Because the power had been knocked out. One press account described the facility as, quote, a deathtrap, end quote, because the elderly are particularly susceptible to heat related illnesses. Last month this photo of residence of an assisted living facility in texas who were trapped in waist deep water went viral. As of these recent disasters make clear, Older Americans are particularly vulnerable before, during, and even after a storm. In fact, when Hurricane Katrina slammed into the gold coast 12 years ago, more than half of those who died were seniors. As the danger of the Senate Homeland security committee, along with senator Joe Lieberman of connecticut, i lead a bipartisan investigation into the response to Hurricane Katrina at the federal, state and local levels. Our investigation which resulted in this 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. It was evident to me in rereading it, that we have 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 effective evaluation of our most vulnerable seniors. Since then weve expanded our efforts to improve Emergency Preparedness and response across the entire country, and weve 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 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 here i was talking with a 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. There 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 are just trying to maintain people. In addition, local Emergency Response teams implemented strategies to identify those most in need and provide a designated shelters that offered necessary medical care in 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 healthcare centers. While weve made many strides since Hurricane Katrina 12 years ago, we must ask ourselves can we better protect the most vulnerable members of our communities . What gaps exist that could 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 even a q8 and relocate. And as i look more into this issue ive learned 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 florida, a cnn reporter waited about a mile in waist 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, but they did not heed the warnings of local and state officials to leave prior to this storm. Inside this mobile home, which was now surrounded by water, lived in 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 here they may suffer from disease, and many of them have lived in the homes for so long that they just dont 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 so many cases they, too, are dealing with the devastation caused by these terrible storms. While we cant and must 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, senator casey. Chairman collins, thank you very much for having this very important hearing, especially at this time. I joined the german in thanking the work of those the chairman those were done Emergency Response, test over many, many days now. The countless volunteers who have helped them throughout these many days of challenge. We are grateful for that work, and we join in thanking them for doing that great work. Together, theyve worked endless hours over 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 we are here today 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. We are also heartbroken for loss of life and also the loss that those families suffered. In this case it was apparently something as simple as the 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 here so thats one of many challenges we will speak to you 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 15 member 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. These are folks who indeed are to say there are greatest generation doesnt adequately capture. These are folks who fought our wars. They have worked in a factory. They built the middle class. They gave us we need to ensure we are doing Everything Possible to learn from these tragedies and we have to make sure we are focused on better policy. Thats why we gather 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 whammys of hurricane lee and irene back in 2011, as well as before hurricanes. In six weeks it ravaged florida in the year 2004. We have learned and they have learned even more from each of these experiences. As we hear from her witnesses, incident management infrastructure is more robust in some important areas like hospitals. Thats good news. That means we have learned lessons to implement those changes. Coordination efforts in advance of storms have been improved. There are more comprehensive emergence response requirements being implemented for Nursing Homes so seniors will be better protected. We have a long way to go to make sure we get this right. Older citizens should not suffer for days and then die in the unbearable heat. No person with a disability should have trouble following evacuation orders because of an accessible transportation or shelters. 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 but i want to thank the witnesses for bringing their experience, their expertise and their passion to these issues, and i want to yank chairman collins for gathering us on this day. Thank you very much senator casey. Im delighted we have senators here with us today. I very much appreciate their participation. I know they had to get off to the Judiciary Committee so i would like to offer him the opportunity for any comments he would like to make. Thank you madam chair. I do have to chair the Judiciary Committee. Once i get there i wont be able to come back. I want to thank you all for being here. The building is a little empty today. We adjourned last night. You see the focus that these numbers have to be here, and thank you all for being here. Im glad that we frame this as a disaster. We are getting immediately to the disaster that is incurring in puerto rico. We can talk about the recent storm. We have a personal story to tel tell. Our office, our staff had to help a senior for the process. We had almost 20 inches of rainfall in almost a 20 hour. That was devastating. So much that we would go to one shelter, that it closed down at the water threaten those shelters. It really raised the question for all of you to potentially respond too. Race is a question of how well we respond to track evacuees through the lifecycle. Until there is a resolution that makes us feel like that senior is safe and secure. One of the challenges we have is a fear of the unknown. If we did a better job of communicating what this would look like earlier, where they are likely to go, and how we are going to be stewards of them over the course of the process, then i think that many who feel like the safest thing to do is to shelter in place will be replaced with a sense of comfort that they will be taking care of through the process, up to and including getting them back on their home and living in a facility where theyve been taking care of. That lifecycle, where it needs to start, how do we better educate, how we better link what we ended up doing in our office was pulling together. I think it can be instructive for things we