Retirement and nursing homes A medication-based measure that restricts freedom may only be executed if considerable risk of harm to the person involved or third parties cannot be averted through more gentle measures in advance (Section 4 of the Nursing and Residential Homes Residence Act). It shall always be examined whether the deprivation of liberty by psychotropic medication can be avoided through professional care standards, individual care concepts and non-medicationbased interventions. In the experience of the NPM, the subsidiarity clause is not sufficiently observed – at least, very often not documented. The causes of unsettled behaviour are not fully looked into. Behavioural disorders with dementia-related illnesses can be caused by somatic conditions or the interaction and side effects of prescribed medication. The documentation work associated with examining alternatives is appropriate according to the court rulings of the Supreme Court, because medication linked to the restriction of freedom can only then be justified if no other measures are actually expedient. Subsidiarity not sufficiently observed Commission 1 observed in a home in Tyrol that previously attempted less severe measures had not been documented in any of the reports to the representatives of the residents. The quality of the documentation generally varies as does the awareness and level of knowledge in this respect. In a home in Vorarlberg, sedating medication including sleeping pills was administered with the evening meal. In the opinion of Commission 1, this constitutes premature tranquilisation and thus a reportable measure that restricts freedom. In isolated cases, it happens that persons suffering from dementia who are unsettled at night are given sleeping medication after midnight. The consequence of this can be a hangover or falls the following day. Medication administered at the wrong time The NPM recommends that nursing homes regularly evaluate the use of measures that restrict freedom, draw up founded biographies and create a customised plan that conserves resources. This should cover alternatives to measures that restrict freedom, individual activities for each resident, appropriate communication and maintaining or improving mobility. Success is noticeable on follow-up visits in cases where – as a result of visits by the commissions - medication is adjusted, training or supplementary expert instructions are provided and care visits focusing on restrictions of freedom are made. A particularly positive example is a home in Lower Austria that succeeded in reducing a large number of measures that restrict freedom and noticed an improvement in the residents’ well-being since then. Recommendations and successes of the NPM XX  The NPM recommends drawing up founded biographies and creating a customised care plan that conserves resources in order to avoid medication-based measures that restrict freedom. 34