During this pandemic year—which I hope we are emerging from for good—I’ve often thought of the urban myth about the mom who lifts a car to save her trapped 5-year-old. If you put stock in Wikipedia, you’ll find it’s called “hysterical strength” and there are cases of lifting Jeeps, Renault Clios and Chevrolet Camaros (and one that involves fighting off a polar bear). You might also discover, as I did, that there’s little research to support the phenomenon.
But the key to these (fictional) short periods of super-charged strength is adrenaline, the need to protect someone at all costs and deep love.
Beyond any doubt most people who work in aging services stepped up to the plate and saved lives. They held the hands of dying residents, found energy to work double shifts for months on end and facilitated virtual visits for anxious family members. At great sacrifice to themselves, sometimes at the cost of their own lives, they lifted metaphorical cars and fought off polar bears.
But what about the hysterical strength shown in the policy arena? One of the clearest messages that keeps coming through in aging services during COVID is that when it really comes down to the wire, everyone can chop through the detritus of excess bureaucracy, process and regulation and take decisive action. In the aging services policy space, we have found nearly complete alignment across all stakeholders—providers, residents, clinicians, advocates and the federal government. Our shared mission, with apologies to Spike Lee: Do the right thing.
Early in spring 2020, when hospitals were overcrowded and nursing homes were identified as places with beds that serve people with COVID-19, HHS moved with unprecedented alacrity to use the 1135 waiver authority to waive the three-day stay requirement, allowing reimbursement for a nursing home stay without conditioning it on a previous three-day stay in the hospital—a longstanding issue of debate in health financing.
Bureaucracies known for moving slowly and deliberately, taking months, even years to issue guidance or award funding Congress had already made available, were able to change under duress, moving faster than Dudley Do-Right stopping a freight train to save Nell, to get guidance and resources to where they were needed to save lives.
In the early, terrorizing days of the pandemic, it became clear that people older than 65, especially those living in congregate settings, faced the highest risk of severe COVID symptoms and death. The pandemic was declared on March 11, 2020. By March 13, CMS had issued guidance to restrict nursing home visitation. Two days! Who even thought a bureaucracy like HHS, with more than 80,000 staffers, could move at that pace?
When lives are at stake, people find a way.
As the months wore on, concerns about loneliness and isolation emerged. Residents, family members, advocates, providers, frontline staff—all were asking: which is worse, the risk of COVID or the risk of a death of despair? Residents with cognitive impairments were losing functional abilities. In September, again, responding with swiftness to a real crisis, CMS issued new conditioned visitation guidance allowing outdoor visits under certain circumstances.
For the record, hundreds of hands touch federal guidance and regulations before they are issued publicly. The clearance process can be overwhelming, even when working on an outlandishly rapid schedule—like less than a year. It always starts with careful financial, policy and legal analysis. Drafts are circulated among the writers and run up their supervisory chains. Once finalized, the clearance process begins. It can take months, sometimes longer.
‘When lives are at stake we can push past the details, lift the metaphorical SUV and save lives.’
For full regulations, a regulatory impact statement must be written and financial impact assessed. Reviews happen within the department in question and at the Office of Management and Budget–White House level.
This involved process can be frustrating (or a blessing) to the people involved and those on the outside, waiting. To be fair, this is how government works. Democracy was never meant to be clean, fast or efficient. Changing important policies and practices that affect hundreds of thousands, even millions of lives, is meant to be analytical and should not be taken lightly.
Mustering Such Strength Is a Lesson to Remember
But, COVID. The pandemic brought a new sense of urgency to the process, and everyone found their hysterical strength, from residents and families to nursing homes and providers across the continuum of care to behemoth government departments. Decisions made one day had to be changed and adapted the next.
It’s a tired cliché that “we must learn from the pandemic year.” Nevertheless, our ability to muster hysterical strength is a lesson to remember. When it comes down to the wire we can all pull together no matter which side we’re on, in even the most passionate debate. When lives are at stake we can push past the details, lift the metaphorical SUV and save lives.
In the policy arena, this means it’s possible to get trillion dollar relief bills through the most polarized Congress on record. The monolithic bureaucrats of HHS can ship testing materials to all nursing homes in the country, and, if asked, can get them to hospice and home health providers, too.
That bureaucracy is made up of human beings who have it in them to do their jobs with as much hysterical strength as the mom of urban myth. Take a look at the CDC Pharmacy Partnership that, so far, has vaccinated nearly 5 million residents and staff in nursing homes, assisted living and HUD 202 buildings. It sprang into action on Dec. 21, days after vaccines were approved. Today, on the first day of Spring, many of these providers are reporting months of zero resident diagnoses of COVID. ZERO.
As LeadingAge members have been saying for nearly a year, isolation and loneliness can be deadly. But we all recognize—COVID is even deadlier. When lives are at stake, everyone agrees that the balance between isolation and potential severe illness and death, is a no brainer. But vaccines brought a tectonic shift.
After effectively closing nursing homes to all visitors (and in turn, other provider settings following suit), and looking at the vaccine data, a few weeks ago CMS moved deliberately but quickly to modify visitation guidance. It may not yet be perfect, but government found a way to move mountains to match the quickly changing situation. it was the right thing to do.
Let’s not unlearn this hard earned insight. When Congress needs to move quickly and find unimaginable pots of money, it can. When human lives hang in the balance, bureaucracies can cut through the process and propel change. Let’s bring some of the urgency of hysterical strength into our post-pandemic policy making. We’re strong enough. Yes, we can.
Ruth Katz is senior vice president of Public Policy/Advocacy at LeadingAge in Washington, DC.