Is this the future of elderly care in Lancashire?
On a residential street in Chorley a woman gives a cheery morning greeting to one of her neighbours.
The pair exchange pleasantries about their plans for the day before heading their separate ways.
The only unusual thing in this otherwise unremarkable scene is that these two neighbours actually live under the same roof.
Yet along with the dozens of other older people who now call Primrose Gardens home, each of them has their own front door leading to separate apartments - all of which line a series of internal ‘streets’ in a single building.
The development, on the edge of Chorley town centre, is the latest “extra care” facility to open in Lancashire - offering an alternative to the traditional residential home for those whose care needs have left them looking for somewhere else to live. Similar schemes are due to open in Preston and Fleetwood in the coming months.
Residents are free to come and go as they please and live their lives as they always have, but safe in the knowledge that their independence is wrapped in a safety net - with round-the-clock support available for them, should they need it, in the place they now call home.
“If they don’t feel well or are in trouble, there is somebody who will respond - and that brings peace of mind,” explains Primrose Gardens’ assistant manager Jacqueline Wilson.
“They can pull a chord and get a response immediately. It allows people just to get on with their lives and it’s stopping them having to move into a care home.”
The extra care concept is based on maintaining an older person’s independence for as long as possible - giving them more freedom, rather than less, even as their care needs increase.
As well as the 24-hour emergency support which they can call upon, residents continue to receive any pre-planned care packages that they were getting in their previous homes to help with daily living. Meanwhile, general staff like Jacqueline are responsible for the running of the building and dealing with practical problems – a service which is also provided out-of-hours by a concierge.
“One of our residents had a fall where she used to live and it stopped her going out. But her confidence has increased again since she moved here and she is just a different woman. She is still nervous, but is getting out and about again, heading off into town,” Jacqueline says.
Each of the 65 apartments in Primrose Gardens is self-contained with its own kitchen, wet room and bedroom. A dozen of the flats have a second bedroom - either for couples who need to sleep separately because of medical equipment or to house a live-in carer or relative coming to stay. Every household also has access to its own patio or balcony.
The comforts within each property - which often include familiar furnishings brought from their previous homes - might make it tempting for residents to remain largely within their own private space. While there is nothing to prevent them from making that choice, one of the guiding principles of extra care is the creation of a community - a group of people who not only share a roof, but a life as well.
Each kitchen has a window that looks out onto the street corridor outside, designed to encourage the kind of daily interaction that can turn from nodding recognition to true neighbourliness.
But the best opportunity for those who want to find new friends is to pitch up in the communal areas of the development - and take part in the growing list of group activities, which so far include bingo and a book club.
“We have started them off with some ideas, but it is really down to the residents to come up with whatever they want. We tell people that this is their home - you don’t live where we work, we work where you live,” Jacqueline smiles.
She adds that the kind of interaction which the facility hopes to promote should have benefits for mental as well as physical wellbeing.
“It gets them out of their apartment - they can come and get involved or just sit and watch the world go by. The main downfall for elderly people is isolation.
“We all like to people-watch and this is the perfect place - even if you just get that little, ‘hello’ from somebody, it can mean so much.”
With the main foyer of the building soon set to welcome businesses open to both the public and residents, including a bistro and salon - plus the dance studio which is already up and running - Primrose Gardens is likely to be a permanently busy place.
But Jacqueline says that the stresses that come with helping to manage it are often soothed by the residents themselves - with care seemingly flowing both ways in this fledgling community.
“One lady told me I looked like I needed a hug the other day,” she laughs
“You get to know the residents by name and have a chat and a laugh together - it’s [about] being formal and informal at the same time.”
The streets of this new undercover village - with names like Bluebell Wood and Snowdrop Walk, along with matching pictures to aid those with memory problems - are beginning to bustle and it is hoped that the development will be fully occupied by Easter.
Those arriving here are greeted with snapshots of Chorley in years gone by - a reminder of how life used to be in the days when they probably never gave a second thought to growing old.
But if places like Primrose Gardens can succeed in offering reassurance in retirement, they may yet be able to recapture that more youthful mindset in their new residents.
'I KNEW THIS SHOULD BE OURS'
When Sylvia and Glyn Bouskill made the short move from Whittle-le-Woods to the Primrose Gardens development in the autumn, they felt that “the time was right”.
Sylvia, 75, is disabled, has been diagnosed with dementia - “but that doesn’t define me” - and was attracted by everything in the apartment being on one level.
“We came to have a look and it was perfect - I just felt that this should be ours, so we said yes straight away,” Sylvia recalls.
For 71-year-old Glyn, a retired joiner, there is only one ongoing worry.
“I just keep wondering when I’m going to have to leave this hotel and go back home,” he laughs.
“The staff are really helpful and we are so happy here.”
But the couple, who recently celebrated their golden wedding anniversary, are aware that not everybody shares their enthusiasm for extra care - especially if their move to the facility was not of their own choosing.
“There are a lot of people here because their relatives feel that this is the right place for them - but they haven’t really said goodbye to where they were living before. There are people who are struggling and I can understand that - but I just keep saying to give it time,” Sylvia explains.
As only the second couple to arrive at the development, Sylvia and Glyn felt responsible for getting some of the initial group activities off the ground.
But Sylvia recognises that it is important in a place like Primrose Gardens to forge - and not force - friendships.
