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What Happens When Homeless Folks Die in Seattle

More people living outside means more people dying outside

If you die in Seattle, you will get buried. The King County Medical Examiner’s Office will make sure of it. It might not be speedy, and it might not be glamorous, but it’ll happen one way or another. And people will come — even if you didn’t know them, and they didn’t know you.

For 25 years, the King County Indigent Burial Remains Program has ensured that all individuals who die in the Seattle area receive a proper service, even if they can’t afford it or have no next-of-kin.

The remains of these individuals — some who died in hospitals, others who died outside, and others still who passed in publicly-owned housing or shelters — are kept at the ME’s office for weeks and often years, while County sleuths try to find anyone who can put them to rest. They talk to people in the community and they do online research and they make phone calls.

Still, it’s hard to locate everyone.

“We believe that 18 of them were likely experiencing homelessness, and they all died between 2007 and 2016,” stated medicolegal investigator and indigent remains ceremony coordinator James Sosik in an interview with King County last year. “Things may have been hard at the time of their death, but we believe someone cared about each one of them.”

When no one can be located — or when the family is unable to pay for burial services — King County’s indigent individuals are cremated and, eventually, buried. Sometimes cremains remain in the ME’s office for years before they’re interred.

When they are buried, they’re buried in a group, sometimes as many as 200 at a time, in a small corner of the Mt. Olivet Cemetery in Renton, southeast of Seattle. Though the cremains are laid in the ground together, they’re not combined; the King County Medical Examiner’s office says that they “use 3D mapping” and unique codes “in case family members are found, so we can retrieve the remains for them.”

A trench at the potter’s field on Hart Island, circa 1890 by Jacob Riis; via WikiMedia Commons

Tracking the bodies of the deceased is a relatively new development. Due to the expense and space required, cities have historically been less than respectful of the dead, especially when those dead were also poor.

Between an unregulated free market for cadavers that encouraged body snatching well into the 19th century, multiple sweeping plagues and other public health crises, and the prevalence of dying in the home and without medical supervision, corpses have historically been disposed of in a piecemeal fashion, in open lots and mass graves, only to be dug up decades later.

As land has become more and more valuable in America’s most expensive cities, the final resting place of millions of deceased paupers have been upgraded, kind of. Plenty of Potter’s fields have been paved over and turned into event centers or hotels. The Cross Bones graveyard in London became a memorial to the city’s grittier days.

Though in most of the Western world, someone’s grave won’t become an upscale eatery any more, there’s still a great deal of inconsistency from state to state, or even city to city, with the handling of indigent remains. Some places just don’t have the money — particularly when the cost keeps increasing — while others don’t have the space or labor needed to find the family or figure out the process.

In Massachusettes, there’s a lengthy backlog of unclaimed bodies because the duty of finding next-of-kin falls on an already exhausted police force. In New York, more than 1 million people are buried on Hart Island and the number continues to grow. The burial is a deed often performed by prison inmates.

In Maricopa County, families who can’t pay (and who can? Industry groups estimate that the average burial costs up to $10,000) but are denied the application for assistance have the option to donate their loved one’s body to science.

West Virginia has been hit hard by the opioid crisis, leaving funeral directors and public health officials on the same side of an uphill battle to make a little money go a lot further. Last year, after running out of money for indigent burial services four months before the end of the year, the state legislature weighed cost-cutting options, it but was a hard sell.

Despite a tax system that makes funding public goods difficult and an increasing number of folks who are ending up outside, Washington State always managed to come up with the funds — though not every municipality handle indigent burials in the same way.

In Pierce County, to the south of King County, cremated remains had been kept in the ME’s office on a shelf. When the shelf got too full in 2014, the ashes were buried at sea.

Photo via King County Public Health

But in Seattle, at least since 1993, the deceased have been buried in a real graveyard, with real markers, and a real funeral. They’re all cremated, and they’re all in the grave together, but it gets done.

The lost are commemorated with a plaque and an interfaith ceremony, featuring clergy of numerous religions, prayers in English, Spanish, and Southern Lushootseed, a language of the Duwamish people.

Every name is read aloud.

Last year, the event was fairly well attended, despite the dreary October day. One woman told me that she learned her father had been interned this way five years ago but she couldn’t make it. She came on this day to see what his service was like. There are maybe 45 people, huddled under umbrellas in the squelching mud.

“I can’t believe this many people heard his name that day, you know?”

She goes to find the plaque with his year and touches it. There’s also a bench there, which reads GONE BUT NOT FORGOTTEN, which was dedicated to the many more people who have died without the resources to find eternal peace.

The ceremony and burial used to happen every two years, but since Seattle has seen a spike in homelessness — more people die outside in King County than are victims of homicide now — it’s become an annual event.

Housing prices have doubled since 2013, property taxes have skyrocketed, rents have increased more than 10 percent each year. Which means more people find themselves outside, sometimes more quickly than they’d realize. One medical bill. One broken down car. One pink slip. That’s all it takes.

And if people are living outside, they must also, necessarily, be dying outside.

In 2017, the ME investigated more than 160 deaths of homeless individuals in King County. That is, according to the ME’s office, “more than double the number of deaths from six years ago.”

About a third of those individuals died from drugs and alcohol — in large part due to increases in opioid addiction and methamphetamine use — but more than that, about 37 percent, died of “natural causes.”

Being homeless in and of itself is something of a natural cause; exposure, long-term sleep deprivation, dehydration, and chronic stress age people prematurely. The average life expectancy of a homeless person is at 17.5 years shorter than the general populations.

So people in King County die. They die in free clinics and emergency rooms and hotel rooms and cars and doorways. They die in greenbelts and tents and on cots in shelters. They die in transitional shelter or permanent supportive housing. They die and many of them are not reported missing because they have already been difficult to reach.

Many of the names are not familiar to anyone. As Americans grapple with new and dramatic levels of social isolation and services for seniors are becoming stretched thin by a rapidly aging population, the King County Indigent Burial Remains Program is seeing a lot of folks who are dying without fanfare and without family. They’re simply getting old and there’s nothing and no one left behind to ensure their remains are properly treated.

It’s a dark reality, but one that the King County Medical Examiner’s Office is prepared to handle. They’re fortunate, too, to have community support.

A lot of their names are familiar to the people who have worked with these communities for years. Members of the faith community, those who work in social services, and medical professionals come out and share stories about some of the folks who have passed. Because some of the individuals who are buried have been dead for years, the publication of the list is often a jarring experience.

So that’s what happened to her. So that’s why he stopped coming into the clinic.

Organizations like the Homeless Remembrance Project keep an updated list of fatalities of homeless individuals in the Seattle area. The list serves to bring visibility to the very real dangers of living outside; entries like “blunt force trauma” and “hypothermia” are sharp reminders. Suicide remains a leading cause of death for homeless folks.

The list can also help family members who have become estranged from their unsheltered relatives and ensure that they don’t become another ID number in the morgue.

Some might. And if they do, they’ll be respectfully handled by public officers. They’ll be stored and stewarded while their kin are contacted. And if no one can afford to lay them to rest, King County will.

And if no one they know can come pay their respects, someone else will.

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