Home care services in Brasov, Romania Home visits in Brasov I have been a nurse at Hospice Casa Sperantei in Brasov for fifteen years. I work in the home care paediatric unit. This morning I am visiting the homes of four girls who are patients. They live near one another in a Roma community outside Brasov. All of them live in very poor accommodation. Their homes are very hot in the summer and very cold in the winter. Wild dogs roam around the site and I always check that I am safe from them before getting out of my car. I come here twice a month to monitor the girls. It is very rare for state medical staff to visit patients in their homes. But these families have no money and cannot afford to travel so if we did not visit the children they would not receive any help. The children are referred to us by their family doctor or the Brasov children’s hospital. Priority is given to those most in need medically but no child is refused. Once we take on a child we continue to care for them until they reach adulthood, recover or pass away. These families need a lot of help and support – their prospects are limited and they have had little or no education. The parents have to take a leading role in the day to day care of the children and part of my job is showing the parents how to do this. Another member of the team, our social worker, is also actively involved with these families. She helps them apply for their disability certificates. This means that the parents receive state benefits allowing them to stay at home to care for their children. My first patient is a little girl called Stefania who has heart disease and Down’s Syndrome. She cannot speak but her family has learned to communicate with her. It took the state hospital a long time to diagnose her and the family struggled to get help because of the costs of transport. We provide the family with medical supplies and equipment such as nappies. I then see Miruna who suffers from cerebral palsy and a genetic disease which is still to be diagnosed by the children’s hospital. She has been one of our patients for five years. Her parents do not like going to the state hospital because they feel the paediatrician is rude to them and they are unwelcome. Third on my list is Denisa. Denisa has heart disease and needs an operation but the state hospital will not do this as she has rotten teeth and the hospital says this needs resolving first of all. Her family is very poor and her clothes are filthy. She has a lot of emotional difficulties and one of my colleagues, the Hospice psychologist, is helping her. My visit finishes at Elisa’s house. Elisa has had a very sad life. She suffers from heart disease and now lives with her father and stepmother. Her mother was a hospice patient and died from cancer. Once this visit is over I return to the hospice and write up my notes. There are two of us who are paediatric home care nurses based in Brasov and we each visit four patients a day. We look after sixty children in their homes and almost one hundred other children are looked after in either our in-patient unit or day care centres. In 2015 Hospice Casa Sperantei made 17,531 home visits. The costs of these are not covered by the state.