**2.3. Home support staff**

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].

Throughout New Zealand there are 22 Alzheimers Societies whose role is to promote education and awareness, and to provide support and advocacy for people with dementia and their caregivers. Kirkman [29] surveyed and collected interview data from 48 women employed as community workers with Alzheimers Societies throughout New Zealand. Despite their low pay, part-time work and the lack of recognition of their professional qualifications, many workers were satisfied with their role as they felt they were making a difference for people with dementia and their families. Overall, Kirkman found a "gendered" patterning of paid and unpaid care for people with dementia commenting that this "reflects the traditional view that women are carers both inside families and outside them as well" and that "what is needed as we plan for the dementia epidemic' is recognition of the value of the work that women have done as paid and unpaid cares" ([29], p. 14).

evidence was gathered from countries with similar social dynamics to New Zealand including Australia, the United Kingdom, the United States and Canada. In addition to providing an overview of best practice elements, the review helped inform the questions for the fieldwork. In stage two, mixed methods using a combination of qualitative and quantitative methods were used to gather a comprehensive range of data from Enliven clients and the caregivers/ families, Enliven home support staff and senior managers, along with key stakeholders in the community who are recognised as experts in the field of dementia care home support services and social/health policy implementation were invited to participate in the research. Qualitative research methods used in the project included semi-structured telephone and focus groups interviews. Semi-structured interviews allow research participants to liberally discuss their thoughts, feeling and experiences about a particular research topic. This process enables researchers to gain rich insights into the 'meaning' individuals formulate about their experiences. Focus groups are an effective means of gathering data across a group of people – this process helps to identify differences and similarities in people's experience and opinions through discussion and participant interaction. Quantitative research methods used in the project included the administration of a paper-based survey questionnaire. Questionnaires are an efficient method for capturing data from a range of key informants in different locations.

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

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Enliven first delivered restorative home- support services under the Community First restorative model established in Hamilton in 2002, as a Ministry of Health funded 'Ageing in Place' pilot programme. In 2009, Enliven was successful in securing a contract to deliver Auckland District Health Board's Enhanced Home Support Services for people over 65 years. This contract introduced a (restorative-like) strengths-based approach promoting client independence using formal goal setting and flexible packages of funding to ensure a right place and right

Over time Enliven restorative home support services have progressively been expanded across the PSN region to include five DHB areas: Auckland, Counties Manukau, Waikato, Lakes, and Bay of Plenty. During this time Enliven has continued to build capacity to support clients who might otherwise be in residential care to remain in their own homes, and this

Additionally, Enliven has incorporated restorative principles within its day programmes – as a component of socialisation and mobility goals, as well as providing mental stimulation and general enjoyment. Day programmes also assist caregiver needs and stress, through provid-

Fieldwork data gathering methods included: telephone and face-to-face semi structured interviews; focus group interviews, and the administration of a paper-based questionnaire. Research participants included: a selection of Enliven clients diagnosed with dementia and their families/caregivers; a selection of Enliven managers and staff; as well as a number of key community stakeholders. All participants were nominated by Enliven senior managers and each data collection method selected for the different groups under study were agreed to as

encompasses people living with various high and complex needs including dementia.

**3.3. Sampling, recruitment of participants and data collection methods**

**3.2. Study setting**

ing respite time.

time experience for older people.

In New Zealand home support services are predominately offered by non-government organisations (NGOs) that offer a range of home support services (from personal care to respite care for carers). The NGOs often have receive government funding for eligible clients Needs Assessment and Service Coordination Co-ordination service (NASC) via the District Health Boards who are funded by the Ministry of Health. Additionally, NGOs attract self-funded clients. NGOs are guided by the implementation of the New Zealand Dementia Care Framework [25].
