**1. Introduction**

New Zealand society, like much of the developed world, is experiencing a steady increase in the number of older people within the community living with dementia. Internationally, the

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number of people affected by dementia is anticipated to rise exponentially as the world population ages. Global improvements in health care and living standards have contributed to people living longer, and this represents a significant challenge to health and social services [1]. A recent World Alzheimer Report noted that in high income countries approximately half the people living with dementia receive a diagnosis and in middle and low income countries under 10% receive a diagnosis [2]. With increased awareness of dementia in communities, it is likely to lead to more cases of dementia diagnosis. It is estimated that 46.8 million people worldwide are living with dementia and that this number is likely to increase to 131.5 million in 2050 [2].

component of service provision, include the (primarily) Australian-based active service model [9], the United Kingdom-(UK) based reablement programme [10] and the United States of

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

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The next section details international research findings: investigating the impact of restorative care initiatives, the needs of family caregivers supporting someone living with dementia, and

International research assessing the impact of restorative care programmes has largely been undertaken in the United States of America (US) and focused upon older adults living within a residential care settings – the results have identified a range of positive outcomes for participants including maintaining and improving functional outcomes, improved quality of life and independence, and psychological gains; a range of positive outcomes for caregivers have also been identified including increased satisfaction and knowledge of restorative care, and

A small number of international studies have investigated the impact of restorative care within a community setting. An Australian-based study compared the outcomes of 100 older adults aged 60+ years (without a dementia condition) who participated in a short-term restorative home-care programme directed at optimising functioning, promoting healthy ageing and encouraging the self-management of chronic diseases; with 100 older adults who received the usual home-care services [8]. Research participants were interviewed at the commencement of the programme and at a 3 month and 1 year follow-up. The research found that individuals participating in the restorative programme showed improvements on all personal outcome measures compared with the control group. The researchers commented that "participants who received restorative home care showed greater improvement in their self-care, home

A US-based study paired 691 older adults aged 65+ years, without a severe cognitive impairment, and receiving a restorative home care programme through a single restorative staffing unit; with 691 similar aged/gendered adults receiving the 'usual' home care programme across five other staffing units [11]. All support staff (restorative and non-restorative) were employed by the same provider. The research identified that older adults participating in the restorative home care programme were significantly more likely to remain living at home and to have a reduced likelihood of visiting an emergency department. The restorative care participants also showed higher levels of self-care, home management and mobility. The researchers commented that the success of the restorative model was supported by an "enhanced sense of teamwork and improved coordination among the home care staff, the reorientation toward maximizing patients' functional independence, and the inclusion of patients, families

A United Kingdom (UK) based study evaluated the impact of a home support programme that incorporated restorative care elements [13]. The experiences of 29 older adults recently discharged from hospital and supplied with a follow-up 6 week restorative home support programme, were compared with a control group of 25 (similar) older adults receiving the conventional community

the needs of paid caregivers supporting someone living with dementia.

America (USA) restorative model [11].

increased outcome expectations [12].

management and mobility scores" ([8], p. 198).

and home care staff in setting goals" ([11], p. 2104).

**1.1. Restorative care**

Due to limited resources and policy development, the provision of services for individuals living with dementia in many developing countries is minimal. In contrast, many developed countries have formulated, or are in the process of developing, policies and services aimed at supporting the needs of individuals living with dementia and their family/caregivers. While the management of dementia care varies globally, home-based support is typically a leading component of government policy as it is viewed as a cost effective support measure [3, 4].

Dementia is not a single disease, it is caused by a variety of brain illnesses that affect memory, thinking, behaviour and ability to perform everyday activities, and is usually of a chronic progressive nature [3]. Dementia is a costly condition from its social, economic, and health dimensions, and numerous nations are formulating strategies such as home support to manage this development such as the provision of home support [1].

Although the levels of provision and nature community-based services vary between nations, the challenges faced by each government in maintaining and improving services, in the context of a rapidly ageing population and changing expectations, remain similar [5]. Community-based services for people living with dementia include home support services offering assistance with domestic tasks, meals, transport, medication administration, and personal care; day programme services that provide leisure, learning and respite activities; support groups in dementia education initiatives; and range of medical support services. International research reveals that the provision of quality community-based services for people with dementia can postpone the need for institutionalised care [6].

Traditionally, home support services for older adults have often emphasised well-meaning dependency model service provision and encourage maintenance and support only [7]. Under this model, as support workers and allied health staff held a task orientated attitude that prioritising getting the job done and doing as much as they could for the client. The service orientation often lacked an emphasis on the promotion of healthy daily routines, exercise, social interaction, autonomy and assisting individuals to undertake the own daily needs [5].

Recent progressive changes in home support practices are, in part, grounded in the developments that occurred over the past three decades in the care of people living with disabilities [8]. Today the concepts of normalisation, engagement with the community, and empowerment, permeated approaches to the management of people with intellectual, psychiatric and physical needs. A number of developed countries propose that home support services catering for the needs of older adults required a similar progressive change of attitude [8] and following this trend a number of new models of care have been developed. Examples of home support models focused on optimising client functioning and independence, is an integrated component of service provision, include the (primarily) Australian-based active service model [9], the United Kingdom-(UK) based reablement programme [10] and the United States of America (USA) restorative model [11].

The next section details international research findings: investigating the impact of restorative care initiatives, the needs of family caregivers supporting someone living with dementia, and the needs of paid caregivers supporting someone living with dementia.
