Background
- Since 2007, Toronto Shelter and Support Services (TSSS) has collected and reported on deaths of individuals staying in municipally administered shelters. When residents or recent residents of Toronto shelters die, shelter providers must notify the City within 24 hours and submit a written report within 30 days.
- Note that shelter operators are not generally advised of cause of death information or presented with a Medical Certificate of Death because this information is not readily shared with anyone other than next of kin.
- In 2017, City Council directed Toronto Public Health (TPH) to expand the scope of data capture and reporting of the deaths of homeless persons that occur beyond TSSS’ reporting criteria. TSSS continues to supplement TPH data collection efforts with quarterly reporting from its DoSR database. For more detailed statistics, see Toronto Public Health’s Deaths of People Experiencing Homelessness.
Key Points
1) While still higher than pre-pandemic levels, total deaths of shelter residents have declined for the second year in a row.
- Since 2007, there have been 766 total shelter resident deaths reported to TSSS, an average of 45 deaths per year.
- 91 deaths occurred in 2023, which is down 17% from 2022.
2) When allowing for the increasing size of the shelter system, proportional rates of death have decreased further in the last two years.
- The shelter system provided nearly twice as many bed nights in 2023 as in 2017, so while deaths in 2023 were 160% larger than 2017 totals, they were 41% higher when allowing for the larger service population.
- Expressed as a proportion of the total size of the shelter population (as measured in bed nights), deaths decreased by 26% per capita from 2022. This is because the shelter system served an average of 9,010 people a night in 2023, as compared to 8,012 people a night in 2022, when the shelter system reported 110 deaths.
3) Opioid overdose remains the most reported suspected cause of death, but more than half of deaths could not be attributed a cause by shelter staff.
- Shelter operators do not have access to actual cause of death information for their clients but do report where possible a suspected cause of death. Opioid overdose remains the leading suspected cause of death but decreased by 19% from 2023 as compared to 2022. This is consistent with data from the Ontario Office of the Chief Coroner that has also indicated a slightly reduced number of opioid overdose deaths in homelessness service settings through the first 9 months of 2023.
- Enhanced harm reduction supports were implemented in December 2020 in response to opioid-related deaths in the shelter system.
Summary of Data
Of the 766 deaths of shelter residents reported to TSSS since 2007:
- The majority of decedents have identified as cis gendered male: 600 or 77.2%
- The average age at death across all genders has been 54 years
- 352 deaths (or 44.7%) occurred within a shelter/respite facility or outdoors but on shelter property whereas 414 deaths (or 55.3%) occurred off-site (e.g., at a healthcare facility or in the community).
Of the 91 deaths of shelter residents reported to TSSS in 2023:
- 78 (86%) were cis male, 12 (13%) were cis female and 1 (1%) was Transgender/Non-binary
- The average age at death was 52.0 years; this continues a downward trend since 2018 in the average age at death. From 2019 to 2023, the average age of death was lower for Homicide and Overdose (43 and 44, respectively) than Organ Failure/Stroke, COVID-19, Â Infection, Cancer, Injury/Accident and Unknown (61, 61, 60, 59, 54 and 51, respectively) related deaths.
- 50 of 91 deaths (or 55%) occurred within shelters. The remaining 41 deaths occurred in other locations (e.g. hospital) and were reported to TSSS as current or recent residents of a shelter.
