3 – RESIDENTIAL CARE AND NURSING HOMES In the year under review, the National Agency visited eight residential care and nursing homes in Berlin, Brandenburg, Hesse, Lower Saxony, Rhineland-Palatinate, Saarland and SchleswigHolstein. Three of these were follow-up visits to check the implementation of the National Agency’s recommendations during its first visit. On top of these visits, the National Agency handled a case in which the residents’ committee of one facility contacted the National Agency on a Sunday. The committee informed the National Agency of serious staff shortages and their subsequent fears that a basic level of care could not be guaranteed. The residents had already informed the police and fire brigade, but were told by these bodies that the matter did not fall under their jurisdiction. The subsequent review – carried out by the supervisory authority once it had been informed – confirmed the severe shortage of staff. Other deficiencies were also found. The supervisory authority reported that appropriate countermeasures had been taken and that it was working closely with the facility to ensure their implementation. The National Agency was highly critical of the reply letter sent by the competent Ministry concerning the report of a visit in Saarland. The letter stated that, for staffing and organisational reasons, the Ministry was unable to comply with the request for a statement on the points raised in the report. The Ministry therefore failed to fulfil the obligation set out in Article 22 of the OPCAT, which states: “The competent authorities of the State Party concerned shall examine the recommendations of the national preventive mechanism and enter into a dialogue with it on possible implementation measures”. There are also doubts as to whether the Ministry is fulfilling its supervisory duties. In 2018, the National Agency will focus on elderly care. To this end, it will visit more residential care facilities for the elderly and draw up appropriate standards. In another facility, exits were clearly marked as such. This facilitated orientation for the residents and allowed them to be more independent. In the care unit for dementia sufferers in one facility, touchpads had been installed on the wall in order to stimulate tactile perception; in another facility, trained therapy dogs are used to help care for this target group, which helps improve interactions between caregivers and residents. All of the facilities cooperate with medical specialists. The National Agency noted in particular that some facilities ensure that residents receive dental and eye care. In one facility, a notice board displaying the dates of all periodic doctors’ visits was also noted positively. This enables residents and their relatives or legal caregivers to directly contact specific doctors. 3.2 – FINDINGS AND RECOMMENDATIONS The visited facilities were given recommendations on the following main topics: 3.2.1 – Accessibility The National Agency was critical of the lack of barrier-free access to the outside area in four facilities, as well as the lack of access to the balconies in one facility. In all cases, the presence of a small threshold posed a tripping hazard which, furthermore, could not generally be negotiated by residents who were alone in a wheelchair. Residents have the fundamental right to move around freely. For this reason, residential care and nursing homes must also ensure barrier-free access from the inside area to the outdoor area and vice versa. 3.2.2 – Deprivation of liberty The use of bed rails may constitute a deprivation of liberty. In some of the facilities, the National Agency examined voluntary declarations consenting to the use of bed railings. In one case, the resident’s personal details had not been fully documented. In another case, a resident had not been informed that she could withdraw her declaration at any time without citing reasons for doing so. As the use of bed rails represents an interference with a person’s right to liberty, voluntary declarations consenting to this measure should always be clearly 3.1 – POSITIVE EXAMPLES The National Agency highlighted several positive examples during its visits. In one facility, regular case reviews were carried out every three months regarding the necessity of continuing authorised measures involving a deprivation of liberty. 46