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Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was interviewed about the COVID-19 testing event in San Francisco. UCSF partnered with the San Francisco Department of Public Health and several community-based organizations to bring testing and information to people in District 10. Unhoused people are high risk for COVID-19, so increasing awareness around the disease is extremely important.

Through ‘United in Health D10 Unhoused,’ UCSF offered free COVID-19 testing for anyone experiencing homelessness in District 10. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, led the effort in partnership with the United Council of Human Services (Mother Brown’s Kitchen), Bayview Hunters Point Community Advocates, and Southeast Community Council, as well as SFDPH.

Homelessness among older adults is increasing; almost half of those aged 50 or older first became homeless after age 50. Benioff researcher found that individuals with late onset homelessness had very different stories compared to indviduals with early onset homelessness. Many individuals struggled with multiple chronic health problems, such as heart disease, chronic lung disease, and cancer. Ending homelessness among older adults will require increasing the supply of affordable housing, targeted prevention efforts, and expanding permanent supportive housing, adapted to older adult needs.

During her internal medicine residency at San Francisco General Hospital, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, saw many patients who were experiencing homelessness and realized no matter how much the health care system improved, she could only help patients so much if they were unable to find safe, permanent housing.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, sees some cause for optimism in the state and federal approach to homelessness, even amid the pandemic: “If we can move thousands of people indoors at a time when the government is under financial constraints, then we can certainly do this in better times."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, spoke about how homelessness is incompatible with health. The conditions of homelessness would leave a healthy person vulnerable to catching a disease like Covid-19. Unhoused people are already among the most sick in society, and they’re physically incapable of following the Centers for Disease Control and Prevention’s most basic virus-fighting directive: stay home. “It’s an enormous crisis superimposed on an existing crisis,” Dr. Kushel said.

As the coronavirus alters daily life for many Californians, state leaders are facing the confluence of two public health challenges: the virus and homelessness. “What you are seeing is two crises—homelessness and the virus—collide,” says Margot Kushel, MD, director of the Center for Vulnerable Populations at UCSF.

Without proper precautions and actions, the virus "could spread like wildfire," warned Margot Kushel, MD, director of the University of California, San Francisco Center for Vulnerable Populations.

Margot Kushel, MD, spoke with ABC7News about how the novel coronavirus is especially dangers for people experiencing homelessness. People in close proximity on sidewalks and in tents, inside shelters, or even living in shared spaces, like SROs, are extremely vulnerable to communicable diseases. "We know that people who experience homelessness experience death rates that are extraordinarily higher than they otherwise would be if they were housed,” explained Dr. Kushel, “and our fear is that it could come to bear in this [crisis] as well." 

Margot Kushel, MD, director of the University of California, San Francisco Center for Vulnerable Populations, shared her concern that the coronavirus outbreak will be dangerous in other ways for the homeless even if they don’t get sick. “My fear,” she said, “is that this will be used as another way to further stigmatize an already stigmatized and challenged population.”

The proportion of single homeless adults over the age of 50 is increasing. In this longitudinal cohort study, researchers examined the prevalence of and risk of falling in a cohort of older homeless adults. Researchers interviewed participants every 6 months for 3 years. They found a high prevalence of falls. Participants reported a prevalence of falls higher than older adults with a mean age of 78 in the general population. Researchers recommended identifying people at high risk of falls reducing unsheltered homelessness.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed the economic forces driving homelessness along with how increasing the supply of extremely low-income housing could prevent it. “The vast majority of people who become homeless could be easily housed if there were housing that they could afford on their income."

Many older homeless adults maintain contact with family. In this qualitative study, researches examine the role of family caregiving for older homeless adults and what is its potential role as a precipitant to and exit from homelessness. The researchers found that in the sample of older homeless adults who were in contact with their family, many older homeless adults provided caregiving services to housed family members.

Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness. Researchers aimed to understand the relationship between race and the experience of homelessness for older adults. They developed a theoretical model of the way experiences with overt and structural racism may lead to and perpetuate homelessness for older Black adults. Researchers recommend that efforts aimed at ending homelessness target the effects of structural racism with polices.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was interviewed about Project Home and how more people than ever before are “aging into homelessness.” Right now, more than half of the Bay Area homeless population is over age 50.

The homeless population has a higher prevalence of mental health and substance use problems than the general population. Researchers aimed to examine the prevalence of and factors associated with unmet needs for mental health and substance use treatment in older homeless adults. They used logistic regression to examine factors associated with unmet treatment needs. Researchers found that older homeless adults have a high prevalence of unmet behavioral health treatment needs and need targeted services.

Difficulty performing activities of daily living (“functional impairment”) is common in homeless adults aged 50 and older. Homeless adults develop aging-related conditions earlier than individuals in the general population, including difficulty with basic activities of daily living (ADLs) that are essential for independence. Researchers conducted a prospective cohort study to assess functional trajectories based on self-reported difficulty performing 5 activities of daily living. They found functional impairment improved in some homeless adults, it persisted or worsened in many others.

A guest column by Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Kevin Prindiville, JD, looks at the rise in homelessness among people older than 50: “With rising housing costs, fewer pensions, and a fraying safety net, many older adults are one crisis away from losing the roof over their head.”