When Enough is Enough

LEARN A LITTLE:

I worked for the state of Illinois within the Mental Health and Developmental Disabilities department for nearly 20 years in a variety of administrative positions. Up to the near end of that time, I enjoyed what I was doing and worked with some great and talented people.

I am often asked why I left state service and began working in the private sector. The primary reasons were politics, especially being unable to employ the most qualified persons and the increasing stultification of bureaucracy.

Unfortunately, the force of the bureaucratic influence extended to the community sector and was a significant cause of conflict between community providers and the State Intellectual and Developmental Disabilities Office. This included the “monitoring” of community provided residential services.

After one such visit, I had the thought and feeling “enough is enough.” You have probably had this experience as well.

What follows is a letter I thought you might appreciate that I wrote as the CEO of Trinity Services to the Director of the Department of Mental Health and Developmental Disabilities. He was actually a director who worked hard to professionalize the department.

“

Dear Harold:

This correspondence may seem like something out of left field, but the precipitatory stimulus has made me sufficiently angry to take the time to bring this matter to your attention.

The actual source of my anger is shared below, especially as it relates to the Bureau of Licensure and Certification’s comments regarding the community group home.

Complaint: Regarding the CILA located at (community group home), the anonymous complaint states that staff are “not trained to pick up and move people properly, the residents are over medicated and cleanliness is a major problem at this house.”

Partially Founded: Trinity Services has documentation of providing a 40-hour, pre-service training session, including a one-hour session in body mechanics that encompasses training in lifting and transferring. Resident records were reviewed for medication prescription and all medications are prescribed by a physician. Upon inspection, the home was found to be lacking cleanliness in the following areas:

The bedroom windows and window sills are very dirty
Some mini blinds are damaged and bent upwards
Feathers and bird seed are lying on the floor of the living area
Cobwebs are hanging from the ceiling beams in the living room area
The linoleum floors throughout the house are dirty, especially in the living areas.

Deficiency: Section 115.300

Item c/6/A: The agency does not ensure that living arrangements are clean.

This captures for me personally what many other providers have been sharing with regards to complaint follow-up or the focus of certain surveyors. I have many issues with the current process as it exists today but will limit myself to one primary issue in this letter, and that is the matter of realistic housekeeping standards. Don’t get me wrong; I will never contend that Trinity is sin-free, bruise-free or dust-free, but that’s sort of how I view the real world.

The Department needs to decide if they want homes in the community to be homes with all of the vulnerability associated with these environments or museums, places that provide an opportunity for individuals, who have never seen a disabled person, to come and view them in a community setting. Staff could wear uniforms, be called docents and give regular tours. Of course, these environments will be spotless and clean. Who would ever think of taking museum property out of the building?

I understand why certain individuals only focus on the visible. It’s an easy way to measure progress—three cobwebs up, three cobwebs down. Besides Department staff can defend themselves from any accusations of not worrying about what’s going on in the community. As I write this, I’m in my office, and there are cobwebs in the ceiling heat vent. What’s to be concluded from this? I’m not a caring individual? I like spiders? I’m against cleanliness?

Furthermore, I can’t buy into the argument that “if the Department pays for it, it should expect it” unless the Department is truly willing to cost out its cleanliness standards.

By now, you’re probably wondering why I’m so angry. I’ll only bore you with the short version. The group home is one of our most difficult homes, and on that I am in very frequently. It’s the home that has six ladies living in it, all very involved physically as they are in wheelchairs. It’s the house where the staff re-upholstered used furniture; the house where we admitted two referrals from the Illinois Mental Health and Developmental Disabilities Department on an emergency basis.

There are two staff on duty most times. They literally assist the ladies in eating as well as take them to doctors’ appointments, clean, shop, and assist the ladies with bathing without lifts. These staff members may be Trinity’s best. Please understand that this letter is not a request for additional funding, though I certainly know that I could use more staff in maintenance. We do not employ any housekeepers, cooks or drivers.

What am I requesting? Feedback and observations that are useful and contextually appropriate. Someone needs to operationally define “deficiency.” I do not accept these comments or findings as “deficiencies,” but rather regard them as manifestations of what it’s like to live in the real world. Would it be better not to have any floors dirty during the winter, not to have any feathers on the floor, not to have any cobwebs? I’m not sure. I have drafted my responses to these references on the following pages. Perhaps our Director of Trinity’s CILA program will be more understanding than I.

A. The bedroom windows and window sills are very dirty.

These particular windows face north and even with staff working to keep a dust-free environment, dust does gather on the sills. Yes, the windows would benefit from cleaning. Once the snow melts and temperatures get above freezing, we will arrange for the windows to be cleaned. We disagree that the windows are “very” dirty. It is our conclusion that these windows reflect the appearance and cleanliness typical of every other such house in the suburbs.

