National Preventive Mechanism is primarily due to the fact that they are less able to report pain verbally, and that pain may therefore be overlooked. However, it also results from the fact that the prejudice that persons with dementia feel much less pain is still widespread. However, it has been demonstrated in a number of studies that persons with dementia suffer from pain just as much as those without any cognitive impairment. During the reporting year, the NPM also found that pain assessments are often not carried out, or are implemented inadequately. In many cases the commissions criticised the fact that patients in pain were not given the appropriate nursing diagnosis, that there were no pain protocols and that pain scales were not applied. Although established electronic documentation systems support the documentation of pain, this possibility is not used. Inadequate treatment of pain The NPM refers to the fact that pain must be incorporated into care planning, determined according to pain scales and evaluated on an ongoing basis. Pain protocols can present the evolution of pain and the effects of pain therapy. Pain scales can establish pain along with its intensity. Special scales and methods for determining pain exist for persons who are not capable of expressing themselves or who have dementia. Commission visits also show the significance of good interdisciplinary cooperation for effective pain management. Nursing staff are often the key link between patients experiencing pain and doctors. XX Pain in elderly persons must be treated. Pain must not be accepted as simply part of old age. In order to ensure this, pain assessments need to be carried out. XX Pain assessments must be a part of every nursing management plan. 5.1.5 State‘s duty to protect also relates to non-approved facilities The commissions have also carried out random controls of the precarious care arrangements in private homes. Private individuals reported that they only rented living space to elderly persons needing nursing care, but were not responsible for organising and implementing care. Residents included not only active individuals who appreciated that they no longer had to run their own home, but also persons with physical and/or intellectual impairments and significant nursing and support needs. One home in Lower Austria was visited twice by Commission 6 during the reporting year. The regional government of Lower Austria informed the NPM that, due to the structural unsuitability, it was not possible to approve this facility as a nursing unit. The private operator was considering the termination Precarious conditions in one home 111