Died in a florida nursing home that lacked air conditioning because the power had been knocked out. One press account described the facility as, quote, a death trap, end quote, because the elderly are particularly susceptible to heat related illnesses. Last month, this photo of residents of an assisted living facility in texas, who were trapped in waist deep water went viral. As these recent disasters made clear, Older Americans are particularly vulnerable, before, during and even after a storm. In fact, when Hurricane Katrina slammed into the gulf coast 12 years ago, more than half of those who died were seniors. As the then chair of the Senate Homeland security committee, along with senator Joe Lieberman of connecticut, i led a bipartisan investigation into the response to Hurricane Katrina at the federal, state and local levels. Our investigation, which resulted in this some would say weighty report, revealed many weaknesses in our nations Emergency Response system. And although i doubt very many people read the whole report, it does have an excellent summary that i was just discussing with the chief, and it was evident to me in rereading it, that weve learned many of the lessons of katrina, but we still have a long ways to go. One of the weaknesses in our nations Emergency Response system included the failure on the part of all levels of government to plan and provide for timely and effect evaluation of our most vulnerable seniors. Since then weve expanded our efforts to improve Emergency Preparedness and response across the entire country and emphasized the protection of the most vulnerable. Meanwhile, Mother Nature continues to unleash her fury. Today, even as we meet, yet another hurricane, maria, is battering a region still struggling to recover and is expected to hit puerto rico particularly hard. This morning we will discuss how our federal, state and local Emergency Response efforts have been critical in limiting the scope of these recent tragedies and we will identify where more work is still needed. On the positive side, improvements in Emergency Response efforts at the centers for medicare and Medicaid Services have helped to identify those seniors who require relocation in order to maintain their dialysis. I was talking with the head of cms just yesterday about this, but she said one of the problems was that the demand was so great, that people were not able to have complete dialysis. They were hooked up to the machines for two hours when they needed a far longer period of time, but the demand was such that they were just trying to maintain people. In addition, local Emergency Response teams implemented strategies to identify those most in need and provided designated shelters that offered necessary medical care and support. But that tragically was not always the case. The lack of electrical power apparently contributed to the deaths of those seniors in the nursing home and to the worsening Health Condition of others, suggesting a very troubling lack of preparedness in some health care centers. While we have made many strides since Hurricane Katrina 12 years ago, we must ask ourselves, can we better protect the most vulnerable members of our community . What gaps exist that could jeopardi jeopardize lives in the next catastrophe, whether its a storm, an earthquake or some other unanticipated event. We should not have to wait for the next irene, sandy, harvey, irma, or unnamed disaster to strike. Today we will discuss concrete solutions to protect and stabilize vulnerable seniors from maintaining necessary resources and connections during emergencies, to relocating and returning to safe and secure homes during the recovery period. We will consider the challenges of making the correct choices of whether it is better to shelter people in place or evacuate and relocate. And as ive looked more into this issue, ive learned that that is often a very difficult decision to make. Particularly if youre dealing with people with some sort of dementia. Just one day after Hurricane Irma slammed much of florida, a cnn reporter waded about a mile in waste deep water contaminated with oil and garbage, to knock on the door of a mobile home in bonita springs. He had been told that an elderly couple lived inside and that they did not heed the warnings of local and state officials to leave prior to the storm. Inside this mobile home, which was now surrounded by water, lived an 88yearold woman and her 93yearold husband, who suffered from parkinsons disease and diabetes. When the reporter asked the woman why they didnt evacuate, she simply replied, we have everything we need here. We have his medications, its just easier. Now, im very grateful that this couple was found safe, but to me the story illustrates how we must expand our efforts to protect vulnerable seniors, not only those who are living in facilities such as assisted living or longterm care facilities, but instead, are living in their own homes. For many of those seniors, evacuation is not as easy as packing a bag and jumping into a car. They may not be able to drive, for example. Some of these homebound older adults are alone and frail and they may suffer from diseases and many of them have lived in their homes for so long, they just doesnt want to leave it behind and are fearful of what will happen if they leave. Let me conclude by offering my condolences to all those who experienced losses as a result of these violent hurricanes. My heart goes out to all of those who are suffering and now face the considerable challenges in the weeks and months ahead. I also want to extend my gratitude to the First Responders, including the volunteers, such as the medical team from maine, and everyone who has reached out to help a neighbor in need, even as in many cases they, too, are dealing with the devastation caused by these terrible storms. While we can and must continue to improve our Emergency Response so that the tragic deaths in floridas Nursing Homes do not happen in the future, we should not overlook the heroic actions of so many. I want to thank our witnesses for being with us today and im delighted to now recognize the Ranking Member. Chairman collins, thank you very much for having this very important hearing, especially at this time. I join the chairman in thanking the work of those who have done Emergency Response, tasks over many, many days now, the countless volunteers who help them throughout these many days of challenge. Were grateful for that work. And we join in thanking them for doing that great work. Together, theyve worked endless hours offer these last several weeks to save the lives of people in texas, in florida, the u. S. Virgin islands and now, of course, folks in puerto rico are facing a difficult number of days ahead and were thinking of them and praying for them at this time. To say that these actions have been heroic is an understatement. Theres no way to adequately describe that kind of commitment, that kind of heroism, but unfortunately, today were here because we know that despite great efforts by a lot of good people across the country, Older Americans and individuals with disabilities face extraordinary challenges in a disaster and again, thats an understatement. So many of us were both outraged and enraged when we saw what happened in florida, that people died, seniors died in the midst of this crisis. Were also heartbroken for loss of life and also the loss that those families suffered. In this case, it was apparently something as simple as a lack of air conditioning, something that many of us