Today we released the largest representative study on
#homelessness
in CA.
This groundbreaking independent research sheds light on causes, consequences & solutions to the crisis.
Here's what we found:🧵
🔗
#CAHomelessnessStudy
#CASPEH
@UCSF
CA Gov Newsom press conference now: 1) home isolation of all >65 and all w chronic conditions. 2) All bars, nightclubs, wineries closed. Restaurants--reduce occupancy by 1/2 w social distancing 3) HOMELESS: procuring hotels/motels/trailers for sites for unsheltered.
#COVID19
1/X
New guidance from
@CDCgov
on homeless
#COVID19
Unless individual housing units are available, don't clear encampments. Clearing encampments can cause people to disperse throughout the community and break connections with service providers.
We
@ucsfbhhi
are proud to partner w
@UCSFHospitals
&
@codetenderloin
to bring these vaccines to the TL every Saturday! Join us and spread the word! 12 and up—no preregistration needed!!
Why is there so much homelessness in SF? THIS “If you earn minimum wage in San Francisco you need to work 4.9 full time jobs a week to afford a fair market rent 2 BR apt.”(That is >hrs than exist in a week).
People who are homeless should not have to choose btw freezing to death &
#COVID19
1) prioritize homeless ppl & staff for vaccines 2) FEMA covers 100% housing costs for hotels—open them 3) enact & enforce true eviction prevention 4) HOUSING
We know how to end homelessness. All we lack is the will. The US has cut homelessness among veterans in half since 2010 by funding evidenced-based housing initiatives.
"Since 2010, the United States has cut veteran homelessness almost in half, providing a model for ending homelessness for all groups nationwide." Read more: via
@naehomelessness
Thrilled to be launching the
@ucsf
Benioff Homelessness & Housing Initiative. Grateful to Marc & Lynne
@Benioff
for their vision & generosity. There is no medicine as powerful as housing. We can & must end homelessness!
@ucsfcvp
@drjoshbamberger
"1,430 Bay dwellers would be homeless if not for their vehicles, according to a citywide homeless count ... by the San Francisco Chronicle. That displaced population is almost evenly divided between those living in
#cars
and
#vans
and people who own
#RVs
."
A🧵about
#COVID
vaccines. The
@ucsfbhhi
has spent last several mos working w great partners to provide vax to folks in the Tenderloin--including those who are homeless/formerly homeless. After providing 2500+vax to folks who face many barriers to vaccines--some thoughts: 1/x
Evictions have led to hundreds of thousands of extra
#COVID19
cases. 433,700 excess cases of
#Covid19
& 10,700 avoidable deaths. There is no way for a vaccine to be successful without addressing the
#eviction
crisis. Our study shows: housing is healthcare.
Boom. "It is clear who is truly unsafe b/c of homelessness & who just feels uncomfortable because of it. Instead of focusing on making communities safer from the homeless, we must keep the homeless safer in the community."
@MKushel
: “I’m pleading with you as a healthcare provider - we can’t do our jobs without housing… if you try to fix those other things without fixing housing, our hands are really tied behind our backs.”
Proud to be a “housing first advocate.” Other things I “advocate.” COVID vaccines are effective; cigarettes cause cancer; racism causes racial disparities; the earth is round. Am I “sensitive” or is there a touch of sexism in “sternly.” Maybe a woman w expertise is threatening?
With SF Prop C next week, lots of talk re: concerns
that ppl who are homeless will move to SF to receive services if SF spends more $ on services. As a homelessness
researcher, wanted to add what research (here & elsewhere) says about this
1/9
“The Initiative will promote the use of housing first, the proven theory that the best way to impact the life of a person experiencing homelessness is to offer housing without preconditions.” 👋🏼👋🏼👋🏼
NEW: White House press sec. Jen Psaki announces House America, a new government initiative to address homelessness.
“On any given night, more than half a million Americans were enduring the pandemic without the safety and protection of a home.”
This 100X, this: "Our homelessness crisis...is a policy choice. It is the foreseeable result of our thin and threadbare safety net and our refusal to turn the wealth of our society into a grant of decent housing, medical care and safety for all."