need to do differently. Fortunately our governor, our Emergency Management folks in North Carolina helped us find this lady get her medications which were desperately needed and get her connected to her family. That sort of lifecycle of disaster that starts before the disaster ever occurs, until we know the senior is safe and sound, is something that i think would be very helpful to see how we can actually work at the federal, state and local level to make that happen. Thank you all for being here. Thank you for being focused on helping us come up with a solution, and again, madam chair, thank you for your help on the subject. Thank you very much senator tell us. Im now going to introduce our excellent panel of witnesses. First is doctor karen disalvo. He is a physician in Public Health expert. She served as Health Commissioner in new orleans where she worked hard to restore health care to areas of the city devastated by Hurricane Katrina. She is also served as the former assistant secretary for health at the u. S. Department of health and Human Services. Next we will hear from doctor kathy higher. Doctor hire is director of the florida policy Exchange Center on aging at the university of south florida. Doctor hire has researched and written extensively about vulnerable Older Americans and the structure of Emergency Response system. I want to thank you 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 inclusive disaster strategies in charleston South Carolina. Despite the mouthful of an organization name, he is leader in the field of Disaster Preparedness and response for people who are aging and those with disability. I will turn to a representative from pennsylvania. I am pleased to announce fire chief of the city of pennsylvania. He led the response efforts when it became hurricane irene and eileen could cause a flooding of the six largest river in the World United States and overwhelm our community. With the clock ticking, he safely evacuated 15000 people in ten hours including our hospitals and Nursing Homes. I look forward to the chiefs testimony. Thank you chief. Thank you very much senator. We will start with doctor disalvo. Thank you and good morning. Distinguish members of the committee, thank you all for making time in a very busy agenda of the senates talk about this priority issue, saying that we have an opportunity to better support and protect Older Americans in times of disaster and everyday. I am karen disalvo. Im a physician and formally the Health Commissioner in new orleans, not during the time of katrina but subsequently within new orleans. I want to share a story that started a little bit later. It was 2012 and i found myself standing in the Emergency Operations center in new orleans, being asked by our Power Company how to restore power for our community. I was relatively new to the job. It was august, it was hot, we knew we were just about seven years after katrina and the we had done very much to heed the advice of better preparations and planning, what we had had was an event that wasnt about flooding but was actually about power outage from prolonged high winds. We were prepared in many ways. We harden the infrastructure of our hospitals. We had better relationships, heeding the senator collins during disaster well before. We had done much better plannin planning. In fact the hospitals had returned to normal functioning. The question i was being asked to address was how to prioritize power for the rest of the community. The situation was compensated because we were getting reports of seniors struggling in the heat throughout our community, and we had offered evacuation assistance to many of those seniors who had been registered in our medical special needs registry, but they wanted to shelter in place and didnt take the opportunity to voluntarily evacuate. We knew some about them, we didnt know where they were clustered and who was highest risk or electricity dependent. In the end, we went doortodoor throughout the community to help prioritize power restoration based on who answered the door when we knocked on it. We were able to help a lot of people. We did this with the support of First Responders like fire, but it was not a great feeling. Nor was it very efficient. Going forward, we did not want to repeat that experience of having to be somewhat haphazard in determining how to restore power in our community. We worked with hhs to leverage medicaid, medicare data and new technologies like geo mapping to be able to create a map in our community of where seniors who are electricity dependent live. We did a drill in the community with fire and police and volunteers and went doortodoo doortodoor. We knocked on the door and said we are from the government and we are here to help. We actually did say that. The people willingly open their doors and learned that we are trying to find out if they were electricity dependent and how we could be helpful for them not only in disaster but everyday. The data worked and we learned something more concerning, of the 600 some people, we only knew of 15 of them in our medical special needs registry. That system called in power has been taken to scale and is available to used across the country, not only in Disaster Response but in preparedness. Its an example of how we can use technology and those to do better in preparedness and use this tool in and harvey. I just want to take a moment to talk about the work that we need to do beyond supporting the most frail in our institutions. When i went doortodoor, the bulk of the people i saw were individuals who were living independently in communitybased settings, often subsidize housing and high rising and what i said i was really heartbreaking. These are People Living on the edge everyday and are not likely to be broken only by a major disaster, but by all the little disasters that touched their lives on a regular basis and tools like empower our great way to get them on a special needs registry so we dont have to sign them but they require human touch as well. Its part of the rebuilding we need to do. We made progress and hardening are in the structure and hardening the relationships necessary to better respond but theres so much we need to do to support our First Responders. There is more my testimony but ill just highlight the heat a few today. Tools remind us that we have technology and data but its only as good as the data in it. For example, if we expanded it to expand medicaid we could do more good for more people. They need to support the action on the ground. Its one thing to have information in a box but we have to be able to act upon it on the front line and that requires training exercises. We need to support the infrastructure. Theyre under resourced to support the community and the most honorable in times of needs. This includes Public Health and other agencies and the private sector trying to help seniors and Older Americans every day. Finally we need to do more to protect. I think the cms, Emergency Preparedness rule helps but it requires robust implementation. Its not pieces of paper and checklist, its