**2. The New Zealand context**

This section consists of three parts: Part one reports on the New Zealand policy environment that has shaped government responses and subsequently social service providers' responses to older people living with dementia and their caregivers. Part two examines New Zealand research on the restorative model. Part three reports on research undertaken on home support staff.

**2.2. Restorative model**

as improve carer's well-being ([27], p. 33).

**2.3. Home support staff**

Research undertaken in 2012, compared the experiences of almost 600 older people at risk of permanent institutionalisation: one half were provided with the usual level of support care and the other half were provided with a strong care-management intervention designed to facilitate independent living [26]. Individuals were tested at 3, 6, 12, 18 and 24 months; and the results showed that older people receiving the care-management intervention had a significantly reduced rate of permanent institutionalisation and risk of mortality. The authors suggested that the intervention benefits could also be due to a "higher level of coordinated care, which offered more comprehensive support and early crisis resolution" and an improved

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

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

151

A recent randomised trial of restorative home care for frail older people undertaken by a team of researchers at the University of Auckland, aimed to "establish the effectiveness of a restorative home support service on institutional-free survival in frail older people referred for need assessment." ([27], p. 27). A secondary outcome of the research was that the health of the informal caregiver was also investigated. Their trial concluded that restorative home care may reduce mortality in older people, potentially lower the rate of institutionalisation, as well

An Auckland based study evaluated the impact of a restorative home care service for older adults aged 65+ years in the Auckland region [28]. Older adults and their caregivers were identified via a home care agency and a clustered randomly to receive a restorative home care intervention (n = 93) or the usual home care support service (n = 93). In contrast to the traditional home support service, the restorative home care programme was more flexible in its delivery and focused upon promoting functional status and improved quality of life. The research findings revealed that older adults participating in the restorative-based programme demonstrated a significant improvement in health related quality of life and there was some evidence of improvement in social contact. Key aspects of the intervention contributing to these findings included: "goal facilitation and development of personalised support plans, the coordinators

enhanced input and support, and improved training for support workers" ([28], p. ii).

While paid caregivers are essential to the provision of home support services, there are ongoing difficulties in recruiting and retaining good staff due to poor working conditions and inadequate training opportunities. The Auckland based study [28] also evaluated the experiences of support staff engaged in the controlled trial in Auckland that allocated 93 older adults and their caregivers to a restorative home care intervention, with a similar sized group receiving the usual home care support. The research findings revealed that the restorative intervention had a substantial positive impact on the participating staffs sense of job satisfaction – primarily due to an improved provision of training, increased support and supervision, and more flexibility in work tasks. This improvement in caregiver work satisfaction lead to a substantial reduction in the turnover of staff participating in the restorative intervention. The researchers noted that in spite of the improvements achieved through the restorative intervention, a majority of staff identified issues in relation to their working conditions including low wages, no reimbursement for travel time between client visits and a lack of guaranteed work hours [28].

"relationship between the participants care manager and GP" ([26], p. 726).
