The UCSF Benioff Homelessness and Housing Initiative collaborated with Kaiser Permanente and the National Health Care for the Homeless Council to provide guidance on COVID-19 screening in congregate shelters.  The Antigen Testing in Congregate Shelters: Process Outline and Implementation Playbook provides key strategic planning and operational considerations for screening using inexpensive rapid-testing solutions in lieu of PCR-only testing. To better protect people experiencing homelessness from the impacts of COVID-19, local health jurisdictions, health care service providers, and congregate shelter sites can use this guidance to coordinate operational needs and processes while implementing a screening testing program.

Several shelter-in-place hotels, where people with medical vulnerabilities have safely quarantined since the pandemic broke out, will close by the end of August, and the city’s largest ...

Before medically advised (BMA) discharge, which refers to patients leaving the hospital at their own discretion, is associated with higher rates of readmission and death in other settings. There is limited information on whether housing status is associated with BMA after surgery. This study used multivariable logistic regression to evaluate the association between housing status and BMA discharge. Researchers found that BMA discharge is more common in patients experiencing homelessness after surgery.

Unhoused patients have worse outcomes and higher health care utilization compared to their housed counterparts. Previous research has primarily focused on physical and behavioral health. This retrospective cohort study investigated the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes. Researchers found that unhoused patients commonly underwent emergent operations and had more complex hospitalizations.

Research from BHHI in collaboration with the San Francisco Department of Public Health and UC Berkeley School of Public Health showed how shelter-in-place emergency housing during the C...

The homeless population is aging and adults who experience homelessness for the first time in older age are more likely to progress to chronic homelessness. To prevent or delay homelessness, many people live temporarily live with family or friends. In this qualitative study of homeless older adults, researchers conducted 46 semi-structured interviews. They found that structural barriers to family and friends providing housing for temporary or permanent exits from homelessness included housing regulations, geographic and transportation challenges, and environments inconducive to older adults.

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.

Patients who experience homelessness face a high burden on chronic disease, including colorectal cancer. There are many barriers in access to colonoscopy procedures. Researchers provide policy solutions to reduce health care disparity.

The Bay Area Council released a report stating that it would take $11.8 billion to get every unhoused person in the Bay Area off the streets. Margot Kushel, MD, who advised on the report, said, "One thing that’s great is for people to have an honest conversation about what homelessness would really cost to end. Maybe that way we won’t just constantly criticize efforts being made, which have never been scaled to address the problem, which has existed for 40 years." Dr. Kushel dates the beginning of modern homelessness to Ronald Reagan’s decimation of poverty programs in his first years as president.

This article reports on weekly vaccination events in partnership with UCSF Benioff Homelessness and Housing Initiative, Glide Memorial Church, the San Francisco Community Health Center,...

Baby boomers own over 35% of all large homes in the US, and many of these older Americans are choosing to stay in their homes, exacerbating housing costs. This problem is even more apparent in California because their unique tax law incentivizes people to stay. On the other hand, younger boomers reaching retirement are increasingly facing homelessness. The University of California, San Francisco Benioff Homelessness and Housing Initiative California Statewide Study of People Experiencing Homelessness, found that over 40% of homeless older adults in California were homeless for the first time after the age of 50.

In this op-ed, Meghan D. Morris, PhD, MPH, an associate professor at the University of California, San Francisco, calls for rapid hepatitis C testing. She outlines the current testing process for hepatitis C, creating structural barriers, and how improving testing can address racial disparities. Dr. Morris writes, "It’s time for a comprehensive approach to eliminate hepatitis C, addressing racial disparities and ensuring timely diagnosis and treatment initiation." 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.

People living with HIV (PLH) experiencing homelessness or unstable housing have lower rates of viral suppression compared to people who are housed. In 2020, only 20% of PLH experiencing homelessness in San Francisco were virally suppressed, compared to 71% of those who were housed. Researchers examined case preferences among PLH experiencing homelessness during the COVID-19 pandemic in San Francisco. They found that the strongest preference were for the same provider, visit incentives, and drop-in visits.

