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Programs in San Francisco that offer people living on the streets respite, shelter, and treatment often fall dismally short of the need. “There just isn’t enough of it,” Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, says. “Without the housing, it all falls apart.”

California’s homeless population has increased in recent years, and so has public investment in addressing homelessness, making understanding the size and needs of the state’s homeless population more important than ever. Discharge data from emergency departments (EDs) can help. PPIC researcher Shannon McConville and UCSF professor Hemal Kanzaria, MD outlined key findings from a new report and discussed the implications for policymakers.

The latest point-in-time count reveals the number of Californians without a stable place to call home increased by 22,500 over the past three years. Homelessness experts attribute the rise to precipitous drops in earnings during the pandemic among Californians already teetering on the edge. They also point to a worsening housing affordability crisis decades in the making. “We have to solve this rotting core in the center of California—we are a million units short of housing for extremely low-income workers,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

A new study from the nonpartisan California Policy Lab and the UCSF Benioff Homelessness and Housing Initiative shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said Maria Raven, MD, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs. The authors advocate for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care.

Hospital emergency departments (ED) are on the frontlines of serving people experiencing homelessness, and this report investigated what ED data can reveal about homelessness in California. Hospitals operated by counties and the University of California reported higher shares of ED visits by people experiencing homelessness. Linking discharge data with homeless services programs can offer insights into how people engage with programs and help provide better resources to evaluate the programs and investments aimed at improving the lives of Californians experiencing homelessness.

In a long-term study of older people experiencing homelessness in Oakland, 26% of the participants died within a few years of being enrolled, UCSF BHHI researchers found. The study, funded by the National Institute on Aging, recruited people who were 50 and older and homeless, and followed them for a median of 4.5 years. Researchers examined how factors like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected participants' risk of dying. They found that people who first became homeless at age 50 or later were about 60% more likely to die than those who had become homeless earlier in life, and those who remained homeless were about 80% more likely to die than those who were able to return to housing.

A UCSF BHHI study that followed older homeless adults in Oakland for nearly a decade found that becoming homeless after the age of 50 ratchets up a person’s likelihood of dying early, underscoring the unmistakable role that housing has in extending life. Researchers determined that people in the study who remained unhoused—compared to those who regained their housing—were 80% more likely to die during the follow-up time period from mid-2013 to the end of 2021.

This news article describes ongoing efforts to vaccinate people experiencing homelessness in San Francisco against COVID. Margot Kushel, MD, is quoted regarding the earliest vaccination efforts, which BHHI helped strategize and implement on the ground with local organizations. She said it wasn’t so much fear about the vaccines that made it hard for low-income and unhoused people to get shots. “So much of it was really about access,” said Dr. Kushel. “Setting up big tents to come get vaccinated was good for a lot of people, but for others we really needed to go to where they were.”

In the first year of the pandemic, San Francisco and other communities in California offered private hotel rooms, three meals a day and on-site medical services to homeless people who were at risk of getting severe COVID-19. The aim was to stop the spread of the virus among a highly vulnerable group, but the policy had another important effect, according to new research by UC San Francisco, UC Berkeley, and the San Francisco Department of Public Health. It dramatically lowered the use of acute medical care by the hotel occupants who had used this type of care the most in the past.

This radio news story reports how mayoral candidates in LA propose addressing homelessness in Los Angeles. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discusses how solving homelessness requires a big systemic fix. "The underlying drivers of homelessness are the lack of deeply affordable housing, income inequality, and structural racism. It’s going to be hard to solve this problem without effort from the federal government."