actually really drilling and paying attention in an ongoing situation. I think the administration should think about creating policy and regulation that can support areas that sometimes forget about for preparedness like Building Codes. Thank you again for raising the profile of the need to better support seniors, Older Americans in the most vulnerable and our community in times of disaster and i look forward to your questions. Thank you very much doctor higher. The morning. On behalf behalf of my colleague, i want to thank all of you for being here and for giving me the opportunity to testify on a topic ive studied since 2004. When four hurricanes traversed florida. My colleagues and i have studied the effect on frail older adults living in nursing home and assisted living. My remarks reflect a decade of research that have been carried out through several foundations. They only became part of the Emergency Response system after several hurricanes. They crisscrossed the state and personnel realize that Nursing Homes were Healthcare Facilities taking care of frail elders and they needed help. They were part of the system. They interviewed nursing home administrators during katrina. Across the board, these nursing home administrators revealed that they wrestled with important decisions about whether to evacuate. They urge them to evacuate despite the difficulty of evacuation. They have them on buses and gymnasiums without supplies and inadequate materials. They realize they declined and they saw their own staff hurt trying to move residents and they believed they would be better served staying where they are. It became the impetus for the National Institute of aging study that we did looking at Hurricane Katrina, rita and ike. Research showed Nursing Homes among 36000 residents exposed , the 30 and 90 day mortality rates increased considerably compared to the non hurricane years. In total, there were 277 extra docs and 800 extra hospitalizations within 30 days after exposure to the storms. Natural disasters result in bad outcomes. We asked a second question we asked if it was better to evacuate or shelter in place. Using those same data from those four storms and methodological techniques in the appendix that we provided, our research concluded that the very act of evacuation prior to the storm increase the probability of death at 90 days and increased the risk of hospitalization independent of all other factors. It should be noted that our data took into account the fact that certain Nursing Homes did not evacuate including saint ritas and lafond Nursing Homes were there are tragically many deaths. Despite these deaths, it proves to be cumulatively. Based on our research, we have the following recommendations. We need generators to support medical needs. As well as fuel Nursing Homes and continued operations. Emergency plans for operations and assisted living must be publicly and easily 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 this means real drills and actual implementation. Assisted Living Communities require much more oversight. They routinely accept patients who wouldve received care in a nursing home only a decade ago. Waiver payments for residents with medicaid have also increased, thereby making the federal government at least an Interested Party and assisted living regulations. Evacuation shipment not be all or nothing. Senator collins talked about the importance of dialysis being evacuated. We need a much more nuanced and Better Research understanding of who should evacuate before, and how people should be sustained appropriately. Nursing homes and assisted living must be built in places that minimize flooding, and they have to be built to standards that allow administrators to shelter in place if at all possible. Every state and local Emergency Management must identify and prioritize Nursing Homes and assisted living for restoration of Power Services and other services. Some degree of litigation protection must be considered for facilities that abide by regulations and provide her road care during disaster scenarios. There are many people working very hard to try to care for elders and disabled people all over florida. It continues as we speak. Finally, older adults matter. I am the pi on this Workforce Enhancement Program grant. We need continued commitment to geriatric Education Programs and training programs. I can only provide the evidence im providing today because research and training was approved and was allowed, but it dried up in the years following katrina. Our country needs ongoing geriatric training. We need Consistent Research funding to evaluate disasters. We know that disasters will continue to occur and we must be prepared. Thank you for allowing this testimony. I look forward questions. Thank you very much. Mr. Timmons. Thank you in the morning. This is a specific mission to serve the Disaster Relief needs for people with disabilities and Older Americans and we are Grassroots Organization with a proud history of serving on the ground in almost every Major National disaster since Hurricane Katrina. Our partnership leads and chordates over 100 disability aging, Public Health, Public Safety and other stakeholder groups including fema and the red cross with a shared commitment to the Emergency Preparedness and disaster related needs of the nations 59 Million People with disabilities and 67 million americans over the age of 60. Weve been convening stakeholder calls daily to identify problems and solutions in operating our hotline from harvey and irma and currently preparing our incredibly dedicated volunteers for hurricane maria. Given people with disabilities and older adults are 2 4 times more likely to die or be seriously injured in a disaster, the agency of our work cannot be understated. This is due frequently to poor planning, inadequate accessibility and the rival shared that people with disability are vulnerable, special or particularly at risk. Because of a diagnosis or stigmatizing about disability and aging. We are extremely valuable experts and problem solving with far more practice than people who dont navigate inaccessible environments on a daily basis. The appropriate approach postefocuses broadly on the access and functional needs of people with and without legal disability rights protections. In a disaster, providing equal access and meeting functional needs makes the difference time again for individuals, families and communities. In fact, the phrase people with access has been codified by dhs and is the working term among Emergency Management professionals and fits our discussion here. Ineffective and inappropriate evacuation, hospitalization, nursing home admission, and separate sheltering and strategies assisting all with functional needs might look great on paper however at the deeply flawed approach and practice and it must be stopped. It has been clearly proven in story after disturbing story to be even worse than we expected. There are few examples of the shortfalls and accessibility as a result. A florida man with quadriplegic using a wheelchair, separated to