**5. Discussion**

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 support for people living with dementia and their caregivers.

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

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 that are flexible in delivery; that set (manageable) goals for clients that encourage physical, mental and social stimulation; empower clients and their families to maintain control over their circumstances; and maximise client's abilities and sense of wellbeing.

Similarly, all managers, staff and key stakeholders commented on the importance of the primary caregiver's role, remarking that many home support clients living with dementia were only able to remain living at home due to the commitment of their caregiver, along with the

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Numerous key stakeholders and staff participating in this study discussed the importance dementia education for people living with dementia, and their caregivers/families. This finding is strongly supported by the research literature and also a key component of the national

While Alzheimers NZ are funded to be the primarily New Zealand provider of dementiarelated education, there is opportunity for Enliven to work with Alzheimers NZ to expand this service for Enliven clients and their caregiver/families – with the organisation providing

Many Enliven senior managers are members of regional social service and/or dementia care networks – some of these networks are working with local DHBs to plan regional dementia service provision. International research shows that the greater the integration of clients services the better the general outcomes for clients [19], and this finding is a central principle of the national dementia care framework i.e. requesting local services to work more closely together for the benefit of the client. These dynamic supports Enliven senior and middle management initiating and maintaining links with key stakeholder organisations within their region.

Key stakeholders and Enliven managerial staff identified that that the home support industry suffers from a high turnover of staff due to funding issues. Similar findings have been found in New Zealand [30] and overseas [19]. Enliven staff identified a range of financial/organisational factors impacting upon home support personnel retention rates, including a modest pay rate, split and difficult working hours, unreliable income due to staff not being paid if the

Many clients and caregivers participating in this study remarked that they valued building a relationship with their home support staff and found it very frustrating when they were presented with a high turnover of home support personnel. Home support staff are often the 'face' of the organisation and Enliven is therefore judged by the quality and consistency of its support staff.

Enliven has good service evaluation processes in place. International research highlights the importance of service evaluation [7, 12] and this theme is incorporated into the national dementia care framework [25]. All managers stressed the importance of Enliven's commitment to evaluating the quality and appropriateness of its home support services. Service evaluation took

provision of Enliven services.

dementia care framework [19, 25].

exclusive educational services for Enliven clients.

client was absent, and transport issues.

*5.2.3. Dementia education*

*5.2.4. Leadership*

*5.2.5. Funding*

*5.2.6. Evaluation*
