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For many, the approach of summer means little more than vacation time.
But for others, Austin’s increasingly hot summers represent something different: a deadly crisis, figures show. Soaring temperatures mean that those experiencing homelessness are suffering escalating numbers of heat-related illnesses and what experts call preventable deaths.
In Travis County, where Austin’s unhoused residents are concentrated, hospitals have seen a marked increase in emergency room visits fueled by heat. According to the 2024 Heat-Related Illness Morbidity & Mortality Report from Austin Public Health, many of these cases are more severe and complicated than in years past.
Heat illnesses can include dehydration, heat exhaustion, heatstroke, kidney distress, and worsening of chronic conditions. A number of heat-related deaths are compounded by substance use, which increases dehydration risks, amplifies physiological stress, and raises the chance of overdose, experts said.
More than 3,000 people are unhoused in Austin. For them, mounting summer heat isn’t a temporary discomfort, it’s a constant threat. As Matt Mollica, CEO of Austin’s Ending Community Homelessness Coalition (ECHO), noted, ‘’I believe every death in the unhoused is in some way linked to the climate.”
Climate change increases peril
Austin’s climate resilience plan acknowledges that vulnerable populations, including people experiencing homelessness, are especially at risk as overall temperatures rise. What’s fueling the danger is more triple-digit days, hotter nights, and longer hot seasons, experts said.
Advocates for unsheltered people said that over the past years, as climate change worldwide has intensified, the window of dangerous heat in Central Texas has begun stretching deeper into spring and fall. The city is recording more frequent and extreme heat waves, and the lack of cooling overnight means the body never gets a break, raising stress on vital organs.
Those who have air conditioning can deal with the problem. But for those who don’t, staying cool is not simply a matter of comfort, it’s a matter of survival.
Cooling centers only help some
To mitigate the heat risk, the city of Austin and Travis County operate cooling centers, public spaces such as libraries, recreation centers, and some community facilities that open during heat waves to allow people access to air conditioning.
In theory, these centers provide a critical lifeline. But in practice, they’re not a panacea. Key barriers include not knowing where the centers are and when they’re available, city and community leaders told Austin Free Press journalism students. Information about which centers are open, when they’re open, and where they’re located is often unclear or hard to find, particularly for people without consistent internet access.
There is also a problem with transportation, advocates for unsheltered people said. Many unhoused people don’t have cars and even with CapMetro sometimes offering free rides to cooling centers, the system is not always navigable or practical for those most in need.
Several centers close early, around 5 p.m., despite the fact that temperatures can remain high into the evening. And some centers restrict the amount of baggage people can bring with them, forcing a choice between health and possessions. Similarly, while service animals are allowed, not all cooling sites accommodate pets, meaning that those who want to stay with their animals can’t come in.
Public health barriers
Many of the unhoused who die or fall severely ill are found in encampments, under bridges, or in open areas, often alone and without access to immediate help, people who work with the unhoused said. Because heat exposure accumulates over days, it can lead to cumulative heat stress, in which the body’s systems slowly collapse rather than fail all at once, according to experts.
Even when unhoused people reach the hospital, systemic barriers limit long-term care and recovery. Identification and insurance challenges can leave many without access to follow-up treatment.
A substantial number of homeless individuals lack government-issued identification, which can block access to primary care clinics, prescription pickup, or specialty treatment. Advocates say that without health coverage, patients rely on emergency departments for care but rarely get the wrap-around services needed to recover fully.
After a heat-related hospitalization, many return to the same unsafe conditions without stable housing, hydration, or regular medical oversight. This fragmented loop can turn a single heat-related hospital visit into a recurring problem.
ECHO published a mortality report covering 2018 to 2023 that underscores how dire the situation is. During that time, 1,010 unhoused people died, with a median age of just 50, two decades younger than their housed counterparts.
According to ECHO’s analysis, deaths rose from about seven per month in 2018 to 22 per month in 2023. Forty-seven percent were in hospitals when they passed. Only 6% of those who died had accessed a shelter bed in the six months before their deaths.
No easy solutions, but some hope
The stakes are growing. Austin’s Homeless Strategy Office received a $70,000 grant through the C40 Heat, Health, and Equity Challenge Fund to improve cooling access and to better understand the health impacts of heat on the homeless. The funding is to support outreach, data collection, and community-driven strategies for protecting people during the hottest parts of the year.
Still, advocates say the city’s heat response remains disjointed. A recent audit from the Office of the City Auditor found that while Austin has mitigation plans for extreme heat, there is no centralized leadership, insufficient funding, and unclear implementation.
These cracks in the system are costing lives. ECHO’s mortality report stated it this way: “All of these deaths were preventable and avoidable with access to quality affordable housing and healthcare that meets the needs of those seeking it.”
Shant’Jeur Pratt is a graduating senior business major at Huston-Tillotson University in Austin. This story was produced in partnership with Austin Free Press’ Enterprise Journalism training project.