But Multnomah county trend this year could exceed last year's deaths among local homeless people.

COURTESY MULTNOMAH COUNTY - Multnomah County Chair Deborah Kafoury, who has made improved services for homeless people a priority, says the numbers call for more aggressive action.At least 79 homeless residents died in Multnomah County last year — a toll that has seemingly leveled off since local officials declared a crisis three years ago.

The yearly count is contained in a joint report issued by county officials with Street Roots, the Portland newspaper distributed by homeless vendors.

Called Domicile Unknown, the report has been issued annually since 2012, following efforts by the state and local medical examiners' offices to track potential homeless deaths in a consistent manner.

This year's release comes at a time when homeless services is being talked about by multiple candidates' campaigns. But the meaning of the trends the report spells out are unclear.

As in previous years, the report finds that half of the deaths were related to substance use and abuse. Three-quarters of them were men, and slightly more were white.

But it's unclear what the number says about the effect of local governments' increased focus and investments in shelter and housing since 2015.

Dr. Paul Lewis, who serves as the Tri-County Health Officer for Multnomah, Clackamas and Washington counties, says without clear data on the local populaton of people who are homeless it's hard to draw a cause-effect between the trend and the efforts by local officials and homeless service providers.

"Are we holding the line with (the county's shelter system)? I'd like to think it is doing some good" relative to the fatalities, Lewis said, but added, "I can't draw that conclusion scientifically. I'd like to think we are holding the line — which is not good."

At a press conference at the Street Roots office on Tuesday to discuss the report, Chair Deborah Kafoury said that a recent housing cost study suggests that "homelessness in our community would be even higher if our community hadn't doubled our housing assistance and opened more shelters. And we fear if we had not done those things the numbers in this report would be even higher than they are."

Lewis noted the report's intent is to help the public put a face on the 438 people who've died since 2011. The report tells the stories of several people, including Rudy Madrid, a Street Roots vendor who suffered from lung and heart disease, and who stopped working after relapsing into alcoholism. He was evicted from his subsidized apartment and died while in a sleeping bag in the doorway of an auto company in Northwest Portland, wearing a T-shirt that read "Don't bother me. I'm busy."

The report was initiated at the suggestion of Israel Bayer, the now-former publisher of Street Roots who'd seen a similar report in Seattle.

Unlike in Seattle, county officials have done it every year, extracting data from the medical examiners' database, then doing follow-up research to narrow the number down to what Lewis calls "definite" or verified deaths among the local homeless population.

Kafoury, a longtime advocate for the homeless, wrote in the report's introduction that the findings underline the need for a more ambitious statewide strategy. "How many of our most vulnerable neighbors have to end up on our streets before we all can agree that this is unacceptable?"

Street Roots Executive Director Kaia Sand echoed that message, saying, "Many of these deaths would have been preventable with housing, and additional support for their addictions and illnesses."

For years, the count tracked in successive editions of the report had trended up until 2015, when the number of verified county homeless deaths peaked at 88. The following year it declined to 80.

The latest toll of 79 verified deaths was increased by an unusual cold snap that led to five hypothermia deaths in January 2017, according to the report.

That verified figure of local homeless people who died is less than the total number of potential homeless deaths in 2017, which was 88, according to the medical examiners. But follow-up research determined some of those either could not be verified as homeless, were not homeless, or were homeless but lived outside the county.

As for more recent numbers, this year, through Oct. 8, the total number of possible homeless deaths in Multnomah had already hit 79, according to Lewis — on pace to exceed last year's rate.

But of those, only 49 can be considered people who were verified to be local and homeless, while 11 were either not homeless or were homeless people visiting from elsewhere, he said. Of the remaining 19 uncertain deaths, some may be considered homeless after further investigation.

The actual number of homeless deaths in the county is almost certainly larger than the official tally, Lewis freely admits. He says the standard is intended to be conservative, and means that homeless people who died after recently moving here may not be counted. And he conceded the final decision on some of the deaths may be a little squishy.

"This is not a precise thing," he said.

The conservative approach to counting was because "we were worried that people would think we were hysterical and making stuff up," he said. "We want to be as objective as possible. We don't want to be accused of inflating the number."

He said the bottom line is the deaths reflect a lack of care and shelter.

"There are people in tents with complicated medical conditions for which they have to take multiple medicines, some of which have to be injected ... Something that would be complicated to do in a hospital they are doing in a van or a tent."

Republican gubernatorial candidate Knute Buehler and city council candidate Loretta Smith have promoted the idea of opening the never-opened, recently sold Wapato jail for use as a homeless services facility.

Smith's opponent, Jo Ann Hardesty, has called the idea misguided and Kafoury has said it is unsound for a variety of reasons, including the building's distance from services and the expense of operating it.

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