Learning from the dead: A posthumous reappraisal of homeless population characteristics

Homeless advocates have long charged that descriptions of homeless populations are biased by an over-representation of persons who use homeless services.  Homeless persons who use homeless services are more accessible to researchers than non-services users, who are often resistant to being engaged or stay in areas that are underserved by services. This study examines homeless population characteristics based upon persons identified as being homeless at their time of death.  Doing so provides an alternative frame by which to assess the demographics, geography, and (non-homeless) services use of homeless persons that is better able to include the “hidden” segment of the homeless population. 

Data for this study comes from the Medical Examiner’s Office of the City of Philadelphia, which investigates and collects data about all decedents identified as homeless. As part of this investigation, a Homeless Death Review Committee reviews all homeless decedent cases and determines the extent of their use of homeless and related services.  This study sorts the homeless decedents into three groups by virtue of their homeless services use and compares each group’s basic demographics (age, race, gender), their places of death (as a proxy for geographic orientation), and their propensity for using health, behavioral health, and criminal justice services. 

Results show that 24% of the 141 persons identified as homeless at their times of death during 2009-11 where what we term “unknown users,” who had no record of homeless services use.  An additional 27% were “occasional users,” and the remaining half were known users of homeless services such as shelter and outreach.  The unknown user group was significantly younger, with higher proportions of persons of white race, and with substantial numbers of deaths occurring in part of Philadelphia that did not contain homeless services. This group was also much less likely to have used other, non-homeless services. 

This study indicates that, based on profiles of persons who died while homeless, that a substantial proportion of homeless individuals may not be counted in conventional homeless enumerations and surveys.  Taking this “hidden” portion of the homeless population into account suggests a homeless population that is more racially diverse, younger, and more geographically scattered, which carries implications for assessing and providing services to the homeless population.