1,010 unhoused people died in Austin/Travis County between 2018-2023, comprehensive new report finds; the average age of death was 50 years old — 20 years younger than their housed neighbors

AUSTIN, Texas (Jan. 8, 2025) – The Ending Community Homelessness Coalition (ECHO) published Austin/Travis County’s first Unhoused Mortality Report this week, a comprehensive analysis of who’s dying on our streets, the leading causes of death, and what homelessness response and health systems can do about it.

Read the full report here.

The report, Bridging for Better Outcomes, collects and analyzes six years’ worth of quantitative data from our local Homeless Management Information System (HMIS), hospital records, medical examiner death data, and the Centers for Disease Control and Prevention (CDCWonder) for comparisons to Travis County. These data, paired with a substantial amount of qualitative data collected through listening sessions with people experiencing homelessness and service providers, make this the most comprehensive report on homelessness mortality in the country.

“This report is more than just numbers and stories – it’s a roadmap for change,” says Danica Fraher, ECHO’s Healthcare Systems Manager and lead author of the report. “By bringing mortality data into our planning, we can build a proactive system that responds to our community’s needs and generates creative cross-sector solutions that protect and uplift our neighbors before it’s too late.”

In total, the report finds, 1,010 people experiencing homelessness died between 2018-2023. Less than half (47%) were in hospitals when they died; the majority of people passed in tents, camps, or parks, in motels, outside businesses, on sidewalks or roads, and other areas of everyday life for someone without a stable home.

Importantly, the report also notes the effect permanent housing has on a person’s life expectancy. While the daily physical and mental traumas of living outside take a lasting toll, median life expectancy is 9.5 years longer for people who moved into permanent housing compared to people who remained unhoused.

“This report is a representation of decades of failed policy and disinvestment in housing for all,” says ECHO Executive Director Matthew Mollica. “All of these deaths were preventable and avoidable with access to quality affordable housing and healthcare that meets the needs of those seeking it. It is for these more than 1,000 people and many more suffering on our streets that we spur action and demand change.”

More key findings from the report:

• Between 2018 and 2023, deaths have risen sharply, from seven per month in 2018 to 22 per month in 2023. The 1,010 people who died in this timeframe had an average age of death of 50 years old. It’s slightly higher for people who died in hospitals (55), and lower for people who died in other places around the community (48).
• While men make up the majority of deaths in our community (82.5%), women die younger, at around 49 years old. The youngest average age of death is among unhoused women who died outside of hospitals, at 46 years old.
• Overdose, transportation accidents (cars and trains), and cardiovascular disease top the list of causes. Overdose deaths have risen sharply, mirroring national trends among the general population. Chronic homelessness is linked to multiple health complications, including sepsis and respiratory system diseases.
• Methamphetamine is the primary driver of overdose deaths, implicated in at least 223 of 304 known overdoses during this period. Fentanyl plays a significant role, often in combination with methamphetamine: 119 overdose deaths involved fentanyl, with 109 cases involving both fentanyl and meth. Only 10 deaths were attributed to fentanyl alone, suggesting unintentional exposure.
• Nearly half of people who died outside of hospitals (47%, 331 individuals) had no record of ever interacting with the Homelessness Response System.
• The cost to care for 364 people in the year prior to their deaths totaled $11.1 million in Emergency Medical Services (EMS), ER visits, and inpatient care. This could have funded 81% of Permanent Supportive Housing (PSH) services and rent for the same population.
• People who die experiencing homelessness sought shelter more often than the general unhoused population. However, just 6% of people who died between 2018 and 2023 were able to access a shelter bed in the six months prior to their deaths.

In addition to the quantitative data, the report includes experiences, memories, and insights shared by people who are or have been unhoused and service providers committed to helping save lives. Their stories are interwoven through the report alongside expressions of loss, grief, and hope in the form of painted handprints and remembrances from participants in listening sessions. These stories inform many of the recommendations. The result is a report that tells the raw life-and-death story of homelessness, highlights the challenges of navigating siloed systems, and shares actionable, life-saving solutions for our community. ECHO is committed to working with City, County, healthcare, and nonprofit partners to implement these immediate and long-term solutions.

In addition to the detailed long-term recommendations, here is a list of five actions our community can take right now:

• Scale permanent housing with the momentum required to support our community. We must also diversify HRS housing opportunities to serve the needs of all persons experiencing homelessness.
• Open the door to recovery by expanding support for substance use respite and low barrier treatment in our community.
• Prioritize folks with complex needs by developing a prioritization system that creates a pathway to housing for people at risk of early death.
• Develop a medical triage team integrated with Coordinated Entry that can facilitate placement into respite, long term care, substance treatment, and hospice opportunities within our community.
• Make low-barrier shelter transparent and accessible with real-time shelter bed availability, a clear process for access, and appropriate staffing and services to meet the needs of anyone seeking shelter.