There are nine hospice and palliative care organisations offering an estimated 36 services in Romania.⁴ Most service provision is home care and is provided through non-government organisations (NGOs). Hospice and palliative care provision for adults/children includes: two inpatient palliative care units; seven inpatient hospices; two consultant teams in hospitals; ten home care teams; and one day centre. Fourteen services include (or are specifically) paediatric care; the palliative care network for children is based on isolated initiatives, and most of them are NGO’s working alone without any formal network and mainly concerning children with HIV/AIDS. Hospice and palliative care for children includes: five paediatric inpatient units (supported by the charity Children in Distress);⁵ two consultant teams in hospitals; six home care teams; and one day centre. Although none of the hospitals has a designated palliative care unit, each has allocated a small number of beds for palliative care, mainly in oncology units. Patients needing palliation at the end of life are under the care of physicians and nurses who have received specialist training on courses run by Hospice Casa Sperantei, Brasov. There are seven bereavement support teams provided by home care services; three are specifically for children and their families.

Table 1 Palliative care provision in Romania 2006

Traditionally, there has been a lack of holistic care in Romania, as described by Melina Dumitrescu, Director of Public Relations for Hospice Casa Sperantei, Brasov:

‘…there was very little interest in developing something for the sake of the patient rather than from the point of view of the [doctors]. So I always felt when I had heard talk among doctors that everything is considered from their side and not really from the one who has to benefit from the care.’ ⁶

However, a growing number of services in Romania appear to be adopting a more holistic approach. A doctor who works in a clinic for children with HIV/AIDS wrote in 2001:

‘The team has physicians specialised in infectious diseases, social workers, one psychologist, nurses, and educators for Kindergarten level. We would like to extend our activity also to home care…Recently a meeting of Orthodox priests discussed the role of the priest of the hospital in relation to the children with AIDS. This is a new initiative of our Church…both parties need to learn, need to exchange experience; also the medical staff.’ ⁷

In 2005, an estimated 3,900 adults and children per year were cared for by palliative care services.⁸ In Romania, approximately 90% of deaths occur at home, in part from preference if the patient and family know the diagnosis, but also due to the practice of hospitals tending to discharge patients at the end of their lives. Where no home care is available, patients and their families prefer, if possible, to receive care at the end of life in a hospice inpatient unit.⁹ A new initiative started in Bucharest during 2006, with a hospital support team working for the first time in Romania.¹⁰