Substance use doesn't drive homelessness..."we would expect WV to have more homelessness per capita than CA." It doesn't. (Psst--it's housing costs)
@resnikoff
@ucsfbhhi
on what
@TheAtlantic
gets wrong in their
piece on meth and homelessness
“I worked all my life...until I hurt my knee...Never thought I would wind up in this parking lot.” Thanks to
@Kevinchron
@sfchronicle
for telling this story.
@UCSF
@ucsfcvp
Nearly half of older homeless people fell into trouble after 50
~5% of SF identify as Black American; 37% of those experiencing homelessness do. We cannot talk about homelessness w/o talking about structural racism.
Every time I give a talk about homelessness, ppl ask “why don’t they move” (& often suggest WY). Ppl living in poverty have strong social networks: family, friends, churches &, often, jobs. This is their home.
But people who don't have wealth often have at least this: social and family networks nearby. Suggesting they move to Kansas is asking them to live without both: financial resources or social support.
Thrilled that we just received the notice of award from the NIH for the next 5 years of the
#HOPEHOME
study--our ongoing study of homelessness among older adults in Oakland, CA.
Why are so many ppl homeless? Fed housing assistance about 1/3 of what it was 50 yrs ago; 1/4 households who qualify get housing assistance; national shortage of 7M affordable/available homes. That is why. Thanks
@dianeyentel
@nlihc
Analysis comparing data from 2017 & 2022 found areas with fast rent growth—Sacramento, Fresno, Raleigh, Phoenix, Austin, and Tucson—saw homelessness spike.
Places with slow rent growth—Minneapolis, Houston, Philadelphia, and Chicago—saw homelessness drop.
Housing First works. We have tons of evidence to support it. The problem is--we don't have the housing. The soln: we need to preserve, protect, produce housing for the lowest income renters. Happy to talk to
@BigadShaban
@nbcbayarea
about the evidence. 1/x
8) What about solutions?
One of the nation's leading experts on homelessness, Dr. Margot Kushel, says her years-long research in nearby Santa Clara County sheds light on what's needed to finally transform streets and lives in San Francisco.
Here's what she found:
@nbcbayarea
Giving a talk in So Cal. Talk before me, govt official quote my work (even my direct quotes) w/o citing me. But cites a man whose work is complementary to mine—and cites my findings as his. Name checks him, has his name on slides. My work attributed to him.
#womeninmedicine
SMH
Why do we view middle class folks make homeless by natural disaster differently than others? What would it look like if, instead of criminalizing homelessness, we treated it like disaster it is? Great piece by Dr
@jabarocas
. I would highlight/add a few things 🧵1/x
Federal and state support for those who lost their homes in the Marshall fire has been overwhelming...in contrast to support for those experiencing homelessness for other reasons. Why?
Housing first works. We simply haven’t brought it to scale. Do you know what the VA does for homeless vets? Housing First. They have more resources to do it. And guess what. While homelessness in every other population is ⬆️ homelessness in vets is ⬇️. Housing First works.
This policy change is v problematic. Don't be fooled by talk of ⬆️mental health. The reason homelessness has ⬆️ is bc the fundamental drivers of homelessness: income inequality, lack of deeply affordable ("ELI") housing & racism-- have worsened. A 🧵 1/x
Our paper, RCT on PSH for the highest user of healthcare is out
@HSR_HRET
. PSH w/ intensive case management ends homelessness for 86% of the highest users of multiple services. A lot of subtlety here. A 🧵
@mravenEM
@ucsfcvp
@ucsfbhhi
@ucsf
1/x
“CA’s (homelessness) crisis is due to the exorbitant cost of housing and the extreme shortage of housing available for the lowest-income households. Busting some myths in
@truthout
with the
@ucsfbhhi
#PublicVoices
@TheOpEdProject
A B.C. research project gave homeless people $7,500 each — the results were 'beautifully surprising'—less homelessness, less substance use, better health.
The 12% national increase of people experiencing homelessness underscores what
@ucsfbhhi
learned in our California statewide study: the homelessness crisis is driven by skyrocketing rents, flat incomes, and widening income equality.
Deeply honored to announce today the 2021 Woman of the Year for CA Senate District 9:
@MKushel
, a Berkeley resident and professor of medicine at UC San Francisco whose work on homelessness in Oakland and the Bay Area have garnered national acclaim.