take for granted, just even on a day like today in this building. Its hard to comprehend the sadness that will engulf those families and those communities. So thats one of many challenges we will speak to today. Just yesterday, senator nelson, who has done great work in his home state of florida dealing with these issues said the following, he said, one life lost is one too many, unquote. And im proud and i know that chairman collins as well is proud that weve joined him in introducing legislation that would do the following. It would require the secretary of health and Human Services to establish a National Advisory committee on seniors and disasters, a 15member panel would be appointed by the secretary of hhs and made up of federal and local Agency Officials as well as nonfederal Health Care Professionals with expertise in disaster response. It its a good bill, its bipartisan and we should pass it. Both he and senator nelson and senator rubio have introduced it. Thats one thing we can do together to better plan for and respond to these challenges in the future. But like all americans, and i think every american was stunned by the viral photo that the chairman just showed about one nursing home and the water, the water that was rising around those seniors. In this case, an assisted living facility in houston where they were sitting in waist deep water waiting to be rescued. These are folks who, indeed, to say theyre our greatest generation doesnt adequately capture. These are folks who fought our wars, they worked in our factories, they built the middle class. They gave us the kind of liao i have life that we take for granted sometimes. Theyve sacrificed so much and lived lives of quiet dignity. We have a sacred obligation to them, to make sure those scenes that were depicted in that photograph and what happened in florida never happens again. Just as the chairman said, all the good lessons that were learned in the aftermath of katrina, we have to implement better practices, best practices, to make sure that we learn from these recent disasters as well. So we need to ensure that were doing Everything Possible to learn from these tragedies and we also have to make sure that were focused on a day like today, on better policy. And thats why we gathered today with such a great panel of witnesses. These witnesses bring not just experience from the recent past, but in many cases from years of experience, from Hurricane Katrina to hurricane harvey, they face the double whammy, so to speak, of hurricane lee and irene back in 2011, as well as the four hurricanes in six weeks that ravaged florida in the year 2004. Weve learned, and theyve learned even more from each of these experiences. So as we hear from our witnesses, incident management infrastructure is more robust in some important areas like hospitals. Thats good news, that means weve learned lessons to implement those changes. Coordination in response of storms have been improved and more Emergency Response requirements implemented for Nursing Homes so that seniors will be better protected. We have a long way to go, to make sure that we get this right. Older citizens should not suffer for days, and then die, die, in the unbearable heat. No person with a disability should have trouble following evacuation orders because of inaccessible transportation or shelters and it should go without saying, no senior should fear drowning in their own home no matter where they live. Our witnesses here today will explain how we can do better. Because we must do better. We have a sacred obligation to do better. I want to thank the witnesses for bringing their experience, their expertise and the passion to these issues and i want to thank chairman collins for gathering us on this day. Thank you very much, senator casey. Im delighted that we have senator tillis and other senators with us today and very much appreciate their participation. I know that senator tillis has to get off to the Judiciary Committee and so i would like to offer him the opportunity for any comments hed like to make. Thank you, madam chair, i do have to chair the Judiciary Committee so once i get there i wont be able to come back, but i want to thank you all for being here. The building is a little empty here because we adjourned last night, but you see the focus that the members have to being here and thank you all for being here. And im glad that weve framed this as really response to disaster. Were going to immediately leave to the disaster occurring right now in puerto rico with maria making landfall at 175 Miles Per Hour sustained winds. We can talk about the recent storms, harvey and irma. And i can talk about North Carolina matthew last year on october the 8th and i have a personal story to tell there because our office, our staff had to help a senior who had gotten lost in the process, who had left her home as she should have. We had almost 20 inches of rainfall in about a 24hour period devastating to the community and river rising so much worse. So much so, they would go to that shelter and that shelter closed down because the water threatened those shelters. And so, it really raised the question, mr. Timmons, im going to submit some questions for you record for you all to potentially respond to, but it raises a question of how well we track evacuees through the life cycle. Not only i think that that life cycle needs to go before the disaster ever occurs and then until theres a resolution that makes us feel that like senior is safe and secure. I think one of the reasons that we have a challenge with evacuating seniors, they just have a fear of the unknown. If we did a better job of communicating what this would look like earlier, where theyre likely to go and how were going to be stewards over the course of the process. I think that many who feel like the safest thing to do is to shelter in place, is to be replaced with a sense of comfort theyre going to be taken care of through the process including getting them living independently again or a facility where theyve been taken care of. So, that life cycle, where needs to start. How do we better link. What we ended up doing in our office is going together and i think it could be instructive for things that we need to do differently, but fortunately our people in North Carolina helped us find the lady and get her medications she desperately needed and get her to her family. That sort of life cycle of disaster that starts before the disaster occurs before that senior is safe and sound. Would be helpful to us how we can work at a state and local level to make that happen. Thank you for being here and focused on helping us for helping get a solution and thank you for your work on the subject. Thank you, senator tillis. Im going to introduce our excellent panel of witnesses. First is dr. Karen desalvo, a physician and Public Health expert. Served as Health Commissioner in new orleans where she worked hard to restore health care to areas of the city devastated by Hurricane Katrina. Has also serves as former assistant secretary for health at the u. S. Department of health and Human Services. Next, we will hear from dr. Kat kath kathy h heyer. She has researched and written extensively about Older Americans and the structure of Emergency Response system. I want to particularly thank you, doctor, for being here today, even as the long Recovery Process in florida continues. We will also hear from paul timmons. Mr. Timmons is president of port life disasters in charleston, South Carolina. Despite that mouthful of an organizations