California’s homelessness crisis is a homegrown problem that is deepening amid a shortage of affordable housing and emergency shelter, and it’s often the brutal conditions of living on the street that trigger behavioral health problems, such as depression and anxiety, researchers found in a comprehensive study on homelessness. The new findings show that at least 90% of adults who are experiencing homelessness in the state became homeless while living in California. “This idea that homeless people are rushing into California is just not true,” said Margot Kushel, a physician who treats homeless people, and the lead investigator of the study for the UCSF Benioff Homelessness and Housing Initiative. “There’s so much myth-making around this magnet theory that people who are homeless flock to California, but this is our own problem.”

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.

Little is known about chronic pain in older adults experiencing homelessness. In this cross-section, population-based study, researchers interviewed 350 homeless individuals aged 50 years and older to assess factors associated with chronic moderate to severe pain. Overall, 46.8% reported chronic moderate to severe pain. Researchers suggest clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness.

Researchers examined whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization among older homeless adults. Using population-based sampling methods, the study enrolled 350 homeless adults aged 50 and older in Oakland, California. They found that childhood adversities are associated with poor mental health outcomes among older homeless adults. Researchers recommend screening for childhood adversities should be undertaken by all providers who care for older homeless adults.

Public policy and common perception have long tied the road to homelessness with mental illness and drug addiction. But a new study—the largest and most comprehensive investigation of California’s homeless population in decades—found another cause is propelling much of the crisis on our streets: the precarious poverty of the working poor, especially Black and brown seniors. “These are old people losing housing,” said Margot Kushel, MD, the lead investigator on the study and the director of the UCSF Benioff Homelessness and Housing Initiative.

In this qualitative study, UCSF BHHI researchers found that providing mobile testing, incentives, and trusted community members for outreach mitigated barriers to COVID-19 testing and v...

This toolkit offers guidance for researchers, advocacy groups, non-profit organizations, government agencies and others interested in, or currently engaging in, meaningful community-eng...

Deciding to live with intimate partner violence (IPV) instead of choosing a shelter is a complex decision. The UCSF Benioff Homelessness and Housing Initiative recently released a special report on IPV and homelessness. Anita Hargrave, MD, assistant professor at UCSF and co-author on the report, said, "Intimate partner violence can precipitate homelessness for many people, and is particularly dangerous for those that are at the economic margins."

The California Statewide Study on People Experiencing Homelessness researchers included people who were formerly or are currently experiencing homelessness. In this op-ed, Claudine Sipili, one of the Lived Expertise Advisory Board co-chairs, writes about the landmark study and her experience participating with the project. She writes, "Throughout the study, the board members’ guidance helped create a safe and dignified space for survey participants to share their experiences openly. By involving individuals with lived experience, we gained deeper insights into the complexities of homelessness."

As a board member of the UCSF Benioff Homelessness and Housing Initiative (BHHI) Lived Expertise Advisory Board that played a major role in the design and implementation of the California Statewide Study of People Experiencing Homelessness, my participation on the project was deeply influenced by my personal experience of homelessness. Having faced the challenges and uncertainties associated with housing instability firsthand, I have dedicated myself to making a positive impact and working towards finding lasting solutions for those facing similar struggles.

The median age of single homeless adults is over 50. Individuals who are homeless visit emergency departments (EDs) at higher rates than the general population. Researchers described the use of and factors associated with ED use in a sample of homeless adults 50 and older. They found that a sample of adults aged 50 and older who were experiencing homelessness at study entry had higher rates of ED use in the prior 6 months than the general US age-matched population. Within the sample, ED use rates varied based on individuals’ residential histories, suggesting that individuals’ ED use is related to exposure to homelessness.

Our Encampment Prioritization Tool is designed to help communities navigate the complex landscape of homelessness. By balancing the urgent need to address encampments with the chronic shortage of housing and shelter resources, along with health and safety considerations, this tool guides stakeholders in making informed decisions. It ensures that actions prioritize housing and shelter placements over displacement, aligning with broader systemic reforms to effectively manage and resolve encampments.

Encampment resolution is a strategic approach focused on connecting unsheltered individuals to stable housing rather than displacing them through sweeps. This method employs evidence-based practices to connect people with housing solutions and prevent re-encampment, involving a wide range of stakeholders to address both the needs of the encampment residents and the community’s broader concerns.

This research letter discusses the experience of violence during homelessness, its impact on health, and recommendations for intervention. In the California Statewide Study of People Experiencing Homelessness, 38% of participants experienced violence during their current homelessness episode, and 74% of participants reported experiencing violence at some point in their lives. These results highlight the need to address violence against people experiencing homelessness through safer housing options, trauma-informed care, and long-term violence prevention strategies.

Researchers evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. They conducted structured interviews and neuropsychological testing with participants. Older homeless adults displayed a prevalence of cognitive impairment 3–4 times higher than has been observed in general population adults aged 70 and older. Future research will be helpful in clarifying whether treatment of alcohol misuse leads to improvements in cognitive function and whether specific treatment strategies are more effective in this population.

The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. Researchers conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. They found older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.

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...

Older homeless-experienced adults are at higher risk of loneliness than general older adults, yet less is known about the factors contributing to loneliness for this group. Loneliness is associated with multiple adverse health and mental health outcomes. This study examines this gap in our knowledge.

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.

The prevalence of substance use decreases as individuals age, but older adults now have a higher prevalence of substance use than older adults did 10 years ago. People experiencing homelessness have a higher prevalence of substance use disorders compared to the general population. In this cohort study, researchers examined the prevalence of and factors associated with substance use in a population of homeless individuals aged 50 and older. They found a high prevalence of substance use and an association between psychiatric hospitalization and depression with substance use. Researchers also recommend targeted treatment programs and geriatric substance use workforce development.

People experiencing homelessness are at an increased danger of dying. A recent study by the National Bureau of Economic Research showed a 40-year-old person experiencing homelessness has a similar risk of death as a 60-year-old person with housing. Previous studies have also found that people who experience homelessness have a greater mortality risk. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re letting people die because we’re not fixing the underlying crisis."

Older homeless adults living in shelters have high rates of geriatric conditions, which may increase their risk for acute care use and nursing home placement. In this cohort study, researchers interviewed homeless adults aged 50 and older to determine the prevalence of common geriatric conditions and if the prevalence of these conditions differs across living environments. Researchers found geriatric conditions were common among older homeless adults living in diverse environments.

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

A groundbreaking UCSF BHHI study challenges common perceptions about drug use among people experiencing homelessness. Researchers found that less than half of this population regularly used drugs, with methamphetamine being the most common substance, not opioids. Many respondents wanted treatment but struggled to access it, highlighting barriers to care. The study emphasizes that homelessness and substance use are interconnected and advocates for reducing barriers to treatment and prioritizing housing solutions. "We need to reduce barriers to substance use treatment, and that includes prioritizing people’s ability to return to housing,” said BHHI faculty member Ryan Assaf, PhD, MPH, the study’s lead author.

A comprehensive new study finds the vast majority of the California's unhoused residents lived in the state before losing their housing. The goal of the report was to take a systematic approach to understanding the causes of homelessness and potential solutions instead of relying on the emotional responses the crisis can trigger, said study author Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “What we were trying to do is take the rhetoric down a bit, and using really scientific best practices, to get a handle on not only who was experiencing homelessness but what was happening in their lives before they became homeless,” Dr. Kushel said.