Tailoring medical care for the homeless

December 28, 2016, University of California, San Francisco
Margot Kushel, MD, visits David Sandow at his home in the Mission Creek Senior Community. Sandow, who was homeless until 10 years ago, found the low-income housing with Kushel’s help. Credit: Noah Berger

When Margot Kushel, MD, first met David Sandow 13 years ago at Zuckerberg San Francisco General Hospital (ZSFG), he was homeless and sleeping in a van despite having had one bypass surgery and needing another.

Kushel's first interaction with Sandow was helping him to receive the medication he needed. But her assistance didn't end there – she eventually aided him in finding low-income housing in Mission Bay.

Sandow, who now has been in the housing for 10 years, said he couldn't have turned around his life without the consistent help from Kushel.

"I became a different person in meeting her," he said. "All of this wouldn't have happened without Dr. Kushel – without her efforts and her persistence in the face of someone who really didn't care about getting help at all."

Too sick for the street, not sick enough for hospital

Kushel's research, clinical and personal work with stretches back to the 1990s when she was a medical resident at ZSFG. She saw first-hand the special problems affecting patients who were homeless, including a host of health problems caused by the strain of living on the street without proper food, shelter or regular medical care.

"These patients are too sick for the street, but often not sick enough for the hospital," Kushel said. She noted that while many discharged patients can recuperate at home – perhaps with the help of home nurses, oxygen or other measures – homeless patients don't have that option. "It's hard to have home care when you don't have a home," she said.

Tailoring medical care for the homeless
David Sandow says he couldn’t have turned around his life without the consistent help from Margot Kushel, MD: “I became a different person in meeting her.”. Credit: Noah Berger

Kushel – now a professor of Medicine in the Division of General Internal Medicine at ZSFG and a core faculty member in UCSF's Center for Vulnerable Populations – has conducted groundbreaking research that has informed interventions to provide homeless patients with better care and to reduce their hospital admissions and stays for non-critical health problems.

Translating research into interventions

One such intervention is the Medical Respite and Sobering Center. Working with the San Francisco Department of Public Health, Kushel helped to create this facility for homeless patients who are too sick to be in a shelter or on the streets, but could be cared for outside of the hospital. Without the respite center, though, these patients would need to remain hospitalized, she said.

Along with the appropriate medical treatment for homeless patients, the center also provides services such as referral to primary care, substance abuse and mental health referrals, and assistance in obtaining housing and social services.

Kushel's work has also helped form the evidence base for the Permanent Supportive Housing (PSH) model, known locally as Direct Access to Housing. San Francisco's leadership on this issue has been instrumental in making PSH the leading national response to chronic homelessness.

Kushel, along with many of her colleagues, continues to develop interventions to improve health outcomes for the homeless, particularly among older individuals over 50.

Her research has found that in their 50s suffer geriatric conditions that usually would appear in people who are 20 to 30 years older.

"The homeless population is older than it used to be, and that brings with it a whole host of additional concerns," Kushel said. "We're working hard to find solutions to what many see as an intractable problem."

Explore further: Childhood adversity looms large for older homeless adults

Related Stories

Childhood adversity looms large for older homeless adults

August 18, 2016
A new UC San Francisco report on an understudied population – older homeless adults – reveals that adverse childhood experiences have long-lasting effects. The researchers found that childhood adversities, such as abuse, ...

Homeless people suffer geriatric conditions decades early, study shows

February 26, 2016
Homeless people in their fifties have more geriatric conditions than those living in homes who are decades older, according to researchers at UC San Francisco who are following 350 people who are homeless and aged 50 and ...

Experts make the case for 'housing first' approach to homelessness

December 1, 2016
In a new perspective published today in the New England Journal of Medicine, five experts, including Dr. David Buck with Baylor College of Medicine, make the argument for Housing First as an approach to end homelessness across ...

Homeless sleep less, more likely to have insomnia; sleep improvements needed

December 27, 2016
The homeless sleep less and are more likely to have insomnia and daytime fatigue than people in the general population, findings researchers believe suggest more attention needs to be paid to improving sleep for this vulnerable ...

Treating ill health might not be enough to help homeless people get off the streets

October 23, 2014
Health care providers should recognize that any effective strategy to address homelessness needs to include both interventions to improve the health of homeless individuals as well as larger-scale policy changes, according ...

LA hospital pays $450,000 after 'dumping' homeless patient

October 26, 2016
A Los Angeles hospital will pay $450,000 to settle a lawsuit alleging that it "dumped" a mentally ill homeless lady in the street, wearing only simple paper pajamas.

Recommended for you

People expect their memory to fade as early as their 50s

April 24, 2018
People across the UK expect their memory to worsen in their 50s, according to new research from Heriot-Watt University.

Aging: The natural stress reliever for many women

April 24, 2018
While some research suggests that midlife is a dissatisfying time for women, other studies show that women report feeling less stressed and enjoy a higher quality of life during this period.

Millennials aren't getting the message about sun safety and the dangers of tanning

April 24, 2018
Many millennials lack knowledge about the importance of sunscreen and continue to tan outdoors in part because of low self-esteem and high rates of narcissism that fuel addictive tanning behavior, a new study from Oregon ...

Drinking affects mouth bacteria linked to diseases

April 24, 2018
When compared with nondrinkers, men and women who had one or more alcoholic drinks per day had an overabundance of oral bacteria linked to gum disease, some cancers, and heart disease. By contrast, drinkers had fewer bacteria ...

Napping and teenage learning

April 24, 2018
Teenagers and sleep. It's certainly a passionate subject for many American parents, and those in China. University of Delaware's Xiaopeng Ji is investigating the relationship between midday-napping behaviors and neurocognitive ...

Craving a cup of joe? What does the research say about coffee and your health?

April 24, 2018
Coffee. Cup of joe. Java. No matter what you call it, millions of people worldwide wake up and fuel their day with it. And though consumers might be jittery about the recent court battle in California over cancer warnings, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.