Recent studies have highlighted how the pandemic has eroded an already frayed safety net for young people experiencing homelessness. Colette Auerswald, MD, a professor at UC Berkeley’s School of Public Health and UCSF Benioff Homelessness and Housing Initiative noted that young people from marginalized communities are more likely to face structural failings that lead to homelessness.

The point-in-time count offers a snapshot into the scope of homelessness in different communities, but most experts agree that the methodology is inaccurate and flawed. In this forum, Sydney Johnson speaks with experts to demystify the counting process and understand this year's numbers. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We learned a lot about what we can do when we treat homelessness like the crisis that it is."

Substance use and homelessness have become synonymous in recent years. But what is the actual relationship between the two? Does problematic substance use cause homelessness or does homelessness increase someone's use of substances? In this episode of HOMELAND, a 10-episode series that brings clarity to the homelessness crisis, host Ben Kay speaks with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and other system and healthcare leaders to discuss how homelessness and substance use interact, dive into how the U.S. has historically addressed substance use, and explore if there’s a better way forward.

In this op-ed, Claudine Sipili, one of the California Statewide Study of People Experiencing Homelessness Lived Expertise Advisory Board co-chairs, highlights the intensifying homelessness crisis impact on families in the US. She writes about her own experiences, emphasizing the need to put real-life stories and perspectives front and center. "As a nation, there is an ethical imperative to ensure every family has a safe, stable home. This is about restoring fundamental human rights that allow communities to thrive, not handouts or government overreach." Ms. Sipili writes. 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.

Researchers at UCSF Benioff Homelessness and Housing Initiative have released the largest representative survey of homeless people in more than 25 years. Researchers surveyed over 3200 people experiencing homelessness in California, and conducted over 300 in-depth interviews. The California Statewide Study on People Experiencing Homelessness paints a different picture, debunking common myths and providing evidence-based solutions.

In this op-ed, Morgan Philbin, PhD, MHS, associate director at the Benioff Homelessness and Housing Initiative and director of the Educations Program, highlights the lack of tailored programming and shelters where LGTBQ+ youth feel safe, resulting in youths feeling safer on the streets. She calls for state and local governments to invest in tailored services to support LGTBQ+ teenagers and youth. Dr. Philbin writes, "These programs should coordinate with each other to most effectively deliver the services within their expertise, while simultaneously ensuring every young person has their needs met." 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

Some homeless shelters now offer resources so that people can squeeze in with family members. This diversion approach was pioneered by the Cleveland Mediation Center around 20 years ago. The approach is not for everyone, but it is meant to catch people before they slip into the shelter system. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Even if it doesn’t work for everybody, if it works for a certain percentage, it’s likely worth it."

Formerly chronically homeless adults who live in permanent supportive housing (PSH) have a high prevalence of smoking. Smoke-free policies and smoking cessation services are among the most effective tobacco control interventions, but these policies are uncommon in PSH. Researchers outline a protocol for a cluster-randomized wait-list controlled trial to evaluate the efficacy of the same smoke-free home intervention on the primary outcome of voluntary adoption of a smoke-free home.

In this op-ed, Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, highlights that those who are often living in homeless encampments are frail older adults. She outlines the health impact of homelessness on aging and why so many older adults are experiencing homelessness. "Now is the time to create an America that doesn’t abandon its elders. In doing so, we will not only improve the world for those experiencing homelessness, but create a future that is better for all." Dr. Kushel writes. 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.

Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. The study aimed to characterize the experience, understanding, and management of physical, psychological, social (e.g., loneliness), and existential (e.g., regret, loss of dignity) symptoms among older homeless adults. Researchers conducted semistructured interviews from June 2016 to March 2017 with a purposive sample of participants from the Health Outcomes of People Experiencing Homelessness in Older Middle Age cohort, a longitudinal study of homeless adults aged 50 and older. They found that homelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering.

