Margot Kushel MD Profile picture
Jul 19, 2018 7 tweets 3 min read Read on X
Homelessness among older adults reaching crisis proportions. Our study, #HOPEHOME has been examining this/warning about this for years. Surge in number of older homeless people catches L.A. officials off guard latimes.com/local/lanow/la…
44% of ppl 50+ who are homeless experienced homelessness 1st time after age 50. These folks have different needs then those homeless since early life, but all have significant suffering & need our compassion. 2/ journals.plos.org/plosone/articl…
And need effective solns. Need to tailor #permanentsupportivehousing to the needs of older adults & need effective age appropriate housing for those newly homeless. We need to focus on prevention as well--if we don't "close the front door" to homelessness, we won't solve it 3/
LTSS programs that pay for services to keep ppl out of nursing homes need to be adjusted to needs of ppl experiencing homelessness. We have found what article states: many ppl exp homelessness receiving or providing IHSS-type services, but can't get paid bc don't have a home 4/
That doesn't make sense--& will lead to ppl needing nursing homes, when they could live in the community. We need to rethink personal care for this pop & should be looking at programs like @sarah_szanton #CAPABLE program as models 5/
The suffering caused by failed housing policies is unfathomable--and falls heavily on older adults who are black--because of the effects of #racism. Letting older adults suffer (& die) homeless is unacceptable. It is costly in every sense--human & financial. 6/
#housingisthebestmedicine. We know what to do---let's do it. /end

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More from @MKushel

Mar 25, 2022
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
Discussed our eval study w @mravenEM @DSTNHome @SCCgov @abode_services @ucsfbhhi which showed that even the "hardest to house" ppl could be housed FOR YEARS w/o preconditions 2/x

hsr.org/node/664701
We gave Abode, SCC a list of the folks who were homeless who faced the most challenges (⬆️use of hospitals, ED, jail, psych, etc)--and randomly assigned folks to Housing First Permanent Supportive Housing w "intensive case management"--a master's trained counselor (e.g. LCSW) 3/x
Read 16 tweets
Jul 14, 2021
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 Bright mural on wall, tree holding homes with inscription: E
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 Sunny day, blue topped tends on city street with ppl in them
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 Ppl. casually dressed, masks--cart with bright pink sign &qu
Read 9 tweets
Oct 19, 2020
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
bit.ly/3dF5Sdn
Housing First has a strong evidence base. Our recent study showed it successfully housed 86% of the "most difficult" to house chronically homeless ppl w high rates of substance use and mental health disabilities. hsr.org/node/664701 2/x
Read 12 tweets
Sep 25, 2020
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 onlinelibrary.wiley.com/doi/full/10.11… 1/x
Multi-year RCT comparing PSH (subsidized housing, mostly scattered site; ICM 1:15 master’s trained led team by @abode_services) vs usual care for chronically homeless ppl who were highest users of acute healthcare/jail in @sccgov 423 participants (199 intervent/224 control). 2x
Inclusions: chronic homelessness; highest users of services. Ineligible: engagement other program, req nursing home, hospice eligible. We created risk score/triage tool to calculate highest users (mult criteria). Triage tool calculated continuously & flagged in records. 3/x
Read 20 tweets
Jul 7, 2020
Thrilled to be listening to @nhannahjones & Marla Newman, Chair BOD @NLIHC on #RacialEquityAndCOVID from lens of housing/homelessness!
Image
& @nhannahjones spelling out how control of housing was mechanism of social control in North (racial covenants, redlining)."You don't have to pass laws saying Black ppl couldn't go to school with White ppl if you control where they live--& create neighborhood schools"
Read 26 tweets
May 15, 2020
Must read editorial in @nytimes on #homelessness that lays out the problem, where blame lays, & solution--"The fed govt could render homelessness rare, brief & nonrecurring. The cure for homelessness is housing." (YES!) A thread 1/x @BCAppelbaum

nytimes.com/2020/05/15/opi…
1. Problem is housing (not individual vulnerabilities) 2. Federal govt (& realistically, only Fed) could solve it 3. Instead, feds heavily subsidize wealthy homeowners, instead of low-income (mortgage interest tax deduction means homeowners live in deeply subsidized housing) 2/x
4. We spend $12 Billion a yr on shelters (shelters are dangerous, difficult places (#COVID19 has made this more evident cdc.gov/mmwr/volumes/6… , but as CA Gov @GavinNewsom says: "shelters solve sleep, housing solves homelessness) & 1/3 (in CA 2/3) unsheltered) despite $12B 3/x
Read 12 tweets

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