necessity of fall prevention measures for this resident. The NPM increasingly found violations of notification and/or uncertainties with regard to notification obligations in accordance with the Nursing and Residential Homes Residence Act in connection with electronic monitoring systems, which can also restrict freedom. In the care of the elderly, technical equipment that registers when a person with dementia or with orientation difficulties would like to leave a ward or facility is called a care system for disoriented persons. Acoustic signal generators prevent doors from opening or alert nursing staff. With the assistance of the representative(s) of the residents in this area, the NPM has been able to ensure that staff can act with greater confidence. Electronic means that restrict freedom In some cases, the commissions found persons who were clearly malnourished. The following process steps were determined as a general approach: prevention begins with early recognition of a nutritional risk. This is the only way to create the prerequisite to begin nutritional interventions as early as possible. Standardised screening instruments are available; the most common are the Mini Nutritional Assessment and the Nutritional Risk Screening 2002. If malnutrition or a corresponding risk is determined, the nutritional status must be established by way of a nutritional assessment; possible causes for the nutritional deficits must be clarified. The results of the assessment are then the basis for the planning of additional interventions aimed at maintaining or improving the nutritional status. The interventions must not be limited solely to nutritional measures. Commissions observed that malnourished persons had obstacles to meeting their nutritional needs, e.g. difficulty with chewing and swallowing or poor dentition. These obstacles must be clarified and remedied if possible. Positive effects can also be achieved by more assistance by staff in food intake as well as by creating a pleasant eating atmosphere, attractive food preparation and meal planning that is suitable for the elderly (smaller portions, multiple meals per day, etc.). In the case of serious errors in dealing with malnutrition, the supervisory authorities were asked by the NPM to pay greater attention during their controls and to ensure that initiated measures were examined at short intervals. Why must such deficiencies always be especially emphasised? Because early signs of malnutrition can be easily missed and from past experience, malnutrition that has become manifest is difficult to cure. Prevention of malnutrition 2.1.2. System-related problem areas 2.1.2.1. Principle of normalisation Care and nursing of the elderly must be underpinned by ethical principles. Quality care is only possible if it is done respectfully. Respectful care is directed towards doing good for those needing care Dignified care 31