In his book, Shields notes that he learned that the first household was moving to a 24-hour dining schedule just days before it was implemented, as well as the staff's plan to do away with three eight-hour shift scheduling with flex work times. A team leader told him about it in passing.

"I don't remember much about the rest of the conversation because my head was swirling," Shields wrote. "I admit my first reaction was to feel a little stung because I didn't know anything about either issue. And then I thought, 'Well, what have you been wanting for all this time, big boy?'"

Since the staff works with the same residents in the households, they build a bond rarely seen in traditional nursing home settings. Workers know residents' needs, both physical and emotional, more intimately.

And residents know about the staff's personal lives, improving trust and communication.