for people ages 50 years and up (full criteria)
Healthy Volunteers
healthy people welcome
at San Francisco, California and other locations
study started
completion around
Principal Investigator
by Margot Kushel, MDRebecca Sudore, MDMargaret Handley, PhD
Headshot of Margot Kushel
Margot Kushel
Headshot of Rebecca Sudore
Rebecca Sudore
Headshot of Margaret Handley
Margaret Handley



The homeless population is aging, with an increasing proportion of individuals over age 50 who experience accelerated aging, high rates of mortality, and a high risk of not having their wishes honored at the end of life. The goal of this randomized control trial (RCT) is to test the effectiveness of adapted evidence-based advance care planning (ACP) interventions for formerly chronically homeless older adults living in permanent supportive housing (PSH).

Official Title

Empowering Formerly Homeless Older Adults to Engage in Advance Care Planning in Permanent Supportive Housing (ACP-PSH): An RCT


Advance care planning (ACP) aims to elicit patients' medical preferences; yet older adults experiencing chronic homeless have low rates of ACP. Significant policy attention has focused on rehousing chronically homeless people into Permanent Supportive Housing (PSH), subsidized permanent housing with voluntary supportive services. Our team will use PREPARE for Your Care (PREPARE) - an easy-to-use, evidence-based, online ACP program with video stories. This program includes easy-to-read advance directives, an ACP group visit guide, and an ACP one-on-one facilitation guide. Our team developed a Community Advisory Board (CAB) and together identified preliminary adaptations to the PREPARE materials for the PSH setting.

The objective of this proposal is to co-develop PREPARE-PSH and compare the effectiveness of facilitated group versus one-on-one visits among formerly chronically homeless older adults in PSH. In Aim 1 the investigators will engage in a rigorous co-development process through in-depth interviews and focus groups with 20 PSH residents and the CAB. The investigators will use a theory-informed framework and qualitative content analysis to co-create a PREPARE-PSH program. For Aim 2, the investigators will conduct a Hybrid (NIH Stage III efficacy/effectiveness), Type 1 cluster randomized trial to compare the delivery of PREPARE-PSH through facilitated groups vs. one-on-one visits using mixed effects models. Randomization will be at the site level, balanced by site size. In Aim 3, the investigators will purposively sample Aim 2 participants for in-depth interviews (n=30-40), conduct focus groups with PSH staff (n=30-40), and obtain input from CAB members (total n=10-15). The investigators will explore implementation-relevant factors associated with: (a) high and low ACP engagement and sustainability of PREPARE-PSH using the Behavior Change Wheel (BCW and the Consolidated Framework for Implementation Research (CFIR) model. Relevance to NIH and public health: PREPARE-PSH may reduce health disparities in ACP among formerly chronically homeless older adults.


Advance Care Planning, Formerly Chronically Homeless, Older Adult, Permanent Supportive Housing, Homelessness, Facilitated Group ACP Session, Facilitated one-on-one ACP visits


You can join if…

Open to people ages 50 years and up

  • Formerly chronically homeless adults living in permanent supportive housing
  • English speaking

You CAN'T join if...

  • Non-English Speaking
  • Screen positive for moderate-to-severe cognitive impairment
  • Self-report being deaf or blind
  • Cannot provide informed consent based on the teach back method


  • Mercy Housing accepting new patients
    San Francisco California 94102 United States
  • Delivering Innovation in Supportive Housing (DISH) accepting new patients
    San Francisco California 94103 United States
  • Episcopal Community Services accepting new patients
    San Francisco California 94103 United States
  • HomeRise accepting new patients
    San Francisco California 94104 United States
  • Lifelong Medical Care accepting new patients
    Oakland California 94612 United States

Lead Scientists at UCSF

  • Margot Kushel, MD
    Margot Kushel, MD is a Professor of Medicine and Division Chief at the Division of Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center and Director of the UCSF Center for Vulnerable Populations and UCSF Benioff Homelessness and Housing Initiative.
  • Rebecca Sudore, MD
    Dr. Rebecca Sudore is a geriatrician, palliative medicine physician, and clinician investigator. She also directs the Innovation and Implementation Center in Aging & Palliative Care (I-CAP) and the Vulnerable Populations Aging Research Core of the NIA-funded Pepper Center.
  • Margaret Handley, PhD
    Dr. Margaret Handley is a public heath-trained epidemiologist in the Departments of Epidemiology and Biostatistics and the Center for Vulnerable Populations, at the University of California San Francisco, Zuckerberg San Francisco General Hospital. She co-Directs the UCSF PRISE Center, Partnerships in Research in Implementation Science for Equity.


accepting new patients
Start Date
Completion Date
University of California, San Francisco
Study Type
Expecting 650 study participants
Last Updated