measures that are suitable for the prevention of violence and aggression and that can have a de-escalating effect in already existing violent situations. Dementia patients are increasingly likely to be subject to measures that restrict freedom. Behavioural abnormalities, such as physically and verbally aggressive behaviour and constant restlessness, are experienced by the people in their environment not just as challenging but as a hardship. It is well known from studies, but also from commissions’ reports that psychiatric drugs are misused in nursing homes to confront these stressful situations and sometimes to “tranquilise” the residents (see also Chapter 2.1.2.3). In the opinion of the NPM, training regarding prevention of falls and dealing with behavioural abnormalities, as well as specific care concepts for dementia patients, are essential approaches in order to prevent measures that restrict freedom. Ten years after the Nursing and Residential Homes Residence Act (Heimaufenthaltsgesetz) came into force, many facilities and institutions are aware that use of milder measures makes it possible to forego mechanical restraints. There are now alternatives such as sensor floor mats, low-profile beds and hip protectors. Sensitivity on the part of staff regarding interference with the right to personal freedom is growing if they are trained in custodial interventions such as validation and biography work. This training is also important with regard to documenting measures that restrict freedom transparently and comprehensibly, to evaluate them on an ongoing basis and to properly notify the representative(s) of the residents. Facilities and institutions that had deficits were urged by the NPM to make appropriate purchases or to improve decision-making capabilities and alternatives on the part of nursing staff by providing instruction on the enforcement of the Nursing and Residential Homes Residence Act. In some serious cases, in which there were systematic violations, the facilities and institutions were requested to promptly contact the representative(s) of the residents and to then notify the NPM that the unresolved problem areas had been dealt with. Alternatives to mechanical restraints In 2015, there were numerous situations that gave rise to complaints by the commissions. Notification violations vis-à-vis representatives of the residents were frequently criticised. But the commissions also endeavoured to improve specific conditions. For example, Commissions 2 and 6 noticed that in some facilities outdated beds were being used that no longer correspond to health care science and made it easy for limbs to being pinched or trapped. Sensor floor mats were purchased in a facility that does not yet have low-profile beds; however, they were only three to four centimetres thick so that the height of the fall from the nursing home beds was still too great. In another facility, during a visit by a commission a sensor floor mat was not at the edge of the nursing home bed, but was leaning against the wall, although the nursing staff had recognised and documented the 30