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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.”

The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. Researchers conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. They found older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.

This landmark gift for the first-of-its-kind initiative aims to decrease homelessness by rigorously examining and evaluating what is known about homelessness and answering unresolved questions about effective intervention strategies. The initiative will work to translate policies into action.

Marc and Lynne Benioff’s donation will create first-of-its-kind initiative to research causes of homelessness and identify evidence-based solutions.

The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. This study aimed to describe the access to and use of mobile phones, computers, and the Internet among a cohort of 350 homeless adults over the age of 50 years. Researchers found that participants with phones used them for social support and communication with healthcare providers; however, few had annual phone contracts.

People experiencing homelessness have inadequate resources for regular dental hygiene and a higher prevalence of risk for tooth loss, including smoking and substance use. This study aimed to describe the prevalence of and factors associated with oral health measures in a sample of older homeless adults in Oakland, CA. Researchers conducted a cross-sectional analysis of data from a population-based study of 350 homeless adults aged ≥50. They found that tooth loss and oral pain are highly prevalent in older homeless adults.

Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. The study aimed to characterize the experience, understanding, and management of physical, psychological, social (e.g., loneliness), and existential (e.g., regret, loss of dignity) symptoms among older homeless adults. Researchers conducted semistructured interviews from June 2016 to March 2017 with a purposive sample of participants from the Health Outcomes of People Experiencing Homelessness in Older Middle Age cohort, a longitudinal study of homeless adults aged 50 and older. They found that homelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering.