"It's horrible," Moe Girton, owner of the Hillcrest restaurants Gossip Grill and Barrel & Board, said about nearby encampments. Sidewalks were stained with feces. Needles could be found by asphalt. A man had recently tried to burn down one of her buildings, she added.

Stefan Chicote, general manager of the nearby restaurant Baja Betty's, said confrontations with unstable passersby had led him to hand out pepper spray to staff. "It feels like nobody's on our side."

Perhaps no recent case better embodies the ways living outside can intersect with crime than the death of a 41-year-old earlier this month in El Cajon. Police said both the victim, a man found with "blunt force trauma," and the alleged killer, a 37-year-old arrested last week, were homeless.

People are dying from fentanyl and hypothermia and heart disease. A decade ago, around 150 homeless individuals died annually, according to the county medical examiner. Last year, the toll was 624, an average of one person every 14 hours.

Even as the U.S. Supreme Court weighs whether to give local officials more leeway to clear encampments, leaders around the region have boosted penalties for living in tents.

Poway passed a camping ban. Chula Vista may be next. San Diego's ordinance corresponded with a drop in downtown's population and more people asking for shelter, yet there are nowhere near enough beds and some proposals to increase capacity face an uncertain future.

One plan to convert an empty warehouse into a 1,000-bed facility has slowed amid apparent concerns over the real estate deal. A separate proposition to host hundreds of people on a lot by the airport could meet a possible legal challenge.

In the meantime, people sleep in trucks, against horse stalls and under tarps.

On Tuesday in Point Loma, Sheila "Chye" Nezzie, 45, sat on a walker across the street from a Goodwill. Two years ago, she and her husband were living in a riverbed. Now they stay in a tent on Midway Drive.

Nezzie said her partner, Juan "Chino" Cota, had advanced stomach cancer but struggled to find regular medical care.

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