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Rebel with a Cause

Sam Perlin

Rebel with a Cause

Tenacious Crusader Fights for Better Nursing Homes

Print Run Date:  3/31/1991

Reporter:  Claudia Feldman 

TAKE a Southerner's instinctive reluctance to get to the point and turn it inside out. Take a habitual do-gooder who claims he doesn't like people, a crusty crusader who can melt like a candle. That's Sam Perlin, the loudest mouth pushing for the rights of the frail elderly and infirm in this state. He's a hell raiser, a rebel, sure he is. But he also is bent on reforming those Texas nursing homes that he says sometimes more closely resemble concentration camps than rest homes.

     For the past 16 years, Perlin has demanded that politicians, nursing home administrators and the bureaucrats who run the regulatory agencies offer fair treatment to those who need round-the-clock care.

     "A nursing home is only good when you're not in it," Perlin says bluntly.

     Perlin does his advocacy work from the extra bedroom in his cookie-cutter, southwest Houston apartment. His eyes are stacks of nursing home reports - lists of atrocities, sometimes - filed monthly by the Texas Department of Health. His ears are the scores of children, spouses and friends of nursing home patients who call him when they have nowhere else to turn.

     During a typical day, Perlin goes to a meeting or two in his '73 Plymouth Duster, writes a couple of letters to an assortment of state agencies on an electric typewriter, then, best yet, works the phone.

     Letters, he says, are often less than satisfactory. "You write one and then you get a stupid answer, then you write another and get another stupid answer, and it can take forever. On the phone I can say, `What are you talking about?"'

     In the give and take of the conversations, Perlin strives to sound determined, not angry.

     "Bureaucrats like it when you lose your cool," he said. "When you sound in control, that bothers them. I say, `Well, OK, if that's your last word, I'll just go further."'

     In person, Perlin looks like a grandpa (he is, times three) whose next stop is the golf course or maybe the grocery store. On the phone, he is more intimidating. He sounds like he knows. He sounds persistent.
He sounds like if you disagree with him, there is cause for you to worry. You will hear from him again.

     However gruff Perlin sounds when addressing officials, those incoming calls sometimes break his heart.

     Calls like the one he got from Sandie Graves Babb.

     Babb accepted that her child Becky was blind, partially deaf, crippled by cerebral palsy and hydrocephalic. Babb also accepted that she had to put Becky in a nursing home. What Babb couldn't accept was the sloppy care.

     Every night, on her way home from work, Babb visited Becky. Many of those nights, she said, her child was dirty, hungry and unkempt.

    But when Babb complained to the staff, they suggested she take Becky elsewhere. Desperate, she called Perlin.

     Responding to Babb's SOS, Perlin found a beautiful woman and a beautiful child. Nine-year-old Becky has big blue eyes, a thin face, a long brown braid spiked with gold.

     The administrator wanted to evict Becky? Perlin says he made a threat, too. He told the staff that if she was kicked out, he would make sure the event was well-covered by the local press.

     By the meeting's end, Perlin says, Becky's eviction notice had been withdrawn. But Perlin saw how much her mom wanted her home - and how much better the care could be.

     Today the state funds that helped pay Becky's nursing home bills are applied to the cost of attendant care in her own bedroom. She had been on a waiting list to get into the home care program for severely handicapped children when she met Perlin. With pressure from him, she finally was accepted.

     Becky will never talk, she'll never walk, she'll never understand the fight Perlin helped wage. But her mom knows.

     "Sam is my knight in shining armor," Babb said. "He has a heart of gold."

     Perlin does not, when he pores over the state's nursing home reports, call the administrator of a particular home and ask why Mrs.
Williams (90 percent of all nursing home residents are women) was not fed the other day or why her bedsheets were soiled or why her bedsore has been allowed to grow and fester.

     There's no point, he says.

     Perlin doesn't visit nursing homes much either. He gets depressed, he says. "How many bedsores do I have to see before I know there is a problem?"

     Instead, he says, he keeps a running record of repeat violations.
"I might call the state health department and say: `This is a repeat thing. What have you done about it?"'

     These days, his relations with the state's regulatory agencies have progressed light years. That's his biggest accomplishment, he says.