B. Tile is missing above the tub in the hallway bathroom.

To be informed of missing bathroom tile is certainly embarrassing in as much as the bathroom is used continuously throughout the day, and the women are, in fact, bathed every day.

The obvious question was asked: “Who stole the missing tiles?” As you might guess, all of the staff denied the accusation and assured the housekeeping police that they each had their own bathroom tiles. One staff did, however, during the course of the the investigation, reveal the fact that she had torn off a “Do not remove” tag from one of the client’s mattresses. She is awaiting trial.

All of the ladies living at the house have been searched, including all body cavities. No tiles have been discovered.

As a result, Trinity staff are considering the case closed and will replace the tile when it comes in from Philbins Paint Store in Lockport. It has been on order for three weeks.

Aesthetically, staff thought that rather than replace the missing blue tile immediately with an available yellow one, it might look nicer to order a replacement blue tile piece, even if that meant a few days of going “tileless.”

Given the severity of this deficiency, staff will in the future replace any missing ceramic tile with whatever is available and paint the a matching, or close to matching, color.

Also, future staff will be instructed in Institutional Compliance Painting and Decorating methods so this type of problem will not reoccur.

Finally, in an effort to prevent future occurrences, permission is being requested to follow other well acknowledged standards of bathroom maintenance and personal hygiene standards (Illinois Department of Public Nursing Home Standards) and to bathe the ladies once a week, thus avoiding any unnecessary wear and tear on such important building resources.

C. Some mini blinds are damaged and bent up.

It is accurate that the horizontal slats on one of the windows was damaged and beat up. One of the ladies living the home did, in fact, bend the slat upwards while looking outside. The nursing home she had been living in did not have blinds. Staff immediately included a goal in her person-centered plan for her to learn how to open and close blinds safely. She is already on step 3. In the meantime, staff have worked successfully to bend the slats back down.

D. Feathers and bird seed are lying on the floor of the living area.

Unfortunately, the ladies in the group home wanted a pet and as several of the ladies are allergic to dogs and cats, birds were the next logical choice. They enjoy al aspects of “owning a pet.”

I have asked Dr. George Henderson, a local veterinarian, if he can shave off all the feathers of these birds. If this alternative is not available, the birds will be humanely killed and “stuffed” and glued to the perches inside the cage. I’m sure we can locate some birdsong tapes and play them throughout the day. The ladies are intellectually impaired, so I’m sure they won’t know the difference and, thankfully, the floors will be clean.

E. There are cobwebs hanging from the ceiling beams in the living area.

Although none of the ladies living in the home have received any spider bites, cobwebs are, of course, a sure signal of danger lying ahead. Knowing that the Department of Mental Health and Developmental Disabilities would not just want to treat the symptom but rather eliminate the cause of any dreaded disease, permission is being requested to temporarily board up the home for a few short days to totally fumigate the home. Eighteen cans of Miss Moffit Misfortune Mist should do the trick. If funding for this important project is not available, Trinity is requesting permission for the ladies to stay briefly in a cobweb-free environment—perhaps at one of the surveyor’s homes or at a state-operated facility.

Should this alternative not be available, Trinity is requesting a waiver from DMH/DD to allow the presence of five Gecko lizards: two on the a.m. shift, two on the p.m. shift and one on the night shift (which would, of course, be awake at all times.)

Geckos aren’t for the faint-hearted, but again rather than have a cobweb deficiency, Trinity is committed to toally eradicating troublesome household pests. Once the criterion of having no cobwebs is achieved, the onenight shift Gecko will be faded from duty and assigned elsewhere.

Permission to pursue this alternative and the attendant waiver is necessary because Gecko droppings are not very pretty, and the crunching, munching sound Geckos make when they eat isn’t very pleasing.

F. The linoleum floors throughout the house are dirty especially in the living area.

In the future, Trinity Services will not serve individuals in wheelchairs unless the State of Illinois provides two chairs per person. That way one chair can be kept in the home so that the floors will stay clean, and the community chairs can be kept in a garage when not in use.

If this is not possible, Trinity is requesting funding for a full-time housekeeper so that the highest standards of cleanliness can be achieved. And if funding for a housekeeper is not available, Trinity is requesting permission to keep the ladies home all day. That way, the in and out traffic will be eliminated and everybody’s goal of clean floors will be realized, especially in the living areas.

Summary:

At some point in time, it would be helpful if Department surveyors would be able to distinguish what is important from pure puffery. Common sense needs to appear somewhere.

Yours truly,

Art Dykstra

“

The Director responds:

The Director of the Illinois State Department of Mental Health and Developmental Disabilities called me shortly after he received the letter. He had my letter in his hand as we talked on the phone.

He had picked up on the fact that I was exceptionally angry, and he, in fact, did remember that he had visited the home and that Developmental Disabilities staff had indeed asked us to admit the ladies on an emergency basis—without adding additional staff. He apologized in general terms and said he would personally talk to the Director of the State Quality Assurance Services Division.

