This article was produced for ProPublica’s Local Reporting Network in partnership with Street Roots. Sign up for Dispatches to get stories like this one as soon as they are published.
As the city of Portland, Oregon, clawed its way out of the pandemic, it faced a new set of crises: The city’s homeless population was growing. Tents lined some city blocks. High-powered business associations held press conferences demanding the city remove homeless people and touted self-funded surveys saying that without action, businesses and residents would flee the city.
By late spring 2021, the city committed to a new strategy that then-Mayor Ted Wheeler said would “reprioritize public health and safety among homeless Portlanders,” ultimately allocating $1.3 billion by the end of 2024.
But although the city spent roughly $200,000 per homeless resident throughout that time, deaths of homeless people recorded in the county quadrupled, climbing from 113 in 2019 to more than 450 in 2023, according to the most recent data from the Multnomah County Health Department. The rise in deaths far outpaces the growth in the homeless population, which was recorded at 6,300 by a 2023 county census, a number most agree is an undercount. The county began including newly available state death records in its 2022 report, which added about 60 deaths to the yearly tolls.
Homeless residents of Multnomah County now die at a higher rate than in any major West Coast county with available homeless mortality data: more than twice the rate of those in Los Angeles County and the Washington state county containing Seattle and Tacoma. Almost all the homeless population in Multnomah County lives within Portland city limits.
These deaths came during the same period that Portland began a two-pronged response to public pressure over homelessness. City leaders began moving homeless people out of public view by removing tents at a rate far surpassing those of its West Coast peers. Since 2021, it carried out 19,000 sweeps, and it dismantled over 20 encampments per day in 2024, according to city records.
At the same time, the city reduced money for stable permanent housing while dramatically increasing its investment in temporary shelters. The city spent $19.4 million to house formerly homeless Portlanders in 2019, according to the city budget. By 2024, the city budgeted $4.3 million, which housed 391 people.
These moves have been echoed in Trump administration policy, which has prioritized the forced removal of homeless people from encampments and public spaces. For decades prior, the federal government’s position emphasized stable housing.
Researchers from four universities told Street Roots and ProPublica that sweep-heavy tactics like Portland’s damage safety rather than improve it, placing homeless people at greater risk of harm or death. Current and former staff members at six local service providers, like Rose Haven Executive Director Katie O’Brien, say the city’s approach failed to do what was promised.
O’Brien said more people are in crisis when they arrive at Rose Haven, a daytime shelter serving women and transgender people.
“It is adding to the complexities and the challenges that they are already dealing with, mentally, physically, safety-wise,” said O’Brien.
Katie O’Brien, right, executive director of Rose Haven, has lunch with guest Leslie and her dog, Norma. Leslie is a sixth-generation Oregonian.
(Leah Nash for ProPublica)
Cody Bowman, a spokesperson for the city, called the increase in deaths during the most recent efforts “heartbreaking and deeply concerning.”
He told the news organizations the city takes “a multifaceted approach to saving lives and supporting individuals in crisis.” The steps the city has taken include providing new shelter beds, investing in outreach, sweeping encampments in areas with accidents and floods, and dispatching emergency personnel as part of the city’s life-saving measures, he said. Bowman also said the city trained sweep crews to use medication that can save someone who is overdosing.
Increased Risk From Sweeps
Homeless residents in Multnomah County die, on average, more than 30 years earlier than the average U.S. life expectancy of 78, according to the most recent Multnomah County homeless fatality report.
Some 1,200 homeless people died in Multnomah County from 2019 through 2023, according to the Multnomah County Health Department. Of those, 659 died of drug- and alcohol-related causes, 323 died of natural causes, and 142 died of homicide or suicide — a rate about 18 times higher than among the general population in Portland.
Multnomah County Had a Higher Death Rate of Homeless Residents Than Other West Coast Counties
The Oregon county, which encompasses Portland and surrounding towns, also saw the biggest death rate increase between 2019 and 2023.
Note: Homeless population estimates are based on point-in-time counts. Data does not include natural deaths in hospitals because it was not available in all counties. The San Francisco Department of Public Health did not respond to requests for data.
(Lucas Waldron/ProPublica)
Forcibly moving homeless people can increase overdoses, according to a 2023 peer-reviewed study published in the American Medical Association’s journal JAMA. The authors estimated that among homeless people who inject drugs, those who face repeated sweeps are 10% to 22% more likely to die from an overdose than those who don’t. They were also far less likely to obtain medication for opioid use disorder.