     "Before, they served the industry. Now, they're doing their very best to serve the public."

     When Perlin makes his many calls, he represents a local group called Texans for Improvement of Nursing Homes and the legislative committee of the Woodlake Chapter of the American Association of Retired Persons.

     To be effective, he said, "You have to represent somebody, you've got to wear a lot of hats. Otherwise, you might as well go to Russia.
There is no response to a regular citizen."

     Malcolm Slatko, executive director of Seven Acres Jewish Geriatric Center, says he likes to see Perlin walk in his door.

     "Sam respects the aged," Slatko said, "and he respects the work we in long-term care are trying to do. Sam is honest, knowledgeable and very committed to his work."

      `Emotional experience'

      Perlin was born in New York City 71 years ago. He started working full time at 17, when his dad died at age 49.

     Perlin's mom died at 75, in a nursing home.

     "That was a very terrible, emotional experience," Perlin said.
"First of all, she was away from the family, and she had to be fed.
They just stuffed the food in her mouth - they wouldn't wait until she swallowed, because they wanted to get done with the feeding. Half the time she would spit it out.

     "One time I visited and someone said to me, `Your mother had a nice bath today.' My mother said to me, `She should live so long."'

     Perlin didn't protest. "If I had known then what I know now, I would have spoken up," he said.

     If you ask Perlin what he does all day, he'll tell you in his distinctive Brooklyn accent that he tries to solve problems. He'll tell you he's spent his whole life trying to solve problems.

     Once that might have meant telling his former bosses that, no, labor contracts shouldn't be changed so that they come due right before Christmas. Now it might be helping the paralyzed woman whose blankets dropped off her bed one cold winter night; she had spent hours shivering because no one answered her call for help.

     Perlin's wife of 48 years, Katie, sometimes tells him that he's being used by the many folks who call asking for favors. It's a funny thing, he says, when you get hooked on helping.

     "I'm using myself," he said. "When all you have to do to straighten something out is make a phone call, how can you not get involved?"

     Back when Perlin earned a salary, he was a middle manager for a New York steel company. He worked for the same company for 38 years, then retired at 55.

     At the time, Perlin was enjoying a big salary, a company car, an expense account and occasional visits to the bosses' country club. When he threw it all over, he had little money saved for retirement and a pension that was really too small to live on.

     "Maybe I was having a middle-age revolution," Perlin said. "I looked around and I said to Katie: `What's in this for me? A heart attack? We're still in good shape. Let's get the hell out of here."'

     And so they did. They moved to Largo, Fla., and tried to adapt to a relaxed, margarita-on-the-mind pace. The fast-talking Perlin couldn't pull it off.

     "I got up in the morning," he remembered, "and I had nothing to do. I'm accustomed to doing something."

     Then there were the money problems. To help pay the bills, Perlin took odd jobs. He worked in a body shop. He cleaned a nightclub from 6 to 8 every morning. He worked for a government job training program, which required spending a few hours every day on the phone.

      Volunteer job

     Still, Perlin had time to fill. He started sitting in on city council meetings, curious about the workings of local government.

     Before long he was chatting with the Largo mayor in the grocery store, and before much longer, he was asked to volunteer. Just by accident, his volunteer job involved nursing homes.

     Bingo. Perlin was outraged almost immediately. In Florida back then, he says, the nursing home industry was protected by politicians and the governmental bodies they served.

     Families who complained about poor care were told to take a hike.

     "That wasn't my background," Perlin said. "I always appreciated a customer."

     Perlin stayed with his government-sponsored committees until he met Fran Sutcliffe, who had started a citizens' group called the Nursing Home Patrol.

     "What a woman," Perlin said admiringly.

     They were soul mates. They seemed to think alike, work alike, even curse alike. Together they worked to improve the laws regulating nursing homes, then tried to ensure that the laws were enforced.

     For help, they called on reporters, politicians, sympathetic state officials. They also practically memorized the state's nursing home reports. To this day, when Sutcliffe sees a bad report on a home, she picks up the phone and calls the administrator responsible.