his fiancee was sent to a special needs shelter and discharged without any assistance or plan other than to return to his destroyed dwelling. He had a sleep outside until the temperature caused him to have a heat stroke. In partnership with the fema disability and immigration advisor we assisted him to obtain temporary shelter in a Wheelchair Accessible hotel room. A woman called from in nursing home and she said the nursing home wanted her to sign over her Social Security and fema benefits would which would make leaving the nursing home impossible. Weve connected her with resources. Many older adults and people with disabilities and highrises, trailer parks, and other locations have been disconnected from response and relief resources and still are. Live had no food, water or power. Our communit communitybased partnership have been there saving grace time again. In my written written testimony, they enumerated the short list of short ideas and actions to improve our approach to Emergency Preparedness and Disaster Response. In summary we are calling for the establishment of a National Commission on disability and aging, Emergency Preparedness and Disaster Management to take the many lessons observed in tournament to hold Community Inclusive actions. For the 59 million americans with disabilities, including over 2 million in Nursing Homes and the 67 million americans over age 60, providing equal access to Emergency Services and programs is not just the right thing to do or simply Smart Business practice. It is also a legal obligation. People with disabilities have a legal right to equal access and nondiscrimination. Civil rights are not waiver of all. There is no disaster loophole that allows the suspension of civil rights. Ensuring the federally mandated rights of people with disabilities will well serve everyone with access and functional needs. A National Program will leverage the expertise of those of us most impacted and impact the mantra of the disability rights mantra which applies to everyone with access and functional needs. Thank you. Thank you very much mr. Timmons. Chief delaney. The morning. Thank you for inviting me here today to discuss how cities and towns across the country can help ensure the health, safety and resilience of Older Americans and individuals with disabilities during and after disasters. I am the fire chief of the city of pennsylvania. Ive been honored to serve the city in this role for over 12 years and have a total of 36 years in Emergency Services. Im also the Emergency Management for nader for the city and a certified paramedic. Over 40000 people reside in wilkesbarre, a city in lucerne county. 19 of the countys residents are over 65 which is 3 higher than the average in the state. Many of the older residents are concentrated within the city limits. Like any fire chief or Emergency Management correlator, i feel a great sense of responsibility for these older pennsylvanians. Many who live by themselves. My concern for their wellbeing is heightened whenever there is a threat of a severe storm or weather event. That is due to a 10000 square mile watershed that drains into wilkesbarre from the river, threatening to flood our streets and our neighborhoods. In 2011, it became very real as the east coast race for hurricane irene to make landfall. What transpired explains why early weather tracking, data, surveillance, and the 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 are scheduled to hit, we heard from the National Weather service. They started to send us regular updates about the storm patterns and the possible rainfall potential of the river. The pennsylvania Emergency Management agency, they disseminated Critical Data to a county Emergency Management officials and Emergency Management coordinators for each minutes pali. Wilkesbarre is protected by a u. S. Army corps of engineer levy to a river level of approximately 42. Feet. The river crested on septembe september 9, 2011 at a record and historic level of 42. 6 feet. For years, the gauges that manager the water height of the river were broken and they were the responsibility of the u. S. Geological survey. Senator casey led the charge here in washington to secure the resources to replace our broken gauges. It is because of senator casey that we can track, in real time, the possibility of a flood and critical river level data. This type of surveillance information provides a needed data to make risk based decisions for possible evacuation. Using maps of flooding that took place in 1972 after hurricane agnes, we created an evacuation zone. On september 9, 2011 we successfully evacuated 15000 residents and about ten hours. This evacuation included city hall, police headquarters, fire headquarters as well as the entire downtown including Kings College and wilkes university. We alerted the local hospital and to Nursing Homes in the evacuation zone. They executed their Emergency Preparedness plan and safely executed 250 seniors. If at any time they thought they were going to have trouble evacuating in the time required, they knew to request additional help from the City Operation Center and we would send ambulances and personnel to help if needed. But, it was the older pennsylvanians, the seniors and those with disabilities that still lived in their homes in this humidity that i worried most about. The mr. And mrs. Smith and mr. Mrs. Jones who had lived in their home for 50 years. In preparation for a possible evacuation, we develop a grid designating areas of responsibility for the fire department, the Police Department and members of the National Guard. Which drove through south wilkesbarre and downtown making announcements from our vehicles, knocking on doors, and posting evacuation orders. We knocked on every door. We left n notes on doors where no one answered to ensure their evacuation. Most people heated the request to evacuate on the first try but if anyone resisted, they took their names, wrote down the address we spent additional time working to get them out of their homes. We successfully executed our plan because of the seamless collaboration and communication among officials from the national, state and local level. Even so, after every major event, we look back and discuss how could we approve. For example, should we ever need to evacuate again, we now have a contact in place with a local bus company that agreed to drive routes throughout the city to pick up people and take them to safety. Following Hurricane Harvey and irma, i hope the congress will conduct its own after action review as it did after Hurricane Katrina in august 2005. While president ial started the advancement of the National Incident management system, it was, for the most part, put into action after Hurricane Katrina and is now the model for how all levels of government manage all types of emergencies and disasters. As part of that review, i hope the congress will commit to continue to fully fund the National Weather service and fema and invest in surveillance tools so we have the most comprehensive Information Available before, during and after disaster