<DOC>
[109 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:28924.wais]
S. Hrg. 109-571
CARING FOR SENIORS IN A NATIONAL EMERGENCY: CAN WE DO BETTER?
=======================================================================
HEARING
before the
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
WASHINGTON, DC
__________
MAY 18, 2006
__________
Serial No. 109-23
Printed for the use of the Special Committee on Aging
_____
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WASHINGTON : 2006
28-924 PDF
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SPECIAL COMMITTEE ON AGING
GORDON SMITH, Oregon, Chairman
RICHARD SHELBY, Alabama HERB KOHL, Wisconsin
SUSAN COLLINS, Maine JAMES M. JEFFORDS, Vermont
JAMES M. TALENT, Missouri RON WYDEN, Oregon
ELIZABETH DOLE, North Carolina BLANCHE L. LINCOLN, Arkansas
MEL MARTINEZ, Florida EVAN BAYH, Indiana
LARRY E. CRAIG, Idaho THOMAS R. CARPER, Delaware
RICK SANTORUM, Pennsylvania BILL NELSON, Florida
CONRAD BURNS, Montana HILLARY RODHAM CLINTON, New York
LAMAR ALEXANDER, Tennessee KEN SALAZAR, Colorado
JIM DEMINT, South Carolina
Catherine Finley, Staff Director
Julie Cohen, Ranking Member Staff Director
(ii)
C O N T E N T S
----------
Page
Opening Statement of Senator Herb Kohl........................... 1
Prepared Statement of Senator Gordon Smith....................... 7
Statement of Senator Thomas Carper............................... 8
Panel I
Maurice Frisella, New Orleans, LA................................ 3
Jean Cefalu, Slidell, LA......................................... 9
Panel II
Daniel W. Sutherland, officer, Office of Civil Rights and Civil
Liberties and chair, Interagency Coordinating Council on
Emergency Preparedness and Individuals with Disabilities,
Department of Homeland Security, Washington, DC................ 20
Cynthia Bascetta, director, Health Care, U.S. Government
Accountability Office, Washington, DC.......................... 36
Amy B. Aiken, assistant director, Miami-Dade Office of Emergency
Management, Miami, FL.......................................... 56
Carmel Bitondo Dyer, M.D., associate professor of Medicine,
director, Baylor College of Medicine Geriatrics Program at the
Harris County Hospital District, Houston, TX................... 70
APPENDIX
Prepared Statement of Senator Susan Collins...................... 83
Prepared Statement of Senator Mel Martinez....................... 83
Prepared Statement of Senator Ken Salazar........................ 84
Letter from William Dunwiddie.................................... 86
Statement and Report from AARP................................... 87
(iii)
CARING FOR SENIORS IN A NATIONAL EMERGENCY: CAN WE DO BETTER?
----------
THURSDAY, MAY 18, 2006
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The committee met, pursuant to notice, at 10:18 a.m., in
room SD-628, Dirksen Senate Office Building, the Hon. Herb Kohl
presiding.
Present: Senators Smith, Collins, Kohl, Carper, and Nelson.
OPENING STATEMENT OF SENATOR HERB KOHL
Senator Kohl. At this time, I would like to call the
hearing to order and welcome our witnesses.
Last September, as the Nation still reeled from the tragic
and shameful images of seniors abandoned during the aftermath
of Hurricane Katrina, this Committee held a hearing on how to
prepare for the next disaster.
Today, we return to that topic, determined that we never
again leave our parents and grandparents to face an emergency
alone. Today is not about pointing fingers for past tragedies.
Today is about looking forward. Hurricane season is just around
the corner. The threat of terrorism remains, and the potential
for an avian flu pandemic looms.
We all agree that we let our seniors down after Hurricane
Katrina. But as sorry as we all are, are we any more ready for
the next hurricane or attack or disaster?
We now know that cookie-cutter emergency plans are of
little use to seniors, especially those who depend on others
for assistance in their daily lives. We must put in place a
concrete strategy that recognizes and masters the challenges of
keeping seniors out of harm's way. This Committee is steadfast
in its pursuit of that goal. We hope that we will learn today
that the administration is equally committed.
