Retirement and nursing homes Upper Austria implemented several measures to better compensate for failing spatial orientation after the visit by Commission 2. For example, a picture of their own (former) hall door was stuck to the door of the residents’ rooms in order to evoke their memory of a safe home. Barrier-free accessibility was established through contrasting wall paint and brighter lamps. Access to the terraces without steps was made possible; exits to the garden were fitted with automatic revolving doors. Recommendations delayed or not implemented at all In some cases, however, the recommendations of the NPM are only partially implemented or with considerable delay. Commissions make follow-up visits in cases where the intention to rectify weaknesses was vague or it is not certain for other reasons whether sustainable conditions that are satisfactory for those in need of care were established. Commission 3 made monitoring visits to one Styrian home in 2014, 2016, 2018 and 2019. Initially, the operator completely refused to cooperate; OPCAT examinations were only tolerated after intervention by the AOB and the technical supervision. Inspections and constraints – several in some cases – set down by the supervisory authority were necessary until the first structural changes were noticeable. The deficits ascertained by the commission included non-compliance with the minimum staffing ratio, administration of medication, insufficient nursing documentation, absence of activity programmes and lack of hygiene amongst others. Commission 3 recently recognised some progress; however, it reiterated on its last visit that correct care planning must contain measures for preventing malnutrition and polypharmacy, and additional mobilisation and animation programmes are also necessary. Regardless of this, the supervisory authority was again informed by the NPM about the results of the unannounced visit. Commission 5 observed little improvement in a nursing home providing longterm and short-term care as well as assisted living compared with the initial visit. The recommendation to extend the night shift had not been taken up; 84 persons aged between 54 and 96, most of whom require a considerable amount of care, are looked after by just two caregivers. They do three rounds per night and have to prepare breakfast at around 5.00 a.m. The evening meal is at 4.30 p.m. so that the day shift can get the persons who are not mobile ready for bed. No incentives are offered for residents to leave their beds or their rooms around 6.00 p.m. This, however, is necessary, as the commission found many persons with physiotherapeutic mobility needs and indications of polypharmacy. In November 2019 the home management informed the NPM that it saw the criticism as an opportunity to evaluate the processes. A working group set up for this purpose is considering revising shift plans amongst others. Commission 2 made several follow-up visits to a home in Upper Austria. Nevertheless, there was still criticism of missing assessments in the care plans viewed on site (falls, pain, malnutrition, decubitus prophylaxis). Progress up to improved day care was positive. In a remote home in Styria, Commission 3 observed deficits in pain management and the use of measures that restrict freedom, in particular with regard to using less severe measures. The residents 25