to guide our decisionmaking. Without early weather surveillance, we have little time to plan and prepare for potential weather events. Im grateful the Senate Special committee on aging for the opportunity to add my voice to this conversation here today, and i thank you. Thank you very much. Thank you for reminding us that while our neighbors to the south tend to be disproportionately affected by whether disasters that we who lived in the northeast are not immune either, how well i remember the historic ice storm of 1998. I have been in the senate for your, which led so many of my constituents without power for so long, and required the opening of emergency shelters through much of the state. The point is, it can happen anywhere, and all of us need to be prepared. Thank you for recounting your experience as well. I was very interested in learning about the empower program. You have been so instrumental in setting up and sharing with others. Obviously, electrical power is key, whether we are talking about airconditioning in florida or were talking about keeping warm in maine. What other gaps 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 population level. It can identify people who are electricity dependent and people who are on dialysis, individuals who have ambulatory challenges, maybe wheelchairbound as an example, and in new orleans, when i was Health Commissioner and we still use it regularly, it is a way that if theres a boil water advisory that we are able to target individuals who might be on special feedings or on dialysis and we want to forewarn them in advance of water issues. Its not just for electricity , but on the other hand, it has to be used but i cant emphasize that enough because we want to try to make the evidencebased decisions and we want to use data and respectful ways to identify people at risk. There has to be humans on other and that can take that information and make use of it by making phone calls and going to peoples doors. The opportunity is really pretty great in big disasters and smaller ones that communities face every day to try to target limited resources to reach those who have the highest risk. Thank you. Doctor higher, you gave an excellent explanation of the divorce, that many longterm care facilities and administrators face when deciding whether or not to evacuate. I remember reading the controversy over the mayor of houston decision to not order an evacuation, and yet, in other cases were evacuations have been ordered more people died in automobile accidents trying to get out of the area, and i can see you are nodding in agreement. Im saying that for our Court Reporter here. So the act of evacuation, while totally appropriate, in many cases, can actually be more dangerous than sheltering in sure you have in place the necessary equipment and food and water. Those are usually in place. Those regulations have been in existence for a long time. One of my colleagues in florida always says you shelter in place into you can 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, wins rip open groups and the place is not safe or habitable. Those evacuations are appropriate. Many of those evacuations occurred because power wasnt restored, because there wasnt generators or the generators werent appropriately created and built in a way that they can sustain. There wasnt fuel. Those regulations have been changed. I dont even know if assistedliving required to have generators. There really under the radar. I think the answer is they want to be in the building but it has to be hardened and it cant be in areas where heavy storms continue to flood. There are Building Codes that allow that to occur. We also need to have them hardened and have generator capacity. Some buildings are very old. Many Nursing Homes are very old. I think we need to think about if were going to allow capital to be used to replenish them or replace some of them. I think we need the new building to require generators with sufficient capacity to run airconditioning and other support systems for a period of time. Ninetysix hours is what hospitals are required to have. Thank you very much. Senator casey. Thank you for your continued leadership. You are doing a great, great job. I have a good recollection of what we all saw into thousand 11. I cant member how many counties we went to, weve had eastern, central and southeastern pennsylvania, almost half the state affected. Irene was a hurricane and the other was a Tropical Storm but they were both bad. The combination was terrible. For me it was an eyeopener because i had never been affected personally by a terrible storm or flood. Even as a public official, im not sure i had ever been as close to it as i was in 2011. We would be walking through those communities, in most cases, a few days after and in some maybe only hours. What i learned from that is just how violating that is or how devastating that is on a personal and emotional way. I remember a friend of mine who was the ultimate tough guy, never bothered by anything, always cocky about everything but i walked up to him. His house had been flooded. I said hows it going and he just sort of dissolved in tears, this really tough guy. That gave me insight into the horror of it what we saw is maybe even worse than what we saw in 2011. The one point you made was the importance of good data to inform decisionmaking. We Work Together on this team and we gauge and helping to gather information. Talk to us about what data you use to inform your decisionmaking when youve got an emergency impending, in this case and 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 that they send to fema, the pennsylvania Emergency Management down to lucerne 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. River gauge that didnt work 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 Operations planned and we write a plan with our municipal officials. In particular, problem lee and irene, they opened early on because of this prediction which set the National Guard in place so if we needed to evacuate that tool was already there to evacuate. I think a lot of the Surveillance Data is critical for that flow of information to come down. Also, the National Incident system and command is used to make decision. Im Emergency Management core nader but hes the boss and we have a mayor and a city administrator, department heads, Emergency Management, one person doesnt make the call. You talk about sheltering in place. We had a small fire in a nursing home two weeks ago and we decided it was only a really small fire but we decided to shelter in place. We had ten decisionmakers there to help make the decision on what the best wellbeing would be for the 166 residents that lived in that place. We have systems in place. We really need to use them and use them adequately. Im almost at a time. I was going to ask you about sometimes, we think about response tools being things, equipment and whether its to remove down trees, but the challenge you have is having enough personnel, enough manpower or human capacity, human infrastructure to be able to go doortodoor. Talk to us about that. Sure, on a daily level we have 12 14 firefighters and paramedics working and maybe the same amount of police, but by getting the surveillance information data we can go to our bosses, our elected officials and say listen, we need to prepare. We need to have all 80 firefighters at work for the next three days. We did that during the disaster, the Winter Weather event this past year. To make these decisions and that information early on, i always have 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 deliver babies, we put fires out, and we rescue people from the river, we take the tree branches, we do all those things. Staffing is critical. This early information early on helps us to have the right amount of people to handle the event. Thank you. Senator cortez mastro, thank you. First of all let me say thank you to chairwoman collins and Ranking Member casey. Its such an important topic and we appreciate the conversation. I dont think people realize we realize how important this is up a local and state level. People are working so hard to get it right. Many times they are underfunded or challenged and they need more support. Have a couple of questions. It came to my attention that they recommend that they dont require that housing establish Emergency Response plans. Im wondering if you are aware of this and how have you brought in some of those vulnerable populations that live in the housing that is established through hud. Im curious if you are aware of this. I want to take this opportunity to thank you for raising the issue. Emergency responses more than people in uniforms and healthcare and health officials. A lot of people have a lot of roles to play in agencies and in housing in particular, i think youve heard that that is a place where we can do a lot of good if we prepare properly if we think about Building Code and think about having generators and exit lighting. We have have information about people who live in housing. Better information and court nation about what they know about the special needs of those in housing could be a great benefit to the people on the front line. Also in between, building resiliency, making sure people have the kind of support so they can be prepared. I just want to point an example more recently where hud leaned in quite well. That was in flint michigan. How to reach kids and families to let them know they were able to get the databases and get the kids and help direct resources. Ive seen it in action but i think theres a lot of opportunity at the state and local level to better coordinat coordinate. I appreciate that because i think just like your interaction and gathering the data in working with medicare to identify a population, hud can do the same thing. Federal agencies have access to this data that can help Emergency Management at the state and local level as well. I think there needs to be more of that partnership. Thats why, mr. Timmons, when you talked about needing and recommending a National Commission, can you talk more about that . Is that your thought that there is more of that interaction and that sharing of data and information with the state and local management systems. Thats exactly right. In my mind, this comes down to planning and i differentiate between plans and planning. Plans are worthless. Planning is invaluable. 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. We need some sort of National Infrastructure to facilitate that. I think that is critical to give us consistency and to help us leverage. The aging disability stakeholder organizations need to be involved in this process from the beginning. We are the experts on what we need and were the experts on how to negotiate getting that in the most efficient fashion. I would like to see each state have an access and functional need coordinator within its Emergency Management function. We have a couple models of mississippi in california and its making a tremendous difference. At the end of the day, i believe this is relationship thing where we see this work is where their preexisting relationships between Emergency Managers and stakeholder organizations. We see it not work so well where they are not. I dont think its continental. So, what im suggesting is creating a framework to do this in 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. Im going to follow up on the question 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 had to which i thought was an excellent idea that we can involve organizations, im thinking of meals on wheels, area agencies on aging that have regular contact with seniors in our communities and would be aware of who would need help or who has housing that might not withstand the blow of a hurricane or storm were a flood. Are they involved at your level with the Emergency Preparedness planning that you do . There are a lot of individual programs out there, but again, how do we engage mr. And mrs. Jones, mr. And mrs. Smith who have lived in the house for 50 years. That is a tough nut to crack because, when you have to evacuate 15000 people in ten hours, you dont really have the time to sit and say heres why you have to go. That is a difficult question. If we could get that answered , i think we will be well on our way. I did want to address the assisted living facilities, nursing home facilities, that is critical that they have their plan and their plans address how to be evacuated thousand 11 we trust their judgment. We said you have ten hours to evacuate in their plans for the strikeforce of ambulances and all the Critical Data needed to get out. Mandating these plans are critical. I just received 40 page document the other day. It seems as though were Getting Better at getting these plans, but there needs to be Regulatory Agency to say you have to have this plan, the local officials need to get this plan so that we are aware of whats in their plan. Senator, to address you, think thats a great discussion to have. The organized facilities know what to do. Average citizen that kind of doesnt understand it. They havent talked to folks for days or weeks about anything potential on. It takes a long time. When we need to get them out, we dont have the luxury of all that time. I think thats a great conversation have. Thank you. Mr. Timmons, i really appreciate your reminding us that this conversation on Emergency Preparedness needs to go beyond seniors and also focus on individuals with disability. What is your assessment of the level of Emergency Preparedness in terms of meeting the needs of people with special needs . Do they have shelters that are equipped to take care of people with disabilities . Are they staffed with people who understand what they need . This is an area that i dont think has received as much attention so i would love to have you elaborate on it. Particularly with the red cross, we have made some progress in terms of trying to create an infrastructure, with them working with the community and our stakeholder organizations and aging stakeholder organizations so that all shelters are assessabl assessable. I reiterate that in