Resource Center

The latest point-in-time count reveals the number of Californians without a stable place to call home increased by 22,500 over the past three years. Homelessness experts attribute the rise to precipitous drops in earnings during the pandemic among Californians already teetering on the edge. They also point to a worsening housing affordability crisis decades in the making. “We have to solve this rotting core in the center of California—we are a million units short of housing for extremely low-income workers,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

In this long-term study of 450 homeless adults age 50 and older, BHHI researchers examined how factors like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected participants' risk of dying. They found that 26% of the participants died within a few years of being enrolled, and people who first became homeless at age 50 or older were about 60% more likely to die than those who had become homeless earlier in life, and those who remained homeless were about 80% more likely to die than those who were able to return to housing. These findings illustrate an urgent need for policy approaches to prevent and end homelessness among older adults in the United States and suggest that addressing older adults’ barriers to health care and high rates of institutionalization may prevent premature mortality.

People with multiple, complex health and housing needs frequently receive fragmented care because the providing systems operate independently. The California Policy Lab at UC Berkeley and the UCSF Benioff Homelessness and Housing Initiative worked with partners in San Francisco’s public health and criminal legal systems to link together ten years of data from the physical health, behavioral health, housing, and criminal legal sectors.

A new study from the nonpartisan California Policy Lab and the UCSF Benioff Homelessness and Housing Initiative shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said Maria Raven, MD, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs. The authors advocate for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care.

To address intergenerational homelessness and housing insecurity, protecting low-income families and mitigating the risk of their children experiencing homelessness is paramount.

Hospital emergency departments (ED) are on the frontlines of serving people experiencing homelessness, and this report investigated what ED data can reveal about homelessness in California. Hospitals operated by counties and the University of California reported higher shares of ED visits by people experiencing homelessness. Linking discharge data with homeless services programs can offer insights into how people engage with programs and help provide better resources to evaluate the programs and investments aimed at improving the lives of Californians experiencing homelessness.

Patients who experience homelessness face a high burden on chronic disease, including colorectal cancer. There are many barriers in access to colonoscopy procedures. Researchers provide policy solutions to reduce health care disparity.

In a long-term study of older people experiencing homelessness in Oakland, 26% of the participants died within a few years of being enrolled, UCSF BHHI researchers found. The study, funded by the National Institute on Aging, recruited people who were 50 and older and homeless, and followed them for a median of 4.5 years. Researchers examined how factors like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected participants' risk of dying. They found that people who first became homeless at age 50 or later were about 60% more likely to die than those who had become homeless earlier in life, and those who remained homeless were about 80% more likely to die than those who were able to return to housing.

A UCSF BHHI study that followed older homeless adults in Oakland for nearly a decade found that becoming homeless after the age of 50 ratchets up a person’s likelihood of dying early, underscoring the unmistakable role that housing has in extending life. Researchers determined that people in the study who remained unhoused—compared to those who regained their housing—were 80% more likely to die during the follow-up time period from mid-2013 to the end of 2021.

This news article describes ongoing efforts to vaccinate people experiencing homelessness in San Francisco against COVID. Margot Kushel, MD, is quoted regarding the earliest vaccination efforts, which BHHI helped strategize and implement on the ground with local organizations. She said it wasn’t so much fear about the vaccines that made it hard for low-income and unhoused people to get shots. “So much of it was really about access,” said Dr. Kushel. “Setting up big tents to come get vaccinated was good for a lot of people, but for others we really needed to go to where they were.”

People living with HIV/AIDS (PLWHA) have an increased risk of experiencing homelessness. The underlying drivers of homelessness are structural, however individual factors such as mental health and substance use problems are also common drivers. People living with HIV/AIDS who experience homelessness are more likely to have uncontrolled viral load. Researchers from BHHI suggest integrating HIV treatment with mental health and substance use treatment.

Housing status is a significant upstream determinant of access to healthcare. In this literature review, researchers identified areas of concern unique to patients experiencing homelessness with surgical disease. Researchers found that there was a gap in the surgical literature with regards to the impact of housing status on optimal surgical care. More studies are needed to accurately characterize the surgical care of patients experiencing homelessness and identify areas for care improvement.

In the first year of the pandemic, San Francisco and other communities in California offered private hotel rooms, three meals a day and on-site medical services to homeless people who were at risk of getting severe COVID-19. The aim was to stop the spread of the virus among a highly vulnerable group, but the policy had another important effect, according to new research by UC San Francisco, UC Berkeley, and the San Francisco Department of Public Health. It dramatically lowered the use of acute medical care by the hotel occupants who had used this type of care the most in the past.

Managed alcohol program (MAPs) manage alcohol consumption by providing eligible individuals with regular doses of alcohol as a part of a structured program and often offer housing and other social services. UCSF BHHI researchers found that benefits of MAPs included improved quality of life, reduced alcohol consumption, less hazardous consumption, and potential stabilizations in biological markers of alcohol use during MAP participation. Researchers found MAP participants reported substantial benefits, including increased feelings of safety and security, reconnection with community, sense of belonging, improved self-efficacy, and a positive reconciliation of internalized shame and stigma.

The homeless population in the United States is aging, however, there is limited studies on the neurologic etiologies of cognitive impairment in this population. Researchers observed a wide range of focal neurological deficits in the study participants, most notably deficits in cranial nerve function, motor function, coordination, and peripheral sensory functions. This study lays the foundation for the development of a longitudinal study of neurocognitive health among unhoused older adults in San Francisco.

Recently, a spate of assaults and murders have highlighted how people without housing are vulnerable to violence. Margot Kushel, MD, Director of BHHI, sheds light on the longstanding crisis of violence against people who are homeless.

This radio news story reports how mayoral candidates in LA propose addressing homelessness in Los Angeles. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discusses how solving homelessness requires a big systemic fix. "The underlying drivers of homelessness are the lack of deeply affordable housing, income inequality, and structural racism. It’s going to be hard to solve this problem without effort from the federal government."