National Preventive Mechanism 5 NPM findings and recommendations 5.1 Retirement and nursing homes 5.1.1 Introduction During the year under review 2016 a total of 125 facilities dedicated to the care of the elderly were visited. When planning their visits, the commissions took care to include facilities of different sizes and operators. So-called followup visits were carried out on 37 occasions in order to determine whether requirement for change previously ascertained had been recognised and whether the recommendations of the NPM had been implemented. This was largely the case. However, it is apparent that wherever structural deficits are primarily attributable to staff resources that are deemed to be inadequate, whilst the NPM was in some cases able to obtain changes to duty rosters; it was largely unable to achieve the appointment of additional staff. The population of Austria is growing and at the same time the population is also ageing. These are the major trends according to the “Population forecast 2016” of Statistik Austria, which will also continue in future. Thus Austria, along with other industrial countries, is undergoing a demographic transition towards an ageing society, with the strongest percentage growth above all within the group of the very elderly (above 85 years old). In 2015, this population group included a total of 216,365 people, with projected growth of 59.6% by 2030 and to 448,805 people by 2040. This represents an increase of almost 107%. Nursing facilities are therefore increasingly taking in individuals with multi-morbidity, persons with dementia or other mental illnesses or disabilities. This places major demands both on the presence of nursing and care staff and on their specialist and social skills. The framework conditions set out by politicians do not take account of this; the imbalance between rising demands and the actual human resources available in facilities was perceived by all commissions. Specialised care expertise as major challenge The regulation of the establishment, maintenance and operation of homes for persons needing constant general care, and only occasionally medical care, falls under the competence of the Laender. In 1993 an agreement was concluded between the Federal Government and the Laender pursuant to Article 15a of the Austrian Federal Constitution with the aim of “regulating provision for persons needing care according to the same goals and principles Austria-wide”. The Funding of Nursing Care Act (Pflegefondsgesetz) 2011 also pursues the defined goal of harmonising the provision of nursing care services, with the financial support of the Federal Government. There is no question of establishing a minimum standard across Austria. The alignment of guidelines for calculating staffing requirements, which in some cases are strongly divergent, and the underlying methods, which has been called for by the NPM and the Austrian Court of Auditors, has still not taken place. No overall political management of longterm care 99