Retirement and nursing homes doubt whether there had subsequently been consensual or coerced sexual acts between the two residents. It should be discussed how staff working in long-term care facilities have to deal with the sexual self-determination of residents but also with sexually problematic situations. It is inappropriate to interpret abnormalities that occur after the onset of dementia as a weakness of character, and not to see psychosocial needs behind them. The incidence of sexual behavioural disorders during the course of dementia-related changes can be caused by many factors and is not simply attributable to long-existing inclinations. Organic changes to the brain or certain types of medication can be critical in this respect. If the observed hypersexuality is due to comorbidities or medication administered for the same, the medical treatment shall be optimised and, if necessary, the medicines used to date replaced by medication with a better side effect profile. Based on observations made on two visits to a care centre, which also included examining anonymous reports, Commission 5 recommended the regional government of Lower Austria to urgently initiate a comprehensive organisational process to minimise the number of violent incidents. The NPM considered it essential to define a comprehensive catalogue of measures in order to guarantee more adequate nursing and care of the residents (including training in violence prevention and de-escalation, regular case reviews, supervision, and drafting of individual crisis intervention plans). The NPM was informed that the recommendations would be taken up. Advanced and further education for management and staff focuses on recognising violence and includes preventive measures with respect to border-violating and challenging behaviour in gerontopsychiatric illnesses. A general pain guideline was published with a catalogue of measures for non-medication therapy forms and assessment instruments drafted for cognitively impaired residents (ZOPA, Doloplus, BESD), with the implementation thereof scheduled for autumn 2019. The NPM was also assured that, after adding psychological experts with external support, the specialised competence will continue to be increased and team development will be supported. In this way, the multidisciplinary work should be improved and activity programmes based on the residents’ needs come into their own. Complex cause of violent incidents call for an organisational process The NPM has been recommending the textualisation and implementation of violence prevention concepts for years. Furthermore, the NPM continuously points out the necessity for violence prevention training as part of effective deescalation management. Even if a home has a violence prevention concept, it is not always put into practice. In their interviews, the commissions often hear that the contents are unknown even to employees who have been working there for a long time. However, there is now – unlike back in 2012 when the NPM assumed its work – a growing number of homes that are stepping up violence prevention training, analysing difficult situations in workshops and regularly using case studies to discuss the appropriate action. Methods for dealing with challenging or aggressive behaviour are taught in de-escalation Violence prevention concepts 30