National Preventive Mechanism priorities for the work of the NPM (including malnutrition, medication and drug safety, the use of measures that restrict freedom and violence). 5.1.2 Geriatric care requires attentiveness and competent leadership In order to be able to guarantee a high standard of care and nursing for very elderly persons with multi-morbidity, it is necessary to adopt a careful approach to the overall organisation. A central aspect of our understanding of human rights and thus the nursing philosophy is the belief in the value and dignity of each individual. Quality development is a task of the overall organisation The task of operators and those responsible for homes and nursing staff is to create the framework conditions that facilitate and ensure nursing that guarantees human dignity. Good relations at work help to counter excessive demands and violence. Staff who are involved in the quality development process and shift planning, who bear individual responsibility and who receive ongoing support thanks to supervision, continuing and advanced training, regular nursing rounds and case discussions are more resistant to stress. It is also the task of all staff to provide “state-of-the-art” nursing and to document it transparently. In the view of the NPM, joint monitoring of nursing documentation, feedback from the head of nursing staff and targeted training in nursing processes and their proper documentation are important prerequisites for enhancing staff skills. Attention and supervision necessary Surveys of nursing staff carried out by the commissions in long-term nursing facilities point to the conclusion that, if there is a good team spirit, even low staffing levels and residents with complex nursing needs can be dealt with. A significant aspect of this is the need for attentiveness and the reciprocal concession of space for reflection in order to be able to discuss conflicts, to concede uncertainties and errors and to be able to accept criticism and change. Mental hygiene is indispensable in the social professions. For this reason, the NPM considers that the management of homes are under an active duty to offer supervision. Positive development In a nursing home of the Land Lower Austria, Commission 5 was able to witness what an effective management is able to achieve within the space of only eight months. Numerous recommendations were issued during a visit in January 2016, most of which had been acted upon by the time the follow-up visit took place in September 2016. The nursing home and ward managers made considerable efforts to improve residents’ living conditions. The Commission found that the rooms in one ward had been rearranged in a much more personalised fashion and that it had been possible to reduce significantly measures that restrict freedom. Additional staff had been hired to occupy the time of residents. Duty rosters were reorganised by mutual 104