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Following is a statement by Dr. Margot Kushel, MD, Director of the Benioff Homelessness and Housing Initiative (BHHI) at the University of California, San Francisco on the 2023 Annual Homeless Assessment Report, released today by the U.S. Department of Housing and Urban Development.

The perception of people experiencing homelessness is often based on anecdote. On this episode of UCLA Housing Voice podcast, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Shane Phillips to talk about the California Statewide Study of People Experiencing Homelessness, and what it says about who experiences homelessness, why they become homeless, their experiences while living without housing, and barriers to re-entering stable housing. As the conversation moved to mental health, substance use disorder, and people experiencing homelessness, Dr. Kushel said, "People in those in depth interviews, talk to us really clearly, that while they might have been using these drugs before they became homeless, they're using them while homeless was a coping strategy."

Half of people experiencing homelessness are older than 50, and almost half of older homeless adults became homeless for the first time after they turned 50. This webinar is about the causes and consequences of homelessness in late life. Margot Kushel, MD, and other BHHI presenters will discuss findings from the Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME) project—a longitudinal cohort study following older adults experiencing homelessness in Oakland, CA, and the California Statewide Study of People Experiencing Homelessness (CASPEH)—the largest representative study of homelessness in the United States since the mid-1990s.

In this op-ed, Shannon Smith-Bernardin, PhD, MSN, RN, assistant professor of nursing, highlights sobering centers as an alternative to bringing an intoxicated individual to the emergency department or a jail. She emphasizes that sobering centers provide a safe, monitored environment for people to sober up, and various models have developed to serve the specific need of the communities and populations they serve. "The path to recovery often requires a comprehensive, individualized approach. A central function of sobering care is to take the opportunity to engage, motivate, and link individuals to community resources that may provide ongoing stabilization and recovery." Dr. Smith-Bernardin writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

There is public skepticism when politicians promise to solve a crisis, and then little progress gets made. Los Angeles Mayor Karen Bass's policies have given new hope, but an increase in violence against people experiencing homelessness has pushed more into despair. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I do really worry that it’s become normalized in public discourse to speak about people experiencing homelessness as, like, a problem for those who are not homeless — as opposed to fundamentally a massive societal failure that’s left usually older, vulnerable people terrified and totally unprotected."

Cancer is the leading cause of mortality for people experiencing homelessness (PEH). However, not much is known about cancer-related surgical outcomes among PEH. This retrospective cohort study aimed to characterize access to care among PEH, evaluate postoperative outcomes, and assess costs associated with surgery for malignancy among PEH. Researchers found that PEH were less likely to undergo surgery for malignancy at cancer centers than hose who are housed. People experiencing homelessness also had a higher risk of requiring unplanned surgery.

Mobile crisis services for people experiencing distress related to mental health or substance use are expanding in the US. In this mixed method study protocol, researchers plan to conduct an interrupted time series analysis to quantitatively examine the impacts of the Street Crisis Response Team (SCRT) on people experiencing homelessness who utilize the services in San Francisco. Researchers also plan to analyze racial and ethnic disparities to understand the impact on health equity.

In this op-ed, Maya Vijayaraghavan, MD, MAS, director of the UCSF Smoking Cessation Leadership Center, highlights the need for widespread access to tobacco treatment among people experiencing homelessness and the structural issues underpinning tobacco use. She emphasizes that in the homelessness advocacy and provider community should not normalize tobacco use among people experiencing homelessness and there is increased awareness and trained staff in shelters to provide tobacco treatment. "Providing tobacco treatment will substantially reduce harm, save lives, and improve financial stability by supporting quitting." Dr. Vijayaraghavan writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Violence against people experiencing homelessness has increased. In Los Angeles, three people experiencing homelessness were killed. The killings are a stark reminder that those experiencing homelessness are profoundly vulnerable. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The public is often very frightened of people who experience homelessness. But what they don’t realize is that people experiencing homelessness are frightened all the time."

Unhoused patients have worse outcomes and higher health care utilization compared to their housed counterparts. Previous research has primarily focused on physical and behavioral health. This retrospective cohort study investigated the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes. Researchers found that unhoused patients commonly underwent emergent operations and had more complex hospitalizations.

A record number of seniors are burdened by high housing costs. A new report from University's Joint Center for Housing Studies sounds the alarm as the US population ages rapidly. The number of seniors who will qualify for federal housing subsidies will continue to grow. The report also notes that more people over the age of 50 are losing housing for the first time. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Increasingly, the story of homelessness among adults is going to be older adults living in poverty, who are spending what should be their retirement years in the streets."

Veteran homelessness has dropped about 55% in the United States, while it has remained relatively stagnant amongst the general population. The US government has reached a consensus and has offered a wide range of programs to limit homelessness or factors that put people at risk for experiencing homelessness. The VA’s Supportive Services for Veteran Families (SSVF), the Department of Housing and Urban Development’s (HUD) Veterans Affairs Supportive Housing (VASH) program are the foundation to the efforts. Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, said "I think it gives us a blueprint of exactly what we need to do."

People experiencing homelessness are at an increased danger of dying. A recent study by the National Bureau of Economic Research showed a 40-year-old person experiencing homelessness has a similar risk of death as a 60-year-old person with housing. Previous studies have also found that people who experience homelessness have a greater mortality risk. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re letting people die because we’re not fixing the underlying crisis."

In this op-ed, Cheyenne Garcia, senior research analyst at the Benioff Homelessness and Housing Initiative, advocates for policymakers, elected officials, funders, and activists to update the definition of homelessness to include those temporarily staying with family and friends. She emphasizes that the current practice of classifying such people as at risk of, rather than as experiencing, homelessness, denies them access to necessary resources and the opportunity to exit homelessness. "It is vital to dedicate more resources to those who are staying in precarious housing situations that can leave them homeless on the streets or in shelters at any time." Ms. Garcia writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

There are over 1 million emergency department visits for non-life-threatening alcohol intoxication each year, many of which are people experiencing homelessness. In this op-ed, Shannon Smith-Bernardin, PhD, MSN, RN, assistant professor of nursing, answers questions about sobering centers, the utilization of sobering centers, and the health impact of sobering centers. Dr. Smith-Bernardin writes, "Sobering centers provide an opportunity for patients to build a consistent relationship with a health care professional who is specifically trained in addiction and trauma-informed care."

The UCSF BHHI recently released a report on the largest representative study of homelessness in the United States since the mid-1990s—the California Statewide Study of People Experiencing Homelessness (CASPEH). The CASPEH was guided by a Lived Expertise Advisory Board—a group of advisors from across the state of California who represent a range of lived and living experiences of homelessness—from rural and urban, living sheltered and unsheltered, young and old, in families and single. This webinar is about creating authentic and meaningful collaborations between researchers and people with lived experiences. Panelists discussed how this partnership between BHHI and the CASPEH LEAB brought equity, collaboration and shared power to each phase of the CASPEH. They also talked about what they did together and shared tips for forming a board to advise on research projects and programs.

In this op-ed, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, explains how neighborhood design and homeownership are entrenched in Jim Crow-era segregation practices. She outlines how the discriminatory, race-based residential segregation, has contributed to Black households being disproportionately vulnerable to displacement. Dr. Ponder writes, "Structural, institutional and interpersonal racism in our housing, criminal justice and education systems mean that Black Americans disproportionately struggle to find consistent housing, are vulnerable to displacement into homelessness and face more barriers when trying to get rehoused." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.