my mind this is a civil rights issue. The red cross is the primary shelter operator across the country. We have seen a tremendous amount of progress from them in terms of being ready and engaging in planning. It makes sense. Its a great business case. We are making progress. Thank you. I wanted to ask you about of related topic. We are in the midst of yet another Health Care Debate and even in the midst of that weve had good bipartisan work on healthcare the last number of weeks, more than two weeks now. In your testimony, you may clear that you have seen in realtime both in your clinical practice and is a Public Health leader the devastation that a hurricane can cause to seniors with chronic conditions as well as individuals with disabilities. Given that experience, how concerned are you about the latest healthcare bill that the senate is considering . Center, louisiana in 2005 was a state with the unhealthiest population and some of the highest rates of uninsurance and access to care was for low income, high need people largely emergency room which prevented them from having relationships with primary care, people know about their health and could get between disasters. When they were evacuated and meant that they arrived in other states without any way to get care because they didnt have a way to pay for it in the absence of having public or private insurance and having relied in our state on the Hospital System and someone who is been in louisiana for decades and has been telling my colleagues about what it was like to practice in an environment when your patients were uninsured and he sent them out on a hope and a prayer that they would be able to get that colonoscopy or get the medication that they needed. It was shocking to my colleagues in other states there were on the receiving end of patients in these individuals who were at so much medical need and social needs and not a means to pay for it when they arrived in a new state. I think it is spotlighted for us in louisiana but our colleagues from the country that it is having a Great Institution in place and it is not the only solution to that access this care. You have to have an affordable way to pay for your care, not only in disaster but everyday. So far in louisiana in the last decade with recent expansion of medicaid the opportunity for us is less focused on what will happen with those who are uninsured or dont have means and how can we make the system work better for them. I would not want us to take a step back as a country and i might mention this additional piece that has been raised because its part of the thinking of what may happen, cuts to the pension fund which support Public Health across the country. Public health and unsung hero in disaster everyday saves her life. And make sure you can drink water safely any food and be rescued in the event of a disaster. But it is struggling already. It is so pertinent to the start of conversation about people with disabilities and people with special needs because you do not want to come in my case, learn about that in the middle of a disaster. As i showed you, you want to know in advance and you want people to leverage local Community Organizations who have connections to those individuals whether it is meals on wheels or the state based trinity and that kind of coordination and communication in relation just doesnt happen just by happenstance but it requires work and requires resources, human resources, Time Resources and that requires Financial Resources to make sure that local communities have the bandwidth to Work Together. I hope it will not step back to continue to step forward. I appreciate that. Mr. Timmons, i wanted to ask you that among your recommendations is the idea a federal task force or committee to coordinate efforts across, not only federal Government Agencies but state and stakeholder groups as well. What are some of the advantages that communities would see if planning were better coordinated . Thank you. In this way i would hope we could optimize our limited resources and reduce efforts that we see. Again, create and nurture relationships because the time to do that is when the sky is blue so we do that in a consistent and meaningful way. Using functional leads and rather than seeing as liabilities but planning perpetual, vigorous planning and exercising is something that we like to see consistently done around the country. Optimizing health, reducing the need for acute medical care in these situations would be a tangible result that makes business sense. Universal accessibility, ensuring the civil rights of people with disabilities affect the broader access and functional community. Doing this in a consistent federally mandated overarching way just makes sense. It has been said all disasters are local. There is truth to that and in this way i think we can build up the local piece so that folks like the chief are serving their community and that people are working together to achieve the goals year after. Thanks very much. Thank you. Senator cortez master. In nevada, and many states, we have Rural Communities that are challenged. Forget just getting resources they are, professionals, you name it and geographically challenged. Some of our Rural Communities take four hours just to drive into and there is no planes or bus service and im curious how we support a state and a statewide effort to pull our Rural Communities into this Emergency Management preparedness and if you have any thoughts on that. I will start and maybe i will spark some additional conversation. Im glad that you raised it but when you map the challenges in Rural Communities it will overlap with challenges in individual resources, access transportation and all the things that make them more vulnerable to disaster. It also and our experience in louisiana is that it also is a challenge because those individuals less willing to relocate to shelters, particularly after living on the coast, for lots of reasons cultural and otherwise they want to shelter in place and its a good reminder that there has to be coordination across jurisdictional lines. Our experience locally was that we have a regular cadence where terrible term but the Emergency Preparedness language of each of our local jurisdictions and our parishes have their own preparedness conversation about their populations by scaling that today to make sure that we are thinking about regional and statewide supporting coordination because this is the thing. Isaac is a great example of this. And hurricane isaac, we had a power outage situation and we didnt flood the countys next was flooded. Because we were hardened and ready from an acute standpoint and because for communicating were also hardened and ready to take people from the parishes and set up special needs shelter to support people. Some of these were rural environments on the coast but without those relationships when the skies are blue and the Communication Infrastructure and everyone knowing what a sister relationship look like we are not ready to help each other and local has to be coordination that scales to help