Care scheduling 2.2.19 – Self-determination At the time of the visit to one facility at the end of June 2018, the care schedules were missing for all individuals in need of care who had been admitted since the beginning of the year. It is doubtful whether targeted care and support can be provided under these circumstances. In another facility, the care team did not hold group discussions regarding care scheduling. Certain issues relating to care and support were only discussed during monthly team meetings. The transfer of information was not organised seamlessly for all staff involved in providing care and support. In some of the visited facilities, residents were restricted in their right to self-determination. One facility, for example, preferred to admit individuals who already had an adult guardian. Those without an adult guardian were required to grant enduring power of attorney to relatives or other trusted persons so that they could make decisions in certain pre-determined areas when necessary. In fact, enduring power of attorney was enacted by the facility at the same time as the affected person moved in. Thus, the authorised persons were immediately noted as the main contact person for all matters relating to the resident in question. This approach runs counter to the purpose of enduring power of attorney and carries the risk of effectively denying the affected person their right to make decisions. If care and support is not based on a predetermined schedule or agreed upon by members of the care team, vital measures may be neglected. As a result, the extent to which affected persons are dependent on care may remain unnecessarily high or even increase. The process of providing care and support to individual residents must be planned at an early stage, implemented in a professional manner and adjusted on a regular basis. Residents’ right to self-determination and an independent lifestyle must also be respected in matters relating to their everyday lives. Some facilities, for example, only permitted smoking outside of the building. This is particularly problematic for residents with insufficient personal mobility and in adverse weather conditions. Measures should be introduced to allow smoking inside the facility – particularly if the residents are not merely visiting the facility but are in fact permanently resident there. Incontinence care The National Agency repeatedly observed shortcomings in the care provided to incontinence sufferers, which resulted in a strong urine smell emanating from the affected residents. In addition to providing genital hygiene care and suitable incontinence products, a change of underwear may also be necessary in order to ensure that incontinence sufferers receive a standard of care that takes into account their individual needs while also respecting their human dignity. An insufficient standard of care can potentially cause skin damage and lead to the affected person being ostracised from the community because of their smell. 2.2.20 – Fall prevention A large number of facilities did not carry out – or did not comprehensively document – personalised and goal-oriented fall prevention for residents at risk of falling. The statistics kept in one facility recorded a total of 77 falls, documenting “serious injury” as the outcome in 18 cases and “hospitalisation” as the outcome in 13 cases. It was concluded on the basis of these statistics that “the increased number of falls is due to the deliberate decision to avoid measures involving deprivation of liberty and thereby provide residents with the greatest possible degree of freedom”. However, this conclusion ignores the fact that an increase in the number of falls can also be caused by inadequate fall prevention measures. Care of persons with catheters As regards the care provided to individuals with an indwelling urinary catheter, it was observed in isolated cases that leg bags were attached without a cover and in a location visible to third parties. Discretion should also be taken into consideration in order to provide dignified care and support. Ensuring and maintaining personal mobility is crucial to an independent and self-determined 47