More than 500 people experiencing homelessness in metro Phoenix died in the first nine months of 2020.
The unexpected and deadly COVID-19 virus — which ravaged the world this year and killed more than 7,000 Arizonans — was known to be responsible for only four of those deaths.
The rest were caused by the same concerns that killed hundreds of homeless people last year and, in all likelihood, will kill hundreds more next year.
Drug overdoses. Heatstroke. Malnutrition. Treatable illnesses. Vehicle collisions.
Nearly all of the people who died were not staying at a shelter at the time of their death. Their bodies were found outside — in tents, on sidewalks, in a Porta Potty, under freeway tunnels and in dry river bottoms.
Most of their deaths were preventable. Nearly all of them were caused or expedited by the conditions in which they lived, according to an Arizona Republic analysis of medical examiner reports.
A surefire way to prolong their lives would be to provide stable housing, and, in the interim, safe and accessible shelter.
Metro Phoenix does not have enough of either of those resources, which is reflected in the record number of street deaths recorded this year.
“This number of people who died on the streets, it needs to be a wake-up call to our policymakers and our leaders,” said Lisa Glow, CEO of Central Arizona Shelter Services.
Most of those who died perished alone on metro Phoenix streets. They were buried only with government employees and a single clergy member to bear witness.
Some had hobbies and college degrees, memorable senses of humor and artistic talents.
They had families and people who cared about them — some of whom learned weeks or months later that their loved one had passed.
2020 brought more challenges, more death
Homelessness is increasing in Maricopa County, but the number of deaths appears to be increasing at a much higher rate.
2020 likely saw a record number of homeless deaths in Maricopa County, although it’s impossible to say for sure since the Maricopa County Office of the Medical Examiner only began tracking the data consistently this year.
Previously, investigators would write “transient” in the address box on their reports if they believed people were homeless at the time of their death. But that wasn’t always done consistently, according to Chief Medical Examiner Jeffrey Johnston.
The office started using a new system in December 2019 that requires investigators to check “yes” or “no” as to whether the person who died was homeless before death. Johnston said investigators now have been trained to ask questions about the person’s housing status during an investigation.
“We probably have undercounted (in the past) and unfortunately we don’t really know by how much,” Johnston said.
Even with the old, less-scientific way of capturing housing information, homeless deaths were increasing exponentially each year between 2017-2019, according to The Republic’s analysis.
And this year, the death rate was significantly higher than in years past, according to Dr. Christopher Pexton, medical director of Circle the City’s downtown family health center. Circle the City is the provider of health care for the homeless in Maricopa County.
“This summer was exceptionally hard and was exceptionally deadly. We saw a flare in medical and mental conditions that resulted in a lot of really preventable deaths,” Pexton said.
Though the COVID-19 virus itself was not significantly lethal in the homeless population, the virus’ impact on services, shelter and psyche likely played a role in the increased death rate, Pexton said.
COVID-19 hit its first peak in Arizona during the summer. Many fast-food restaurants, libraries, community centers, homeless service providers and other places where people living on the streets would congregate and take respite closed to the public in an attempt to slow the spread of the virus.
Homelessness is already isolating, but with gathering places closed, people spent even more time alone, leading to more symptoms of mental illness, less willingness to seek help and more self-medicating with drugs and alcohol, Pexton said.
The closures also meant fewer indoor spaces to cool down from the extreme summer heat. Heat deaths of people experiencing homelessness more than doubled between 2019 and 2020, according to Maricopa County data.
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Pexton said the economic consequences of the pandemic also pushed more people into homelessness this year. Those people had less knowledge about services available to them. And some services stopped operating altogether because of COVID-19.
More people are expected to become homeless after the first of the year when the U.S. Centers for Disease Control and Prevention’s eviction moratorium expires. Providers are preparing for more deaths unless there is a significant influx of housing and shelter.
There is no such influx planned.
Who are the people who died on the streets of metro Phoenix?
The average person experiencing homelessness who died in the first nine months of 2020 in Maricopa County was older than 45, white and male, according to The Republic’s analysis.