Low income & minoritized populations ⬆️ risk of death from COVID d/t ⬆️ health prob(❤️, lung disease, DM) ⬆️ chance infxn (crowded housing , (homeless/incarceration!) front-line work) & ⬇️ access to care. Racism/poverty are lethal.
Why are so many ppl homeless in CA? We have 23 units of housing affordable & available for every 100 extremely low income renter: short 1M units. The '22 Gap report
@NLIHC
is a must read to understand the housing/homelessness crisis--and the work ahead.
Before COVID, I travelled a lot to speak about homelessness. Every community I went to believed that the ppl experiencing homelessness in their community came from somewhere else. It is our collective failure to own up to our own policy failures. (& racism)
Read & as I did--weep. And then scream. And then--take action. Mr. Curry: thank you for sharing your story. I am so sorry you had to go through this. (44% of homeless adults 50+ have never been homeless before age 50.)
Look at what happened when we gave housing vouchers to a lot of veterans.
Now imagine what *would* happen if we gave housing vouchers to every low income family.
Homelessness is a policy choice.
We vaxxed on street corners, stores, treatment ctrs, SROs. We served old folks, teens, homeless, workers--lots of folks face barriers to vax. It is on us to get vaccines to them. We used our local sites as hubs to vax those who could drop in & to support mobile teams-- 7/x
Shelter is NOT housing. It is costly & makes homelessness appear to go away, but doesn’t solve it. Strong OpEd in
@latimes
Btw: Solutions to homelessness that don’t center the needs (& opinions) of homeless ppl are unlikely to work...
We talk alot about vax "hesitancy" but--we found, access>>>hesitancy. We had small, local sites (
@GLIDEsf
& Boeddeker Park)--with great outreach/ no appts needed. Helpful for those who couldn't get to mass vax sites. Reached 100s of folx, but not enough: So, what worked? 2/X
Honored & excited for this new role. Grateful to build on the visionary work of Drs.
@KBibbinsDomingo
& Dean Schillinger & to work w amazing faculty & staff
@ucsfcvp
to reduce health disparities & seek health equity in clinic, community & policy
The
@UCSF
Center for Vulnerable Populations is excited to announce Dr. Margot Kushel
@MKushel
as our new incoming Director. So much ❤️for our co-founders Dr.
@KBibbinsDomingo
& Dr. Dean Schillinger for their vision to improve health & reduce disparities in at risk communities.
Rising homelessness is NOT due to a failure of Housing First/PSH.Rather, it is caused by the lack of affordable housing, rising income inequality & racism. via
@HuffPostImpact
Monica McLemore, associate professor of nursing at UC San Francisco, says that saving the lives of Black women requires medical teams listening to their patients.
Learn more in the newest
@Secondopinionla
:
So--just had a paper rejected after about a year of review and two rounds of revisions (so, third review) because it "wasn't a good fit for the journal." Fair enough---but shouldn't journal fit be one of those things you determine---before the third review of the same paper?🤷♀️
We didn't shame. We gave choices: J & J or mRNA & explained tradeoffs. Yes--we had some folx not want vax, but many changed minds when saw friends getting vax. Vax became a community event. The ppl we vaxxed became ambassadors/cheerleaders. Making vax visible helps! 6/x
It is amazing that every city thinks that homeless ppl r from somewhere else, despite data showing the opposite. I asked (homeless) participants in a focus group recently whether they would go elsewhere for services. Their answer: NO. This is my home.
Homeless populations are at ⬆️risk:⬆️ age, ⬆️ health conditions, can't stay"home," ⬇️ access to hygiene, info, healthcare. Desperate need for RESOURCES, coordination, housing. Fed response must include $$$ for
#homeless
#COVID19
(Housing is best medicine)
My bff
@marjoriesue
died on December 1 & I miss her more, not less, w each passing day. What joy, today, so send future pediatricians gifts from
#medgradwishlist
in her honor. I just wish that they could have all met & learned from her.
