of this kind can help staff to become more confident in dealing with challenging situations, while at the same time reducing the level of stress they experience personally in such situations. One facility had stated in its overall care concept that medical decisions on prescribed measures should be viewed by staff members as direct orders. The concept, however, did not state that the patient must first have given their effective consent to undergo medical treatment. Guidelines such as this could be misinterpreted, while their implementation has the potential to violate the residents’ right to self-determination and physical integrity. Medical treatment based solely on an agreement between a carer and a doctor without the effective consent of the person concerned is not permissible. Staff guidelines must be in line with legal provisions. Care and support for persons with dementia In a number of facilities, tactile reliefs had been mounted on the walls in the living areas for residents with dementia in order to stimulate their haptic perception. To support residents with a cognitive disability, one facility had brought in several dogs, including trained therapy dogs. The initiative helped to improve interaction with those residents. Not all facilities offered opportunities for basic medical check-ups. For example, in several facilities there was no cooperation with an ophthalmologist. As a result, regular eye checkups did not take place. Good vision has a fundamental effect on a person’s ability to perform a number of tasks, such as orientating oneself and walking steadily, as well as generally leading an independent life. Medical care in the facilities should be organised in such a way that any deteriorations in health are largely prevented or at least detected at an early stage so that appropriate measures can be taken. As part of its overall care concept, one facility had established a fundamental approach whereby the residents could do as they pleased as long as their actions did not harm themselves or others. To facilitate this, a carer was available at the reception area in addition to the administrative employees. Whenever a resident with a severe cognitive impairment wishes to leave the premises on their own, that carer is able to intervene and attend to the resident appropriately. This allows the residents to structure their day with a significant degree of autonomy, while also limiting stress for both the residents and the staff members. 2.2.2 – Furnishings and design In the residents’ rooms in one facility, the only lighting available was the ceiling light; there were no smaller lights, for example above the beds. This inconvenience was all the greater for persons sharing a double room. The furnishings in residents’ rooms should include additional lighting above their beds. This not only allows residents to read etc. whilst in bed, it also offers a less disruptive light source at night, for example when residents go to the toilet or require nursing care. Legal aspects Two facilities had displayed large, clearly legible posters on the walls, which explained residents’ rights. These provided residents, family members and visitors with relevant information in easy to understand language. 2.2 – FINDINGS AND RECOMMENDATIONS In one of the facilities visited, several areas did not seem especially homely and had a rather gloomy atmosphere. The corridors, for example, were dark due to a lack of natural light. In the communal areas, the radios and televisions were not plugged in. There was also a bad smell in several areas. The residents’ kitchen appeared to be used as a storage room for boxes and decorations. Residential care and nursing homes are the primary domestic environment of the residents who live there, and should be designed 2.2.1 – Medical care In one facility, a resident’s request to be examined by a doctor in a specific matter was not granted. Not only could this have health consequences, it also violates the resident’s right to physical and psychological integrity. All express requests by residents to receive medical treatment should be granted. 38