The average age at the time of death was 49, and almost one-quarter were over the age of 60 when they died, illustrating a troubling trend of increasing senior homelessness.
More than 80% of the people who died were men.
The races and ethnicity of the people who died do not align with Maricopa County population numbers, but they do match up with the homeless population demographics in the county.
Homeless deaths for White, Black and Native American people occurred at higher rates than their representation in the general Maricopa County population. Homeless deaths of Latino and Asian people occurred at rates significantly lower than their representation in the greater population.
People experiencing homelessness died in nearly every ZIP code in metro Phoenix, but clusters occurred in downtown Phoenix, midtown Phoenix, Sunnyslope, downtown Tempe and downtown Mesa.
Why did they die? ‘The perfect storm’
Of the 484 deaths where the cause of death has been determined:
- Almost 300 were accidental deaths involving drugs or alcohol.
- The medical examiner confirmed that heat was a primary or contributing cause of death in 146 deaths. The medical examiner listed another 10 deaths as suspected heat deaths, but the final reports were not yet ready for release.
- One person died of frostbite, and another died of hypothermia.
- At least 143 deaths were caused at least in part by treatable diseases or illnesses such as diabetes, heart disease, pneumonia or malnutrition.
- Sixteen people were hit and killed by vehicles.
Most deaths were a combination of several factors.
“The things that I saw consistently were some combination of heat, chronic illness and either an acute illness or substance abuse that just resulted in the perfect storm that resulted in a lot of people dying,” Pexton said.
Drugs, alcohol: Major contributors to deaths
John Spence was a hyperactive child. He would construct booby traps in his childhood bedroom that would trigger if anyone opened his door without permission. He was worried about intruders, he said.
His mother, Sandy Browne, said the paranoia seemed like a normal, imaginative childhood trait until he got older. He eventually was diagnosed with bipolar disorder and later schizophrenia.
Browne and her husband took three months of classes from the National Alliance on Mental Illness to understand their son’s diagnosis. When Spence served time at the Maricopa County Tent City jail after a DUI conviction, Browne, who lived in Gilbert, would pick him up and drive him to jobs for his work release program.
No matter how severe his mental illness symptoms became, or how many run-ins he had with the legal system, to Browne, he was still John.
Handsome. Funny. An involved son who never missed her birthday.
Spence’s condition got worse when he refused to take his medication. He told his mother it made him feel “flat,” like he had no emotions, and it made him gain weight. Instead he started self-medicating, first with alcohol and eventually with illegal drugs.
Two years ago, Spence told his mother he wasn’t going to call her anymore. Browne thought he was exaggerating.
But after two Christmases and a birthday without a phone call, she started to fear that she may never hear from him again.
“He knew he was loved. I know he knew he was loved. I don’t think there was a doubt in his mind he was loved,” Browne said. “The only thing I can think of is he did it to protect us because he was going on a downward spiral.”
Browne began checking obituaries in the newspaper for his name and recently subscribed to a website to search graves.
She didn’t know John had died in February until a Republic reporter called her in December. The county never contacted her after her son’s death.
Spence died of methamphetamine toxicity and pneumonia, according to the medical examiner. He was 55.
Drugs and alcohol — most often meth and fentanyl — were factors in more than half of the deaths in the homeless population in the first nine months of 2020, according to The Republic’s analysis.
Pexton said there is a significant meth addiction problem in Maricopa County, and illicit drug makers have started lacing their product with fentanyl in an attempt to get users addicted to opioids as well.
“It’s just a horrific manipulation of human vulnerability,” Pexton said.
He said he sees two different types of drug users in his patients. There are people who have “a genetic code” that makes them susceptible to addiction. And then there are those who use drugs because they feel like they have to.
Pexton said he hears from older women especially who say they use meth to stay awake all night so they can protect their tent and themselves. Over time, they develop an addiction.
“We see a lot of people who use substances to survive being homeless who have no desire to use,” Pexton said.
Environmental deaths: Heat exposure and more
Andre Frison, 65, was found unresponsive outside a gas station in Phoenix. Emergency medical personnel transported him to a hospital, where his core body temperature was measured at 108.5 degrees Fahrenheit. He died the next day.
