turning on any lights. An objection was also made that a video monitoring system had been installed without the consent of staff or residents. Working with older persons can be both physically and psychologically challenging. Commissions have noted that managers of the nursing staff change frequently in facilities and that there is a high degree of staff turnover, as well as a large number of staff on long-term sick leave. Furthermore, older and experienced nursing staff complains that there is no commensurate reaction to difficult situations resulting from inadequate staffing, frequent overtime, recurring shift work and night shifts and the fact that older staff needs longer breaks and would like to give their input on work schedules. Early retirement of older nursing staff should be a societal alarm signal that working conditions in the nursing profession must be improved and made suitable for older employees and an ageing workforce. When nursing staff despair of their profession and think about leaving, the reasons also lie in leadership deficits that result in poor work situations and an icy work environment. A lack of support, insufficient transparency, inadequate information as a result of a lack of communication and an absence of appreciation are the reasons cited most often by nursing staff for the decline of satisfaction with their work. Many employees indicated to the commissions that they experience aggression and violence in their job. Therefore, during their visits the commissions also regularly check whether employees have an adequate offering of continuing education measures regarding violence in nursing care. During their visits in retirement and nursing homes, the commissions repeatedly emphasise the importance of supervision and counselling. This is an important component in a professional environment of the caretaking professions. In the opinion of the NPM, it should be mandatory to provide such offers for all employees. Violence against nursing staff Excessive demands on and overload of nursing staff are a major risk factor for violence against residents. The forms thereof are diverse and range from insults and neglect (e.g. malnutrition, decubitus or incontinence) to restriction of freedom by way of medication or mechanical means. Today, prevention of violence against older persons is considered a social concern. The commitment by the World Health Organisation (WHO) clearly demonstrates this. It defines violence as “intentional use of threatened or actual physical force or power against oneself, another person, or against a group or community that has a high likelihood of resulting in injury, death, psychological harm, or deprivation”. The WHO estimates that prevalence of violence against the elderly is high and relies on international studies: it can be assumed that 2.7% of elderly persons in Europe become victims of physical violence every year. This corresponds to around 4 million people in Europe who are 60 or older. The percentage of those who Violence against persons needing care 28

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