“We know that the more people are swept, the more they lose access to their medications,” said Dr. Josh Barocas, a physician and co-author of the study. “They lose access to their community. And they lose access to hope, and therefore they actually are at increased risk of overdose and death.”
Perhaps no one knows the risks to Portland’s homeless population better than Dr. William Toepper, a volunteer physician working to reduce Portland’s rising homeless mortality for the past seven years. And since the surge in sweeps after 2020, Toepper sees an increasingly scattered population.
“I don’t know why they’re spending this money on destabilizing people and displacing them,” Toepper said of the city of Portland. “I don’t know why anyone thinks that would help. It’s not like they’re being swept to services.”
Toepper leads one of four crews at Portland Street Medicine, a nonprofit he co-founded in 2018, each crew covering a different part of the city. Toepper’s team makes weekly rounds in North Portland in and around Delta Park, where industrial districts and strip malls converge on one of the city’s largest parks. The team goes from tent to tent — along bike paths, sidewalks, waterways and freeway overpasses — treating wounds, infections and post-operative incisions, and helping people monitor and manage chronic health conditions. While they can’t dispense prescription medication, they write prescriptions and help coordinate pharmacy trips.
First image: Dr. William Toepper, co-founder of Portland Street Medicine, shares supplies during a street round in Portland, Oregon. Second image: Patient Duane, who lives in his car, receives treatment from Mary Sorteberg, a nurse and volunteer with Portland Street Medicine.
(Leah Nash for ProPublica)
Toepper said medically vulnerable and disabled people are especially at risk of severe outcomes from sweeps. That was the case with one of Toepper’s patients, Debby Beaver, 57, who died in 2019. Beaver had seizures, high blood pressure and diabetes. She lived in an encampment at the intersection of Southeast 35th Avenue and Yamhill Street, a residential area one block removed from a bustling shopping district, when city contractors dismantled the encampment and took her medications, according to a wrongful death suit filed by her family.
John Mayer, former executive director of a homeless services nonprofit across the street from where Beaver slept, described her as a “very sweet, kind of elderly stateswoman of the place.”
Beaver died a week after the sweep as a result of losing her medication, according to the lawsuit. In court, the private, for-profit company hired to remove homeless people living in the area said it never swept Beaver’s encampment or took her medication. The company maintains its workers did not seize Beaver’s medication, but it settled the lawsuit for $45,000 in July 2024, without admitting any wrongdoing.
“It was a little bit of a sense of, you know, this was bound to happen to somebody, and here it is,” Toepper said of Beaver’s death. “Even with this story and with the publicity it gained, and a pretty decent amount of witnesses to it, as far as I can tell, well, nothing’s changed.”
In an email to Street Roots and ProPublica, the city acknowledged sweeps can be traumatic or harmful but said it works to minimize the risks. Bowman said the city worked in consultation with Oregon Justice Resource Center, a civil rights law firm, to minimize harm.
The firm said it represented homeless plaintiffs in a lawsuit against the city and agreed to a settlement. While the city posts notices saying its contractors will sweep an area in the next three to 10 days, the settlement required the city to give additional notice the day before a sweep and provide more precise sweep locations and descriptions of items it would discard or save.
“Sweeps in and of themselves are traumatic, harmful experiences for those experiencing them and are simply not necessary to solve homelessness,” said Alice Lundell, the firm’s communications director. The group “does not endorse or support the city’s current sweep policies,” she added.
When asked if sweeps led to more deaths, the city said the relationship needed more study.
“We keep detailed records and make our camp removal data publicly available,” Bowman said. “We would welcome research using that data as part of a comprehensive analysis exploring this question.”
Neglecting Housing
The other prong of the city’s approach to homelessness was a pivot toward shelters and away from long-term housing — another move each of the four experts said could contribute to the increasing death rate among homeless people. Case narratives from the county report on homeless deaths often cite a lack of stable housing as a factor.
Matthew Fowle, a University of Pennsylvania researcher who’s studied homeless mortality, said data shows cities with robust shelter systems like New York City and Boston still have high homeless mortality rates, but they are considerably lower than Portland’s.
