California accounts for about a third of the nation’s homeless population and among this population, seniors are the fastest growing group. Research shows that living on the streets prematurely ages and sickens people. “When talking about homelessness, 50 is the new 75,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Whether it be measures of cognitive decline, mobility, problems with function falling, all of the things that we usually think of happening to people in late life just happen to people 20 or 30 years earlier,” said Dr. Kushel. “And tragically, people also die.”

"You cannot have a healthy society with this many people living on the economic and social margins," said BHHI Director Margot Kushel, MD. "Homelessness is lethal. We’re not going to ...

Advocates for people experiencing homelessness refer to sidewalk planters as “hostile architecture” meant to push the homeless population out of sight. The tactic is not new, residents, business owners, and the city have used architecture to prevent encampments on the street. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I get why people don’t want this suffering in our neighborhoods, I really do, but because we feel so overwhelmed by the hard work we need to do to solve this crisis, people start to lose hope."

San Francisco was one of the first major cities to adopt a housing-first policy: give someone a permanent place to live, provide access to robust care and resources, and positive outcomes will follow. Margot Kushel, MD, said, “Solving the homelessness crisis will take resources and a commitment to house everyone—and then the ability to match services to the need.” While there will always be a need for emergency short-term shelter options, Dr. Kushel said, “a focus on shelter in lieu of housing is the worst of all options” because it “costs society a lot and doesn’t solve homelessness.”

California's homeless emergency stems from a lack of housing, but it is also a public health emergency. Governor Gavin Newsom has had the state government invest billions in public fund...

The California Statewide Study of People Experiencing Homelessness “paints a representative picture” of homelessness and suggests policies backed by evidence, said Dr. Tiana Moore, the Policy Director at the UCSF Benioff Homelessness and Housing Initiative. “There's a lot of noise in California around who's experiencing homelessness and why,” Dr. Moore said, adding that the study pushes back against narratives that are dominating conversations right now. The study found that nine out of ten participants lost their last housing in the state. It is the largest study of its kind since the mid-1990s and the first large-scale study to use surveys as well as in-depth interviews, allowing researchers to “amplify the voices of those who are experiencing homelessness directly,” Dr. Moore said.

This news article describes ongoing efforts to vaccinate people experiencing homelessness in San Francisco against COVID. Margot Kushel, MD, is quoted regarding the earliest vaccination efforts, which BHHI helped strategize and implement on the ground with local organizations. She said it wasn’t so much fear about the vaccines that made it hard for low-income and unhoused people to get shots. “So much of it was really about access,” said Dr. Kushel. “Setting up big tents to come get vaccinated was good for a lot of people, but for others we really needed to go to where they were.”

California is home to 12% of the United State's population, but makes up to half of all the country's unsheltered population. In this podcast episode of Fifth & Mission, host Cecilia Lei speaks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator, about California's largest examination of homeless adults since 1996. "This is a story of deep poverty in a state with incredibly high housing costs." said Dr. Kushel.

Little is known how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. Researchers examined the perceptions and use of telehealth, sampling from a larger longitudinal study on homeless-experienced adults in Oakland, CA. They found that the participants experienced challenges accessing the necessary technologies for telehealth.

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.

Nearly one-third of all Americans experiencing homelessness live in California. Starting in the fall of 2021, Aaron Shrank and Sam Comen conducted interviews and photographed unhoused people living in Los Angeles and Northern California as a companion piece to the University of California San Francisco Benioff Homelessness and Housing Initiative’s California Statewide Study of People Experiencing Homelessness to shed light on those affected. You can read a lightly condensed version of their stories. More of Comen and Shrank’s work is available at the website Unhoused CA.

People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities. Researchers conducted a qualitative study in Vancouver, Canada's downtown eastside, interviewing PWUD who were recently evicted fron the downtown eastside. Narratives from the interviewees provided context on how the demands of the institutional circuit deepened vulnerablitities and prolonged experiences in homelessness. Researchers suggested that interventions that address survival needs and preserve agency will be necessary to mitigate risks within the institutional circuit.

Through interviews of HOPE HOME participants who reported living with family or friends, this qualitative study from BHHI researchers found that intergenerational trauma significantly a...

A large new study, conducted by the UCSF Benioff Homelessness and Housing Initiative asked people experiencing homelessness from all over California about what would have helped them avoid losing their housing. Margot Kushel, MD, the study’s principal investigator and director of UCSF BHHI, spoke with TIME about the studies key findings and recommendations. “You can’t build a homelessness prevention program only around eviction prevention. Those programs are important, but you’re going to miss a big chunk of people.” said Dr. Kushel.