According to the medical examiner’s report, Frison was dehydrated, and multiple organs had failed because of his extremely elevated body temperature.
The high temperature on July 3, the day Frison was found outside, was 102 degrees.
Exposure to the heat, combined with a common form of heart disease, killed him, according to the medical examiner.
More than 30% of the deaths in the homeless population were caused by heat.
Maricopa County senior epidemiologist Vjollca Berisha said the county has seen 285 confirmed heat deaths this year, with 50 additional suspected heat deaths still under investigation.
Last year, there were a total of 199 heat deaths.
According to The Republic’s analysis, 146 of the confirmed heat deaths in the first nine months of 2020 were of people experiencing homelessness, compared with 67 confirmed heat deaths for all of last year.
Berisha said she suspects COVID-19 played a role in the increase in heat deaths because fewer air-conditioned places were open to the public this year to prevent the spread of the virus.
In years past, the county and its partners offered hundreds of indoor cooling stations. That number was significantly reduced because of COVID-19.
“This year we didn’t have that (same) number of cooling station available. So that may have been a reason, not having a cool place to go,” Berisha said.
Heat is often not the sole cause of death, according to The Republic’s analysis. Often, heat exacerbates chronic health conditions or side effects of drug use.
According to the analysis, 110 of the heat deaths also involved drugs or alcohol.
“We have a huge crystal meth problem, and in the summer it’s that much more deadly because it causes dehydration,” Pexton said.
Deaths from chronic illnesses hard to manage on the street
A Phoenix police detective came to Florentine Moran’s house on March 9 with news that officers found her son Robin Moran, 53, dead in the dry Salt River bottom at 19th Avenue.
It was a year and nine days after her husband of 59 years died.
Robin was a bright child. Florentine worked as a cook at Maie Bartlett Heard Elementary School to get him into the west Phoenix school, which was regarded as offering a better education than their neighborhood school. Robin’s job was to raise and lower the American flag each day.
He graduated from Alhambra High School and Glendale Community College. He worked for several car dealerships and spent some time as a long-distance truck driver.
His passion was with wood carving, though. He belonged to three clubs and loved to carve owls to pass out to kids at the Desert Botanical Garden.
A few years ago Robin met a woman on the internet. He fell in love.
Florentine said she lived out of state and was always in need of money for some reason or another. Florentine and her husband tried to warn him that it sounded like a scam, but he wouldn’t listen, she said.
He traveled to Chicago and New York to try to meet her, but she never showed, Florentine said. By the time he realized she wasn’t real, he’d already spent all of his money on her.
Robin moved in with Florentine and his father but he became violent. His parents told him he had to leave. Florentine said she wasn’t sure where he was staying after that.
He would still stop by their house occasionally. The last time Florentine saw him he came by to pick up his mechanics toolbox to sell for extra money. She remembered he looked skinny.
Moran had to wait until the summer for the medical examiner’s report that showed how Robin died: malnutrition and chronic dehydration.
“But yet he had (gift) cards for McDonald’s in his wallet,” Moran said.
Much like with Robin, although many homeless deaths are listed as natural in medical examiner’s reports, they’re often a byproduct of their living conditions.
About 30% of homeless deaths between January-September 2020 had a treatable disease or illness listed as the primary or secondary cause of death, according to The Republic’s analysis. Diabetes and cardiovascular issues were the most common.
Pexton said that although diabetes and heart disease are extremely common among people who are homeless and housed, it’s much more difficult for someone living on the street to care for their conditions properly.
With diabetes, for example, patients are often prescribed insulin, which is supposed to be refrigerated. People living outside don’t have access to a fridge.
It’s also much more difficult to control diet and exercise when you don’t have a safe place to stay, he said.
In addition to a medical center and respite center for people experiencing homelessness who are ill, Circle the City has expanded its mobile medicine units to treat people who don’t have the ability to transport themselves to downtown or midtown Phoenix for medical care.
“A lot of people we know that’s the only medical care they receive. I think it’s one of the most valuable services we do because it’s truly trying to get to people where they’re at,” Pexton said.