This week & always, I am grateful to the activists who led the fight for equal rights for people w disabilities. (& remembering that in '88-89, my college wouldn't submit my application to med school bc "no one would ever take anyone as sick as you")
#ADA30
#docswithdisabilities
@colleenmfarrell
My wheelchair was my wings. I was able to become a physician because of my chair (& colleagues/family/friends/mentors). Ppl would come up to me & say “I’m sorry” when they saw me in my chair. I would stare BC what they saw as a tragedy, I saw (& see) as a gift
Mobile teams! Teams, led by the incredible
@codetenderloin
--ppl w deep roots in community, lived expertise--w MD/NP or RN & "scribe." Teams walked around neighborhood and vaccinated folks wherever we found them. We answered ?s, supported ppls' choices--& when ready--vaxxed 3/X
"If we’re designing health apps for those who already have access to healthcare & stable housing, we’re missing the point." Why tech needs to listen to needs of diverse pops to improve health by
@sarahlisker
@ucsfcvp
@SOLVEhealthtech
via
@techcrunch
Doing this for last few months was a privilege. Working in TL--a neighborhood w challenges, but pulsing w life, amazing ppl and joy. Working w
@codetenderloin
@GLIDEsf
@SFCHC415
@UCSFHospitals
&
@SF_DPH
& 100s of volunteers was ♥️♥️♥️ The work continues...
Criminalizing homelessness is NOT a response---homelessness is d/t disinvestment in affordable housing, structural racism and widening income inequality. If the Feds provided funding for deeply affordable housing (w/services for those who need it), we could solve this crisis.
“If the federal gov is interested in helping, that's great...What they can start with is dramatically ⬆️ their financial support for affordable housing” CVP & Benioff Homelessness and Housing Initiative Director Dr.
@MKushel
@UCSF
@UCSFMedicine
@USATODAY
As Delta variant spreads--we shouldn't leave folks behind. SF is doing fantastically w vaccine--but those not vaxxed remain vulnerable--& many want vaccines, but have complicated lives. Mobile vaccines take alot of effort--but compared to preventing illness--it's worth it! 8/x
The longer people live on the streets, the more their health deteriorates. “There’s almost nothing as destructive to health as homelessness, and there’s very little that the health care system can do to make up for it,”
@MKushel
tells
@KHNews
Essential workers in overcrowded housing has fueled COVID19 pandemic. Structural racism fuels housing inequities & shortage of affordable housing. Housing justice is necessary for a healthy society.
💯There is no medicine as powerful as housing. Thrilled that
@RWJF
is focusing their annual message on the need for equitable and accessible housing in order to create health equity.
.
@RWJF
’s Annual Message focuses on an important health equity issue: Housing. 🏘️
We're highlighting housing because of the strong connection between where we live + our opportunities for health + well-being. Where we live may determine how long we live.
📢📢📢Blueprint for ending homelessness crisis from Houston, which has seen success. 1. Work collaboratively 2. Embrace Housing First 3. Focus on highest need ppl first.
Excited to dig into
@compatibilism
&
@ColburnGregg
“Homelessness is a Housing Problem. Glad to have read
@jenny_schuetz
“Fixer Upper” two weeks ago—thoughtful, brilliant books about homelessness & what to do about it…
📣 New
#HOPEHOME
paper in
@JAMAInternalMed
We studied mortality in 450 members of
#HOPEHOME
cohort. All were homeless & 50 years old + when we enrolled them (most enrolled 2013-14)
26% died by 12/31/21
A 🧵… 1/x
Today, our fierce but scrappy
@ucsfbhhi
@codetenderloin
teams did 42 COVID vaccines on the streets of Tenderloin w amazing help of
@UCSFHospitals
(who did many more at local park) Grateful for the partnership & chance to bring vaccines to where ppl are
Great piece--It (homelessness) isn't about mental health, it isn't substance use, it is HOUSING (and the lack of housing affordable to low income households). h/t
@jenloving23
More than half of the unhoused people staying at the SF shelter tested positive for Covid, with one shelter official saying it's the biggest outbreak she's seen since the early days of the pandemic.
Project RoomKey is important way to keep ppl experiencing homelessness safe during pandemic— Non congregate shelter (in hotels & trailers) for those at ⬆️risk. FEMA $s just extended. We need to maximize its use as COVID spreads in shelters (& unsheltered) environments
BREAKING NEWS:
@POTUS
&
@FEMA
have agreed to extend Project Roomkey funding until the end of 2021. This is major.