name, he is a leader in the field of Disaster Preparedness and response for people who are aging and those with disabilities. Finally, im going to turn to our Ranking Member to introduce our witness from pennsylvania. Thanks very much. Im pleased to introduce jay delaney, fire chief and Emergency Management coordinator in wilkesbarre in pennsylvania. And when hurricane irene and lee could affect the susquahanna and could impact the levees in wilkesbarre. Chief delaney safely evacuated 15,000 people in just ten hours, including our hospitals and Nursing Homes. I look forward to the chiefs testimony. Thanks, chief. Thank you very much, senator. Well start with dr. Desalvo. Thank you, and good morning chairman collins, and Ranking Member casey and others, and to make time for this priority issue to see that we have an opportunity to better support and protect Older Americans in times of disaster and every day. I am karen desalvo, im a physician and i was formerly the Health Commissioner in new orleans, not during the time of katrina, but subsequently and certainly was in new orleans during katrina. I wanted to share a story that started later. It was 2012 and i found myself standing in the Operations Center in new orleans, asked by the Power Company how to prioritize electricity. I was new to the job, it was august, it was hot. We were seven years after katrina and we heeded the advice. And we didnt have flooding, but from high winds. Wed hardened the infrastructure of our hospital, better relationships, particularly heeding the advice of senator collins not exchanging business cards during disaster, but doing it well before and we had done much better planning. Our hospitals will returned to normal functioning. The question, was ow prioritize, we were getting reports of struggling in the heat. And many centers had been registered in our special needs registry and they wanted to shelter in place and didnt take the opportunity to voluntarily evacuate. We knew some about them. We didnt know who was clustered and who was at high risk and energy dependent. I resulted in going doortodoor in our community to help prioritize power restoration depended who answered the door when they knocked on it. We did this with the support of First Responders, like fire, but it was not a great feeling, more was it very efficient. So Going Forward we didnt want to repeat the experience of being somewhat happen hazard. So we worked with hhs with geo mapping to create a map in our community to seniors who are electricity dependent live. We did a drill with fire and police and volunteers and went doortodoor on the dots on the map, a subset of them. Knocked on the door, were here from the government and were here to help. We actually did say that, i did. And people willingly opened their doors and that we were trying to find out if they were electricity dependent and we learned that the medicare data worked and learned something more concerning of the 600some people on the list as electricity dependent for their oxygen, we only knew of 15 of them in the registry. That system called empower has been taken to scale and is available to be used across the country in every community, not only in disaster response, but preparedness. Its an example how we can use technology and local experiences married with federal resources to really do better in preparedness and response. Hhs recently used this tool in irma and in harvey. We to tend to focus on the disaster that make the headlines and those who are most frail in hursting homes, but i just want to take a talk about those who are frail in institutions. After isaac they were living independent and subsidized houses and high raises and what i saw was heartbreaking. These are People Living on the edge every day and not only likely to be broken by a disaster, but little disasters that touch their lives on a regular basis. Tools in our power to get them on a special needs registry so we can find them and they need human touch as well. Since katrina we have made a great deal of progress and infrastructure and building readiness to prepare pan respond. Theres so much to do to support our seniors. In that vein i offering actions in three areas that. Theres more of my testimony, but ill highlight a few today. Cools reminds us we have technology and data, only as good as the data in it. If we expanded that for medicaid and insured population. And congress, its one thing to have information in a box, but that requires training exercises perhaps the Public Health and commission core. We need to support the local health and response infrastructure. Theyre under resource to support the community and most vulnerable in times of need. This includes Public Health, but other agencies and who are trying to help Older Americans every day. Finally, we need to to more. I think the thats strengthening infrastructure, but its not pieces of paper, but for ongoing fouel supplies like generators. And then tools that can help policy regulation and ordinances and when we forget about preparedness like a Building Code. Thank you for raising profile for need to better support seniors and americans in our times of disaster, but also in every day and i look forward to your questions. Thank you very much, doctor. Doctor hyer. Good morning, on behalf of my colleagues, dr. David doesa who could not be here today, i want to thank you for giving me the opportunity to testify on a topic ive studied since 2004. Since that time my colleagues and i have looked at disasters on frail individuals living in Nursing Homes and weve worked for disaster responsiveness and theres been Research Carried out by grants from many organizations, specifically National Institute on aging. Nursing homes only became a part of the national Emergency Response system, and National Security homes are Health Care Systems taking care of frail elders, they needed help. Getting fuel for generators and power restored and that they were a part of the system and he willing they were ignored until then. Following katrina. O they interviewed nursing home administrators. They wrestled with the decision whether to evacuate prior to the storm. They cited pressure from Emergency Managers and despite the difficulty. Having them bush on bursts, evacuate to gymnasium without adequate supplies and mattresses and they recognized they declined and their staff hurt. And they believed they would be better served staying where they are. This initial work became the impetus for the National Look at gauging this on residents. 36,000 nursing home residents exposed to those gulf hurricanes, the 30 and 90day mortality rates increased considerably, compared to the nonhurricane control years. Whether they evaluated or sheltered in place. 