Vehicle dangers: Excessive speed, inattention
Almost 3% of people experiencing homelessness who died in 2020 were killed in motor vehicle collisions. In the total Arizona population, pedestrian fatalities make up less than one-tenth of a percent of all deaths.
In March, David Allen, 32, was crossing the street in west Phoenix when he was hit by one driver who fled, and then run over by another driver who also fled, according to the medical examiner’s report. He was pronounced dead on the street.
Two months later, Michael Groth, 61, was riding his bike and was hit by a vehicle traveling at 40 mph after failing to stop at a stop sign. He was transported to a hospital and died three hours later.
Arizona has one of the highest pedestrian fatality rates in the country.
Most people experiencing homelessness don’t have a motor vehicle and use walking or biking as a primary mode of transportation, increasing their likelihood of getting hit or killed by a vehicle.
Stacey Champion, who advocates for pedestrian safety and homeless solutions, lobbied Phoenix to install two crosswalks on Jefferson Street across from the Human Services Campus.
“You have a high pedestrian population and you have like highway streets running through our urban core with people driving at excessive speeds, not even slowing down, yet alone yielding to pedestrians,” Champion said.
Even with the new crosswalks, drivers still speed through, putting people experiencing homelessness who are trying to access the Human Services Campus at risk, she said.
Champion said it’s particularly dangerous for seniors who use wheelchairs or walkers and don’t have the ability to jump out of the road if a driver ignores the crosswalk.
Two of the people who died in vehicle collisions this year were using a wheelchair or walker when they were hit, according to The Republic’s analysis.
Vehicles also posed a threat to people experiencing homelessness when they were sleeping.
A semitruck driver in west Phoenix did not realize Rickie Sorensen, 28, was sleeping underneath his trailer and ran him over, killing him, according to the medical examiner’s report.
A Scottsdale garbage truck driver was collecting trash in an alley way when he ran over Freddy Tombo, 34, who had been sleeping there. The driver told police he thought he had driven over trash scattered in the alley until he looked back and saw something move.
The man was pronounced dead in the alley.
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Metro Phoenix lacks shelter, housing
To many homeless service providers, there’s a simple solution to preventing the vast majority of premature homeless deaths: Put a roof over everyone’s head.
“You aren’t healthy as a person physically or mentally if you’re not housed,” said Amy Schwabenlender, executive director of the Human Services Campus. “It’s this spiraling, compounding effect when you’re living in toxic stress and making decisions moment to moment, day to day, just to stay alive.”
While the solution is simple, implementing it is not.
Maricopa County is short on emergency shelter beds and short on housing that is affordable for people in middle- and lower-income groups.
According to the last point-in-time count in late January, at least 7,419 people experiencing homelessness were not staying in a shelter. The point-in-time count is widely believed to be an undercount of the true number of people without a home in Maricopa County.
The county has about 1,700 emergency shelter beds, which means the only option for thousands of people experiencing homelessness is to sleep outside or in their vehicles.
The Human Services Campus, which is home to the 425-bed CASS shelter, is asking Phoenix to allow an additional 375 permanent shelter beds on the campus near downtown Phoenix.
The City Council was supposed to weigh in on the request by the summer, but a series of mostly political delays has left the fate of the new beds in limbo.
“It is frustrating to have a proposal for part of the solution and for it to be so difficult and challenging and to watch homelessness get politicized. It’s frustrating. We don’t give up, though,” Schwabenlender said.
Phoenix City Council member Michael Nowakowski, who opposes the bed increase and has pushed for the delays to the Human Services Campus’ request, did not return a call for an interview but sent a statement saying he is “concerned with all deaths, including the deaths of individuals experiencing homelessness.”
He said crises “deserve thoughtful, comprehensive, solution-driven plans,” which is why he supports “smaller, specialized shelters shared equitably across Maricopa County.”
“Data shows that mega shelters hurt rather than help those experiencing homelessness and I encourage city leaders, neighborhoods and nonprofit providers to join in an effort to support the work of Mayor Gallego and the city approved homeless strategies plan,” Nowakowski said. “Our residents and neighborhoods deserve a long-term solution rather than band-aids to temporarily fix.”