Just before hanging up our phones, he quietly asked, “Art, you aren’t really going to do the things you mentioned in the letter, are you?” I think he was worried that I was going to euthanize the parakeets.

“Harold,” I replied, “I don’t know exactly what I’m going to do, but don’t you think it would make a great Chicago Sun Times article?”

Note: It was our belief that the anonymous complaint was from a recently terminated employee, who had worked at that home.

P.S. I know this letter was published on April Fool’s Day, but I can assure you it was and is not a joke.

Until next time,

Art

LAUGH A LITTLE:

REFLECT A LITTLE:

Proverbs 31:9

Stand up for what you know is right, and judge all people fairly. Protect the rights of the poor and those who need help.

READ A LITTLE:

Nine Minutes on Monday

James Robbins

(McGraw-Hill, 2013)

Nine Minutes on Monday is an excellent leadership book packed with keen insights and helpful information. Each chapter concludes with a summary of the key lessons, a key question and key action steps.

Understanding the title paves the way for understanding the book. James Robbins, a well-known management consultant and conference speaker, contends that the key to an engaged and productive workplace is to begin your work week by asking nine questions—preferably first thing on Monday. He suggests the following:

Minute 1: “How will I take a genuine interest in my employees this week?”

Minute 2: “Whom will I give feedback to this week?”

Minute 3: “Whom will I reward or recognize this week?”

Minute 4: “Whom will I give the second paycheck to this week?”

Minute 5: “How can I promote a feeling of autonomy in one employee this week?”

Minute 6: “How can I help someone grow this week?”

Minute 7: “What can I do to make my team “stickier” this week?”

Minute 8: “Where can I inject some fun this week?”

Minute 9: “What model do my people need from me this week?”

He also suggests initiating this practice for the first month by attending to specific universal human needs:

Care (“the need to be more than a number”)
Mastery (“the need for challenge and achievement”)
Recognition (“the need to be appreciated”) and
Purpose (“the need to contribute and be significant”).

After gaining confidence in addressing the first four needs, attention can be given to the next five at a reasonable and comfortable pace. These secondary needs are:

Autonomy (“the need to be in control”)
Growth (“the need to progress”)
Connection (“the need to connect with others”)
Play (“the need to enjoy work”) and
Modeling (“the need for a path to follow”). Proactive and proper role modeling are essential in working to meet these universal human needs.

Robbins discusses all of the nine need areas thoroughly. He explains, “It is helpful to visualize these needs as switches. Each time you turn one on, it unlocks a portion of potential inside another human being. The more switches you flip, the greater potential for elevated and excellent performance.”

As mentioned, this book would be a great resource for individuals new to organizational leadership roles. What follows are selected “tidbits” of wisdom, useful ideas and questions on which you can reflect.

“The essential skill of leadership is awareness.”
“Airplanes need pilots, not janitors.”
“Trust is influence. Without it, your leadership will be severely hindered. A recent survey found that the more trust an employee has in his or her manager, the higher their engagement.”
“What you are interested in is where your attention will be.”
“The better you know your employees, the better you are able to communicate.”
“Motivation is not necessarily the goal itself; it can be spurred by the gap that the goal creates. Gaps create unpleasant feelings of incongruity, which motivate us to act in order to alleviate some of the discomfort.”
“Knowing where we are gives us security.”
“Feedback is one of the most important tools in a manager’s toolkit and yet one that is not put to work nearly enough. Feedback is the magic sauce that gives power to goals.”
“Reward and recognition is not about saying thank you (although that’s a good place to start). It’s more about helping people feel valued. We all want to know we are needed.”
“Purpose is our ‘why’ and is fueled by an inner source of intrinsic motivation that derives its reward from the job itself.”
“Serving people is always more motivating that working for a company.”
“Employees who enjoy a sense of autonomy at work take fewer sick days than those who don’t.” “Purpose is a huge source of employee engagement.”
“Deep within every human being is the need to grow. One worldwide study revealed that the opportunity to grow and develop was the second highest driver of employee engagement.”
“Boosting someone’s feelings of competence is an integral part of a manager’s job.”
“Believing in someone has a profound effect on their behavior.”
“On your team, a slacker will hurt motivation more than a hard worker will boost it.”
Regarding new employees: “Your relationship with them will do more to determine their satisfaction and happiness at work than any other single thing.”
“The best teams are built day by day, meeting by meeting, and memory by memory.”
“Humor, fun, and laughter act as a sort of gauge of workplace health. A lack of fun and humor at work are signs that something is amiss” -Michael Kerr
“As a leader, you become the ceiling in a variety of areas, and fun at work is one of them.”

When Enough is Enough — April 1st. 2026

LEARN A LITTLE: