Firehouse Shelter’s most distinctive contribution to the well-being of individuals experiencing homelessness is its growing emphasis on respite care, providing a humane discharge plan for individuals who are medically fragile, having been forcibly discharged from hospitals with multiple acute medical needs. The medical respite program at the Firehouse Shelter is the only respite program for the homeless within the state of Alabama.
The medical respite care program is a program for people who identify as men and who are medically fragile, usually having an acute illness, disease, or injury. These men are not sick enough to stay in the hospital but are not well enough to stay on the streets. MRP is designed to facilitate the care of the most medically fragile homeless individuals by providing onsite case management, support and recovery groups, therapeutic fine arts, transportation, and medical referrals. While the homeless shelter has operated since 1983, Respite been a formal pilot project program since 2020, when the agency moved to a larger building with dedicated respite space and medical rooms. In order to qualify for the MRP, individuals must be able to complete all ADLs independently, ambulate without assistance, be stable enough to live in a congregate housing environment, abstain from using drugs or alcohol on premises, and self-administer medications and medical treatment. MRP does not have skilled nursing onsite and is not a medical care facility.
The most significant challenge facing Firehouse is a growing population of men experiencing chronic homelessness and in need of respite care. Firehouse faces the challenge of providing emergency care for men discharged by hospitals into homelessness. As a low barrier shelter, Firehouse is best situated in Birmingham to care for men in such dire circumstances. Firehouse has made significant progress since 2020 when the agency began its respite care program in a new and larger building with dedicated respite space and medical rooms. The only respite program for the homeless in Alabama, the shelter currently has space to house 10 men in its respite care dorm, which is only one section of a 100-bed shelter. Not only has Firehouse adjusted to the housing needs of respite care clients, but it also employs a full-time medical social worker and hosts weekly medical volunteers from the University of Alabama at Birmingham and Cahaba Medical Care’s mobile health unit.
There is no overestimating the need for respite care in Birmingham, Alabama. According to the point in time count for Firehouse’s three-county service area, 943 individuals experienced homelessness in 2022. The actual number, beyond a 24-hour snapshot, is likely four times that, with a significant and growing number of individuals experiencing chronic homelessness and acute healthcare needs. There are simply not enough beds at Firehouse for respite care. There is not enough space for someone to die in the comfort of a bed instead of under a bridge. There is not enough care for someone to receive chemotherapy in medically appropriate conditions instead of under a bridge. There are people experiencing the most medically fraught circumstances a human can face in Alabama’s heat, under Birmingham’s bridges, and without the care and dignity every human deserves.