**2.2. Restorative model**

**2. The New Zealand context**

decision-making around dementia policy [23].

with dementia in the caregivers/families [25].

**2.1. Policy environment**

150 Cognitive Disorders

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 latest 'Economic Impact of Dementia' report authored by Deloitte [23] and commissioned by Alzheimers New Zealand, suggests there will be approximately 170,000 New Zealanders living with dementia by 2050, up around 300 percent on current figures of 62,000. The report highlights the significant economic impact of dementia with the costs of supporting dementia diagnosed people could reach nearly \$5 billion by 2050. It is suggested that new models of care that delay entry into residential care have the potential net benefit of \$22 million a month, leading to substantial savings over time. The economic impact report is a key information source on the size and scale of the dementia challenge in New Zealand and is used to inform

The New Zealand policy framework for senior home-based support is primarily founded upon two Government strategy documents: the Ministry of Social Development's New Zealand 'Positive Ageing Strategy, 2001' and the Ministry of Health's 'Health of Older People Strategy, 2002'. The Positive Ageing Strategy promotes the concept of positive ageing, affirms the value of older members of society, and highlights the importance of issues such as access to health services, financial security, independent living, the physical environment and personal safety. The Health of Older People Strategy details an integrated continuum of care, which seeks to ensure that all relevant health and disability services are coordinated in such a way that older peoples' needs are appropriately met "at the right time, in the right place and from the right provider" [24]. In recognition of the increasing challenge of burgeoning numbers of older adults diagnosed with dementia, the New Zealand Ministry of Health released in 2013 the 'New Zealand Dementia Care Framework' to initiate and coordinate dementia services for people living

The vision of the framework is to ensure: people living with dementia, their family are valued partners in an integrated health and support system. They are supported throughout their journey with dementia, to enable them to maintain and maximise their abilities, optimise their sense of well-being and have control over their circumstances [25]. While the national framework recognises that many individuals living with dementia may ultimately require residential care facilities, the framework actively promotes community-based services that support those individuals living with dementia to remain living at home and home-based support services are a central component of this approach. The Framework is not directly based upon the restorative model of care, it does advocate for a person-centred and people directed approach that includes many restorative like principles ensuring that people living with dementia and the families/caregivers are respected, valued and are engaged partners in care planning, receive clear communications and education that enable them to be engaged at all levels of decision-making, and able to self-determine many aspects of their lives [25].

the restorative model. Part three reports on research undertaken on 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 "relationship between the participants care manager and GP" ([26], p. 726).

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

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).