     "I'll say, `What the hell is going on at your place?"' Sutcliffe, 78, said from her home in St. Petersburg. "I just yak 'em up. Hell, I have no authority to do anything. I'm just an average citizen. But an average citizen can make one heck of a difference in nursing homes.

     "Sam is fearless, and I am, too, 100 percent."

     The team broke up in 1983 when the Perlins moved to Houston. He hadn't been here very many hours when he signed up with the local group, Texans for Improvement of Nursing Homes.

      The group's mastermind was Billie Herman, a Southern gentlewoman who first made her acquaintance with nursing homes when her mother moved into one. What she saw spurred her to action.

     "You would never in your wildest nightmares believe what goes on," Herman said. "In my mother's case, her body was gone but her mind was still bright. She knew what was going on, though I wish she hadn't."

     Herman's mother died in 1980, the same year she started the nursing home improvement group. Over the years it has evolved and has 15 officers and board members. There are no dues and only quarterly meetings.

     "We're a loosely structured group - that's why we're effective,"
Perlin said. "By the time you have a big membership, dues, all that, the patient is dead and buried."

      New life for group

     Perlin, Herman says, breathed new life into the group. "He knew how to do everything," she said.

     Herman sounds as if she would follow Perlin anywhere. So would Beth Hill, who assists families in their search for appropriate senior housing.

     "I'm so biased about Sam it's almost shameful," she said. "I adore him. He is the one figure I've uncovered in the past three years who has made a difference. He's the one person who is persistent, who continues to knock on doors, who is tireless."

     Less effusive is Dr. Don Kelley, deputy commissioner of the state's Department of Human Services. But he's fond of Perlin, too.

     "He may come across a little crusty, a little frustrated, but it's constructive crustiness," Kelley said. "He's not out to destroy something but improve something."

     Added state Rep. Talmadge Heflin, R-Houston: "Sam's strong point is his tenacity. He never gives up. He may run down a blind alley somewhere, but when he comes out, he's running harder than when he went in. He's a wonderful resource for our office."

     Some folks, Heflin allows, consider Perlin abrasive. "I find him very frank, one who will get to the real issue without wasting a lot of words. I appreciate that."

      Less cordial relations

     Perlin calls Heflin a friend. He and state Sen. Chet Brooks, D-Houston, chairman of the powerful Senate Committee on Health and Human Services, have a less cordial relationship.

    "Brooks favors the nursing homes too much," Perlin said. "I don't mind if he does something for them, but he should balance that by giving something to the public, too."

     Said Brooks in his laid-back drawl: "If Sam wouldn't kick people in the knee before he asks for a favor, he'd do a whole lot better in the world. Sam's theory is that he's got to stir things up. He does get people's attention, but they're liable to return fire."

     Tom Suehs is executive director of the Texas Health Care Association, the umbrella group for 800 of the 1,100 nursing homes in the state. Suehs declined comment about Perlin.

     There are 130 nursing homes in Houston. Perlin says half of them have problems and half of them don't. "Something is wrong with the half that runs into problems. It's the administrators."

     It can be a little confusing to talk to Perlin about nursing homes.
He is fighting like a mama grizzly bear to improve the quality of care.
At the same time he wants to see alternatives.

     If the money spent on nursing homes could be spent on attendant care or other systems of keeping people in their own beds, he figures the world would be a happier place.

     Some days Perlin sounds pleased with recent changes in nursing home regulations. Conditions here still aren't as good as in Florida, Perlin says, but "we've come a long way."

     Other days he seems ready to jump out of his skin, he is so impatient for more change.

     One thing for sure, he doesn't want to wake up one day in a nursing home. His friend Sutcliffe jokes that she'll never go to a home because no nursing home administrator in the country would take her.

     Perlin puts it differently. "I'd rather die than go to that torment. I've seen too many people suffer for no damn reason. Some of the people in nursing homes - they can't hear, they can't read, they're in pain, they sleep a lot - what the hell kind of life is that?"

     But it's not like Perlin to be unremittingly pessimistic.

      "I sound like a big shot, but when I'm faced with it, I don't really know what I'll do," he says.

     Besides, he added with some cheer, "I may be 71, but I feel 30."


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