The UCSF Benioff Homelessness and Housing Initiative released a special report on Intimate Partner Violence (IPV) and homelessness. The report found that 8 percent of the unhoused experienced IPV, a more formal term for much domestic violence, including 17 percent of all women living on the streets or in homeless shelters. Domestic violence causes and prolongs homelessness. More should be done to prevent domestic violence.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, delivered the Harvard Joint Center for Housing Studies’ 23rd John T. Dunlop Lecture. Dr. Kushel spoke about the impact that homelessness has on an individual’s quality of life, highlighting the lived experiences of unhoused Californians who participated in the California Statewide Study of People Experiencing Homelessness. After the lecture there was a panel, featuring, Boston Healthcare for the Homeless founder, Harvard Medical School professor James J. O’Connell, and Peggy Bailey, a leader of a housing policy research center. JCHS Managing Director Chris Herbert, the moderated the panel. Dr. Kushel said, "While it is really easy to blame people impacted by homelessness, doing so not only is not fair or right, but it also isn’t going to get us any closer to a solution."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted in this article describing how, despite detailed statistics on the demographics and comorbidities of the nation’s more than 500,000 COVID-19 deaths, it is unknown how many of those deaths occurred among unhoused people.

For the California Statewide Study on People Experiencing Homelessness, the largest study on homelessness in California since 1996, the research team included people who were formerly or are currently unhoused residents in California. The CASPEH Lived Expertise Advisory Board members at the UCSF Benioff Homelessness and Housing Initiative provided input on survey questions and planned outreach to people experiencing homelessness. Robynne Rose-Haymer, CASPEH Lived Expertise Advisory Board representative, said, "We did extensive training with our interview team, not just in being trauma-informed, but in being empathetic listeners and approaching everyone with dignity."

Becoming homeless is an extreme example of the financial squeeze on caregivers. In the early 2000's research revealed people experiencing homelessness in California were getting older. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and her team found that older homeless adults who occasionally stay with a family member were actively caregiving. Dr. Kushel said, "These were folks who had left behind something to go care for mom, and then the bottom falls out."

A special report, released by UCSF Benioff Homelessness and Housing Initiative, explored the relationship between intimate partner violence (IPV) and homelessness in California. Findings from the report showed how violence and economic insecurity can be intertwined. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "There are only so many places you can hide when you’re unsheltered."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was interviewed on KQED's Forum along with other guests providing an update on programs to help the homeless during the pandemic and what’s being done to ensure permanent solutions to the housing crisis.

More than 3,000 of the 11,500 people who died while unhoused in Los Angeles County between 2014 and 2023 were 60 and older. This crisis has grown over time. In a groundbreaking study on homelessness in California by Benioff Homelessness and Housing Initiative researchers found that nearly half of unhoused adults were age 50 and older. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They talk about how ashamed and stigmatized they feel – they know the public thinks they’re bad because they’re outside. And they just feel incredibly alone in the world."

One hundred tiny home villages for people experiencing homelessness have opened in the US over the past five years. However, tiny homes, built mainly with philanthropic support, offer more patches than solutions to homelessness. Tiny homes can be built quickly, but issues with securing permits, financing, and local government approval can add costs and delays. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I would say that tiny homes are an absolutely important part of the ecosystem, but they are not housing."

Tobacco-attributable deaths contribute significantly to the increased mortality observed among homeless adults aged 50 years or more. In this longitudinal cohort study, researchers examine smoking behaviors and factors associated with smoking cessation among homeless individuals aged 50 years or more. Researchers found tobacco use in older homeless adults and rates of quit attempts were similar to that observed in the general population, but successful quitting was lower.

Over 70% of people experiencing homelessness report current tobacco use, compared to 14% in the general population. One of the structural barriers that hinder cessation attempts among people experiencing homelessness is inadequate access to health care and other smoking cessation services. Researchers in this study aimed to explore tobacco use behaviors and factors influencing acceptability of engaging in a clinical trials. Researchers found that participants had attempted to quit smoking, and were interested in engaging in clinical trials as a method to quit smoking.

People experiencing homelessness have significantly lower life expectancies than the general population, and among those aged ≥ 45, tobacco-related illnesses are the leading cause of death.[1] Compared to the general population, tobacco use among people experiencing homelessness is six times higher, and the quit ratio (ratio of former to ever-smokers) is five times lower. [2],[3] We used the largest representative study of people experiencing homelessness since the 1990s to estimate tobacco use prevalence and its association with shelter status, behavioral health, and health services use among adults experiencing homelessness in California to identify opportunities to address unmet tobacco treatment needs.