277 extra deaths and 872 extra hospitalizations within 30 days after exposure to the storms. Natural disasters result in bad resul results. And we asked whether or not it was better to evacuate or shelter in place. Using those same data from those four storms and techniques in the appendix provided our research concluded the very act of evacuation prior to the storm increased the probability of death at 90 days and increased the risk of hospitalization independent of all other fabbictorfactors, it e noted our data took into account certain Nursing Homes that did not evacuate. Including st. Ritas and la font homes where there were many deaths. Despite the deaths, they could be more rust than sheltering in place. Based on our research and experience we have the following recommendations. We need generators to support medical needs and air conditioning to cool reasonable temperatures, as well as fuel for Nursing Homes, these generators need to be elevate today assure continuing operation. Emergency plans for nursings homes and assisted living must be publicly and easy available for all to see and for residents and families to understand before they enter a nursing home. Nursing home surveyors and Emergency Managers need to be sure all plans are actually tested and that their and this means real drills and actual implementation. Assisted Living Communities require much more oversight. Assisted Living Communities routinely accept patients who would have received care in a nursing home only a decade ago. Waiver payments have been increased making the federal government at least an Interested Party in assisted living legislations. Evacuations should not be all or doing, senator collins talked about dialysis residents being evacuated. We need a better nuanced Research Understanding who should evacuate before and how people can be sustained appropriately. Nursing homes of assisted living must be built in places that minimize flooding and allow administrators to shelter in place if at all possible. Every state and local Emergency Management organization in this country must identify and prioritize Nursing Homes and assisted Living Communities for refor ration restoration of power and some part of litigation must be considered for facilities that abide by there are many people working hard to care for disabled people all over florida continuing as we speak. Finally, older adults matter. I am the geriatric work force grant. We need continuing education for the programs. Im only providing evidence that i am providing today because research and Training Research and training was approved and was allowed, but it dried up in the years following katrina. Our country needs ongoing geriatric training and to evacuate disasters. We know that disasters will continue to occur and wes must be prepared. Thank you for allowing this testimony and i look forward to questions. Thank you very much, mr. Timmons. Thank you, and good morning. Fort light in the only ngo to assist the Disaster Relief for people with disabilities and Older Americans. Its serving on the ground in basically every major disaster since katrina. Our Partnership Includes disaster, strategies, and aging Emergency Health stake holder groups including fema and red cross with a shared commitment to the Emergency Preparedness and disaster related needs to the nations 59 Million People have disabilities and 67 americans over age 60. Weve been convening stake holders and hot line to assist disaster survivors from harvey and irma and preparing incredible volunteers for Hurricane Maria. Given the people would disabilities and older adults could be in a disaster, this could not be understated. This is frequently due to poor planning and widely incorrect thought that adults are particularly at risk because stigmatizing beliefs about disability and aging. In fact, were extremely valuable on exit emergency strategy with far more practice than younger people and people who dont navigate in section cess of environments and problems on an appropriate basis. The approach this is probably on the access of functional needs. In a disaster, providing equal access makes the dinners time and again for individuals, and families and communities. In fact, the phrase, people with access and functional needs has been codified by dhs and working term among Emergency Management professionals and perfectly fits our discussion here. Ineffective and inappropriate evacuation, hospitalization, nursing home admission and assisting people with pack cess and functional needs might look right on paper, however, its a deeply flawed approach in practice and must be stopped. Its been in story after disturbing story to be fewer than expected. Here are a few examples of shortfalls of this proportion and impact. A florida man with qu quadraplegia, separated from others, he had to be in his destroyed dwelling, he was there and had a heat stroke. And woman called from a nursing home she had been transferred to evacuated from houston to dallas. They wanted her to sign over her Social Security and fema berths and weve looked at addressing her needs to return to houston as soon as housing can be found. Many older adults with disabilities in high rises, trailer parks and other locations have been disconnected from response and relief resources and still had. Had no food, water or power. Our Community Based partnerships have been their saving grace time and again. In my written testimony ive enumerated actions to improve our actions to whole community, inclusiveness Emergency Preparedness and disaster response. In summary were calling for the establishment of a National Commission on disability and aging, Emergency Preparedness and Disaster Management to take the mini lessons observed and turned them into whole Community Inclusive actions. For the 59 million americans with disabilities, including 2 million in Nursing Homes and those over age 60 providing equal access to services and programs, it wasnt the right thing to do, its a legal obligation. People have disabilities have an equal right to access and nondiscrimination, there is no disaster loophole that allows for the suspension of our several rights. Eninsuring the federally mandated that people with disability will serve everyone with functional needs. A National Commission on disability and aging Emergency Preparedness and Disaster Management will serve to leverage the expertise of most of us impacted and the mantra of the disability rights, with those with functional needs, nothing without us, about us. Thank you. Thank you very much, mr. Timmons. Chief delaney. Good morning, chairman collins, Ranking Members casey and the members of the special commission on aging. Thank you for inviting me here today to discuss how cities and towns across the country can help assure the safety and resill yans of Older Americans and individuals with disabilities during and after disasters. Im the fire chief for the city of wilkesbarre, pennsylvania, ive been honored to serve the city in its role for 12 years and im also the Emergency Management coordinator for the city of wilkesbarre and a certified may certified paramedics. 19 of the countys resident of over 65, 3 higher than the average in the state and many of the older residents are concentrated within the city limits. Like any fire chief or Emergency Management coordinator, i feel a sense of responsibility for these older pennsylvanians, many who live by themselves. Whenever theres a severe storm, or events, that a watershed that drains into wilkesbarre from the susquahanna river threatening to flood our streets. In 2011 the threat was real for hurricane irene and lee to make landfall. What followed explains why early tracking data, surveillance and flow of information across all levels of government is a priority and critical to the health and safety of our residents. About seven days before the storms were scheduled to hit. We heard from the National Weather service. He started to send regular updates from the patterns and possible rainfall and the potential crest of the susquahanna river. The pennsylvania Emergency Management agency disseminated Critical Data to the emergency officials and Emergency Management coordinators for each municipality. Wilkesbarre is protected by a u. S. Army corps of engineer levee to a level of approximately 42 feet. The susquahanna river crested at a record and historic level of 42. 