bridge the gap. In some ways is a paradigm that we should let the local communities draws into the way they do their theres a lot to be said about the power of community and some of our more rural areas. I live in South Carolina and i saw this two years ago and the flood and we saw last week as he experienced some of irma. A lot of the things that i am talking about, the Broader Community engagement and the local nature of this has done wellin our Rural Communities. So, there are challenges but there are lessons to be drawn from that that we can apply 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 that 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 thank our staff which worked hard to bring this hearing together and we delayed the date of this hearing because we cannot want to interfere with the Immediate Response that was occurring in florida, for example, and in texas. I know from the medical team that it helps in both places that First Responders from all over the country were assisting in the response which is a real 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 and from this hearing today i can see the huge amount of progress that has been made since i conducted that investigation so many years ago into the very inconsistent in some ways build response to Hurricane Katrina. We have made great progress but we still have a long ways to go. I love the list of exactly the five i wrote them down, the four things that need to be done. I would note that Governor Scott has issued an order that says assisted living facilities also have to have generators and fuel to supply them. We are learning from every disaster and were learning how to be prepared today can make the difference between safety and danger and in many cases literally the difference between life and death. 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 and 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 that you shouldnt be exchanging business cards when disaster strikes. That is 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 these storms, of the many scams that have already arisen. This committee has held a hearing after hearing on financial exploitation of our elderly and there are two scams in particular that seem to be prevalent and one is what i call the charity scam where people are trying to get donations that reportedly are going to the victims of the hurricanes but in fact, are lining their own pockets. I would urge people to deal with recognized charities and to be careful and i know the former president have come together to encourage donations. You can be sure that is a safe one and that is the scam that is relentless and heartless. 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 to prepare homes and to make them habitable again and as for an upfront payment and then they will do the work. Of course, they disappear with that upfront payments and are never heard from again. My heart goes out to people that have been affected by the storm but i also want to give them a caution to be very wary of people who would exploit the suffering of others in the devastation of these storms in order to line their own pockets. I just wanted to mention that this committee will put out a bipartisan alert to try to raise Awareness Among the victims of the storm hit again, thank you to all of our witnesses and to all of 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 that both of the senators from florida who are on this Committee Really wanted to be here today but they rushed back to their home state as soon as they possibly could to help out and that is certainly understandable as well. Senator, any closing docs you would like to make a smart. Madam chair, thanks for much. Thank you for calling this hearing. We are grateful that you were here today. You brought real expertise and experience to the issues. Special thanks to chief delaney. We live in the same home area, one county away and we are grateful you made the trip down from pennsylvania. I share senator collins commitment to making sure that we are doing everything within our power to ensure that seniors and people with disabilities are prioritized in Emergency Response in the midst of these horrific challenges. It should not take the dept deaf americans with photos that we saw to cause us to take action and to move this issue to the top of the agenda including here in washington. Thats right were grateful we now have legislation that we will begin to address some of these issues. We need to learn from these tragedies and we need to commit ourselves to the goal that they will never happen again. I look forward to continuing to work with members of this committee on these issues and we are grateful for this opportunity today. You, madam chair. Thank you. Since you are such a dedicated member of this committee, if you have any final words, feel free. Thank you for your participation. This hearing is now adjourned. [inaudible conversations] [inaudible conversations] for the weekend republican senators Lindsey Graham and bill cassidy, authors of the latest attempt to repeal and replace the purple care act, made changes to their proposal. Those changes would provide additional benefits to more states including alaska and maine senators are currently undecided about their proposal. Coming up in about 40 minutes here on cspan2 the Senate Finance committee will be hearing from the bill cosponsors, senators graham and cassidy. Will have live coverage of that beginning at two eastern. That hearing taking place in the Senate Office building, quite a line building to get into that hearing. Folks to get into the audience of that hearing, i should say. This is actually the building next door to where the hearing is happy. This is the heart Senate Office building and people have been in line since 9 00 oclock this morning. As of that time, box reporting 200 people in line with 80 people in wheelchairs. The line has got longer obviously and lets take a look at our cameras walk the line between heart center Office Building and the dirksen building where the meeting is being held. [background noises] cameras now going into the dirksen Senate Office building. There are three Office Buildings and the signal is back. I want to let you know that the hearing is coming up at 2 00 oclock eastern and will have that coverage here on cspan2. Here is what the rest of the week looks like in congress and the senate and the house. Tonight on the communicators. Comcast Senior Executive Vice President david cohen talks about telecommunication development, competition and fcc regulations. Mr. Cohen is interviewed by policy and politics senior editor. What is your take on the Trump Administration . For small, i feel compelled to say this and Brian Roberts pointed this out at the Goldman Sachs conference, we love our company. We post at t acquisition and universal acquisition and we view ourselves as essentially strategic complete. We are not out there saying oh my god, to survive have to find Something Else to buy. I want to make that clear
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