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A growing number of people with lived experience of homelessness are finding opportunities in California to influence academic projects. More entities are beginning to create entire boards or councils of people who know what it is like to lose their housing. With regards to including a lived expertise advisory board in UCSF BHHI's California Statewide Study of People Experiencing Homelessness, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "The researchers had missed an entire world of economic insecurity, and the survey was much richer because the board members could see things the researchers could not."

California accounts for about a third of the nation’s homeless population and among this population, seniors are the fastest growing group. Research shows that living on the streets prematurely ages and sickens people. “When talking about homelessness, 50 is the new 75,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Whether it be measures of cognitive decline, mobility, problems with function falling, all of the things that we usually think of happening to people in late life just happen to people 20 or 30 years earlier,” said Dr. Kushel. “And tragically, people also die.”

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."

In the state of California, the three major utility companies, have nearly doubled electricity rates over the last decade. With growing increase in energy demands, the rising utility costs are pushing families already at the margins to the brink of homelessness. Many people are forced to making an impossible choice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I think recognizing energy insecurity as a contributor to this crisis, this is the next frontier that we need to really worry about."

An increase in the number of deadly attacks on people experiencing homelessness has coincided with a spike in people experiencing homelessness in the US. What concerns many is that the attacks occur regularly and without notice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This violence is happening every day, just outside of our vision."

The perception of people experiencing homelessness is often based on anecdote. On this episode of UCLA Housing Voice podcast, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Shane Phillips to talk about the California Statewide Study of People Experiencing Homelessness, and what it says about who experiences homelessness, why they become homeless, their experiences while living without housing, and barriers to re-entering stable housing. As the conversation moved to mental health, substance use disorder, and people experiencing homelessness, Dr. Kushel said, "People in those in depth interviews, talk to us really clearly, that while they might have been using these drugs before they became homeless, they're using them while homeless was a coping strategy."

There is public skepticism when politicians promise to solve a crisis, and then little progress gets made. Los Angeles Mayor Karen Bass's policies have given new hope, but an increase in violence against people experiencing homelessness has pushed more into despair. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I do really worry that it’s become normalized in public discourse to speak about people experiencing homelessness as, like, a problem for those who are not homeless — as opposed to fundamentally a massive societal failure that’s left usually older, vulnerable people terrified and totally unprotected."

Violence against people experiencing homelessness has increased. In Los Angeles, three people experiencing homelessness were killed. The killings are a stark reminder that those experiencing homelessness are profoundly vulnerable. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The public is often very frightened of people who experience homelessness. But what they don’t realize is that people experiencing homelessness are frightened all the time."

A record number of seniors are burdened by high housing costs. A new report from University's Joint Center for Housing Studies sounds the alarm as the US population ages rapidly. The number of seniors who will qualify for federal housing subsidies will continue to grow. The report also notes that more people over the age of 50 are losing housing for the first time. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Increasingly, the story of homelessness among adults is going to be older adults living in poverty, who are spending what should be their retirement years in the streets."