Retirement and nursing homes XX  Every seriously and terminally ill person has a right to the comprehensive medical, nursing, psychosocial and spiritual care and support that is commensurate with their individual life situation and hospice-palliative care needs. XX  The nationwide implementation of an equal access to hospice and palliative care in nursing homes has to be sensitive to the personal and cultural values, beliefs and rituals in order to facilitate dying with dignity. XX  Care Dialogues should be established in all facilities. Residents and their trusted persons should be supported in making decisions that affect the final phase of their life. This requires space and time for passing on comprehensible information related to predictions as well as treatment and care options. 2.1.5 Drug safety - polypharmacy Many of the residents of retirement and nursing homes are multimorbid and have cognitive and/or physical restrictions. This means that they are extremely vulnerable and worthy of protection. During their visits to retirement and nursing homes the commissions observe that geriatric patients often receive polypharmaceutical treatment. The NPM is well aware that prescriptions are necessary in isolated cases under certain circumstances. In most cases however, it is not possible for the commissions to examine whether or in how far the prescribing doctors and nursing staff considered the possible effects of this type of medication. In many cases, it is also not transparent how medication-based therapy objectives and care planning are aligned and evaluated. The number of side effects and undesired interactions increases with the amount of medication taken. According to a study, there is a 13% probability of interaction if two medicines are taken simultaneously. If four medicines are taken, the probability is 38%, and 82% for seven medicines taken on the same day. If ten medicines are prescribed per day, over 45 interactions can be expected mathematically speaking (source: Hiemke, C. / Eckermann, G. (2014): “Kombinationstherapie/Polypharmazie – Interaktionen von Psychopharmaka”. Arzneimitteltherapie 2014; 32: 361-370). However, these medication-based interactions are often misinterpreted as the symptoms of new diseases in elderly people. Dizziness, disorientation and falls are often seen as age-related changes for which new medicines are prescribed. For elderly persons, the most frequent health problems caused by medication are states of confusion, depression, tendency to collapse, constipation, incontinence and Parkinson’s disease with impaired movement. The undesired effects of medication foster intellectual decline, immobility (impaired movement), instability and incontinence. For this reason, drug safety is of key importance. It is also scientifically proven that inconsiderate 35