We often view a hospice as an inpatient facility with a set number of beds. In doing so, we tend to overlook those who remain at home. No matter how good a hospice is, it can never replace the comfort of familiar surroundings and loved ones nearby. It is quite common for a hospice ward to care for, for example, 30 inpatients, while up to 1,000 patients are supported by a home care service. These patients do not require urgent hospitalisation, complex procedures, or constant pain monitoring—yet they still need professional care and the support of experienced specialists.

Many modern hospices began as home care services and later expanded to include inpatient facilities. Home care teams are, in many respects, the circulatory system of a hospice—transporting professionals, care, and continuity to patients’ homes. It is often here that the initial, most vital communication with families takes place.

In this article, I share a few hours spent with the home care team of Firefly World Children’s Hospice in Tbilisi, Georgia. At the end, you will also find brief interviews with these extraordinary people.

In the morning, we left the hospice as a group of five: Nikolai, the driver; Inga, a nurse; our photographer, Alina; and a relative of one of the patients, who was being taken home by the hospice vehicle as a form of social transport. The vehicle is a six-seat minibus equipped with a lift and space for a wheelchair.

We arrive at the first house. Behind the gate, there is a beautiful garden with a quince tree. We are greeted by the mother and grandmother of a young patient. Inside the house, there are many pieces of medical equipment: a suction device and an oxygen concentrator with a battery—an important detail due to the periodic power outages in Tbilisi.

Inga immediately begins her work. She evaluates the patient’s condition and notices early signs of pressure sores. Calmly and professionally, she reassures the mother, who is struggling to hold back tears, offers recommendations, and answers questions.
After the examination, we go to the sitting room and realise they were expecting us: a freshly baked persimmon pie is on the table. The photographer and I have tea with the pie, while Inga chats with the family and updates the medical records. She smiles a lot—and that sense of calm spreads throughout the room.

We try to invite Nikolai, the driver, to join us at the table, but he declines. Instead, the patient’s mother and grandmother pack him a snack for the road—a slice of pie and some fruit. Hospitality holds a special place in Georgian culture.

On the way to the next address, we talk with Inga about the visit. I learn that the girl we saw is 16 years old and will need to move to an adult hospice in two years. Such transitions are always difficult—for both patients and families who become deeply attached to the care team. That is why many children’s hospices run young adult programmes, allowing patients to stay with the same team until they turn 25. Unfortunately, Firefly World does not yet have the funding to establish such a programme, although they are very hopeful to do so.

At the next address, we are welcomed by a mother and her smiling young son. As always, Inga conducts an examination and answers questions. This time, she has brought a saliva suction device from the hospice—an essential piece of equipment for patients with swallowing difficulties. A significant part of the visit is dedicated to teaching the mother how to use it properly.

At the third address, we face a challenge familiar to many Tbilisi residents—particularly those with disabilities, older adults, and families with young children—a five-storey building without an elevator. The patient and his family live on the top floor. It's hard to imagine the effort needed for every trip to the hospice—or even for a simple walk. And how does one bring a medical bed upstairs? I once had the experience of carrying a dismantled but still heavy functional bed up to the fourth floor—not an experience I would recommend.

Our visit here is brief: to check on the patient, ensure everything is fine, and determine whether any further assistance is needed. Inga checks the boy's breathing and vision, takes his temperature, and confirms that the boy is doing well. She quickly completes the documentation.

Meanwhile, the mother requests the photographer to take a family photograph as a memento. Alina happily agrees. These are her first visits to palliative care patients, and she is deeply impressed by both the staff’s efforts and the resilience of the families.

We return to the hospice. Inga continues her shift in the inpatient unit, while Nikolai sets off to take the children who arrived in the morning back to their homes.

Inga and Nikolai work together every day. I visited only three homes, while a home care service may support hundreds—sometimes thousands—of families. Each visit is a unique story, experienced with openness and care. The team fights not only against pain, pressure sores, and physical symptoms, but also against despair, fear, and hopelessness—for both patients and their loved ones.

