National Preventive Mechanism reliant on meaningful occupational activities that are provided by third parties (nursing staff or carers). The lack of person-centred concepts has the result that in some facilities occupational activities are not tailored to the cognitive abilities of residents with dementia. Structures lead to a reduction in necessary support During some visits in the year under review, residents reported to the commissions that they did not use call bells out of the fear of a defensive response by staff, who were perceived of as being stressed. Even if these residents required support they would have rather waited for relatives to come and help them. One elderly woman reported that she stopped drinking in the afternoon in order to avoid having to ask for help going to the toilet during the night. In one nursing home elderly persons were provided with incontinence products during the night despite not having been diagnosed as incontinent, i.e. without needing them. Many residents acquiesce in weekly showering and bathing days, even though previously they washed every day and would like to continue doing so. In one facility weekly showering and bathing days were cancelled if they fell on a public holiday. In some retirement and nursing homes there is a lack of awareness regarding these forms of structural violence. For example, the NPM was informed in one facility that any deviation from fixed mealtimes was only possible in “exceptional cases”. One operator alleged that early mealtimes (lunch at 11:15 a.m.) were mandated by an external provider and that changes could therefore not be made. Rigid daily routines that are not structured around the needs of elderly persons facilitate aggression, which above all puts staff under strain. NPM praises the development of individual concepts Positive examples show that things can be different. A number of facilities have developed standardised questionnaires for collecting biographical information and take account of these when arranging care. One retirement and nursing home drew up an eating biography for all residents. This resulted amongst other things in the abolition of fixed mealtimes. Some facilities have developed their own concepts and guidelines with the assistance of external experts in order to promote the well-being of persons with dementia. They keep nursing documentation in which the changing sensitivities of cognitively impaired persons are precisely noted. This means that it becomes transparent over the course of time which action is taken in order to minimise “disruptions” in everyday life, where possible. The NPM also found nursing schedules that included “outdoor activities” to be particularly beneficial. Violence against staff Nursing staff are also affected by violence and assaults. Anxiety, depression and behaviour such as shouting, restlessness and agitation are side effects of cognitive impairment. This can complicate the provision of nursing care and lead to defensive actions (scratching, biting etc.). Although these symptoms are frequently direct consequences of a process of cerebral decline, it must however also be considered that challenging behaviour is often the only form of communication of persons with severe dementia. They can communicate by means of expressing anxiety, discomfort, pain, hunger, thirst or even the 108