We will hear today from a senior who was forced to navigate
Katrina without much assistance from the government and from a
nurse who has helped countless seniors after hurricanes. Also
with us today are the Government Accountability Office, the
Miami-Dade Office of Emergency Management, and a renowned
geriatrician. We look forward to their recommendations.
I am particularly interested in hearing testimony today
from the Department of Homeland Security, which is the lead
Federal agency for emergency preparedness. We are happy that
Dan Sutherland is here from the Office of Civil Rights and
Civil Liberties, and we look forward to hearing what that
department is doing to prepare seniors for emergencies.
We expect to work with the department on some common sense
solutions. We must do a better job in telling older people what
supplies and plans they need to have in place if a terrorist
attack or flu pandemic hits.
As a start, my office has developed a tip sheet, and the
Department of Homeland Security should follow with pamphlets,
public pronouncements, and specific directions for seniors and
the agencies that serve them. DHS also should direct States and
local governments to plan, train, and practice evacuations and
sheltering in place exercises that specifically target seniors.
DHS should also require hospitals and nursing homes to plan
ahead for evacuations and fund training for first responders to
help seniors who live at home and may be unable to evacuate.
Our office will be developing a report outlining
recommendations from our witnesses and other groups. I hope the
Department of Homeland Security will take these ideas seriously
and will turn them into action.
Our lack of preparation for seniors after last summer's
hurricanes and the terrible price we paid in lives and
suffering is, indeed, a national tragedy. That tragedy is
compounded if we ignore the painful lessons of the past.
We need specific plans, programs, and information for all
seniors facing emergencies, and we need the commitment and
energy of a DHS determined, as this Committee is, never again
to desert our seniors when they need us the most.
So we look forward to hearing from our witnesses today, and
we will now turn to the first panel.
Our first witness on the first panel is Maurice Frisella.
Mr. Frisella is an 82-year-old man who survived Hurricane
Katrina mainly on his own, with limited help from government.
His journey has included being airlifted from New Orleans to
Baton Rouge, stays in two nursing homes, and also a hospital.
Mr. Frisella's testimony will help us understand the
challenges seniors face when the Government does not adequately
prepare for emergencies.
Also on the first panel is Jean Cefalu. Mrs. Cefalu is a
nurse who volunteered her services after Hurricane Katrina. She
will discuss how the gulf region dealt with the needs of
seniors and how it continues to struggle with their needs and
appropriate planning for future emergencies.
We welcome you both, and we look forward to your testimony.
First, Mr. Frisella.
STATEMENT OF MAURICE FRISELLA, NEW ORLEANS, LA
Mr. Frisella. Good morning, Senator and friends. Good
morning.
I am Maurice Frisella.
Senator Kohl. Is your mike on?
Mr. Frisella. This is my testimony as best I can do it. All
right.
Orleanians have endured hurricanes in the past.
Courageously, we decided to face this Katrina, too. Our 100-
year-old house is high and study Victorian. We decided to
remain within our own shelter, see Katrina to the finish.
Slowly, the monstrous wind began to rise, blowing apart the
security of our world. Rain and wind began to lash the house.
The old place seemed to tremble, wind beneath the house. The
floor creaked.
Suddenly, with no warning, the electric power was cut.
Candle power was blindly groped for in the black and eagerly
sought, and it was found. Gas and water were soon suffered the
same privation. No radio batteries because the batteries long
lay unused.
I ventured to look out the front door. The high wind
snatched the door from my hand. Rain lashed, and in an instant,
I was wet. The trees were in a fury. Flying trash seemed
endless. The wind blew me backwards. Fear caught me. Was there
no help? Was there no warning? But when? I had no knowledge.
Surely, the city's fathers must have given warning? I saw
no police prowl cars, no National Guards, no lights, no
neighbors. In the dark, I sensed that water was gathering about
the house, but how high?
I heard the screech of tearing timber. Something had
fallen, something awful. I braved the beating wind. I could not
see too well. My God, the upper bathroom was gone. The
onslaught of wind increased more fearfully. I closed the front
door, not feeling too secure. In the flickering glow of
candlelight, the draperies billowed and trembled.