— Please tell us about yourself.

— My name is Nikolai, I am 45 years old and from Tbilisi. I studied at university and later found work as a driver. I have been driving ever since.

— How did you come to work at the hospice?

— Honestly, it was just by chance. A friend worked here as a driver, then found another job, and I took his place. Before this, I was also a driver—delivering bread and pastries. But here, the cargo is much more serious. Human life has no price.

— How long have you worked here?

— Seven years.

— Are your duties limited to driving?

— Formally, yes. But in a hospice, everything is very human. If something needs buying, bags carried, or a relative taken home, we help. We don’t just transport people; we accompany them.

— Is your route already planned for you?

— Yes. Usually, I first take a patient to the hospice, then go out with the nurse on visits. She performs procedures, I wait and assist where needed. Afterwards, I bring home the child we admitted in the morning.

— How are the traffic conditions in Tbilisi?

— They are demanding. A driver here needs nerves of steel. You must manage both the roads and the mental pressures of the job.

— What is the most challenging part emotionally?

— Seeing children in a grave condition or adults on the brink of a breakdown. It stays with you. You try to maintain some distance, but you still remember them.

— Do any patients stay with you particularly strongly?

— Nearly all of them. Sometimes a child recognises you, looks at you, and you can see it matters to them. Even if they don’t speak, you feel a connection. That’s very moving.

— Have you got children?

— Yes. Before, I never believed something like this could happen to my family. Now it’s terrifying. I don’t even want to think about it.

— How do you manage stress?

— It’s my character. In Georgian, we say ‘surface-level’. I don’t want to go too deep. For people, you need to be cheerful and keep the mood up. When you’re alone—that’s when you think.

— Has this work transformed you?

— Yes. Very much.

— Who is able to do this work?

— Only good people. You can’t think about yourself here. When you leave home, you leave your problems behind. Here, you only think about the patients.

— Could you please tell us a little about yourself?

— My name is Inga. I have a husband and an adult son. I have worked at the hospice for five years, and my total nursing experience is 27 years. Prior to this, I worked at Georgia’s largest paediatric clinic.

— Why did you transfer from the clinic to the hospice?

— Initially, it was a side job. However, I enjoyed working in hospice so much that I decided to move here full-time.

— What difficulties do you encounter most frequently during home visits?

— The most challenging cases involve children with complex conditions—including gastrostomies and unusual diagnoses. They require a lot of attention. We stay longer, offer assistance, and teach parents. This is a vital part of our work.

— How challenging is it to assess a child’s condition on site?

— Very challenging. You must carefully assess everything and respond accurately—determining which inhalation is needed, which medication to use, and whether home care is sufficient or hospitalisation is required. There have been cases where we immediately recommended hospital admission—and that has saved lives.

— Which procedures do you carry out most frequently?

— Pressure sore care, gastrostomy care, dressing changes, flushing, and inhalations. We are consistently in contact with a doctor—especially if IV therapy or treatment adjustments are required.

— Do children frequently experience severe pain?

— Yes, quite often. But we don’t have morphine. Sometimes families have it, sometimes not. We use whatever prescription pain relief is available.

— How do you manage emotionally?

— I don’t experience burnout. After work, I spend time with family and friends—that helps me re-energise.

— How do people react when they find out where you work?

— Everyone is surprised. They say, ‘I couldn’t do that’. Both medical professionals and non-medical people say this.

— How important is teamwork between you and the driver?

— Very important. We work well together, and Nikolai always helps me. A good team makes the work easier.

— Is communicating with families difficult?

— All parents are different, but usually they greet us warmly. They appreciate being listened to. We sit down and have a chat—that helps build trust.

— Have there been any cases where a child has died at home during your shift?

— No. However, in critical situations, we are always reachable by phone to advise and support families.

— What qualities does someone require to work in home care?

— Calmness and communication skills are vital. Parents often feel anxious — even a fever can seem like a crisis. You need to remain calm, explain clearly, offer support, and speak gently about difficult topics. Empathy, patience, and the ability to listen are essential.