66 feet. For years, the gauges that measure the water height of the susquahanna river in wilkesbarre were broken and the responsibility of a u. S. Geological survey. Senator casey led the charge here in washington to secure resources to replace our broken gauges. Its because of senator casey that we can track in realtime the possible floot of critical river level data. This provides the needed data to make riskbased decisions for possible evacuations. Using maps of flooding that took place in 1972 after hurricane agnes we created an evacuation zone on september 9th, 2011, we successfully evacuated 15,000 residents of wilkesbarre in about ten hours. This evacuation included wilkesbarre city hall, wilkesbarre fire headquarters and including the Kings College and university. We alerted the local hospital and two Nursing Homes in the evacuation zone. They executed their Emergency Preparedness plans and safely executed with 250 seniors. And they knew to ask for additional help from the operation center, we would send ambulances and personnel to help, if needed. But it was the older pennsylvanians the seniors and those were disabilities, that still lived in their homes in a community that i worried most about. The mr. And mrs. Smiths, mr. And mrs. Joneses who lived in their homes for 50 years. In preparation for a possible evacuation we developed a grid to designate areas for the fire department, for the Police Department and members of the National Guard. We drove through south wilkesbarre in the downtown, making announcements from our vehicles, knocking on doors and posting evacuation orders. We knocked on every day. We left notes on doors of the homes where no one answered and made additional checks. And most heeded the call to evacuate, but for others we take their names and homes. And we executed the plan, seamless among officials from the national, state and local level. But even so, after every major event we look back and discuss how can we improve . For example, shall we ever need to evacuate again, we now have a contact in place with the local business r bus company that agreed to drive routes throughout the city to pick up people and take them to safety. Following hurricanes harvey and irma. I hope the congress will conduct its own after action review as it did after Hurricane Katrina in 2000 im sorry, august of 2005. While president ial directive five started the National Management system it was for the most part put into action after Hurricane Katrina and is now the model for all how all levels of government emergency disasters as part of that review i hope the congress will commit to continue to fully fund the National Weather service and fema and investigate in surveillance tools so we have the most comprehensive Information Available before, during, and after disaster to guide our decision making. Without early weather surveillance, we have little time to plan, to prepare, for potential weather events. Im grateful to the Senate Special committee on aging for the opportunity to add my voice to this conversation today and i thank you. Thank you very much, chief and thank you for reminding us that while our neighbors to the south tend to be disproportionally affected by weather disasters, that we who live in the northeast are not immune either. How well i remember this horrific ice storm of 1998. I had been in the senate for a year, which left so many of my constituents without power for so long and required the opening of emergency shelters throughout much of the state. So the point is, it can happen anywhere and all of us need to be prepared. So, thank you for recounting your experience as well. Dr. Desalvo, i was very interested in learning about the empower program. Which you have been so instrumental in setting unand shares with other states. Obviously, electrical power is key. Its key whether were talking about air conditioning in florida, or were talking about keeping warm in maine. What other steps do you see that seniors and disabled citizens need . Senator, the tool like empower that uses medical claims data gives us a sense of Peoples Health on a pop laying level, can identify people who are on dialysis, maybe wheelchair bound, for example. And when i was Health Commissioner we used. And if theres a boil water to target individuals to are special feeding and forewarn them of water issues. Its not just for electricity. On the other hand it has to be used. We want to try to make the evidencebased decision and want to use data in respectful ways to identify people at risk. There has to be humidity on the other end to make sure of it and going to peoples doors. Really, the opportunity is pretty great not only in big disasters, but the smaller ones that communities face every day to try to target limited resources to reach those who have the highest risk. Thank you. Dr. Hyer, you gave an excellent explanation of the dilemma that many longterm care facilities administrators case when deciding whether or not to evacuate and i remember reading of the controversy over the mayor of houstons decision to not order evacuation and yet in other cases where evacuation have been ordered more people died in automobile accidents trying to get out of the area. And i can see youre nodding in agreement, so im saying that for our the Court Reporter here. So the act of evacuation, while totally appropriate in many cases can actually be more dangerous than sheltering in place. And you talked about what is needed, however, for people to safely shelter in place. Weve also talked about seniors who simply seem to be fearful or unable to evacuate. So give us a little more guidance on how you would advise Public Officials or nursing home administrators to make the critical decision between sheltering in place and evacuation. Thank you, senator collins. Yes, with rita there were 22 People Killed in a bus as they evacuated. I think its a very complicated question, but Emergency Management people that i work with say that you run from the water, so if you expect there will be water and you cant evacuate you cant sustain that water, then you should leave. But you hide from the wind. I think we ought to be thinking about building buildings that are appropriate and can sustain a usual disasters. I think if youre going to get a hurricane category 5. Im not sure that Nursing Homes should stay, any nursing home should stay in a category 5 coming directly at them. Its just devastating. However, i think for the most part, many buildings can, in fact, evacuate can shelter in place appropriately. In countries in taiwan, they build water gates and thats exactly what they did in houston and people will evacuate up. You can stay within the building, but be sheltered on a different floor. Now, that requires a lot of planning and a lot of forethought. It also requires you to make sure that you have in place the necessary equipment and food and water. Those are usually in place in Nursing Homes. Theyve been those regs have been in existence for a long time. One of my colleagues in florida always says you shelter in place until you cant shelter in place. Things happen after storms. There were 40 evacuations in florida of Nursing Homes after irma. Some of those were because trees fall, things happen. Wind rip open roofs and the place is not safe and habitable. Those evacuations are appropriate, but many of those evacuations occurred because power wasnt restored just there werent generators or the generators werent appropriately created and built in a way that they can sustain. There