64 social welfare – older people draw attention to any shortcomings that have been overlooked, and to report these to the authorities. The NPM has noticed a positive development trend in the standard of treatment and living conditions of the elderly. For example, the protection of privacy has improved: most residents in care homes for older people now have private rooms and bathrooms. The standard of care has improved, and less medication is used. The quality of food, the cleanliness of the facilities and the quality of indoor air have also improved. The most common deficiencies observed during visits involve lack of outdoor exercise, poor oral health, and lack of rehabilitation and activities. There have also been deficiencies in end-of-life care. All visits made to care units for the elderly in 2017 were made under the NPM mandate. A total of 9 visits were made in 2017. All visits were made unannounced. Five of the units were run by private service providers. The sites visited were: – Viherlaakso service centre, Espoo (48 long-term residents, run by local authorities) – Taavin muistipalvelukeskus, Espoo (46 residents, run by local authorities) – Antinkoti, Helsinki (94 residents, run by a foundation) – Kannelkoti, Helsinki (93 residents, run by a foundation) – Arvola-koti, Kajaani (54 residents, run by an association) – Menninkäinen care home, Kajaani (30 residents, run by a private family business) – Aamurusko care home, Suomussalmi (14 residents, run by a foundation) – Marttila serviced housing, Orimattila (45 residents, run by a joint authority) – Timontalo serviced housing, Nastola (24 residents, run by a joint authority) The recommendations presented in the reports are usually promptly implemented. Some key observations and recommendations made by the Deputy-Ombudsman based on the visits are presented in the following: Atmosphere/treatment • The relationship between the care personnel and the residents seemed close and the personnel were mindful of the residents’ needs. • As a positive observation, it was noted that the care plan included the resident’s own views on the care and other services they received. Restrictive measures • It was considered a positive initiative that the use of back-zip overalls was going to be reviewed so that the use of restrictive clothing would always require a physician’s decision in the future. • When a person is subject to restrictive measures (e.g. bedrails, back-zip overalls), a documented decision on the measure must be made and the need for the continuation of the measure must be systematically reviewed. Restrictive measures must be discontinued immediately when there is no longer reason for them.