Advance Care Planning in Permanent Supportive Housing

Empowering Formerly Homeless Older Adults to Engage in Advance Care Planning in Permanent Supportive Housing (ACP-PSH): A Randomized Controlled Trial received a five-year NIA notice of Award on April 1, 2023. This large research award will receive approximately $600,000 in direct costs annually. Advance care planning (ACP) prepares people to make informed medical decisions that are best for them so their wishes can be honored in the case of serious illness or at the end of life. People who belong to marginalized groups are less likely to engage in ACP yet are more likely to have premature mortality. Since April, the Principal Investigators, Drs. Margot Kushel, Margaret Handley, and Rebecca Sudore, along with the team at BHHI and the Department of Geriatrics, has begun the project planning to launch the trial in Permanent Housing Sites (PSH) in San Francisco and Alameda counties. Beginning in January 2024, the team will visit PSH sites and enroll individuals over the age of 50 to participate in the research and attend the PREPARE ACP intervention. Participants will be randomized to receive the intervention either in a group setting or one-on-one with our research staff. The objective is to compare the effectiveness of facilitated group versus one-on-one visits. Participants will complete 4 surveys in a 6-month period. The goal is to recruit 650 participants over a 3-year time span.


The ACP-PSH Community Advisory Board (CAB) consists of participants with lived experience of homelessness who are living in permanent supportive housing, PSH staff members, and PSH organizational leaders, who provide input to all aspects of the project. The CAB participates in the design of the proposal - they inform study protocols, provide feedback on our project materials, guide our fieldwork efforts, and review our interview protocols.