The neighborhood surrounding the Human Services Campus does not want more beds because business owners and residents believe it will draw more people experiencing homelessness to the area. Right now, between 400-500 sleep on the streets outside the campus because they either can’t get or don’t want a shelter bed on the campus. The shelter is full virtually every night.
Even if Phoenix approves an additional 400 beds on the campus, it won’t be nearly enough to serve the thousands of people without a bed now.
The city of Phoenix recently approved a homelessness plan that calls for smaller shelters scattered throughout Maricopa County. City leaders have put pressure on the state, county and other cities to do more to house people experiencing homelessness.
There have been some conversations about new shelters, but little to show for it so far. Homeless shelters are hard to fund and even harder to get neighborhoods to support.
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Transitional housing: A bridge to a longer-term solution
People experiencing homelessness often aren’t able to quickly move into permanent housing because there’s a shortage of affordable options. In Phoenix alone, city staff estimated that an additional 100,000 units of subsidized housing are needed to shelter all the people in need of housing now.
This keeps people experiencing homelessness longer, either in an emergency shelter or on the streets.
“We can’t build affordable housing fast enough,” Glow said.
She’s forming an alliance with other nonprofits and agencies to come up with interim housing solutions that can come online in the next 2-3 years while local cities, counties and the state implement long-term plans on permanent housing and shelter.
Phoenix recently provided CASS with funds to rent 85 rooms in a hotel in north Phoenix for homeless seniors so they had a safe place to isolate during the COVID-19 pandemic.
Glow said she’d like to see more programs like that continue past the pandemic to give people places to stay after they’ve been in an emergency shelter but before a housing unit is available.
This type of housing, typically called “gap housing” or “transitional housing,” used to be fairly common. But in 2016, the U.S. Department of Housing and Urban Development cut funding from those programs to focus more attention on permanent housing, a strategy federal officials said was cheaper and more effective.
Nancy Marion of House of Refuge, one of the few remaining transitional housing programs in metro Phoenix, said her organization lost about 75% of its funding overnight when the change went into effect.
House of Refuge maintains 80 two-bedroom single-family homes in Mesa for families experiencing homelessness. The housing program allows people who recently stayed in shelter or on the streets to gain independence, set financial goals and get ready for reintroduction into traditional housing.
Local donors stepped in to keep House of Refuge running, but other transitional housing programs weren’t as lucky.
Now, some local agencies want to reintroduce transitional housing on a larger scale. The federal government is still not providing significant funding for transitional programs, so local governments or nonprofits will have to find ways to finance it without federal assistance.
Marion said the filling the “gap in the middle,” between emergency shelter and permanent housing, is essential to help most people succeed in the transition out of homelessness.
More compassion: ‘These people are really no different than you’
Ash Uss, who has worked with the homeless population in Phoenix for several years, said that while housing and shelter is an obvious way to save lives, there’s another obvious solution, too.
Uss reviewed the medical examiner’s reports for people who died on the streets for the past two years and was struck by the number of reports that cited passersby seeing people in distress but not calling for help until it was too late.
“How could we have intervened before that (death) happened?” Uss said.
She said she’s working with a task force to try to form a crisis response hotline specifically for people experiencing homelessness so people who see someone on the sidewalk in extreme heat or another dangerous situation can call and get that person help.
Uss said she’s also working to re-educate the community on homelessness to break down stigmas associated with people living on the streets.
“These people are really no different than you,” she said.
Mother’s search ends at a final resting place
The White Tanks Cemetery can’t be seen from Camelback Road, the main road leading to the cemetery.
There’s a tan-colored fence surrounding the vast, mostly empty, cemetery. The public is not allowed to visit without an appointment.
It’s surrounded by farmland, and on a Thursday morning in September, just before 8 a.m., workers on tractors were stirring up dirt that carried into the cemetery.
This is where Maricopa County buries the indigent — people whose families can’t afford to pay for their final disposition or people whose next of kin can’t be located. Often, the people buried here were experiencing homelessness before they died.