“Some people are hard to get to know, because they’re private and you have to let them be like that. Some people have got a lot of baggage, but they’ll settle.”
Glyn - who plans to tempt his new neighbours on a trip to the town’s bowling alley and also set up a whist group - adds that the relationships between residents will bring broader benefits than simple companionship.
“If people sit by themselves or as a couple in a room, that’s it - you just vegetate. You need to get out and meet other people - and this is ideal, because you don’t actually have to go outside,” he says.
As a former nurse, Sylvia says she often longed for the model of care which underpins her new home.
“[When I was working] in hospital, elderly people weren’t cared for well enough - they were looked upon as people who had no value and that used to upset me.
“You really need to dig down into people’s life experience. I’m always asking people in here what they used to do - because people have history behind them and that’s what makes them.
“They tend to forget that they have got some value, but everybody has value - and we feel valued here.”
HOW DOES EXTRA CARE WORK?
Extra care facilities are operated by housing providers or district councils, which are responsible for the building itself. They charge rent on the apartments and a service charge for maintenance and upkeep of the communal areas.
Fees will vary depending on the operator, but the Primrose Gardens development charges £134 per week for a one-bedroomed apartment and £50 per week for maintenance. If a resident is eligible for housing benefit, it can be used to help cover these charges. However, living costs are the responsibility of the residents.
Lancashire County Council commissions the 24-hour ‘background’ support provided on-site should anybody need assistance. A flat fee of £17.50 per week has been set for this service across all extra care developments in the county and at least two staff will be available at any one time.
Separate packages of planned care to help people with specific needs can also be secured by the county council, usually from the same organisation providing the round-the-clock support - to offer continuity and utilise any overlap in staff. However, residents can arrange planned care themselves and pay for it directly using their own personal care budgets.
Depending on the development, some apartments may be available to buy.
The Primrose Gardens scheme also provides a room for family members to rent out for a nominal fee so that they can be close to their relatives if they are visiting from a long way off or if their loved one is ill.
WHO IS ELIGIBLE FOR EXTRA CARE?
Extra care schemes are designed for people over 55 who have care needs that would be met by moving into one of the apartments or whose own home is no longer suitable for their circumstances.
The likely demand for places prompted Lancashire County Council - which is responsible for the care element of the facilities - to darw up priority criteria.
The greatest priority will be afforded to individuals who have been assessed as having high care needs and who would otherwise be forced to move into a residential home. This may include people waiting to be discharged from hospital.
Individuals whose lower-level care needs would be met or reduced by securing a place in an extra care development, will be given medium priority. Remaining places will be allocated to anybody who feels that their wellbeing would be improved – and any future care requirements delayed – by moving into one of the facilities.
WHY EXTRA CARE?
Local authorities with social care responsibilities are required by law to promote the wellbeing of those in need of support, to prevent or delay the onset of such needs and offer choice to individuals about how their needs can be met.
Lancashire County Council has identified extra care as a way of fulfilling its duties and providing a “genuine alternative” to residential care - to which it admits more people over the long-term than the England average. The authority also estimates that each extra care placement it creates can save £33 per week compared to the cost of looking after an individual in another setting.
County Hall wants to see one extra care facility built in each of its 12 districts within the next five years; there are currently three in operation - Chorley, Ormskirk and Whitworth. The 1,000 places which it expects to generate will be less than half of those that would be needed to bring the county up to the average level of extra care provision across England - but the authority says that it has to be realistic about what can be achieved.
County Cllr Graham Gooch, cabinet member for adult services, said more people were wanting to live independently as they get older and “in their own space”.
"These new extra care services provide superb, modern accommodation, a range of facilities on-site as well as care and support workers available 24/7 for those who need that level of support.
"They are usually located close to the centres of towns and villages so people have easy access to facilities and can truly feel part of the community.
"Extra care helps people to enjoy a more active lifestyle and evidence shows that this benefits not just the individuals who live there, but also reduces pressures for admissions into hospital and residential care.”
Chorley Council became the first local authority in Lancashire to establish an extra care facility when Primrose Gardens opened in October - the other schemes in the county are operated by housing providers. Chorley committed £6.3m to the £10.5m development - but, as the landlord for the building, expects to generate an annual income of £111,000 within two years.
Lancashire County Council provided a further £1m in funding, with the remainder coming from Homes England.
Chorley Council leader Alistair Bradley said residents in the development can live “as independently as they like”.
“Our vision when we started the Primrose Gardens development was to provide accommodation that would promote independence and social integration whilst catering to care needs. We’ve certainly achieved this and are so pleased with it.
“It’s also brought more residents to the town centre who can access nearby amenities such as GP surgeries, pharmacies and town centre shops, therefore supporting local businesses.”
The scheme was a finalist in the recent Inside Housing Development awards in the "Best Older Persons' Scheme" category.
Two more extra care facilities are due to open during the first half of this year:
Preston - The Courtyards on Dovedale Avenue in Ingol - a 60-apartment complex, operated by the Community Gateway Association.
Fleetwood - Lighthouse View on Chatsworth Avenue - a 72-apartment complex, operated by Regenda Homes.
34,300 - number of extra over 65s in Lancashire by 2025 compared to 2017
3,214 - Lancashire older adults in long-term residential care (June 2018)
£515 - average gross weekly cost of residential care in Lancashire