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SAN FRANCISCO – The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released the largest representative study of homelessness in the United States since the mid-1990s, providing a comprehensive look at the causes and consequences of homelessness in California and recommending policy changes to shape programs in response.

Homeless people in California are already a vulnerable group, often struggling with poor health, trauma and deep poverty before they lose their housing, according to a new study on adult homelessness. The study attempts to capture a comprehensive picture of how people become homeless in California, and what impeded their efforts at finding permanent housing. Researchers at the UCSF Benioff Homelessness and Housing Initiative hope that the study will strengthen public support for policies that focus on offering housing and emergency rental assistance—rather than policies emphasizing punishment or stigma. “People are homeless because their rent is too high. And their options are too few. And they have no cushion,” said Margot Kushel, MD, UCSF's BHHI director and lead investigator. “And it really makes you wonder how different things would look if we could solve that underlying problem.”

California’s homeless population is predominantly made up of people who lived in the state before losing their housing, with nearly half older than 50 and a disproportionate number who are Black and indigenous, according to a new statewide study. “We have got to bring housing costs down, and we’ve got to bring incomes up,” said Margot Kushel, MD, the study’s principal investigator and director of UCSF’s Benioff Homelessness and Housing Initiative. “We need to solve the fundamental problem—the rent is just too high.”

Conducted by the UCSF Benioff Homelessness and Housing Initiative, the California Statewide Study of People Experiencing Homelessness (CASPEH) is the largest representative study of homelessness in the United States since the mid-1990s. The study provides a comprehensive look at the causes and consequences of homelessness in California and recommends policy changes to shape programs in response.

The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) has released the largest representative study of homelessness in the United States since the mid-1990s, providing a comprehensive look at the causes and consequences of homelessness in California and recommending policy changes to shape programs in response. The California Statewide Study of People Experiencing Homelessness (CASPEH) used surveys and in-depth interviews to develop a clear portrait of homelessness in California, where 30% of the nation’s homeless population and half of the unsheltered population live.

The United States has an aging population, and sufficient end-of-life care is a growing problem. For people adults who are unhoused, long-term medical care is often inaccessible. There are a few facilities across the country that provide end-of-life hospice care to people experiencing homelessness, but there is not much known about mortality figures among the unhoused. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "The truth of the matter is most of the country is entirely unprepared for this."

In this episode of the Prioritizing Equity series, Dr. Emily Cleveland Manchanda speaks with a panel about health care planning and caring for patients experiencing houselessness. The panel included, Dez Martinez, Denise De Las Nueces, MD, Margot Kushel, MD, Stephen Brown, MSW, and Yinan Lan, MD. Dr. Kushel, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "If you look at the states with the highest percentage of their population experiencing houselessness, those are the states with the lowest level of housing. So, we need to raise our voices and say every place we can that the solution to homelessness is housing."

This news piece describes the complex economics surrounding homelessness. Margot Kushel, MD, director of UCSF's BHHI, emphasizes “Homelessness is a symptom of our country's failure to prioritize housing as a human right.” Highlighting the societal costs of homelessness, it underscores the urgency for comprehensive policy interventions and a paradigm shift towards viewing housing as a fundamental human need rather than a commodity.

In many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. This study examined WaSH access among unhoused communities in Los Angeles, California. Researches found that WaSH services for unhoused communities in LA is most difficult at night, however community differences exist.

In this podcast episode of Marketplace, host Kai Ryssdal spoke with Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative about the complicated role mental health plays in the homelessness crisis. Dr. Kushel said, "Homelessness is devastating to one's mental health. The constant violence that people are exposed to...the lack of sleep, the stress and uncertainty, the humiliation - all of these worsen people's mental health."

Nearly a quarter of a million people 55 years or older are estimated to be homeless in the US. Communities are trying to come up with a novel solution. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "It's just a catastrophe. This is the fastest-growing group of people whoa re homeless."

People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities. Researchers conducted a qualitative study in Vancouver, Canada's downtown eastside, interviewing PWUD who were recently evicted fron the downtown eastside. Narratives from the interviewees provided context on how the demands of the institutional circuit deepened vulnerablitities and prolonged experiences in homelessness. Researchers suggested that interventions that address survival needs and preserve agency will be necessary to mitigate risks within the institutional circuit.

In this podcast episode of In Clear Terms with AARP California, host Dr. Thyonne Gordon spoke with Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative. Dr. Gordon and Dr. Kushel talk about the state of older adult homelessness in California, and the complex interactions between health and homelessness, and potential solutions to prevent and address the issue. Dr Kushel said, "The reason so many people are homeless in California, is we do not have the housing. If you ask the question though, 'Why is this person homeless', then you can see how things like illness, including mental health or substance use, can leave you vulnerable."

People who inject drugs (PWID) experience housing instability and other structural barriers, making it hard for PWID to complete direct-acting antiviral (DAA) treatment of Hepatitis C. Researchers found that simple, low-cost medical storage containers, can be incorporated as a key component of a medication management plan. It is important to create a non-judgemental approach to providing HCV care.

The pandemic has had and continues to have a profound impact on youth experiencing homelessness  in the Bay Area. Youth and Allies Against Homelessness (YAAH) employed a web-based survey of such youth in San Francisco and Alameda counties to document the impact of the pandemic on their trajectory to adulthood during the summer of 2021.

Margot Kushel, MD, director of the UCSF Benioff Housing and Homelessness Initiative, said far too many reactions to visible homelessness, as well as conversations addressing potential solutions, are “based on people’s fears as opposed to action.” Dr. Kushel called violence against unhoused people a “hidden epidemic” in a blog post last year, noting that homeless people are disproportionately likely to be victims of violence. Unhoused offenders are comparably rare, she said, yet often draw outsized attention and media coverage as opposed to unhoused victims.

Little is known how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. Researchers examined the perceptions and use of telehealth, sampling from a larger longitudinal study on homeless-experienced adults in Oakland, CA. They found that the participants experienced challenges accessing the necessary technologies for telehealth.

In this Medical Grand Rounds at the University of Washington, Margot Kushel, MD, a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative, discusses the drivers and precipitants of homelessness, the demographics of homelessness in the United States, the health consequences of aging in the homeless population, and interventions and solutions.