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The UC Berkeley Social Science Matrix hosted Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, for an in-depth discussion of homelessness in the Bay Area, emphasizing the causal factors of a chronic shortage of low-income housing and structural racism. “Homelessness is not caused by mental health and substance use problems,” Kushel explained. “The more we blame this problem on highly stigmatized medical conditions, the more it lets us off the hook for solving the fundamental problems that have brought us to this point.”

An innovative strategy to house Santa Clara County’s struggling homeless residents is working, according to a new study co-authored by Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. The results could impact how agencies in the Bay Area and beyond address homelessness.

The vast majority of even the most impaired homeless people can be successfully housed if they are given access to permanent housing with voluntary supportive services, a rigorous new study from UCSF has found. “The bottom line is that even really high-risk folks can be housed,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

For unhoused people living in areas impacted by wildfire smoke, “The choice is being in a congregate shelter or being outside, and [with] COVID it's pretty clear that it's safer to be outside than to be in a congregate shelter," said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. "For people who are outside, it's just worsened their already precarious health situation."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed how low-wage workers and their families are at particularly high risk during the pandemic. “The type of work that (homeless) people do is the type of work that we have seen to be at highest risk because it has been the type of work that you can’t do from home.”

Homeless people are among the most vulnerable populations in the COVID-19 pandemic, yet they’re largely invisible during this crisis. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, called the pandemic “a crisis within a crisis,” noting that most homeless people are usually in poorer health and, with widespread closures, had lost access to services providing food, water, and shelter.

Researchers and advocates say much is unknown about how the pandemic has affected the estimated half-million people without housing in the Untied States. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed how obtaining good data on the homeless population is difficult because hospitals and death certificates don’t track housing status. While she was hesitant to draw conclusions about how the pandemic has affected homeless people overall, she said, “This may be an example where being outside and unsheltered, just in terms of COVID, maybe let people be at lower risk. But again, we just don’t really know.”

Margot Kushel, MD, and Kirsten Bibbins-Domingo, MD, discuss how the pandemic has highlighted "a tale of two Californias."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, realized early in her career that the most important thing for her patients’ health was housing. Now a preeminent expert on homelessness and director of BHHI, she delves into what the COVID-19 crisis reveals about housing and health.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted in an article about how unhoused people in San Francisco and nationwide are contracting the coronavirus at about the same rate as housed people. Isolating people in hotels and thinning out shelters helped—and for those left outside, the fresh open air was a greater protector than experts anticipated. "There’s no question that the hotel rooms and downsizing the shelters helped a lot," said Dr. Kushel.

As shelters in San Francisco face increased rates of infection, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed what’s needed in response, and why the approach can’t be exactly the same as for the housed population: “There is no way to shelter in place when you don't have housing.”

In an effort to understand the spread of the coronavirus among the large population of homeless people in San Francisco’s District 10, UCSF joined with the United Council of Human Services and other community organizations to put together the weekend event.

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.