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In this UC San Diego Department of Medicine Grand Rounds, Margot Kushel, MD, one of the world’s leading experts on homelessness, discusses why the homeless population is aging, the health consequences of aging in the homeless population, and possible interventions and solutions. Dr. Kushel is a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative.

"You cannot have a healthy society with this many people living on the economic and social margins," said UCSF Benioff Homelessness and Housing Initiative director Margot Kushel, MD. "Homelessness is lethal. We’re not going to be able to solve this without solving homelessness." An analysis from 2016 to 2020 shows homeless deaths have increased in cities across the United States, and numerous negative health outcomes are associated with homelessness.

This podcast episode tackles some of the most common myths about homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, is among the guests who discuss why it’s harder to get housed than people think, explain how most people who are homeless are not suffering from mental illness or substance abuse, and highlight how anyone can experience homelessness. The hosts also interview two people with lived homelessness experience.

San Francisco was one of the first major cities to adopt a housing-first policy: give someone a permanent place to live, provide access to robust care and resources, and positive outcomes will follow. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, “Solving the homelessness crisis will take resources and a commitment to house everyone—and then the ability to match services to the need.” While there will always be a need for emergency short-term shelter options, Dr. Kushel said, “a focus on shelter in lieu of housing is the worst of all options” because it “costs society a lot and doesn’t solve homelessness.”

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, spoke about Oakland’s new shallow subsidy program, which will help 200 low-income households pay rent for 18 months by sending money directly to their landlords. The UCSF Benioff Homelessness and Housing Initiative will evaluate the impact the program has on families to determine whether people who received subsidies were more likely to remain housed than those who did not.

This article reports on how state spending on homelessness in California will be allocated to creating more living spaces and how Caltrans plans to address encampments. “Spending state money on harassing people who are struggling under the impacts of local, state, and federal policy failures is counterproductive,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, of clearing encampments.

A new shallow subsidy program in Oakland will cover a portion of rent for extremely low-income households. While giving 200 families monthly subsidies is a “drop in the bucket” compared to the need, it could encourage more programs like it, said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, who will analyze whether the program prevented people from losing their housing. A night at a shelter, with no support services attached, could cost about $100 a night, or $3,000 a month, Dr. Kushel said, versus $700 a month spent in this pilot to keep them housed.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was a guest on KQED Forum discussing the role health care, low wages, and lack of affordable housing play in Oakland’s growing homelessness crisis. Dr. Kushel said, "There is a myth that the homeless population comes from other communities. That simply isn't true. What we see is about 70%-85% of people experiencing homelessness are from that community." She added that shelters are often "large, warehouse-like environments" where risk of COVID-19 transmission can be very high. Although some emergency shelter (preferably non-congregate) is needed, the solution to homelessness is permanent housing.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted in this article about how California moved thousands of people experiencing homelessness into private hotel rooms during the COVID-19 pandemic—in an effort named “Project Roomkey”—which eventually provided temporary shelter to more than 48,000 people in hotel rooms leased by the state. Dr. Kushel said, “What you don’t see are that many, many of those folks who are out there are getting out of their tents and going to jobs.” 

San Francisco is buying hotels to house people experiencing homelessness, but some neighborhoods are resisting supportive housing efforts. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The usual opposition forces who really don’t want to be part of the solution have had time to mobilize and that’s going to be a problem not just in San Francisco, but other cities."