BHHI News

Across San Francisco, there are 8,000 unhoused people on a given day and upward of 20,000 over the course of a year. With rising housing costs, some individuals have transitioned to living RVs on Winston Drive. However, new street parking restrictions will force people living in RVs to leave the area. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, said, "People told us they preferred vehicles to shelters, but they would have preferred housing."

California's 'housing first' rule prohibits the use of housing funds on drug-free or sober housing facilities. However, there is growing support to change policies to favor tolerance of drug use in housing for people experiencing homelessness. San Francisco supervisors announced a new plan to prioritize drug-free housing options for people who experience homelessness. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, said, "You want to make sure that any relapse is not punished with homelessness, because to do so may turn something that is in fact a short backward step into a deep fall."

People over age 50 are the fastest-growing segment of people experiencing homelessness and makeup almost half of the total homeless population. These unhoused individuals typically have the health of someone 20 years older in the general population. DeDe Hancock, a CASPEH Lived Expertise Advisory Board member, discusses her own experience with becoming homeless when she was 52 years old, and Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, outlines the health impacts of older adult homelessness. Ms. Hancock said, "I was going from shelter to shelter. Over seven years, I was out on the street for maybe five days - otherwise, I was in a shelter."

Although only 9% of Sacramento's general population is Black, Black residents now comprise 35% of Sacramento's homeless population. A special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences of homelessness highlights the systemic causes that have left so many unhoused. Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "When you consider (leaving) homelessness, you think about the requirements needed to get back into housing — waiting lists, who gets a voucher, who doesn’t get a voucher. It’s hard to get housing or a room. It’s even harder for Black Americans."

The aging of the homeless population is a stark demographic shift. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, found that unhoused people have the health profiles of patients two decades older, with similar rates of incontinence, dementia, and falls. Respite care, a temporary, short-term, 24-hour supervised care for seniors, is rapidly growing for people experiencing homelessness, reflecting the aging of the unhoused population.

On the second day of the CalMatters Ideas Festival panelists discussed homelessness solutions, moderated by Marissa Kendall. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, and Robynne Rose-Haymer, one of the CASPEH Lived Expertise Advisory Board members, were panelists. Ms. Rose-Haymer said, "By rooting people out forcibly, it does nothing to build that trust, and in fact, harms the very services that we are paying billions of dollars to stand up."

A panel at the CalMatters Ideas Festival debates how to reduce homelessness without punishing poverty. Panelists discussed the underlying causes and what California should be focusing on. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, said, "We know how to treat people, you have to start, though, with the housing." 

Homelessness is detrimental to health, and clinicians can play an essential role in mitigating the deleterious effects of homelessness. Margot Kushel, MD,  director of the Benioff Homelessness and Housing Initiative, San Francisco, discusses this and more with JAMA Senior Editor Karen E. Lasser, MD, MPH. Dr. Kushel said, "When you are an individual provider, in a room, you are trying to understand the difficult environmental conditions that your patient has and do things to decrease that part."

A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness found that nearly half of California's homeless population is now 50 and older. These older adults are staying homeless for longer and are in poorer health than their younger peers. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, said, "These are people living on fixed incomes, on disability, on really meager pensions, and they really need housing that they can afford."

Among people experiencing homelessness in California, nearly half of the population is now over the age of 50. By 50, a homeless person’s health more closely resembles that of someone in their 70s, with a higher chance of chronic disease, mobility issues, and cognitive decline, according to a recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, said, "We could meaningfully reduce the number of people experiencing homelessness if we focused on this group."