It means California can continue our life-saving homelessness work as COVID variants continue to spread, reimbursed 100% by the Feds.
This is NOT the answer to our country’s housing crisis. Amazing how often we hear it proposed by ppl across political spectrum. Basically internment camps for ppl victimized by our housing policy failures.
Miami commissioners voted to build a homeless camp on Virginia Key. No US city has ever concentrated people experiencing homelessness on an island - removing them from any chance at rehabilitation, public transportation and jobs to get them back on their feet. 1/
Remarkable article, written by a man who is currently incarcerated, on the immense challenges faced by ppl exiting prisons to obtain housing—with some solutions. We all thrive when we have housing for all.
@nytimes
The UCSF Benioff Homelessness and Housing Initiative is hiring an Executive Director! Looking for a skilled leader passionate about finding evidence-based, equitable solns to homelessness.
New article by
@emma_ava_lo
& colleagues examined >1.2 million national substance use disorder treatment records, found that 16% were. homeless at treatment entry and the large majority (69%) remained homeless at treatment discharge. (1/)
Working together,
@GLIDEsf
,
@codetenderloin
@SFCHC415
&
@ucsfbhhi
vaccinated ~ 100 ppl in the TL today--by bringing vaccines to the streets. Even in SF, nearing herd immunity, there are many unvax. To protect all, we need to take vaccines to where ppl are. It's that simple.
“We have to put the needs of the most affected Californians first. Our failure to provide and enforce workplace & worker protection has negated efforts to flatten the pandemic’s curve.”
@KBibbinsDomingo
& I write in
@latimesopinion
@ucsf
Read “Homelessness is a Housing Problem” start to finish yesterday. Strong recommendation for all interested in homelessness & what to do about it. Every policymaker & journalist covering homelessness should read it asap.
@compatibilism
@ColburnGregg
Excited to dig into
@compatibilism
&
@ColburnGregg
“Homelessness is a Housing Problem. Glad to have read
@jenny_schuetz
“Fixer Upper” two weeks ago—thoughtful, brilliant books about homelessness & what to do about it…
📢“The evidence is very clear. If a person has substance abuse challenges or mental illness, they are best able to address those from a stable, secure, affordable home” Thanks to the always amazing (& unflappable)
@dianeyentel
@NLIHC
speaking truth!
At last week’s hearing, Senator Vance said familiar mistruths about homelessness - that substance abuse is root cause & that homeless people should be required to address addiction before receiving housing assistance. I was very glad to respond for the record.
Berkeley CA 10A 9/9. Thinking of everyone impacted by the fires & of all the ppl experiencing homelessness who can’t just shut their windows to keep out the smoke & turn on their lights to keep darkness at bay.
Watch this. & remember, In CA, there are 22 units of housing affordable & available for every 100 households who earn <30% of area median income via
@NYTimes
"There have probably been tens of millions of injections people have done in these sites over the last 35 years," said
@alexhkral
"And no one has ever died of an overdose."
@NPR
reports on opening Safe Consumption Sites in CA
We used basic principles: 1) ensure equitable access 2) tailored approach 3) commit to being trustworthy. We answered ? honestly. We anticipated sxs & explained that these were expected/safe; gave care packages (socks,ibuprofen, drinks) 4/x
“The underlying drivers of homelessness are the lack of deeply affordable housing, income inequality and structural racism. It's going to be hard to solve this problem without effort from the federal government.” I’m quoted
@MorningEdition
ICYMI: 🔥🔥🔥commentary: If we care about ⬇️drug OD, we need to address homelessness: "the association between homelessness and drug use is bidirectional, & homelessness plays a role in drug use and OD risk"
@KellyMDoran
@callan_fockele
@Cella65
1/2
In the past week I've spoken to two people 70+ who are homeless for the 1st time in their lives and in a shelter because they've been evicted and can't afford anything else
Homelessness is increasingly striking people who thought it could never happen to them
#bcpoli
#Vancouver
“The goal should be to get everyone into permanent housing,” said
@resnikoff
, policy manager
@ucsfbhhi
. “If getting them sheltered doesn’t get you closer to that goal, then you actually haven’t solved anything.”