A record number of seniors are burdened by high housing costs. A new report from University's Joint Center for Housing Studies sounds the alarm as the US population ages rapidly. The number of seniors who will qualify for federal housing subsidies will continue to grow. The report also notes that more people over the age of 50 are losing housing for the first time. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Increasingly, the story of homelessness among adults is going to be older adults living in poverty, who are spending what should be their retirement years in the streets."

The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. This study aimed to describe the access to and use of mobile phones, computers, and the Internet among a cohort of 350 homeless adults over the age of 50 years. Researchers found that participants with phones used them for social support and communication with healthcare providers; however, few had annual phone contracts.

In this podcast episode of Clinical Changemakers, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, spoke with host Jonathan Hoogerbrug, MD about the moral injury of being a frontline clinician and having to discharge people back onto the streets. Dr. Kushel also elaborates on her landmark research into Homelessness in California, highlighting the moral, medical, social and economic impact that that this issue has on those individuals, their families and society as a whole. Dr. Kushel said, "The people who are most impacted, obviously, are those experiencing homelessness and the impacts for them are just incalculably horrible. But it impacts everybody." She adds, "There are huge costs to society. There's the intangibles, like loss across the business, community, to tourism. There's the moral injury. What do we say to our children about what does it mean to grow up in a place where so many people are so visibly suffering?"

Traumatic injury is a leading cause of hospitalization among people experiencing homelessness. In this retrospective cohort study of the American College of Surgeons Trauma Quality Programs (TQP) researchers evaluated whether homelessness was associated with increased morbidity and length of stay (LOS) after hospitalization for traumatic injury. Researchers found that challenges in providing safe discharge to people experiencing homelessness after injury may lead to prolonged LOS.

A guest column by Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Kevin Prindiville, JD, looks at the rise in homelessness among people older than 50: “With rising housing costs, fewer pensions, and a fraying safety net, many older adults are one crisis away from losing the roof over their head.”

A growing number of people, many of them older and homeless, are freezing to death during winter. In 2023, 166 Californians died from hypothermia, double the number who died in 2015. People who experience homelessness are particularly susceptible to hypothermia because so many older, vulnerable adults live outside, where they are exposed to the weather. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "A changing climate, more temperature extremes, more soaking rains — people are older and thus unable to even tolerate it, so they get much sicker, faster."

The new, unlikely face of homelessness: Working Americans with decent-paying jobs who cannot afford a place to live. Years of rising rents and a shortage of affordable housing have created a situation where even a strong labor market and rising wages haven’t been enough to offset the financial strains of inflation. About 1 in 4 renters spend at least half of their income on rent and utilities, making them at greater risk for eviction and homelessness. Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative at the University of California at San Francisco, said, "The general public doesn’t see these folks as homeless — they’re not as visible as the people who occupy public spaces, who have substance abuse issues or mental health problems."

Among people experiencing homelessness in California, the group rising the fastest by proportion is older adults. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness highlights their experiences during homelessness, and what impacted their return to permanent housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The dramatic rise in homelessness among older adults has severe consequences for the health and safety of those who experience it and for our society at large. Now is the time for investments in real solutions to prevent and end homelessness among this vulnerable population."

This radio program takes an in-depth look at how more people experiencing homelessness in Las Vegas are now living in vehicles. UCSF Benioff Homelessness and Housing Initiative Postdoctoral Scholar Graham Pruss, PhD, describes how BHHI research in Oakland showed that people living in vehicles need a variety of temporary and long-term parking spaces, which could mean safe parking programs and long-term supportive parking programs. Pruss noted it can take months or even years for a transition into permanent housing.

This UCSF study examined deaths among people experiencing homelessness in San Francisco from 2016 to 2018. Although heart disease and cancer are the first and second causes of death for California’s general population, the leading causes of homeless deaths were acute intoxication (unintended overdose) and trauma (including homicide and suicide rates over triple that of the US general population). The authors advocate that these differences in cause-specific mortality should inform death prevention efforts within the homeless population differently than the general population.