In this perspective, Margot Kushel, MD, and coauthors describe how prioritizing vaccines for people experiencing homelessness is vital to an equitable and effective public health respon...

California harbors 30% of the United State's homeless population, despite being home to 12% of the nation's population. A new study released by UCSF Benioff Homelessness and Housing Initiative tries to provide a comprehensive picture of how people become homeless and offers policy recommendations to build better programs to address the crisis in California and nationwide. Margot Kushel, MD, BHHI director and lead investigator speaks with Ali Martin about the study's findings. "Absolutely, we need more services, but you can’t ask the health care system to solve a housing problem." said Dr. Kushel.

A new report estimates California could end homelessness by 2035 if it spent at least $8.1 billion every year on the problem. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative said, “The main way to solve homelessness is through housing.” She pointed out that research shows California is short by 1 million affordable and available housing units for extremely low-income renters—those making less than 30% of area median income. “By shrinking that deficit, we will reduce homelessness,” she said. “It will take a sustained investment by federal, state and local governments to do it.”

California invested $17.5 billion over four years to combat homelessness. However, despite the investment, there has been an increase in the number of people experiencing homelessness across the state. A recent report by the UCF Benioff Homelessness and Housing Initiative dispelled common myths about homelessness. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator said, "Nine out of 10 people lost their stable housing here. These are Californians. We have to create the housing for all Californians"

The latest point-in-time count reveals the number of Californians without a stable place to call home increased by 22,500 over the past three years. Homelessness experts attribute the rise to precipitous drops in earnings during the pandemic among Californians already teetering on the edge. They also point to a worsening housing affordability crisis decades in the making. “We have to solve this rotting core in the center of California—we are a million units short of housing for extremely low-income workers,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

On this podcast episode of Think Out Loud, Dave Miller speaks with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, about the new study on homelessness and how the findings could be relevant to Oregon. When talking about how the study's findings could provide insight to Oregon, Dr. Kushel said, "I'm afraid what we're seeing in California is definitely a model, in not a good way, up and down the west coast, and throughout other parts of the country."

California’s homeless population is predominantly made up of people who lived in the state before losing their housing, with nearly half older than 50 and a disproportionate number who are Black and indigenous, according to a new statewide study. “We have got to bring housing costs down, and we’ve got to bring incomes up,” said Margot Kushel, MD, the study’s principal investigator and director of UCSF’s Benioff Homelessness and Housing Initiative. “We need to solve the fundamental problem—the rent is just too high.”

The California Statewide Study on People Experiencing Homelessness is the largest representative study on homelessness since the 1990s. The study used a mixed methods approach, collecting data from more than 3,000 surveys and 365 in-depth interviews to uncover who is experiencing homelessness, what individual circumstances have led to them becoming homeless, and how their health issues have affected their life experiences. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative and principal investigator on the report, also delivered the annual John P. Dunlop Lecture at the Harvard Joint Center for Housing Studies (JCHS), presenting the findings and discussing policy recommendations.

Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, spoke with Jaden Jefferson about the need for affordable housing and the UCSF BHHI California Statewide Study of People Experiencing Homelessness. A major finding of the study was that homelessness doesn't affect everyone equally, communities of color are disproportionately vulnerable to being displaced into homelessness, especially Black, Latinx, and Indigenous Californians. One reason that is the case is "when we look at the history of housing in this country, what we see is that our neighborhoods were actually built through racial covenants between the government and realtors in the form of what we now call redlining", said Dr. Ponder.

More than 181,000 Californians were unhoused in 2023, with nearly 70% living on the streets. Cities provide resources for emergency solutions, but it is not really a solution. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re at a place in California, unfortunately, where doing well is often running in place." This is the first installment of a 4 part series exploring solutions to homelessness in California.