In this Medical Grand Rounds at the University of Washington, Margot Kushel, MD, a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative, discusses the drivers and precipitants of homelessness, the demographics of homelessness in the United States, the health consequences of aging in the homeless population, and interventions and solutions.

In this op-ed, Lourdes Johanna Avelar Portillo, PhD, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, underscores the importance of providing access to water and sanitation services to people who are experiencing homelessness. She explains how the lack of water and other hygiene services can create added barriers among those experiencing homelessness, increasing stigmatization, as well as an increase risk in public health. Dr. Protillo writes, "the need for public access to water, sanitation and hygiene services is not just for people experiencing homelessness — it’s important to everyone."  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, Lourdes Johanna Avelar Portillo, PhD, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, underscores the importance of providing access to water and sanitation services to people who are experiencing homelessness. She explains how the lack of water and other hygiene services can create added barriers among those experiencing homelessness, increasing stigmatization, as well as an increase risk in public health. Dr. Protillo writes, "the need for public access to water, sanitation and hygiene services is not just for people experiencing homelessness — it’s important to everyone." 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.

Homelessness hasn’t necessarily become worse, but it is more visible—especially in CA cities. This is due to a combination of factors, including rising number of people who experience homelessness and living nearly full time one the street, increased real estate development in some cities, and police action in prohibiting and forcing the relocation of people experiencing homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homelessness has become more obvious without necessarily becoming worse. It's much more in your face than it was before."

High users of the health care system use a disproportionate amount of health services yet have poorer health outcomes. This study aimed to examine natural trends in emergency department visits among high users of health and social services and assess whether the trends differed during the COVID-19 pandemic. In this retrospective cohort study, researchers found that there was a decrease in emergency department visits. Further research is needed to elucidate COVID-19 pandemic specific factors associated with a decrease in emergency department visits.

Margot Kushel, MD, director of the UCSF Benioff Housing and Homelessness Initiative, said far too many reactions to visible homelessness, as well as conversations addressing potential solutions, are “based on people’s fears as opposed to action.” Dr. Kushel called violence against unhoused people a “hidden epidemic” in a blog post last year, noting that homeless people are disproportionately likely to be victims of violence. Unhoused offenders are comparably rare, she said, yet often draw outsized attention and media coverage as opposed to unhoused victims.

This podcast episode highlights homelessness’ impact on health, the structural and racialized nature of homelessness, and practical interventions to address housing inequities. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Bobby Watts discuss what brought them into their fields, how their work reaches the most marginalized, and what can be done at the community and structural level to address homelessness.

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 congregate shelter has paused intakes for weeks due to positive COVID tests from residents. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, “Non-congregate shelter is a really important intervention. It has been throughout the pandemic and with the virulence of the delta variant is, arguably, more so now. Getting people into safety is important for all.”

Before medically advised (BMA) discharge is associated with higher rates of readmission and death in other settings. In this study, researchers 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 even after adjusting for observable confounding characteristics. A deeper understanding of the drivers of BMA discharge in patients experiencing homelessness through qualitative methods is critical to promoting more equitable and effective care.

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...

Over 60% of permanent supportive housing (PSH) residents smoke cigarettes, and over 50% use cannabis. Co-use of tobacco and cannabis may be linked with other substance use. We explored attitudes toward tobacco-free and cannabis-free policies among PSH residents who smoked cigarettes, co-used tobacco and cannabis, or other substances.

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.

People who live in cars and RVs throughout the Bay Area are moving between cities as crackdowns on street encampments ramp up, a trend that pushed Oakland officials to adopt a new policy speeding up tows over concerns the city is becoming a “destination” for displaced residents. BHHI Director Dr. Margot Kushel says that cities are competing in a “race to the bottom” to pass stronger restrictions on encampments than their neighbors.

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, director of the UCSF Benioff Homelessness and Housing Initiative, 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.

Behavioral health challenges both contribute to and are exacerbated by homelessness. To better understand behavioral health and homelessness, we examined data from the California Statewide Study of People Experiencing Homelessness. Our latest report examines the relationship between homelessness, substance use, and mental health, providing critical insights for policymakers, program leaders, Continuum of Care leaders, and healthcare systems.

Research shows that people living in RVs want permanent housing but are hesitant to give up their biggest asset for a temporary shelter stay. Berkeley just closed a lonstanding encampme...

In January 2025, the City of Berkeley launched an innovative program to resolve the 2nd Street encampment by combining a low-barrier motel shelter with cash payments for residents’ RVs. Outreach workers built trust and tailored policies—allowing pets, partners, and friends—to boost participation. So far, 36 people and 26 animals have moved into the Capri Motel, and only three RVs remain on site. “The city designed this to really gain people’s trust and to make sure that people were not left worse off than they were when they started,” said Dr. Margot Kushel, calling the program “quite innovative.” BHHI is independently evaluating its impacts to inform future strategies.

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, and the city's Department of Public Health to distribute COVID vaccines and support packages. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said biotech companies have helped fund the efforts, allowing community-based organizations to hire trusted ambassadors to spread word about the vaccination events.

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."