*national dementia care framework, promotes staff education and training in dementia care, and maintains strong relationships with key regional stakeholder organisations.*

Enliven was viewed by many clients, caregivers and key stakeholders as a leading provider of home support services. To be a leading provider of restorative home support services for people living with dementia and their caregivers/families; Enliven leadership will need to ensure a strategic vision linking to appropriate policies and resources that facilitate the best services for dementia clients and their caregivers/families. Senior staff will also need to effectively share this vision/initiative with Enliven staff at all levels of the organisation.

A number of staff noted that in order for Enliven to strengthen its position as a leading provider of community services to people living with dementia at home, senior management will need to increase expertise in dementia care, and that a specialist dementia-care position could be created to provide training and support for staff, thus building staff capacity. It was also noted by staff that given the limited budget for home support staff training, senior management will need to be innovative in the way they utilise (existing) resources to achieve best practice goals.

Staff and key stakeholders discussed the importance of Enliven maintaining relationships with key regional stakeholder organisations, e.g. DHB, MOH, NASC, Alzheimers NZ, community health professionals and community groups. Many staff and key stakeholders remarked that Enliven is well positioned to engage with emerging DHB-facilitated dementia care pathways and to promote integrated community-based services for people living with dementia.

Factor 7: Workforce capability and development.

**4.2. Community**

158 Cognitive Disorders

Factor 4: Dementia education.

component of its integrated dementia care service.

*Assessment and Service Coordination (NASC) assessment.*

grated into a comprehensive range of community-based services.

tunities for home support clients to more fully engage with these services.

clients to for other allied support services.

services in an integrated manner.

**4.3. Organisational**

Factor 6: Organisational leadership.

*Effective home support services for people living with dementia provide caregivers/families and clients with educational dementia-based resources and opportunities to attend educational programmes.*

Numerous key stakeholders and staff discussed the importance of dementia education for clients and their caregivers/families during all stages of the client's condition. While Alzheimers NZ are the national provider of dementia-related education, there is opportunity for Enliven to work with Alzheimers NZ to expand this service for Enliven clients and their caregivers/ families. A staff member remarked that if Enliven employed its own dementia care specialist, then the organisation would be in a position to deliver dementia education programmes as a

With systematic dementia-care training opportunities, Enliven staff, at all levels of the organisation, would be in a stronger position to provide clients and their caregivers/families with dementia-related information. Staff would also be better positioned to know where to refer

*Effective home support services for people living with dementia are integrated into regional DHBinitiated dementia care pathways and are predicated upon clients receiving a specialised Needs* 

Key stakeholders and Enliven senior managerial staff discussed the importance of people living with dementia receiving a specialised dementia assessment as early into their condition as possible. An early diagnosis of dementia provides the dementia-affected person and their family with an enhanced opportunity to understand the cognitive and behavioural changes that are occurring, and increased opportunities to access available medical and social support

Effective home support services for people living with dementia are (as funding allows) inte-

Enliven has developed a range of initiatives to support older adults within the community, including day programmes, walking groups, swimming groups, café conversation groups, men's groups, interactions with church volunteer groups, and home-share care programmes (to name a few). Staff and key stakeholders remarked that these community-based services are formulated to promote restorative-care for client wellbeing through physical and cognitive stimulation, and social connectedness within the community – and that there were oppor-

*Effective home support services for people living with dementia requires organisational leadership that maintains a strategic vision incorporating the principles of restorative care, familiarity with the* 

Factor 5: Comprehensive community-based integrated dementia care services.

*Home Support Care: Effective home support services for people living with dementia employ home support staff with a positive and respectful attitude towards clients/caregivers and are well-trained in home support care for people living with dementia and their caregivers.*

A majority of clients and caregivers remarked that the qualities and skills of the support worker staff they interacted with was an important feature of the Enliven home support service: for example, the support worker's ability to understand of the client's needs, the manner in which they interacted with the client, their ability to communicate clearly with the client/ caregiver(s), their knowledge of the client (e.g. what the client likes, their past and preferences); alongside the support worker's competency in undertaking various domestic, housekeeping and personal tasks. Effective home support staff also liaise with other home support staff who are working with the client (often through the client logbook), to ensure important client-related information is passed on, and that clients and caregivers are not required to repeat themselves for every new worker.

