National Preventive Mechanism Nine Laender - nine different regulatory systems According to the Upper Austrian Nursing Homes Regulation (OÖ Pflegeheimverordnung), the staff shall be provided based on the number of persons needing care and their allocation to care and nursing allowances, without taking account of social components. The minimum staffing ratio laid down in the Regulation applied in Styria uses other parameters for this purpose and, according to the Styrian Chamber of Labour, is comparably lower in spite of an increase in 2016. The Regulation adopted under the Viennese Nursing Homes Act in turn lays down a minimum staffing ratio calculated according to different parameters, which must be increased “for residents with particular nursing needs”. The Tyrolean Nursing Homes Act is limited to the regulation stipulating that “sufficiently qualified staff [must be available] at all times”, although the standard times (measured in minutes) specified by the regional government, which have been widely criticised, limit the time available for individual nursing. In Burgenland, the ratio between persons needing nursing care and staff is determined by ordinance according to a mathematical formula. This includes minimum care times, which are calculated in broad and extremely approximate terms. In Vorarlberg the “guarantee of reasonable nursing care” has been laid down by decree. It stipulates the maximum number of persons under each care and nursing allowance level who may be cared for. In Carinthia the Nursing Homes Regulation provides that staff should be made available based on the number of persons needing care. The qualification of the necessary staff depends on the special care needs of the respective persons; care and nursing allowances levels do not play any role. The Salzburg Nursing Homes Act obliges the provision of “a sufficient number of salaried, specially qualified nursing staff and auxiliary care staff according to the number of residents and the type and extent of the services to be provided to these residents”; no specific requirements are stipulated in this regard. In Lower Austria the regional government has drawn up a manual containing guidelines for calculation, which has been declared binding for its own institutions and facilities. Private operators are subject to the statutory requirement that “sufficient qualified staff for nursing care and other operations of the home [must be available] at all times”. It is therefore difficult to compare staffing requirements in different Laender based on the size of the home. A consideration of qualitative or multi-disciplinary staffing requirements points to a similarly unsatisfactory picture. Insufficient staffing In the view of the NPM, there is an urgent need for action. The care of persons with neurodegenerative cognitive impairments, dementia or disabilities requires the presence of specialists with the right skills set and a high level of geriatric know-how. This additional costs and needs are not sufficiently accounted for within staffing ratio calculations. The NPM calls on the Federal Government and the Laender to take account of the change in circumstances. Symptoms such as restlessness, apathy, depression, suicidal feelings, disorientation, hallucinations or aggressive and defensive behaviour are everyday occurrences within long-term care. They necessarily give rise to 100