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On this weeks episode of As Prescribed, Alice Wertz spoke with Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF about the aging homeless population. Older people who experience homelessness tend to have health problems more commonly found in people who are in their 70s or 80s. Recent research has shown that about 48% of adults experiencing homelessness were 50 and above. "They really were hanging on every month, scraping by, barely able to make the rent,” said Dr. Kushel. “And sometime after the age of 50, something happened. And what was really interesting about these folks, as they could kind of pinpoint the moment when things fell apart.” she added.

In this op-ed, Dalma Diaz, MA, a health equity fellow at the California Health Care Foundation, highlights the increase in people experiencing homelessness among the Latinxs. Despite the rising rental costs and displacement, more than two thirds of Latinx said they are not worried about experiencing homelessness in California, and yet research has shown that Latinxs are more likely than other ethnic groups to experience first time homelessness. Ms. Diaz writes, "Let us not return to the apathy, silence, or whatever it was before the pandemic that kept us on the sidelines of the homelessness crisis. It’s up to us, now, to do the work in coalition, and make the change for future generations." 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.

Homelessness hasn’t necessarily become worse, but it is more visible—especially in CA cities. This is due to a combination of factors, including rising number of people who experience homelessness and living nearly full time one the street, increased real estate development in some cities, and police action in prohibiting and forcing the relocation of people experiencing homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homelessness has become more obvious without necessarily becoming worse. It's much more in your face than it was before."

In this op-ed, Zena Dhatt, a Qualitative Research Project Manager at the Benioff Homelessness and Housing Initiative, calls for action to decriminalize drug use. She outlines that hyper-policing and escalation of drug war policies will not resolve the increasing rates of overdose or people experiencing homelessness. Ms. Dhatt writes, "Prison and jail cells should not be an alternative to housing or treatment." 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.

Oregon is one of several states betting on housing and outreach programs using Medicaid funds. Officials hope that by keeping people from experiencing medical crises that lead to repeated emergency room visits, Oregon will save enough money to pay for increased housing costs. California is also working to implement a program similar to Oregon's, spending more than $100 million a year on housing from its Medicaid budget. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative said, "I know that if I could get my patients who are experiencing homelessness housing, we could make everything else work better".

The UCSF Benioff Homelessness and Housing Initiative (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. BHHI study staff administered nearly 3,200 questionnaires and conducted 365 in-depth interviews with adults experiencing homelessness in California to better understand the characteristics and experiences of adults experiencing homelessness, precipitants of homelessness, barriers and facilitators to regaining housing, and opportunities to better prevent and end homelessness. Our presenters, Margot Kushel, MD, Kara Ponder, PhD, Tiana Moore, PhD, and Sage Johnson discussed key findings from the study, reviewed evidence-based policy recommendations, and answered questions from attendees.

West Virginia leads the nation in overdose deaths per capita, presenting a paradox to people who believe that drug use is to blame for the increase in people experiencing homelessness in cities. People who lose housing are more likely to increase their drug and alcohol use. Furthermore, experiencing both homelessness and drug addiction lengthens the time it takes to solve each problem. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said, "People conflate these crises. They are related but they are far from one and the same."

In this op-ed, Ryan Assaf, PhD, MPH, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights the common misconception among many Californians that substance use is the primary cause of people losing their housing. He outlines that drug use is correlated with the length of time someone is homeless and the extremity of their living conditions. Dr. Assaf calls for a housing first approach, writing, "Regardless of an individual’s drug use, policymakers and advocates should prioritize getting people experiencing homelessness into safe, secure and stable housing." 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.

In this op-ed, Lourdes Johanna Avelar Portillo, PhD, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, underscores the importance of providing access to water and sanitation services to people who are experiencing homelessness. She explains how the lack of water and other hygiene services can create added barriers among those experiencing homelessness, increasing stigmatization, as well as an increase risk in public health. Dr. Protillo writes, "the need for public access to water, sanitation and hygiene services is not just for people experiencing homelessness — it’s important to everyone." 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.

This paper describes the qualitative component of a large mixed method study, the California Statewide Study of People Experiencing Homelessness. The qualitative study consisted of seven sub-studies across eight counties, each exploring different dimensions of homelessness. BHHI researchers recruited participants from the overall sample, a statewide representative sample of adults experiencing homelessness recruited in eight counties, based on their responses to questions from the survey interviews. The researchers' mereological study design presents an approach for developing complex qualitative policy studies across a range of topic areas.

In this op-ed, Lourdes Johanna Avelar Portillo, PhD, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, underscores the importance of providing access to water and sanitation services to people who are experiencing homelessness. She explains how the lack of water and other hygiene services can create added barriers among those experiencing homelessness, increasing stigmatization, as well as an increase risk in public health. Dr. Protillo writes, "the need for public access to water, sanitation and hygiene services is not just for people experiencing homelessness — it’s important to everyone."  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.

Sleep is essential to health and affected by environmental and clinical factors. There is limited longitudinal research examining sleep quality in homeless older adults. This exploratory study examined the factors associated with poor sleep quality in a cohort of older adults in Oakland, California. Researchers found that participants had higher prevalence of poor sleep and worse Pittsburgh Sleep Quality Index (PSQI) scores than in studies of housed adults 20 years older.

In this op-ed, Tom Murphy, the Senior Director of Communications for the National Alliance to End Homelessness, brings attention to the frontline professionals who respond to homelessness. He highlights the demanding work and economic disparity among the frontline workers who engage with unhoused individuals. "If we truly want to end homelessness, we must honor frontline workers with a living wage" Mr. Murphy 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.

In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, explains how homelessness is not just a housing issue, but a health care issue. She outlined the pertinent health needs of people experiencing homelessness and the barriers of treating illness against a background of homelessness. Dr. Raven writes, "The health care system in general, and emergency departments specifically, cannot solve this problem — we can only respond to its consequences." 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.

In this op-ed, Alma Yates, MSW, the Education Program Manager at the Benioff Homelessness and Housing Initiative, implores world leaders to do more in helping migrants and asylum seekers. She highlights her own story as a former refugee from Bosnia and Herzegovina who relocated to the United States following the Bosnian War. "Thousands of displaced people were living here, mostly elderly, women and children from Prijedor. The conditions were horrific" Ms. Yates writes. "I was able to leave this place to continue my long migration journey, which had its own twists and turns, but, unfortunately, thousands of others had no place to go." 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.

In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, explains how homelessness is not just a housing issue, but a health care issue. She outlined the pertinent health needs of people experiencing homelessness and the barriers of treating illness against a background of homelessness. Dr. Raven writes, "The health care system in general, and emergency departments specifically, cannot solve this problem — we can only respond to its consequences." 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.

Nearly one-third of all Americans experiencing homelessness live in California. Starting in the fall of 2021, Aaron Shrank and Sam Comen conducted interviews and photographed unhoused people living in Los Angeles and Northern California as a companion piece to the University of California San Francisco Benioff Homelessness and Housing Initiative’s California Statewide Study of People Experiencing Homelessness to shed light on those affected. You can read a lightly condensed version of their stories. More of Comen and Shrank’s work is available at the website Unhoused CA.