Margot Kushel, MD, was quoted regarding the success of Project Roomkey, which could become a model for future efforts to aid the estimated 150,000 homeless people in California. “It’s b...

Margot Kushel, MD, discussed how the Johnson & Johnson vaccine has been popular among homeless and low-income populations as it requires people to come in for only one shot. She ...

Margot Kushel, MD, was quoted in this article about how California moved thousands of people experiencing homelessness into private hotel rooms during the COVID-19 pandemic—in an effort named “Project Roomkey”—which eventually provided temporary shelter to more than 48,000 people in hotel rooms leased by the state. Dr. Kushel said, “What you don’t see are that many, many of those folks who are out there are getting out of their tents and going to jobs.” 

In this podcast episode of In Clear Terms with AARP California, host Dr. Thyonne Gordon spoke with Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative. Dr. Gordon and Dr. Kushel talk about the state of older adult homelessness in California, and the complex interactions between health and homelessness, and potential solutions to prevent and address the issue. Dr Kushel said, "The reason so many people are homeless in California, is we do not have the housing. If you ask the question though, 'Why is this person homeless', then you can see how things like illness, including mental health or substance use, can leave you vulnerable."

California’s homelessness crisis is a homegrown problem that is deepening amid a shortage of affordable housing and emergency shelter, and it’s often the brutal conditions of living on the street that trigger behavioral health problems, such as depression and anxiety, researchers found in a comprehensive study on homelessness. The new findings show that at least 90% of adults who are experiencing homelessness in the state became homeless while living in California. “This idea that homeless people are rushing into California is just not true,” said Margot Kushel, a physician who treats homeless people, and the lead investigator of the study for the UCSF Benioff Homelessness and Housing Initiative. “There’s so much myth-making around this magnet theory that people who are homeless flock to California, but this is our own problem.”

A proposal to spend $12 billion to end homelessness in California is "a really good start, but can't be the end," said Margot Kushel, MD. Project Homekey was remarkable because

Margot Kushel, MD, was quoted about California’s Project Roomkey and Project Homekey, including their prospects to make a lasting impact on homelessness across the state. “(Roomkey) really grabbed those who were at the highest risk of doing poorly and got them to safety,” said Dr. Kushel.

Housing First focuses on getting people into permanent housing and offering them support services. A 7-year randomized trial of chronically homeless individuals found those in the housing-first group spent 90% of their nights housed and made less use of psychiatric emergency services and more use of outpatient mental health services compared to the control group. “The experiment intentionally sought to try housing first for the very most complicated patients—those who society says are most hard to house—and it worked,” said study co-author Margot Kushel, MD, who directs UCSF’s Benioff Homelessness and Housing Initiative.

Oregon is one of several states betting on housing and outreach programs using Medicaid funds. Officials hope that by keeping people from experiencing medical crises that lead to repeated emergency room visits, Oregon will save enough money to pay for increased housing costs. California is also working to implement a program similar to Oregon's, spending more than $100 million a year on housing from its Medicaid budget. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative said, "I know that if I could get my patients who are experiencing homelessness housing, we could make everything else work better".

Margot Kushel, MD, spoke about Oakland’s new shallow subsidy program, which will help 200 low-income households pay rent for 18 months by sending money directly to their landlords. The ...

Margot Kushel, MD, was quoted about upcoming changes to hotel programs for unhoused people. With California’s Project Roomkey winding down, hotels for Bay Area residents experiencing homelessness are slated to close. Despite uncertain prospects for keeping people housed in the future, “Project Roomkey has played a huge role in decreasing the disasters in the Bay Area,” said Dr. Kushel, including slowing the spread of COVID-19.

There is public skepticism when politicians promise to solve a crisis, and then little progress gets made. Los Angeles Mayor Karen Bass's policies have given new hope, but an increase in violence against people experiencing homelessness has pushed more into despair. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I do really worry that it’s become normalized in public discourse to speak about people experiencing homelessness as, like, a problem for those who are not homeless — as opposed to fundamentally a massive societal failure that’s left usually older, vulnerable people terrified and totally unprotected."

Public policy and common perception have long tied the road to homelessness with mental illness and drug addiction. But a new study—the largest and most comprehensive investigation of California’s homeless population in decades—found another cause is propelling much of the crisis on our streets: the precarious poverty of the working poor, especially Black and brown seniors. “These are old people losing housing,” said Margot Kushel, MD, the lead investigator on the study, done at the request of state health officials.

There is an overrepresentation of Black people in people who experience homelessness in California. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences homelessness highlights the systemic racism. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This didn’t just happen by accident and it didn’t just happen because there were a few bad people. This was organized." Dr. Kushel further adds in regards to reparations, "That feels like a conversation that, if we are being honest, we need to have."

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, 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.”

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, discussed ho...

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." 

Volunteers, on a clear night in San Francisco, count the number of people who are unhoused on the streets. Groups of people were assigned specific areas, and write down whether a person is confirmed, suspected, or if no one on the block is unhoused. The point-in-time count is nationwide. However, the counts are not perfect and some groups are undercounted. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homeless families do everything they can to stay out of the public eye because they are really worried, for good reason, that their children will be taken from them."

Margot Kushel, MD, was quoted regarding lower vaccination rates in people experiencing homelessness in the Bay Area, where multiple outbreaks and rising case rates in homeless shelters ...

Margot Kushel, MD, was quoted in the San Jose Mercury News discussing rollout of COVID vaccines for people experiencing homelessness. The Benioff Homelessness and Housing Initiative team recently surveyed unhoused people in Oakland and San Francisco and found they were more likely than the general population to want the vaccine.

Homeless people are among the most vulnerable populations in the COVID-19 pandemic, yet they’re largely invisible during this crisis. Margot Kushel, MD, 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.

Through ‘United in Health D10 Unhoused,’ UCSF offered free COVID-19 testing for anyone experiencing homelessness in District 10. Margot Kushel, MD, director of BHHI, 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.

As San Francisco works to launch the CARE Court program, even some supporters are skeptical it will have a big impact on tragedies unfolding on the streets, arguing there aren’t enough treatment beds, housing, and intensive case managers. Maria Raven, MD, an author of the study who is chief of Emergency Medicine at UCSF Medical Center and co-leads the Benioff Homelessness and Housing Initiative COORDINATE HOME program, said there’s not enough permanent supportive housing. She hoped the report could start a conversation between the state and the city on how to fill gaps—"Otherwise it’s just going to be another program that doesn’t really have any impact."

An increase in the number of deadly attacks on people experiencing homelessness has coincided with a spike in people experiencing homelessness in the US. What concerns many is that the attacks occur regularly and without notice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This violence is happening every day, just outside of our vision."