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.

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.

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.

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.

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.

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.”

Black Californians make up only 7% of the states population, but make up more than 25% of the state's population of people who experience homelessness. The number is higher in Sacramento County, where 31% of the population experiences homelessness. The obstacles to housing, employment, income and health care that Black Californians have historically faced are also among the pathways to homelessness. "The situation for unhoused Black Californians is dire, but it is not insurmountable,” said Tiana Moore, PhD, the report’s co-author.

This New York Times article reports on increasing deaths among people experiencing homelessness and highlights a recent JAMA Network Open study from BHHI researchers. BHHI faculty members Maria Raven, MD, and Margot Kushel, MD, are quoted.

Safe Ground Sacramento is a nonprofit that advocates for the decriminalization of homelessness and the establishment of Safe Ground communities. In March 2023, Safe Ground Sacramento signed a lease with the city of Sacramento. Under this agreement, the city cannot close Camp Resolution until every resident has been placed in "individual permanent durable housing." The agreement with the city is set to expire in June and the city has decided not to request an extension. This is the fourth installment of a 4 part series exploring solutions to homelessness in California.

California state lawmakers say they need more tools to help get people experiencing homelessness into treatment, debating the use of involuntary commitments. Homelessness is caused by a lack of affordable housing, not mental illness. “The problem of homelessness is that people don't have housing. If you had all the treatment in the world and you didn't have the housing, we would still have this problem,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

As the coronavirus alters daily life for many Californians, state leaders are facing the confluence of two public health challenges: the virus and homelessness. “What you are seeing is two crises—homelessness and the virus—collide,” says Margot Kushel, MD, director of the Center for Vulnerable Populations at UCSF.

There is a massive shortage of affordable housing for people with very low incomes in California. Only 24 units of housing are affordable for every 100 extremely low income households in California, compared to 33 units nationally. To address the housing crisis, the statewide study on people experiencing homelessness recommend a variety of policies to increase affordable housing and provide more effort to prevent people from becoming homeless. "This is all about the disconnection between people’s incomes and housing costs" said Margot Kushel, MD, a physician who treats homeless people, and the lead investigator of the study for the UCSF Benioff Homelessness and Housing Initiative.

California is home to 30% of the nation's homeless population, and 50% of the nation's unsheltered population. The UCSF Benioff Homelessness and Housing Initiative released the largest representative study on homelessness in decades. The study's findings dispel common myths and take a systematic approach to understanding the causes of homelessness and potential solutions. Inside the Issues host Alex Cohen speaks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, about the landmark study and the root causes of homelessness. When talking about older people experiencing homelessness, Dr. Kushel said, "The story of homelessness in California is really older adults, usually older adults of color, living their last years on our streets."

Public policy academics Pamela Herd and Don Moynihan have an interesting brief in Health Affairs on how administrative burdens can harm the health of low-income people. Herd and Moynihan quite literally wrote the book on administrative burdens, so their work on the subject is always worth a look.

When pandemic aid programs begin expiring at the end of September, advocates worry that San Francisco’s most vulnerable homeless women will once again be left behind. Margot Kushel, MD, discussed the rate of violence impacting homeless seniors, women, and transgender people. After two decades of studying high rates of assault and the health impacts of homelessness, she has watched Bay Area seniors placed into hotels during the pandemic transform, to the point where staff didn’t recognize some of them. “It’s been a life-changing experience,” Dr. Kushel said. “When people regain housing, everything gets better.”

San Francisco and California have been reckoning with the issue of housing instability for years, but additional complexities arise as people experiencing homelessness grow older. In this Grand Rounds, Margot Kushel, MD, one of the world’s leading experts on homelessness, discusses the drivers and precipitants of homelessness and the health consequences of aging in the homeless population. Dr. Kushel is professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative.

In this Grand Rounds at Dartmouth Medical School, Margot Kushel, MD, one of the world’s leading experts on homelessness, discusses the drivers and precipitants of homelessness, the demographics of homelessness, and the health consequences of aging in the homeless population. Dr. Kushel is a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative.