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 a 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.

In this UC San Diego Department of Medicine Grand Rounds, Margot Kushel, MD, one of the world’s leading experts on homelessness, discusses why the homeless population is aging, the health consequences of aging in the homeless population, and possible interventions and solutions. Dr. Kushel is a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative.

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."

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.

The UCSF Benioff Homelessness and Housing Initiative collaborated with Kaiser Permanente and the National Health Care for the Homeless Council to provide guidance on COVID-19 screening in congregate shelters.  The Antigen Testing in Congregate Shelters: Process Outline and Implementation Playbook provides key strategic planning and operational considerations for screening using inexpensive rapid-testing solutions in lieu of PCR-only testing. To better protect people experiencing homelessness from the impacts of COVID-19, local health jurisdictions, health care service providers, and congregate shelter sites can use this guidance to coordinate operational needs and processes while implementing a screening testing program.

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...