A BBC investigation has uncovered appalling conditions and abuse in adult institutions in Romania, 20 years after the fall of Nicolai Ceausescu exposed conditions in the country's orphanages.
As the care worker unlocked the door and pushed it open, a musty stench of body odour and urine filled the air. There were 10 people crammed into the room, bed-bound on rotting mattresses and lying in their own faeces, some two to a bed.
Among the dirty, scarred faces peering above the duvets were the orphans whose plight roused the international community when Romanian orphanages opened their doors to Western journalists in 1990.
Staff at the Recovery and Rehabilitation Centre in Carpenis had no idea how old the latest arrivals from a children's orphanage were - they guessed 18 but they looked much younger.
The three boys cowered under their dirty duvets, escaping from the wrinkled faces of the disturbed men and women they shared a bed with.
 The overthrow of Ceausescu shone a light on the plight of the orphans |
One of the boys was desperately thin. A worker explained that they didn't know anything about him. He couldn't talk and they suspected he has hepatitis, but they had no means of finding out for sure.
Another new arrival had deep cuts to her head. Like others who have been institutionalised since birth, she exhibits self-harming behaviour, including violent rocking backwards and forwards. She repeatedly banged her head against the wall, and wore a makeshift helmet to cushion the impact.
Notorious institutions
There were dozens of rooms, packed with 160 adults aged up to 80. It was difficult to tell the men and women apart, but they all shared a confined existence. They are all unwanted human beings, abandoned by their impoverished parents at birth and neglected into adulthood by the state.
The Romanian government had promised it had dealt with its notorious institutions as part of its conditions for joining the European Union. The only way we could witness the reality of conditions in adult institutions was to pose as charity workers, and secretly film our findings.
The Carpenis institution is just 32km (20 miles) from the capital Bucharest, the heartbeat of the country's growing economy. In the main squares, neon lights advertise the biggest Western brands; shopping centres are bursting with families spending new money on Christmas gifts. It is a measure of how far Romania has come since the fall of its dictator Nicolai Ceausescu who bankrupted the country. But not everyone has seen change in the last 20 years.
In Bolintin, another village close to the capital, a lone nurse and six helpers take care of more than 100 patients - they are not sure exactly how many. They were wrapped in blankets and thermal jackets to escape the freezing cold.
 Signs of gangrene were evident at one institution in Bolintin |
In a wooden cabin, separate from the main building, we found 15 severely disabled people slumped on uncomfortable chairs. The nurse insisted they were at least 20 years old, but their tiny faces and bodies suggested they were much younger.
Unlike the able-bodied in the main building, they had nothing to escape the cold. Their clothes were thin and tatty and their bare feet produced an odour of rotting flesh. A closer look revealed signs of gangrene.
Low standards
Georgiana Pascu of the Romanian human rights group the Centre for Legal Resources has visited nearly every one of Romania's 150 adult institutions. She says adults in state care face a long list of problems.
 Nicolai Ceausescu was executed with his wife Elena on Christmas Day 1989 |
"There is overcrowding, lack of access to adequate medical treatment, lack of access to psychologists and social workers. We came across several institutions where there were cases of human rights abuses during our visits this year. With a little help, most of them could live in a community environment."
But that help has never come. Again, posing as charity workers, we witnessed some pitiful scenes at the Ganesti Social Medical Unit in eastern Romania.
Staff there told us that there was one carer to 40 residents, and that there were 160 people sharing 140 beds.
Most staff at the institutions we visited were caring and compassionate, but with ratios like this it is little wonder that standards are so low. It was mid-afternoon, and we found most patients still in bed, many showing signs of heavy sedation.
One girl was restrained in her bed by her jumper which acted as a straitjacket.
Human rights activist Eric Rosenthal gives his views on the BBC's secret footage
We showed the findings of our investigation to Eric Rosenthal, who campaigns to protect the human rights of institutionalised people and is an adviser to the US government.
"I cannot say I'm surprised given Romania's record, but I am horrified," he said. "My organisation Mental Disability Rights International documented this abuse in great detail. We talked to government officials, and we brought it to the European Union. They promised they would end these abuses and they have failed on that promise.
"These conditions are exactly what we saw five years ago, 10 years ago. They did what they needed to do to get into the EU, but the abuses are still going on."
Well-cared for
Some institutions, however, have been turned around. The orphanage in Cighid, north-west Romania, was one of the institutions that achieved notoriety in 1990.
 A young man from the orphanage in Cighid, an institution that has been turned around |
At least 137 children died in the space of two years, most of them no older than three.
Foreign aid and the efforts of a new director, Dr Pavel Oarcea, who has now retired, led to many improvements.
Cighid - now an adult institution - was the only facility we got permission to visit as journalists. Around 60 of the children have remained there into adulthood, and they appeared well-cared for.
They had musical instruments, crayons and colouring books. But many have only ever known life in an institution. The disabilities they were either born with or developed as a result of previous neglect in the orphanage meant they were always unlikely to be adopted.
Dr Oarcea defied orders by the local authority not to speak to us. He told us the 15 years he spent in Cighid were the most rewarding of his life, but that he still has regrets.
"A disabled child who's lived with a family his whole life doesn't rock backwards and forwards. What the Cighid children have missed out on is family life, the love that only a family can give," he said.
"Twenty years ago I believed the Romanian government would have made much greater progress in protecting their unwanted children and adults."
Since 1990, Romania has received 100m euros (£89m, $144m) from the EU to improve its institutions.
In response to our investigation, the Romanian government said the conditions we found were not representative of care in the country.
"The Romanian authorities continue the reform and the protection of the disabled with social risk by implementing proactive policies and good practices," it said in a statement.
It added that two of the institutions we visited were scheduled for closure in the next three years.
Standing up places the head above the heart and thus makes it harder to provide blood flow to the brain 