“All solutions to homeless deaths begin and end with housing — with safe, stable and affordable housing,” Fowle said, adding that supportive services sometimes need to accompany that housing. “It’s an absolutely necessary condition to reduce homeless deaths.”
An encampment in Portland. Experts say stable housing can reduce deaths of homeless people.
(Leah Nash for ProPublica)
In Portland, the decision to focus on short-term shelter came after Wheeler wanted to enforce a public sleeping ban in the city. A federal court had ruled cities could not fine or arrest homeless people for public sleeping if the city could not offer shelter. Although the Supreme Court has since reversed it, at the time, the federal court ruling meant Portland needed thousands of shelter beds to enforce its ban on public sleeping. The city more than quadrupled its annual sweep and shelter spending — from $16.3 million in 2021 to $72.5 million in 2025 — adding up to nearly a quarter of a billion dollars across the five years. It added 826 shelter beds since 2021.
Multnomah County’s local public shelter system now has approximately 3,000 beds and operates near capacity each night, according to the county. Although the county homeless census shows 6,300 homeless people on any given day, as many as 15,245 use homeless services in a month. Some may be temporarily homeless.
The city says emergency shelters are an important tool for connecting homeless people with services like addiction treatment, but critics say shelter restrictions push people back to the streets. Shelters are often first-come, first-served, and may prohibit or limit pets, romantic partners and belongings. Strict in-and-out times may also preclude homeless Portlanders with jobs.
The city has also placed 651 shed-sized single-person pods with heat and electricity in several parts of the city away from the downtown core. The pod cities are managed by contractors, some of which have faced criticism for heavy-handed management, overly strict security protocols and a confusing referral process.
Bowman said the city does not view the effort to address homelessness as a choice between shelter and permanent housing. In an email to Street Roots and ProPublica, he referenced the city’s affordable housing program as evidence of a continued investment in permanent housing. The city spent more than $1 billion since 2019 to increase affordable housing supply to low- and medium-income people via the city’s Inclusionary Housing program.
Much of that housing is out of reach for homeless people. City records show landlords could charge at least $1,229 per month for 95% of the units created under the program in 2024, which local and federal standards deem affordable only to people earning $49,560 or more.
The lack of available permanent housing for homeless Portlanders is cited in the county’s annual report on homeless deaths.
Of the 17 narratives published in the last five reports about individuals who died, 10 include some reference to a lack of consistent access to housing, shelter, services or some combination of the three. Multiple narratives discuss emergency shelter not providing long-term solutions.
Nancy Lee Charlotte Hill, 35, grew up in foster care with physical and learning disabilities. Hill worked hard to get through high school with good grades while working a job, her sister Loraine said. It was around that time Hill began using drugs and alcohol. She applied her penchant for hard work to sobriety, accessing treatment on multiple occasions. But without housing, she had nowhere but the streets when she left treatment and struggled to stay sober, her sister told the county.
She died on a sidewalk July 5, 2023, in downtown Portland near the Tom McCall Waterfront Park after taking a combination of fentanyl and methamphetamine.
“Nancy had a strong desire to live her own path,” her sister said in a narrative. “But she was only in her 30s when she died. She had a whole life left to live.”
John Ellstrom, 54, was another resident who needed stability he never found, said his sister Tamara. Ellstrom first became homeless as a kid after running away from abusive foster homes. He spent years with addiction and tried to get help. He managed a year of sobriety and began renting a place and going to school for engineering. He and Tamara were close, and she did everything she could to support him. But he relapsed and was back on the streets. A driver in an SUV struck and killed Ellstrom while he walked across the Morrison Bridge on Mother’s Day, May 8, 2022.
“He needed a place where he could’ve stayed and gotten help,” Tamara told the county in a narrative.
A memorial to homeless people who have died in Portland hangs on the wall of Portland Street Medicine’s office.
(Leah Nash for ProPublica)
Data sources for graphic: Multnomah County Medical Examiner’s Office, Multnomah County Homeless Services Division, San Diego County Medical Examiner’s Office, San Diego Regional Task Force on Homelessness, Los Angeles County Department of Public Health, Los Angeles Homeless Services Authority, Public Health — Seattle & King County, All Home — Seattle/King County, Santa Clara County Medical Examiner, Santa Clara County Homeless Census and Survey, U.S. Department of Housing and Urban Development.
Originally sourced via trusted media partner. https://www.propublica.org/article/portland-homeless-deaths-multnomah-county
