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.

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...

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.

Cancer is the leading cause of mortality for people experiencing homelessness (PEH). However, not much is known about cancer-related surgical outcomes among PEH. This retrospective cohort study aimed to characterize access to care among PEH, evaluate postoperative outcomes, and assess costs associated with surgery for malignancy among PEH. Researchers found that PEH were less likely to undergo surgery for malignancy at cancer centers than hose who are housed. People experiencing homelessness also had a higher risk of requiring unplanned surgery.

Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, talks about aging, the structural and individual factors that contribute to homelessness, and much more in the GeriPal podcast with Eric Widera, MD, and Alex Smith, MD, MPH, MS. During the conversation, Dr. Kushel said, "I like to say homelessness is a state and not a trait. It’s not an intrinsic quality of a person. It is an experience that they go through."

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.

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.

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.

A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness found that nearly half of California's homeless population is now 50 and older. These older adults are staying homeless for longer and are in poorer health than their younger peers. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, said, "These are people living on fixed incomes, on disability, on really meager pensions, and they really need housing that they can afford."

In this cohort study, UCSF BHHI researchers found that most older homeless-experienced adults needed caregiving assistance and few received such assistance. Interventions that increase caregiving access for homeless-experienced individuals may help avoid poor health outcomes and costly long-term care needs due to untreated disabilities.

Patients with prolonged hospitalizations often require alternative levels of care (ALC) and there stays strain hospital capacity and patient flow. This study aimed to descriptively compare prolonged ALC and short ALC. Researchers found that patients with prolonged ALC were more likely to be older and have experienced homelessness. Furthermore, prolonged ALC patients were more likely to be admitted for acute care and had greater psychosocial complexity.

This study from BHHI researchers describes five distinct subgroups of the highest users of the health care system in San Francisco with differential comorbidities, health care needs, and social determinants of health, spanning from patients with medical comorbidities solely using medical services to patients grappling with housing insecurity, incarceration, substance use disorder, and mental health comorbidities. Frequent users of the health care system are not a homogenous population as previously thought. This study sheds new light on how to help the most vulnerable patients and inform clinicians and care coordination teams on making sure patients get the care they need the most. 

This UCSF study found that adults experiencing homelessness have a high risk of incarceration. The authors emphasize the need for targeted interventions addressing substance use, homele...

In this long-term study of 450 homeless adults age 50 and older, BHHI researchers examined how factors like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected participants' risk of dying. They found that 26% of the participants died within a few years of being enrolled, and people who first became homeless at age 50 or older were about 60% more likely to die than those who had become homeless earlier in life, and those who remained homeless were about 80% more likely to die than those who were able to return to housing. These findings illustrate an urgent need for policy approaches to prevent and end homelessness among older adults in the United States and suggest that addressing older adults’ barriers to health care and high rates of institutionalization may prevent premature mortality.

Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naive or experienced people with human immunodeficiency virus (HIV; PWH). The researchers performed the first LAI-ART demonstration project to include PWH unable to achieve or maintain viral suppression due to challenges adhering to oral ART at San Francisco's Ward 86. Researchers found preliminary short-term effectiveness of the treatment. More data on LAI-ART in hard-to-reach populations are needed.

The aging of the homeless population is a stark demographic shift. Margot Kushel, MD, the director of the Benioff Homelessness and Housing Initiative, found that unhoused people have the health profiles of patients two decades older, with similar rates of incontinence, dementia, and falls. Respite care, a temporary, short-term, 24-hour supervised care for seniors, is rapidly growing for people experiencing homelessness, reflecting the aging of the unhoused population.

In this qualitative study, UCSF BHHI researchers interviewed older unhoused adults to understand how structural determinants affect stays with family members among individuals experienc...