Our Research

COVID-19 impacted access to medical care and social services, potentially worsening HIV outcomes among people experiencing homelessness. In San Francisco, Ward 86, initiated POP-UP, a low-barrier, multicomponent model of care to address barriers to care for people living with HIV experiencing homelessness. Researchers found that care engagement and viral suppression did not worsen among the 85 patients enrolled, despite concerns that the COVID-19 pandemic might worsen outcomes. The study suggests that multicomponent interventions may help maintain viral suppression despite unanticipated structural barriers.

A new study from UCSF Benioff Homelessness and Housing Initiative and the San Francisco Department of Public Health describes how San Francisco rapidly scaled a hotel-based isolation and quarantine (I/Q) system of care for people experiencing homelessness during the COVID-19 pandemic. Researchers found the program safely delivered integrated medical and behavioral health support to more than 1000 individuals outside the hospital setting, while helping to preserve hospital capacity.

During the COVID-19 pandemic youth experiencing homelessness (YEH) were disproportionately impacted; there were common upstream factors, including racism, homophobia, poverty, and structural violence that place youth at risk for homelessness and exposure to SARS-CoV-2. Public health guidelines overlooked YEH. In this commentary, researchers discuss practical strategies to address the unique health and social needs of YEH.

This UCSF study examined whether permanent supportive housing reduces the use of acute health care and other services among people experiencing chronic homelessness. The Permanent Supportive Housing program intervention was able to house 86% of chronically homeless adults randomized to the treatment group based on their high use of multiple systems. Even the most frequent clients of medical, psychiatric, and emergency services were housed successfully, as demonstrated in this study of Project Welcome Home in Santa Clara County.

Older homeless-experienced adults have low rates of advance care planning (ACP) engagement. In this cross-sectional qualitative study, researchers examined potential barriers and solutions to ACP engagement. Researchers found that participants believed that ACP is important, but acknowledge the multiple barriers to engagement. Potential solutions include capitalizing on opportunities outside health care setting and focusing on the period after housing and tailoring content.

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.

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.

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.

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.

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.