completely cleaned by 4 p.m. Some residents complained to the commission about early bedtimes and spending a long time lying in bed, which they were forced to do due to their physical limitations and the resulting physical impairment. In some facilities, the NPM was successful in attaining that late shifts were set up to enable greater flexibility. The number of staff tends to be low everywhere during night shifts and this does not permit responding to requests by residents for more needs-based activities during the day and especially towards evening. The NPM considers it positive if elderly persons can have a snack at any time after a main meal and that offerings are still available during the night hours, as seems to be the case in many facilities in Tyrol. The staff in a retirement and nursing home in Lower Austria was especially committed. Kitchen staff ask the residents personally if they liked the food; requests for changes are met quickly and the kitchen is staffed until 7:30 p.m. In order to respond to the habits of each person, biography work should be used in all retirement and nursing homes. The NPM is of the opinion that the inclusion of residents, in the sense of input and co-determination, should be observed in every retirement and nursing home. Positive examples are, the installation of a “residents’ council” in a facility in Lower Austria, or as is the case in Vienna, the election of residents’ advisory boards. Inclusion of the residents The NPM also recognises the need to expand palliative care. Many facilities have already dealt with the topic of “dying with dignity” and have introduced a special unit for palliative care. The commissions have, however, found situations that are not consistent with modern palliative care.  Activity and occupational offerings during the day as well as regular access to the outdoors increase well-being and prevent complications.  Respecting the right to self-determination is also necessary with regard to organisation of mealtimes and bedtimes.  Non-medication-based measures to minimise sleep disorders should be used systematically and documented. 2.1.2.2. Requirements for the effective prevention of falls The fact that elderly people have a tendency to fall is an especially significant risk factor in retirement and nursing homes. However, contrary to what the term suggests, falls are not a sudden and isolated event, but they often have a history, can happen repeatedly and often have dramatic consequences. The tendency to fall is a risk factor 34