Institutions for persons with disabilities and organise their lives just as others can. Ensuring as much independence as possible for persons with disabilities and the right to decide for themselves are some of the most important principles of the UN CRPD. The care and support services provided in institutions must be customised as far as possible in order for this to be realised. Special attention must be given to rituals and needs, age, health condition, sexual orientation or language abilities. For example, it makes an enormous difference if existing abilities and preferred movement patterns are taken into consideration when moving persons with physical impairments. The more physical impairments a person has, the more important the tactile and kinaesthetic interaction when performing everyday activities (e.g. motion support, conscious motion control and help in using still existing body tension). A lot of discipline, empathy and attention are required to allow that the current physical and mental state of persons with multiple disabilities flows into their everyday routine. Every nursing action on persons whose ability to move is actively or passively impaired is an intrusion into their private and personal space. Boundary violations for reasons of needing help can easily become a matter of course but are still unacceptable. The commissions found enough examples of this in the year under review. Rounds on which physical examinations were performed in the presence of third parties, be they other residents or their relatives and friends, were criticised as were changing dressings while the patient was eating or missing protection screens during personal hygiene, intimate care or excretion. Occasionally, clients in residential facilities or sheltered workshops complained that they are not involved in decision-making processes. Decisions are made only with legal guardians or they are given no opportunity to inspect the documentation. The way in which everyday behaviour is documented mirrors the basic attitude of the respective organisational culture. These “unwritten rules” almost always deviate strongly from official internet presentations and models. Entries such as “XY is acting up or defiant today, but also wellbehaved, obedient, weepy etc.” that judge behaviour in a derogatory manner without reference to the relevant situation demonstrate a power gap. For the NPM, remarks like these are evidence that there can be no mention of the joint development of rules for living together and communication with and about each other. When paternalistic fundamental convictions already prevail towards those who are able to express their dissatisfaction, it can be assumed that a sensitive approach to dealing with persons who cannot articulate their discontent is not possible. As there is no universal “person with disabilities”, “one fits all” concepts are not compatible with the UN CRPD. In order to cater to the individual person, customised development and objectives planning should be defined together regularly (see NPM Report 2016, p. 93 et seq.). Customised support necessary 85