Retirement and nursing homes health and care into consideration (see Austrian Court of Audit, Bund series 2020/8). Many recommendations by the NPM were implemented in the retirement and nursing homes in 2020 too. Many recommendations implemented A nursing home in Vienna expanded its activities programme, which is now organised and implemented by social care experts. Concepts for violence prevention and dealing with dementia were also introduced as well as a late shift for the purpose of allowing residents to go to bed later. Commission 1 was able to identify considerable improvement in a home in Tyrol since their last visit. Medication is now “packaged” by qualified care staff only. Measures for preventing falls were introduced and were effective. The evening meal was served later on a trial basis in a home in Styria. Additional staff were deployed on the late shift, in particular due to the large number of residents suffering from dementia. In accordance with a recommendation by Commission 6, team and individual supervision are actively offered and availed of in a home in Burgenland. A home in Upper Austria acted on a recommendation from Commission 2. Staff satisfaction is now evaluated regularly. Mental stress is recorded and analysed every year with the support of an occupational psychologist. As in previous years, homes frequently performed evaluations of medicationbased measures that restrict freedom and reporting of the same to the residents’ representatives as a consequence of visits by the commissions. Structural modifications and changes in design were implemented in some homes. Complaint letter boxes were mounted or placed in a better location, lighting systems adjusted to better illuminate the corridor area, automatic door openers installed, acoustic announcements activated or improved in lifts, and ramps ordered for balconies. If the statements of opinion by the owners and operators or the supervisory authority fail to clearly indicate that sufficient action has been taken on the criticism by the NPM and recommendations implemented, follow-up visits ensue. The procedure is the same if commissions have the impression that one monitoring visit will not suffice to cover more complex issues. This was the case, for example, in a private home in Vienna. The NPM received credible accounts of possible assaults on residents by employees. These could not be verified; however, the commission had the impression after talking to residents that the conduct of the employees was not appropriate. In particular, the behaviour of one qualified nurse was described by several residents as unpleasant, unprofessional and disrespectful. Structural violence was evident on fixed shower days. The call bells for some residents with very restricted mobility were placed too high and they were thus unable to reach them, as observed during the visit. All of the residents confined to their bed wore Indications of structural violence always result in a follow-up visit 26