Resource Center

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.

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.

In this retrospective observational cross-sectional study of patients in the Trauma Quality Improvement Program (TQIP), researchers looked to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in TQIP. Researchers found that overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals.

Alcohol use disorders (AUDs) are common among those experiencing homelessness. Managed alcohol programs (MAPs) are an evidence-based solution for helping people with AUD experiencing homelessness. Researchers examined and evaluated MAPs in Canada and California. They found that MAPs have successes and stabilization effects.

Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, talks about aging, the structural and individual factors that contribute to homelessness, and much more in the GeriPal podcast with Eric Widera, MD, and Alex Smith, MD, MPH, MS. During the conversation, Dr. Kushel said, "I like to say homelessness is a state and not a trait. It’s not an intrinsic quality of a person. It is an experience that they go through."

In this Grand Rounds at Dartmouth Medical School, Margot Kushel, MD, one of the world’s leading experts on homelessness, discusses the drivers and precipitants of homelessness, the demographics of homelessness, and the health consequences of aging in the homeless population. Dr. Kushel is a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative.

The UC Center Sacramento hosted a "Special Winter Symposium: Dimensions of Chronic Homelessness and the Search for Solutions." In session 4, Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, joined State Senator John Laird and Dr. Toby Ewing to discuss how California is addressing the issue of people who are chronically unsheltered and what barriers remain.

Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, wrote an editorial in JAMA about a recent study on the negative health consequences of involuntary displacements on the lives of people experiencing homelessness. Dr. Kushel writes, "The question is not whether living in unsheltered settings is dangerous, but rather what is the role of forced displacements in addressing the harm caused by them."

This study from BHHI researchers describes five distinct subgroups of the highest users of the health care system in San Francisco with differential comorbidities, health care needs, and social determinants of health, spanning from patients with medical comorbidities solely using medical services to patients grappling with housing insecurity, incarceration, substance use disorder, and mental health comorbidities. Frequent users of the health care system are not a homogenous population as previously thought. This study sheds new light on how to help the most vulnerable patients and inform clinicians and care coordination teams on making sure patients get the care they need the most. 

Patients with prolonged hospitalizations often require alternative levels of care (ALC) and there stays strain hospital capacity and patient flow. This study aimed to descriptively compare prolonged ALC and short ALC. Researchers found that patients with prolonged ALC were more likely to be older and have experienced homelessness. Furthermore, prolonged ALC patients were more likely to be admitted for acute care and had greater psychosocial complexity.

LifeMoves Mountain View is an interim shelter program that provides supportive services to help people who experience homelessness find stable housing in 3 to 4 months. However, data has shown that many of those experiencing homelessness are unable to find stable housing within that timeframe. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "People are not homeless because they need services. People are homeless because there isn't any housing."

Oregon and California lawmakers are reconsidering their approaches to mental health and involuntary confinement. Parallel debates in both states reflect the ongoing homelessness crisis. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "If you try to fix homelessness by tinkering with the health care system, we're not going to get anywhere."

California state lawmakers say they need more tools to help get people experiencing homelessness into treatment, debating the use of involuntary commitments. Homelessness is caused by a lack of affordable housing, not mental illness. “The problem of homelessness is that people don't have housing. If you had all the treatment in the world and you didn't have the housing, we would still have this problem,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

California is trying to tap federal health care funding to cover rent for homeless people and those at risk of losing their housing. Yet, health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable housing shortage. “We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.