California passed the Community Assistance, Recovery, and Empowerment (CARE) Act in 2022 to provide behavioral health and housing services to individuals with psychotic spectrum and schizophrenia disorders who are deemed unable to care for themselves. This policy brief from the Benioff Homelessness and Housing Initiative at UCSF and the California Policy Lab uses anonymized data to estimate how many San Franciscans in a database of individuals who have contact with the urgent and emergent care system may be eligible for referral to CARE Court and describe their service needs.

During the COVID-19 pandemic, UCSF partnered with government and community groups to address racial, economic, and cultural barriers with the goal of providing equitable care to vulnerable people. The UCSF Benioff Homelessness and Housing Initiative spearheaded many of those partnerships. “The secret sauce was putting the community-based organizations in charge,” said Margot Kushel, MD, who envisioned a program to serve people experiencing homelessness that became a national model.

People experiencing homelessness (PEH) have a high rate of tobacco use. Researchers examined factors associated with cigarette consumption and quit attempts. They found having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption. The findings highlight the role of community-based pharmacists to expand smoking cessation services in homeless shelters.

Margot Kushel, MD, 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.

In this op-ed, Alma Yates, MSW, the Education Program Manager at the Benioff Homelessness and Housing Initiative, and Lourdes Johanna Avelar Portillo, PhD, an alumni postdoctoral fellow with the Benioff Homelessness and Housing Initiative, call to recognize menstrual health as a human right. Many countries and the United States have tried implementing initiatives that address menstrual health inequities, but "period poverty" continues, especially in armed conflicts." Dr. Portillo and Ms. Yates write, "Everyone who menstruates –  in conflict zones and refugee camps, in shelters and unhoused – needs and deserves access to necessary information, sanitary products, and facilities to manage their periods safely and with dignity." 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.

In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, outlines the civic responsibility physicians have, even as private citizens, to be thoughtful in how they share their views. She explains that free speech protections are crucial for physicians regarding their practice of clinical medicine, but physicians should take care to not create an environment that could cause patients harm. Dr. Raven writes, "While hate speech from a physician's private social media account may be protected by the First Amendment, it stands in stark contrast to the ethical embodiment of 'first do no harm.'" 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.

In this op-ed, Claudine Sipili, one of the Lived Expertise Advisory Board co-chairs, calls for restoring dignity to people experiencing homelessness. She outlines the need to prioritize human worth and respect while pursuing practical solutions to address homelessness. "The erosion of dignity that comes from losing one’s home can make it more difficult to take advantage of housing solutions." 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.

This paper describes the qualitative component of a large mixed method study, the California Statewide Study of People Experiencing Homelessness. The qualitative study consisted of seven sub-studies across eight counties, each exploring different dimensions of homelessness. BHHI researchers recruited participants from the overall sample, a statewide representative sample of adults experiencing homelessness recruited in eight counties, based on their responses to questions from the survey interviews. The researchers' mereological study design presents an approach for developing complex qualitative policy studies across a range of topic areas.

The Centers for Disease Control and Prevention recommends new covid-19 booster vaccines for all. A boost in protection is important to protect people against severe COVID and death. However, structural factors have prevented booster uptake among those who could benefit the most from the vaccine. Booster rates among people who experience homelessness is largely unknown. Tiana Moore, PhD, the Policy Director at the Benioff Homelessness and Housing Initiative is concerned that people experience homelessness face high barriers to vaccination. Dr. Moore said, "Many of our participants talked about concerns about leaving their belongings when unsheltered since they don’t have a door to lock."

There are a lot of myths about people who are homeless in California: They’re from another state. They don’t want a job. They don’t want a home. A new study published by the University of California, San Francisco, paints a different picture, one of people who were working and living in poverty in the state until they suddenly lost their homes. Not knowing where to turn, they ended up on the street, where they endure violence and poor health as they try for years to climb back to stability. “Something goes wrong, and then everything else falls apart,” said the study’s lead researcher, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Everything in their life gets worse when they lose their housing: their health, their mental health, their substance use.”

People who inject drugs (PWID) experience housing instability and other structural barriers, making it hard for PWID to complete direct-acting antiviral (DAA) treatment of Hepatitis C. Researchers found that simple, low-cost medical storage containers, can be incorporated as a key component of a medication management plan. It is important to create a non-judgemental approach to providing HCV care.