When Children's Needs Do Not Fit the System: Street-Level Bureaucrats Facilitating Home Care for Children Living With Respiratory Support.

This study explores the meanings of acting as a street-level bureaucrat in facilitating home care for children living with respiratory support and their families. A phenomenological hermeneutic approach was used, based on interviews with professionals involved in assessment, decision-making and care provision across different parts of the welfare system. The findings show that this work is lived in tensions between compassion and regulation, closeness and distance, and enduring needs and finite resources. Acting as a bureaucrat in this context means being confronted by the vulnerability of the child and family while being bound to formal language, legal categories and organisational limits. Home care is made possible through these structures, yet never fully contained by them. Responsibility emerges as exposed, stretching beyond the moment of decision and continuing into a life that unfolds elsewhere. Bureaucratic work thus appears as more than administration. It is lived as an effort to respond to what is pressing and fragile while remaining within frameworks that cannot fully receive it. The study highlights the importance of institutions that not only uphold justice but also make good care possible.