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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 UCSF Benioff Homelessness and Housing Initiative, 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 UCSF 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 UCSF Benioff Homelessness and Housing Initiative, said, "We could meaningfully reduce the number of people experiencing homelessness if we focused on this group."

The point-in-time count offers a snapshot into the scope of homelessness in different communities, but most experts agree that the methodology is inaccurate and flawed. In this forum, Sydney Johnson speaks with experts to demystify the counting process and understand this year's numbers. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We learned a lot about what we can do when we treat homelessness like the crisis that it is."

Becoming homeless is an extreme example of the financial squeeze on caregivers. In the early 2000's research revealed people experiencing homelessness in California were getting older. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and her team found that older homeless adults who occasionally stay with a family member were actively caregiving. Dr. Kushel said, "These were folks who had left behind something to go care for mom, and then the bottom falls out."

Among people experiencing homelessness in California, the group rising the fastest by proportion is older adults. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness highlights their experiences during homelessness, and what impacted their return to permanent housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The dramatic rise in homelessness among older adults has severe consequences for the health and safety of those who experience it and for our society at large. Now is the time for investments in real solutions to prevent and end homelessness among this vulnerable population."

The California Statewide Study on People Experiencing Homelessness is the largest representative study on homelessness since the 1990s. The study used a mixed methods approach, collecting data from more than 3,000 surveys and 365 in-depth interviews to uncover who is experiencing homelessness, what individual circumstances have led to them becoming homeless, and how their health issues have affected their life experiences. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative and principal investigator on the report, also delivered the annual John P. Dunlop Lecture at the Harvard Joint Center for Housing Studies (JCHS), presenting the findings and discussing policy recommendations.

Californians experiencing homelessness are aging, presenting unique challenges. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness highlights their experiences during homelessness, and what impacted their return to permanent housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The older you are when you first become homeless, sort of the more stuck in homelessness you get."

The Centre for Homelessness Impact May 2024 Research Network Meeting features presentations from Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, Beth Watts-Cobbe, PhD, a senior research fellow at the Institute for Social Policy, Housing, and Equalities Research at Heriot-Watt University, and Niamh Flannigan, Implementation Lead at the Centre for Homelessness Impact, highlighting landmark pieces on research and policy. Dr. Kushel presented on the California Statewide Study of People Experiencing Homelessness. Dr. Kushel said, "We need to build housing, create housing at every price point, but particularly for those with extremely low income."

As of January 2024, Californian landlords accepting Section 8 vouchers or other housing subsidies may not use credit reports when screening tenant applications. This policy reform will greatly benefit people who have experienced intimate partner violence. The financial instability can cascade into all parts of survivors lives. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, “There are only so many places you can hide when you are vulnerable.”