Resource Center

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."

In this op-ed, Margot Kushel, MD, Tomiqua Moss, and Jen Loving explain how scaling evidence-based solutions to prevent and end homelessness can yield tangible results. They characterize the underlying, interlocking causes of homelessness as structural racism, income inequality, and lack of affordable housing for low-income households. "The research is clear: When there is more affordable housing in a community, fewer people experience homelessness," they write. "Providing affordable housing with permanent subsidies and supportive services, if needed, is the best way to end homelessness. Such programs have for years successfully housed more than 90% of those with the most severe disabilities."

This radio program takes an in-depth look at how more people experiencing homelessness in Las Vegas are now living in vehicles. UCSF Benioff Homelessness and Housing Initiative Postdoctoral Scholar Graham Pruss, PhD, describes how BHHI research in Oakland showed that people living in vehicles need a variety of temporary and long-term parking spaces, which could mean safe parking programs and long-term supportive parking programs. Pruss noted it can take months or even years for a transition into permanent housing.

In Los Angeles, 85 people experiencing homelessness were murdered last year—the highest number ever recorded, according to LA Police Department data. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, noted that the trend of unhoused homicide victims may seem contrary to what many think of when discussing homelessness. Countering the common misperception that unhoused people are dangerous, she explained how people experiencing homelessness are vulnerable to violent crime. Dr. Kushel said, "What I hear when I spend time with many people experiencing homelessness is how terrified they are and how terrifying the experience is, and this is layered on top of a public who is afraid of them."

People experiencing homelessness (PEH) have a high rate of tobacco use. Researchers examined factors associated with cigarette consumption and quit attempts. They found having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption. The findings highlight the role of community-based pharmacists to expand smoking cessation services in homeless shelters.

People living with HIV (PLH) experiencing homelessness or unstable housing have lower rates of viral suppression compared to people who are housed. In 2020, only 20% of PLH experiencing homelessness in San Francisco were virally suppressed, compared to 71% of those who were housed. Researchers examined case preferences among PLH experiencing homelessness during the COVID-19 pandemic in San Francisco. They found that the strongest preference were for the same provider, visit incentives, and drop-in visits.