This study from UCSF BHHI researchers examined deaths among people experiencing homelessness in San Francisco during the first year of the COVID-19 pandemic. They found 82% of 331 deaths were associated with drug overdose, not COVID-19 infection. Traumatic injury, including homicide and suicide, was the second most common cause of death. This research highlights a need for strategies that address both homelessness and drug use, including housing, evidence-based treatment of opioid addiction, and overdose prevention programs.

In this op-ed, Marguerita Lightfoot, PhD, MA, Associate Dean for Research at the OHSU-PSU School of Public Health, highlights the need to make youth experiencing homelessness more visible. She outlines that the estimates of youth experiencing homelessness are vastly underrepresented. Youth experiencing homelessness are often not in the locations that are surveyed. Dr. Lightfoot writes, "It falls to HUD and lawmakers to make the invisible, visible — to look for and truly see young people experiencing homelessness." 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 Los Angeles, 85 people experiencing homelessness were murdered last year—the highest number ever recorded, according to LA Police Department data. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, noted that the trend of unhoused homicide victims may seem contrary to what many think of when discussing homelessness. Countering the common misperception that unhoused people are dangerous, she explained how people experiencing homelessness are vulnerable to violent crime. Dr. Kushel said, "What I hear when I spend time with many people experiencing homelessness is how terrified they are and how terrifying the experience is, and this is layered on top of a public who is afraid of them."

On this podcast episode of Factually! with Adam Conover, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Adam Conover to discuss the findings in the California Statewide Study of People Experiencing Homelessness and dispel myths related to homelessness. The number of people experiencing homelessness has reached a record high in the US. "You are not seeing the 12 people to a room because that's invisible to those who are lucky enough not to experience that."

Among people experiencing homelessness in California, nearly half of the population is now over the age of 50. By 50, a homeless person’s health more closely resembles that of someone in their 70s, with a higher chance of chronic disease, mobility issues, and cognitive decline, according to a recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We could meaningfully reduce the number of people experiencing homelessness if we focused on this group."

The homeless population in the United States is aging, however, there is limited studies on the neurologic etiologies of cognitive impairment in this population. Researchers observed a wide range of focal neurological deficits in the study participants, most notably deficits in cranial nerve function, motor function, coordination, and peripheral sensory functions. This study lays the foundation for the development of a longitudinal study of neurocognitive health among unhoused older adults in San Francisco.

This landmark gift for the first-of-its-kind initiative aims to decrease homelessness by rigorously examining and evaluating what is known about homelessness and answering unresolved questions about effective intervention strategies. The initiative will work to translate policies into action.

Over the weekend, Ned Resnikoff had an op-ed in the San Francisco Chronicle considering California’s homelessness crisis in light of its similarities to the climate crisis. One theme in this piece is the need for federal intervention. California has long been a leader among U.S. states on climate policy, and in recent years it has started to make significant progress in developing effective programs to prevent and end homelessness.

A landmark study by UCSF Benioff Homelessness and Housing Initiative (BHHI) paints a different picture on people experiencing homelessness in California. The report released in June 2023, examines the demographics of people experiencing homelessness in California, how people enter and experience homelessness, factors that block or enable a person’s return to housing, and policy recommendations.

Homeless people in California are already a vulnerable group, often struggling with poor health, trauma and deep poverty before they lose their housing, according to a new study on adult homelessness. The study attempts to capture a comprehensive picture of how people become homeless in California, and what impeded their efforts at finding permanent housing. Researchers at the UCSF Benioff Homelessness and Housing Initiative hope that the study will strengthen public support for policies that focus on offering housing and emergency rental assistance—rather than policies emphasizing punishment or stigma. “People are homeless because their rent is too high. And their options are too few. And they have no cushion,” said Margot Kushel, MD, UCSF's BHHI director and lead investigator. “And it really makes you wonder how different things would look if we could solve that underlying problem.”

Homeless people in California are already a vulnerable group, often struggling with poor health, trauma and deep poverty before they lose their housing. Lead investigator of the new study, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, spoke with KTLA's the reports findings. Dr. Kushel said, "the main drivers of homelessness are deep poverty."

A new study from authors at the San Francisco Department of Public Health the UCSF Benioff Homelessness and Housing Initiative showed that San Francisco’s early use of isolation and quarantine hotels for unhoused residents who showed symptoms of or had been exposed to Covid-19 may have significantly freed up hospital capacity and prevented transmission.