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In San Diego County, more than one-third of renters over 65 spend the majority of their income on rent. Along with a shallow rental subsidy pilot program, San Diego County is also working on adding more affordable housing units. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The truth of the matter is that if we don't spend these small amounts of money we’re spending it on the back end but for really bad outcomes."

The number of older adults over the age of 50 experiencing homelessness is increasing in the US. Overall, 48% of the population of single homeless adults in California is 50 or older, with most of them living unsheltered. A new special report, Toward Dignity: Understanding Older Adult Homelessness, by the Benioff Homelessness and Housing Initiative at the University of California, San Francisco, took a deep look at the aging homeless population in California. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re talking about older frail adults. That is who is outside."

The face of homelessness in America is growing older. Recent projections report that the population of unhoused older adults will triple between 2017 and 2030. As more generations reach retirement age, there is a need for policymakers to consider how housing and homeless services should be adapted to meet the needs of the aging unhoused population. Marc Dones, policy director at the UCSF Benioff Homelessness and Housing Initiative, said, "The country is in the midst of a housing crisis so severe that people who have worked their whole lives are suddenly becoming homeless."

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 UCSF 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 for changing 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 UCSF 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 UCSF 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 UCSF 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 UCSF 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 UCSF Benioff Homelessness and Housing Initiative, said, "We know how to treat people, you have to start, though, with the housing."