At many nursing homes across the U.S., the residents wake up and go to bed at a specified hour, eat breakfast, lunch and dinner together at set times and receive their medications when the medication cart reaches their room.

At the Households at Levindale in Baltimore, a six-building complex that serves as many as 84 residents, there’s no such thing as a typical day.

The Households at Levindale don’t look like traditional nursing homes, and they don’t function like them either.

"What makes it different is the kitchen area," said Gloria Blackmon, RN-BC, BSN, director of long-term care. "It’s set up as a very large, community-type kitchen. You can sit in there, drink your coffee, read your newspaper, chat with friends, just like you would at home.

"The other aspect is there’s no immediate time that you have to eat your breakfast, lunch and dinner. They get up when they want to get up. They eat when they want to eat. They go to bed when they want to go to bed. It’s a lot more about preferences and choices."

The Households at Levindale, a $31 million expansion project that opened this year, are part of Lifebridge Health’s Levindale Hebrew Geriatric Center and Hospital.

About 12 years ago, Levindale began using the neighborhood concept of care, which broke the facility down into smaller communities served by a specific group of staff members for each neighborhood. Each of these smaller units is overseen by a neighborhood leader, who serves in a non-nursing, administrative role.

The creation of the Households took the neighborhood concept of care one step further and resulted in some eye-opening moments.

Residents who came from the previous building to the Households had become set in their ways, especially when it came to meals, according to staff.

"You still see how institutionalized people were," Blackmon said.

"They all lined up for lunch like they normally did. We were like, 'No you don’t have to eat lunch if you don’t want to.’ And they would say, 'Whatever is the best time for you.’ And we’d say, 'No, it’s about you.’ We have seen that improve. It was very hard for residents to choose for themselves."

Working in the Households requires nurses to go about their daily routine differently, as well.

Not only are the nurses given more freedom regarding such things as scheduling of hours, but they are expected to be more like family members than nurses to the residents.

"It gives them an opportunity to be empowered," said Clinical Leader Amy Boulware, RN. "They have more of a chance to grow and make decisions. Previously, it was all dictated out. But they now decide how their assignments will look; whether they want assignments.

"It’s very positive for residents. They feel like they’re in a hotel. ... They feel like they’re being pampered, and that’s what we want."

Boulware said it wasn’t easy for some RNs to adjust to being so involved in the residents’ lives.

But Resource Nurse Tonya Harris, RN, said she had no such problems.

Harris, who works in a unit for residents with dementia, has been with Levindale for five years.

"I love working here in the Households," she said.

"It’s so much different from where [I] and the residents came from. We clean. We do housekeeping. We help at mealtime. We wash residents’ clothes. We put them away. We do everything in this household.

"One thing I notice," Harris said, "you’re not doing the same thing where you can get tired or bored with it. You’re doing several things. It keeps you motivated."

Tom Clegg is a freelance writer.