wasnt fuel. Those regulations have been changed by cms for Nursing Homes, not for assisted living. I dont know if assisted living in florida are required to have generators. Assisted living is under the radar. So i think the answer is you want to be able to have people stay in the building, but the building has to be hardened, they cant be built in flood areas that routinely in heavy storms continue to flood. And there are Building Codes to that, that allow that to occur. We also need to have hardened and generator capacities. Many Nursing Homes in this country are very old and i think we need to think about it were going to allow capitol to be used to replenish them or search the needs, i think we need New Buildings to require generators with sufficient capacity to run air conditioning and other support systems for a period. I want to use the right. Terminology. The combination was terrible. For me it was an eyeopener because i had never been affected personally by a terrible storm or and, even as a public official, i dont think i was as close to it as i was in 2011. In most cases it was a few days after, some areas just a few hours. What i learned from that is just how violating or how devastating that is in a personal or emotional way. A friend of mine who is the ultimate tough guy, another engine never bothered by anything, i walked up to him and i said how to how is it going and he just dissolved in tears. This really tough guy was just absolutely devastated. That gave me an insight into the horror of it and what we saw in texas and florida and all these days and all these other places is maybe even worse than i saw in 2011. One point you made was the importance of good data to inform decisionmaking. We Work Together on this team to help gather information. Talk to us about what data you use to inform your decisionmaking when youve got an emergency or an impending hurricane. What data do you use . This is not really hard. We start with the Critical Data, hydrological data from the National Weather service. Thats why i say that agency is critical for the information they send to fema down to luzern county and that flow of data to us, they have some of the best scientists available that can predict what the rainfall will be, what the river cresting will be, and that data, we use for riskbased analysis to decide whether we are going to evacuate or not. It almost crippled us where we didnt know what the river was doing. I think from an Emergency Management standpoint, we can prepare for a lot of these disasters because we have some of the best scientists in the world that can predict whats going to happen. We take that data, we make sure we have our Emergency Operation plans and write up plan with our municipal officials. In particular, they open their center early on because of this prediction which set the National Guard in place so we needed to evacuate. That tool was already there to help us. I think a lot of the Surveillance Data is critical for that flow of information to come down and the unified command is used to make decisions. We have a coordinator and my boss and department heads, in Emergency Management, one person doesnt make the calls. You talk about sheltering in place, we had a small fire in a nursing home and we decided, it was only a really small fire and we probably had ten decisionmakers to help make the decision on what best being would be for the residents who live there. We have systems in place and we really need to use them. Im almost out of time. I was going to ask you, sometimes we think of, as you point out, response tools being things, equipment, whether its too remove down trees, the challenge you have is having enough personnel or human infrastructure to go doortodoor. Talk to us about that. On a daily level, we have 12 14 firefighters and paramedics working, but by getting the surveillance we can go to our bosses and say we need to prepare, we need to have all 80 firefighters at work. We did that during the disaster, during the Winter Weather event this past year we utilized that. To make these decisions that information early on, and i always had to put my request in for the federal programs that help us have the proper staffing, my department does about 11000 calls. Year. We are set up for all hazards. We put ferret fires out and we take care of hazmat, we rescue people, we do all those things. Its critical. This early information early on helps us have the right amount of people to handle the event. Thank you very much. Senator cortez, thank you to the chair of women and Ranking Member casey, and all of you here. Its such an important topic. I had the opportunity to work in state and local government in the state of nevada and i think people dont realize how important Emergency Management at the local and state and federal level is and people are working everyday to get it right. God prevents something should happen, but they want to make sure they get it right. Many times Emergency Management services are underfunded and challenged and they need more support. I have a couple questions because it came to my attention that the department of housing and urban development recommends but does not require that Public Housing authorities establish Emergency Preparedness. Im curious if you are aware of this and if in your own communities, how have you brought in some of those vulnerable populations. Some of that thats establish through hud. Im curious if you are aware of the. I want to take this opportunity for raising the issue. Health and Health Care Officials and a lot of officials have roles to play. In housing in particular, i think its a place where we can do a lot of good if we prepare properly and think of Building Code or generators or having exit lighting thats available with a generator. We had to have access to a lot of people who live in housing. A lot of what they know about the special needs of people in housing could be of great benefit to the people on the front lines and also in between, building resiliency, making sure people have the support so they can individually be prepared, i just want to point to an example more recently where hud leaned in quite well and thats in flint michigan where when we were trying to understand how to reach kids and families to let them know about opportunities to get treated for lead poisoning, hea hud agencies were able to get their databases and help direct resources. Ive seen it in action, but i think theres a lot of opportunity at the federal state and local level to better coordinate the information and resources. I appreciate that because i think just like your gathering the data and working with medicare to identify a population, hud canoe the same thing. Have access to the state and local level as well. I think there needs to be more of that partnership. When you talked about needing and recommending a National Commission, can you talk a little bit more about that . Is that your thought that there is more interaction. Thats exactly right. In my mind it comes down to planning and i differentiate between plans and planning. Its not a matter of just creating a plan and hitting the print button. I think we need to be in a perpetual state of planning and some sort of infrastructure to facilitate that is critical to give us consistency and help us leverage the stakeholder organizations. We are the experts on what we need and how to negotiate getting that in the most efficient fashion. I would like to see each state have a functional coordinator within its Emergency Management function. We have