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The perception of people experiencing homelessness is often based on anecdote. In the first episode of WPLNs 9 part housing series, In My Place, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Khalil Ekulona to talk about the causes of homelessness, the misconceptions and myths of homelessness, and what cities can solve the problem. As the conversation moved to the misconceptions of people experiencing homelessness, Dr. Kushel said, "I think the single biggest misconception is that homelessness is synonymous with mental health and substance use problems." Dr. Kushel adds "At its heart, homelessness is a problem of housing cost."

In San Diego, people 55 and older make up at least 29% of the people experiencing homelessness. The seniors experiencing homelessness face tough choices with many of them on a fixed income and unable to afford housing costs in the city. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "When talking about homelessness, 50 is the new 75."

The mortality rate for people experiencing homelessness in America has increased in recent years. People are dying at increased rates because of overdoses, but also of things that may have been avoided if the individual had a home or regular access to preventative medical care. Furthermore, the population of people experiencing homelessness are getting older. In California, the number of people 55 and older who sought homelessness services increased 84%  between 2017 and 2021. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "As the homeless population continues to age, you’re just going to see death rates keep going up and up and up."

About two-thirds of those who were kicked off state Medicaid rolls lost it for technical reasons like incorrectly filling out paperwork. In Montana, 120,000 people lost Medicaid as the state re-evaluated everyone's eligibility. Homeless service providers and experts have stated that many unhoused people have lost their Medicaid coverage. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "It doesn’t seem like such a big deal to fill out paperwork," but "Put yourself in the position of an elder who’s experiencing homelessness and has lost their vision, who has no access to [a] computer, no access to [a] car, doesn’t have [a] cell phone."

Deciding to live with intimate partner violence (IPV) instead of choosing a shelter is a complex decision. The UCSF Benioff Homelessness and Housing Initiative recently released a special report on IPV and homelessness. Anita Hargrave, MD, assistant professor at UCSF and co-author on the report, said, "Intimate partner violence can precipitate homelessness for many people, and is particularly dangerous for those that are at the economic margins."

Housing is linked to lower cancer mortality in US veterans, a recent study found. Hannah C. Decker, MD, of the University of California, San Francisco and lead author of the study, spoke about the study, the pervasiveness of veteran homelessness, and how homelessness affects health. Dr. Decker said, "We are really interested is getting a deeper understanding of how the VA gets veterans into housing, especially those that are diagnosed with serious chronic diseases, like cancer."

There is an overrepresentation of Black people in people who experience homelessness in California. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences homelessness highlights the systemic racism. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This didn’t just happen by accident and it didn’t just happen because there were a few bad people. This was organized." Dr. Kushel further adds in regards to reparations, "That feels like a conversation that, if we are being honest, we need to have."

Black Californians make up only 7% of the states population, but make up more than 25% of the state's population of people who experience homelessness. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences homelessness highlights the systemic racism. Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "California is one million units short of affordable and available housing for extremely low-income renters, of which Black Californians are over represented."

Domestic violence – also known as Intimate Partner Violence – is one of the leading causes of homelessness, particularly for victims with limited financial resources. A new study released last month by the University of California San Francisco Benioff Homelessness and Housing Initiative finds that at least 17% of homeless people fled their homes because of partner violence.

Between 2010 ad 2022, the population of veterans experiencing homelessness has dropped by more than 50%. The long term success in reducing the number of people experiencing homelessness among veterans is the funding to cover the costs and coordinated efforts between the local, state, and federal agencies. The Veterans Affair's approach to homelessness offers a model for how to decrease the number of people experiencing homelessness nationwide. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, that the VA has a clear, "organized mechanism" to screen and offer support services for veterans.