confiscating their belongings.

Advocates emphasize that the long-term solution to the rising hypothermia death rate lies in preventing homelessness and securing housing for those currently without shelter. In the interim, they call for cities to establish additional warming and cooling centers to ensure accessibility for vulnerable populations.