a couple models of that in mississippi in california. Its making a tremendous difference. At the end of the day i believe this is a relationship thing where we see this work where theres preexisting relationships between Emergency Managers and stakeholder. Where we see it not work so well is where its not. I dont think thats coincidental. What im suggesting is creating some sort of a framework to do this in an efficient manner. Thank you. My time is up. Thank you so much for the conversation and the work that you do everyday. Thank you so much. I will follow up on the questions to my colleague, chief delaney, let me start with you. You had talked about Emergency Preparedness must start with the community. What are some ways beyond looking at the data, which i thought was an excellent idea , that we involve organizations like meals on wheels and area agencies on aging that have regular contacts. It would help us know who needs help or whose housing to sustain a hurricane or a storm or flood. There is a lot of individual programs that are out there. How do we engage mr. And mrs. Jones who have lived in their house for 50 years. That is a tough nut to crack. When you have to evacuate so many people in such a short amount of time, you dont have time to say heres why you need to go. Thats a difficult question. If we can get that answered we are well on our way. I did want to address assisted living and nursing home facilities. That is critical. They have ambulances and all the Critical Data to get out. I just received a 40 page document the other day. It seems as though were Getting Better but there needs to be Regulatory Agency to say and the local officials need to get this plan so we are aware of whats in their plan. I think its a great discussion to have. The organized facilities know what to do. Thank you. Thank you for reminding us that this conversation on Emergency Preparedness needs to go beyond seniors and focus on individuals with disabilities. What is your assessment. Do they have shelters that are equipped to take care of people with disabilities. This is an area that hasnt received as much attention. Id like to have you elaborate on it. Particularly with the red cross weve made some progress. [inaudible] the red cross is the primary shelter operator costs the country as far as being ready and engaging in planning. We are seeing a tremendous difference. There is the Industry Leader in this. They will all learn some lessons on that. Were making incremental gains. Its a slow hall, but we are beginning to see some understanding from the folks in the shelter business that its a civil rights issue and economics and makes all the sheltering and servicing assessable to everyone. Its a legal obligation. It just makes sense, its a great business case. Were making progress. I like to ask you about a related topic. We are in the midst of yet another health care debate. Even in the midst of that weve had some good bipartisan work on healthcare the last number of weeks. In your testimony made clear youve seen in real time, both in your clinical practice and as a Public Health leader, the devastation that a hurricane can cause to seniors with chronic conditions. Given that, how concerned are you about the latest Health Care Bill that the senate is considering. 2005, louisiana was a state with the unhealthiest population in the country and some of the highest rates of uninsurance and access to care for low income, high needs people, largely in emergency room and people who knew about their health and could reach out between disasters, when they were evacuated the men they arrived in other states without any way to get care because they couldnt pay for. Someone whos been in louisiana for a decade telling my colleagues about what it was like to practice in an environment where your patients were uninsured and you sent them out on hope and prayer that they could get the colonoscopy for the medication they needed, these individuals had so much medical need and not a means to pay for. I think it spotlighted for us in louisiana and our colleagues around the country that having a great institutional place is not the only solution to access to care. You have to have an affordable way to pay for it, not only in disaster, but every way. With come so far in the we see louisiana that the opportunity for us is less focused on how we help those who dont have the means by how we can make the system better. Id hate to lose our focus on that. This bill supports Public Health across the country in disaster in every day and it literally saved your life. Make sure he can drink water and eat food and be rescued in the event of a disaster for that struggling already. Much less having a different cart. You dont want to know about that in the middle of a disaster. You want to know about that in advance and leverage local community organizations. It requires work and resources that requires Financial Resources to make sure local communities have the time to Work Together. I hope we will not step back but continued to step forward. I appreciate that. Mr. Timmons, i wanted to ask yo you, among your recommendations is a federal task force or committee to coordinate efforts across. What are some of the advantages that communities would see if planning were better correlated. In this way i would hope we can optimize our limited resources and reduce application of efforts, create nurture relationships. The time to do that was when the sky is blue. Do that in a consistent and meaningful way. Plan and exercising is something we would like to see. Consistently around the country, optimizing health, reducing the need for acute medical care. Universal assess ability, ensuring the civil rights with people with disability. It has been set all disasters are local. There is truth to that, and this way i think we could build up the local piece so folks like the chief are serving their community and people are working to achieve the goals we are all after. Thank you. In nevada and im sure many states we have many areas, resources, professionals, some areas take four hours to drive into. Theres no plane or bus service. Im curious how we support estate in the statewide effort to pull them into this Emergency Management preparedness and if you have any thoughts on that. I will start. Maybe i will spark some additional conversation. Im really glad you raised it that when you map the challenges in Rural Communities it will overlap with challenges in individual resources, access transpiration and all the things that make them more vulnerable to disaster. It also, in our experience in louisiana, its also a challenge because those individuals may be less willing to relocate. They want to shelter in place. Its a good reminder that there has to be coordination across jurisdictional lines. Our experience locally where each of our local jurisdictions and parishes have their own preparedness conversations about their populations and scaling that across the day to make sure we were thinking about regional and statewide coordination because isaac is a great example of this. We didnt flood and hurricane , because we were hardened and ready from acutecare standpoint and because we were communicating, we are also hardened and ready to take people from the surrounding parishes. Some of those are pretty rural environments on the coast, but without the preexisting relationships when the skies are blue, Communication Infrastructure and everyone knowing kind of what a sister relationship will look like, were not really ready to help each