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For the first time in six years, the number of people experiencing homelessness in Los Angeles decreased from the year before, according to the most recent point-in-time count. However, there has been less success in finding people experiencing homelessness permanent homes. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "If the underlying economic conditions don't change, and if the money gets cut, you're going to see an increase again."

In San Diego County, more than one-third of renters over 65 spend the majority of their income on rent. Along with a shallow rental subsidy pilot program, San Diego County is also working on adding more affordable housing units. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The truth of the matter is that if we don't spend these small amounts of money we’re spending it on the back end but for really bad outcomes."

The number of older adults over the age of 50 experiencing homelessness is increasing in the US. Overall, 48% of the population of single homeless adults in California is 50 or older, with most of them living unsheltered. A new special report, Toward Dignity: Understanding Older Adult Homelessness, by the Benioff Homelessness and Housing Initiative at the University of California, San Francisco, took a deep look at the aging homeless population in California. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re talking about older frail adults. That is who is outside."

The face of homelessness in America is growing older. Recent projections report that the population of unhoused older adults will triple between 2017 and 2030. As more generations reach retirement age, there is a need for policymakers to consider how housing and homeless services should be adapted to meet the needs of the aging unhoused population. Marc Dones, policy director at the UCSF Benioff Homelessness and Housing Initiative, said, "The country is in the midst of a housing crisis so severe that people who have worked their whole lives are suddenly becoming homeless."

In this op-ed, Dalma Diaz, MA, a health equity fellow at the California Health Care Foundation, highlights how housing supports other social determinants of health, providing a lifeline. She puts forward the idea of prescribing housing as a way to provide limited rental subsidies. Ms. Diaz writes, "Our housing was a lifeline. It meant that my family, which included two children under 12 — one with a developmental disability — had a stable place to live during one of the most frightening and precarious moments of our lives." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Across San Francisco, there are 8,000 unhoused people on a given day and upward of 20,000 over the course of a year. With rising housing costs, some individuals have transitioned to living RVs on Winston Drive. However, new street parking restrictions will force people living in RVs to leave the area. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "People told us they preferred vehicles to shelters, but they would have preferred housing."

California's 'housing first' rule prohibits the use of housing funds on drug-free or sober housing facilities. However, there is growing support for changing policies to favor tolerance of drug use in housing for people experiencing homelessness. San Francisco supervisors announced a new plan to prioritize drug-free housing options for people who experience homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "You want to make sure that any relapse is not punished with homelessness, because to do so may turn something that is in fact a short backward step into a deep fall."

People over age 50 are the fastest-growing segment of people experiencing homelessness and makeup almost half of the total homeless population. These unhoused individuals typically have the health of someone 20 years older in the general population. DeDe Hancock, a CASPEH Lived Expertise Advisory Board member, discusses her own experience with becoming homeless when she was 52 years old, and Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, outlines the health impacts of older adult homelessness. Ms. Hancock said, "I was going from shelter to shelter. Over seven years, I was out on the street for maybe five days - otherwise, I was in a shelter."

Although only 9% of Sacramento's general population is Black, Black residents now comprise 35% of Sacramento's homeless population. A special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences of homelessness highlights the systemic causes that have left so many unhoused. Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "When you consider (leaving) homelessness, you think about the requirements needed to get back into housing — waiting lists, who gets a voucher, who doesn’t get a voucher. It’s hard to get housing or a room. It’s even harder for Black Americans."

In this op-ed, Claudine Sipili, one of the California Statewide Study of People Experiencing Homelessness Lived Expertise Advisory Board co-chairs, advocates using AI as a component of a holistic strategy to address homelessness. She outlines the concerns and need for clear guidelines, transparency, and community oversight when employing predictive AI. "With the vital input of people with lived experience of homelessness, urban leaders have an opportunity to harness AI's vast capabilities to identify vacant properties for conversion to affordable housing, automate and expand rental assistance programs, coordinate entry into a comprehensive continuum of care, and equitably allocate limited resources for maximum community impact." Ms. Sipili writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

The aging of the homeless population is a stark demographic shift. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, found that unhoused people have the health profiles of patients two decades older, with similar rates of incontinence, dementia, and falls. Respite care, a temporary, short-term, 24-hour supervised care for seniors, is rapidly growing for people experiencing homelessness, reflecting the aging of the unhoused population.

On the second day of the CalMatters Ideas Festival panelists discussed homelessness solutions, moderated by Marissa Kendall. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Robynne Rose-Haymer, one of the CASPEH Lived Expertise Advisory Board members, were panelists. Ms. Rose-Haymer said, "By rooting people out forcibly, it does nothing to build that trust, and in fact, harms the very services that we are paying billions of dollars to stand up."

A panel at the CalMatters Ideas Festival debates how to reduce homelessness without punishing poverty. Panelists discussed the underlying causes and what California should be focusing on. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We know how to treat people, you have to start, though, with the housing." 

Homelessness is detrimental to health, and clinicians can play an essential role in mitigating the deleterious effects of homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discusses this and more with JAMA Senior Editor Karen E. Lasser, MD, MPH. Dr. Kushel said, "When you are an individual provider, in a room, you are trying to understand the difficult environmental conditions that your patient has and do things to decrease that part."

People experiencing homelessness have worse mental and physical health than the general population. They also have limited access to primary care for reasons including the absence of health insurance, lack of money for co-payments or transportation, and communication barriers. In this JAMA Insights, researchers examine the adverse effects of homelessness on physical and mental health and suggest strategies to improve access to care.

A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness found that nearly half of California's homeless population is now 50 and older. These older adults are staying homeless for longer and are in poorer health than their younger peers. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "These are people living on fixed incomes, on disability, on really meager pensions, and they really need housing that they can afford."

Among people experiencing homelessness in California, nearly half of the population is now over the age of 50. By 50, a homeless person’s health more closely resembles that of someone in their 70s, with a higher chance of chronic disease, mobility issues, and cognitive decline, according to a recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We could meaningfully reduce the number of people experiencing homelessness if we focused on this group."

The point-in-time count offers a snapshot into the scope of homelessness in different communities, but most experts agree that the methodology is inaccurate and flawed. In this forum, Sydney Johnson speaks with experts to demystify the counting process and understand this year's numbers. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We learned a lot about what we can do when we treat homelessness like the crisis that it is."