Restorative Care: Effective home support services for people living with dementia ensure staff at all levels of the organisation receive education and training in restorative care.

Enliven has a strong tradition of training staff in restorative care principles and there was an acknowledgement from staff that ongoing monitoring of restorative practices was required to uphold the quality of Enliven service provision. Key stakeholders also acknowledged that many aspects of the restorative care model are a feature of the national dementia care framework – although it must be noted that the national framework does not use the terminology 'restorative care'.

Dementia Care: Effective home support services for people living with dementia ensure that home support staff and service coordinators receive training in dementia care and participate in regular case-review meetings to discuss client management issues.

with DHB funders, need to be able to track support worker case-load details to ensure that clients are receiving appropriate service provision from well trained staff. It was noted that

Effective Restorative Home Support for Older People Living with Dementia and Their Caregivers:…

http://dx.doi.org/10.5772/intechopen.73165

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*Effective home support for people living with dementia requires the service provider to maintain good* 

Many caregivers commented on the importance of being able to communicate effectively with home support staff and service coordinators when various care issues arose. Key stakeholders also remarked on the significance of clients and caregivers being able to approach service providers, and the importance of having well developed mechanisms to collect client and

*Effective home support for people living with dementia requires the service provider to undertake regu-*

All managers stressed the importance of Enliven's commitment to evaluating its provision of home support services. Service assessment took a range of forms including informal evaluation undertaken through client, caregiver/family and staff feedback. Regular Formal evaluations are undertaken through service coordinator case-reviews and service Results Based Assessment (RBA) evaluation. All key stakeholders remarked on the importance of service

This section details the principal conclusions arising from the research findings and the research literature. It commences with an overview of the context that dementia services currently exist within. It then features central components of best practice in delivering home

As the post Second World War baby boomer population progressively ages and New Zealanders live longer, the demand for older adult support services will continue to grow. While residential facilities for seniors, including hospital-affiliated residences, will meet a proportion of this demand; it is home support services assisting older people to remain living in their own home (in conjunction with other community-based services supporting quality of life) that will service much of this need. The popularity of non-residential support is driven by the wish of many older adults to remain living within their own home for as long as possible, and by governmen-

The national dementia care framework is predicated upon the best practice principles of providing proactive, accessible and integrated services that are flexible and client-centred [25]. Over the past decade, Enliven has integrated the principles of restorative care into its home support services. There is a great deal of commonality between the principles of restorative care and the national dementia care framework principles. Both models advocate for client-centred services

Enliven intended to upgrade its current databases as funds became available.

*communication processes with clients and their caregivers/families.*

support for people living with dementia and their caregivers.

tal policy supporting this preference as a cost effective (budgetary) option.

Factor 9: Organisational communication.

Factor 10: Organisational Evaluation.

providers evaluating service delivery.

caregiver feedback.

*lar service evaluations.*

**5. Discussion**

Enliven staff at all levels of the organisation strongly supported an expansion of staff training opportunities in dementia care; with many recommending the employment of a dementia care specialist to work directly with senior staff and service coordinators, and to overview support worker training and case-review meetings. A majority of key stakeholders remarked on the growing importance of dementia trained, and well supervised/supported, home support personnel.

A majority of respondents, across all respondent groupings, discussed the importance of consistent staffing personnel for people living with dementia and the difficulties it can cause when clients are faced with changing staff personnel. While many home support staff had worked for Enliven for many years, Enliven managers acknowledged that the service experienced a turnover of home support staff and that this situation created ongoing difficulties in maintaining staff training levels/requirements.

Managers and key stakeholders identified a range of factors that impact upon home support staff retention rates including a modest pay rate, split and reduced working hours, unreliable income (due to clients being absent), and transport issues. Managers also acknowledged that home support work can be a difficult and that not everyone is suited to assisting clients with personal hygiene tasks, cleaning, and dealing with challenging client behaviours.

The Enliven service covers a range of diverse ethnic communities across the greater Auckland, Waikato and Bay of Plenty regions. As a consequence, Enliven actively endeavours to maintain an ethnically diverse home support staff group, and service coordinators attempt to meet clients' various language and cultural needs.

Factor 8: Organisational database.