other. Though its local, its got to be coordination that scales to help bridge the gap. In some ways i think maybe the paradigm should be that we help the local community decide how they do this. Theres a lot to be said about the power of community and some of our more rural areas. I live in South Carolina and we saw this two years ago and was out last week as we experienced some of irma. A lot of the things im talking about, its done really well in our Rural Communities. There are some challenges and ways we can apply this in other areas as well. Thank you very much. Thank you, senator. I want to thank all of our witnesses for your testimony today, and for the really important work you are doing at the local, county and state level, private sector, public sector, nonprofit, you are all making a difference on the front line. I also want to think our staff that worked hard to bring this hearing together. We delayed the data this hearing because we could not want to interfere with the Immediate Response that was occurring, in florida and in texas, i know from the medical team that helped out in both places that First Responders from all over the country were assisting in the response, which is a tribute to the First Responder community. September is National Preparedness month and this years theme is disasters dont plan ahead, you can. We should take that motto to heart. From this hearing today, i can see the huge amount of progress that has been made since i conducted the investigation so many years ago into the very inconsistent and somewhat failed response to Hurricane Katrina. We have made great progress but we still have a long ways to go. I love the list of the five come of the four things that need to be done, i would note that Governor Scott has issued an order that says assistedliving facilities also have to have generators and fuel to supply them. We are learning from every disaster and learning how being prepared today can make the difference between safety and danger, and in many cases, literally the difference between lifeanddeath. For Older Americans and those with disabilities, there are ways to anticipate the unique challenges associated with aging, mobility impairments and medical needs. For seniors living at home, for those in assisted living facilities and for those in Nursing Homes, there are ways to prepare even though disasters can strike with little warning. I think we have learned a lot today about the importance of communication, working together, and as the doctor notes, my favorite expression is to say you shouldnt be exchanging business cards when disaster strikes. Thats the worst time. You have to prepare in advance. I want to close my remarks by also warning the residents who have been affected by the storms of the many scams that have already arisen. This committee has hearing afteheld hearing after hearing on financial exploitation of our elderly. There are two scams in particular that seem to be very prevalent. One is the charity scam where people are trying to get donations that are going to the victims of hurricanes, but in fact are lining their own pocket. I would urge people to deal with recognized charities to be very careful, and i know the former president s have come together to encourage donations. That is a scam that is relentless and heartless and the other one is an old scam that occurs every time there is a disaster like that. That is when people are pretending to be qualified homes to make them habitable and of course they disappear. I want to caution them to be very wary of people who would exploit the suffering of others in the devastation of the storms. I just wanted to mention that this will put out a bipartisan alert to try to raise Awareness Among the victims of the storm. Thank you to all of our witnesses and our members who are here today and Committee Members will have until friday september 29 to submit any additional questions for the record. I should say both of the senators from florida really wanted to be here today but theyve rushed back to their home state as soon as they possibly could to help out. That is certainly understandable as well. Senator casey, do you have any closing comments you would like to make. I do. Thank you very much and thank you for calling this hearing. Special thanks to chief delaney. We are grateful you made the trip. I share the commitment to make sure we are doing everything within our power to ensure seniors and people with disabilities are prioritized in Emergency Response, in the midst of these horrific challenges. It should not take the death of americans, or the kind of photos we saw, to cause us to take action. And to move this issue to the top of the agenda, including here in washington. We are grateful we have legislation that would begin to address these issues. We need to learn from these tragedies and commit ourselves to the goal that they will never happen again. I look forward to continuing to work with members of this committee. We are grateful for this opportunity today. Thank you madam chair. Thank you. Senator cortez master, since you are such a dedicated member, if you have any final words, feel free. Thank you for your participation. This hearing is now adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] Hurricane Maria blew over puerto rico this morning with 155 mileperhour winds. That is just too Miles Per Hour short of a category five hurricane. Samantha smit is there and forwarded this video. The rain is causing flooding. Supreme Court Justice will speak to law students this afternoon. Cspan will have live coverage. It starts up for eastern. You will find live coverage on line or listen with the free cspan radio out. Sunday night on after words , New York Times magazine contributor traveled abroad in her book no son of foreign country. She is interviewed by foreignpolicy interruptive cofounder. There is the question of why havent i thought this was a form of propaganda and what was the job that it was doing for individual americans. One thing i was realizing is that the very language that we use when we talked about Foreign Countries had been kind of determine for us a very long time ago because we tended to look at muslim countries and countries in the east as were they catching up with us, or were they behind us. What that does is that prevents you from being able to see the country on its own terms. Watch after words sunday night at 9 00 p. M. Eastern on cspan to book tv. Ive been on the other end of a phone call from my team, asking for my help because we received it call from the department of Homeland Security telling us that a 7yearold girl was being sexually abused and that content was being spread around the dark web and she had been being abused and they watched her for three years and they could not find the perpetrator. Asking us for help. We were the last line of defense. An actor is the potential last line of defense. The Video Library is your free resource. Whether happened 30 years ago or 30 minutes ago, find it in the cspan Video Library. Where history unfolds daily. Present trump is urging the senate to pass the latest republican healthcare log repeal thing i hope republican senators will look for graham cassidy. One republican has already come out against the bill which could be voted on next week. He is a friend of mine but he is such a negative force when it comes to fixing healthcare. This morning we talked with a reporter following the bill. U joining us now, they are talking about the latest effort in the senate toha repeal and replace the af