resources, in particular for the care of elderly persons with dementia. It should be positively highlighted that institutions and facilities perceive and accept the commissions’ suggestions as feedback and have provided assurances that improvements will be made. Whether these assurances have been fulfilled is monitored by the NPM during follow-up visits or subsequent investigative proceedings carried out by the AOB. It has been found that recommendations that can be realised more easily are often acted upon. For example, screens to protect privacy and lower beds to avoid measures to restrict freedom have been purchased and seating has been acquired that is used to transfer persons in wheel chairs to prevent decubitus and to allow them to participate in interaction in the kitchen/dining/communal areas. In some institutions and facilities, information in pictograms was made available for persons with dementia, measures were taken to achieve barrier-free accessibility, animation programmes and leisure time activities were expanded, more specific continuing education programmes were provided, etc. Besides, in several homes measures were taken to improve documentation and complaint management as a reaction to concluding discussions with the commissions. In some cases, increased measures to prevent falls or improve pain assessments were recommended and implemented. It often becomes clear during commission visits that measures which restrict freedom are often not promptly reported to residents’ representatives as is required under the Nursing and Residential Homes Residence Act (Heimaufenthaltsgesetz). This makes these restrictions per se inadmissible. Therefore, there were corresponding “ex post facto reports” in several cases. Positive reactions to commission visits Suggestions regarding very specific care situations where freedom was restricted were also acted upon. For example, a visiting delegation encountered a resident with dementia who had washcloths tied around both hands to prevent her from scratching her body. During the follow-up visit, it was found that, after this was criticised, the woman had received anti-itch medication and was now able to move her hands freely without injuring herself. Generally, a corporate culture that attentively notices the needs of the residents and a respectful attitude play a decisive role in care. Selfdetermination and dignity of persons who are increasingly dependent on help and must permit intrusions into their private sphere can be very easily threatened. In several cases, the commissions objected to “assembly line care” and behaviour that departed significantly from normal standards, e.g. when breakfast is served although a woman is still sitting on a commode wheelchair or when all residents have to wear bibs normally used for toddlers while they eat; this is degrading. Very little stays private when personal information has to be provided in communal areas and conversations with doctors and relatives can be heard by others. There also seems to be a lack of respect when 29 Respect in care is essential