National Preventive Mechanism urgent need to urinate. Provocative sexual behaviour, which not infrequently arises as a side effect of dementia, may cause major problems for inexperienced nursing staff, as they do not have sufficient awareness of how to respond to aggressive intrusiveness. In some facilities staff are left alone to deal with such experiences. Staff in several facilities reported to the NPM that they are overwhelmed by challenging behaviour and are therefore not able to exchange their views with colleagues or to receive training in this regard. Case discussions between specialist doctors and nursing staff do not take place. Insufficient support despite care duty A model for protection against violence and the duty of care is e.g. the project “Further development of gerontopsychiatric expertise in Vorarlberg nursing homes” (“Weiterentwicklung der gerontopsychiatrischen Kompetenz in den Vorarlberger Pflegeheimen”) which has been implemented on behalf of the Vorarlberg Social Fund (Vorarlberger Sozialfonds) since 2014. The project report published in 2015 shows how prerequisites can be established for the provision of person-centred care for residents with challenging behaviour that is free of violence. Staff need to be trained in how to communicate with cognitively impaired persons. This may be assisted by training in non-judgemental conversation, geriatric specialisations or measures to prevent delirium and psycho-social care concepts. It is important to recognise the causes of and risk factors for violence within the care of residents in order to be able to base interventions on this, if necessary. However, as far as the NPM is aware, many operators of retirement and nursing homes have not yet taken adequate action. The NPM calls for guidelines to be drawn up in every retirement and nursing home on the issue of “violence in nursing care”, which will be binding for all staff. These will help not only to protect the elderly against violence (psychological, physical or structural) but also to protect staff against attacks by elderly persons. Measures to prevent violence can only be adopted if there is a clear commitment within the organisation to provide care that is free of violence. Guidelines on the prevention of violence It must be regarded as a success on the part of the NPM that in almost all retirement and nursing homes in which attention was directed to the issue, measures to prevent violence were adopted after the NPM visit. Success of the NPM XX Specialist medical and nursing care for persons suffering from gerontopsychiatric illnesses, who are mostly very elderly residents, must be guaranteed. Case discussions between specia list doctors and nursing staff must be arranged. XX Violence prevention concepts must be elaborated in all facilities. The commitment to care free of violence must be established in guidelines. 109