Local faith leaders take turns giving the service before county employees bury the remains. It was the Rev. Dan Ponisciak’s turn. Ponisciak is a Catholic priest and the executive director of Andre House, which provides meals, showers and other services for people experiencing homelessness.
Ponisciak stood before a row of 18 black boxes, containing cremated remains. He wore a short-sleeve button down with a priest collar and black jeans, a religious chain hanging from his neck.
He flipped through the pages of a blue book titled “Order of Christian Funerals” and recited the cremation rites for each of the deceased.
“Our brother, Pedro, has gone to his rest in the peace of Christ. May the Lord now welcome him to the table of God’s children in heaven. With faith and hope in eternal life, let us assist him with our prayers.”
When he finished with Pedro’s burial rites, Ponisciak pulled out a small bottle of holy water from his breast pocket and with four flicks of his wrist watched the water droplets fall on and around the box of remains.
Then he stepped six inches to his left and started again.
“Our sister, Louise, has gone to her rest in the peace of Christ. May the Lord now welcome her to the table of God’s children in heaven. With faith and hope in eternal life, let us assist her with our prayers.”
Occasionally, Ponisciak paused as the deafening sound of military jets from nearby Luke Air Force Base filled the cemetery,
When he got to the black box marked “Robert,” he took a deep breath and shook his head slightly. He was 10 in and still had eight to go.
“There’s nobody here but us,” Ponisciak said. It’s not common for family members to attend the indigent services.
Then he continued.
When he got to the last black box, the remains of a man named John, he recited the burial rites one last time and made the sign of the cross.
“We ask this in the name of the Father, the Son and the Holy Spirit,” Ponisciak said.
An employee from Maricopa County thanked Ponisciak for volunteering his time.
“We walk with people through their journey at Andre House. And so in that way it is a privilege to walk with them to the end of their journey,” he said, looking around at the hundreds of bricks affixed to the dirt, each with a name, birth date and age.
This is where the county buried Spence earlier this year without alerting his parents to his death.
Maricopa County spokesperson Fields Moseley said typically law enforcement would provide next of kin contacts to the county, and county officials would pass along that information to the funeral home, which would be responsible for contacting the family. However, no next of kin information was provided to the county for Spence, he said.
Chirstina Vollaro, indigent decedent manager for Legacy Funeral Home, said that when Spence’s remains were sent to the funeral home, the county did not have a Social Security number for Spence. If the funeral home had that information, it would have mailed a notice to his family, she said.
Vollaro and Moseley said the county and the funeral home used search tools like Accurint, Truepeople.com and FamilyTreeNews.com to try to locate Spence’s family. But it appears somewhere along the way, Spence’s birth date was typed incorrectly, which made the process more difficult. The county also published an obituary for Spence trying to find his family but again used the wrong birth date.
“Maricopa County agencies work hard to connect families to their lost loved ones, and they regret not being able to do that in this case,” Moseley said.
Browne is now trying to come up with $8,500 to have her sons body exhumed so he can be cremated. She plans to separate his ashes so that she, her ex-husband and daughter can each have some.
Browne is angry that no county or police official was able to locate her after Spence’s death and that she had to learn about his death 10 months later from a reporter writing a story about homeless deaths.
“You found us, so why couldn’t they?” she asked.
Browne has asked the funeral home and county to lower the price of exhuming his body, since they should not have buried him in the indigent burial ground.
Moseley said the county will not seek reimbursement of the $350 incurred by the county to bury Spence. The rest of the cost will depend on which funeral home Browne selects for disinterment.
Browne faces another challenge as well. Spence married before he died, making his wife his next-of-kin, not his mother. Browne has been trying to find her since she learned of Spence’s death, with no luck.
Regardless, she will find a way to get her son home, she said.
“I’d want him to know that I’m far prouder of him than he realized. That I could see only his good points, how funny and smart and how kind he was,” Browne said.
Coverage of housing insecurity on azcentral.com and in The Arizona Republic is supported by a grant from the Arizona Community Foundation.
Reach Jessica Boehm at email@example.com. Follow her on Twitter @jboehm_NEWS.