Wind, wind, invading every chink and crack. Somewhat short
of breath, I paused to gather my intelligence. Then for a
moment, the wind stopped. The world was silent. The house
seemed so dreary. A dead calm in the calamity. Peggie began to
meow and cry. We waited for the dawn. It would not come.
``It is OK, Peg.'' The frightened cat was in my lap. As for
food, there was bottled water, canned food, crackers, peanut
butter, and some candy. I tried to rest on the sofa. The
candles were burning low, too low. I feared fire. Surely some
help would come. A skiff, a guard? Somebody, please.
It was still calm, cold, damp. I looked out. I knew
instinctively water was there, but would it rise more? No
humans, no sound. Only blackness and fear. Where was the
police? Where was the militia?
Finally, after 3 days within the house, September 3, 2005,
I went outside. I stepped into the water up to my knees. Filth,
garbage, branches, pieces of furniture floated. Believe it.
Even a wingchair.
Being fatigued, after prowling in the street, I dared rest
in the floating chair. I jumped to my feet, foolishly trying to
get the attention of a helicopter. I waded to St. Rock Park
Avenue about 100 yards from my own residence with heart fear.
Nobody in sight, silence and water. Bedraggled trees. I
waded back to the house for my adopted brother, Buzz. Once
indoors, I demanded we have got to get out of here. Come on.
Step into the water. It is not so deep.
I managed to gather some valuables, stuffed in my little
leather shaving kit. We waded and waded. Good Lord. What
happened to our world?
Finally, I was seized with joy. Hope. A National Guard
vehicle came into my sight. Boy, they spotted us. Two young
Guards boosted us up. I felt a hot hand on my backside. Buzz,
too.
So with soggy trousers and heartfelt thanks, we were seated
on something like a bench, handed a sandwich and a drink, and
then we rode wildly and roughly down St. Claude Avenue up to
Canal Street. The young Guards, no more than boys, were in a
crouched position with rifles paused looking for trouble.
However, to end this winded episode, we were driven to the
arena next to the Super Dome. Some kind medics changed our damp
clothes. I know I was in a blue paper suit. The helicopter took
Buzz and me to Baton Rouge and then to a nursing home in
Gonzalez, about a half hour's drive from the capital city.
In the nursing home, we unhappily lived there from
September 3 to April. We missed every joyous holiday. I was
cursed, hit, and informed by the aides, ``Kiss my gluteus
maximus.'' You translate that yourself. I am not going to do
that.
There were other incidents, too. Food was awful. Buzz went
into a terrible decline. I lost my place.
He of the United States Air Force, his knowledge of botany
and food, Buzz could not eat. The kitchen was filthy. I was
simply helpless--too much?
Senator Kohl. It is all right.
Mr. Frisella. I was simply helpless in the nursing home. I
called, called, waited, waited--FEMA. Then that Spanish. I was
offended. This is an English-speaking nation. Let us keep it
that way.
My home has been looted. Valuable antiques gone. Pigeons
have invaded the house. My home has been closed since
September. I was presented today with two $500 bills from the
Entergy Company. My house has been closed for seven months.
Seven months, nothing done. The levee neglected.
Now this is a rumor, but this was certainly overheard.
Watch this now. ``Nothing was wrong with that son of a bitching
levee. It has been that way since I have known myself.'' I lost
my place. OK. Where is my place? Oh, this, sirs, is my
sorrowful lamentation. Our elected officials are not taking
care of our Nation.
As for the Corps of Engineers, by thunder, they blunder.
Does no one see the United States is in a decline? No one.
Divine Father, spare our Nation. So I humbly lift my being
to God. Pray my words are not false. The elected ones are truly
only for one thing--privilege, prestige, possession, and power.
They are exalted and way above the citizens. This is the end.
Here is a quotation from Shakespeare from Richard III. ``In
the base court, come down. Come down.'' That, sir, is the end
of my statement. I hope I haven't been too foolish.
[The prepared statement of Mr. Frisella follows:]
[GRAPHIC] [TIFF OMITTED] T8924.001
[GRAPHIC] [TIFF OMITTED] T8924.002
Senator Kohl. Thank you. You have made a beautiful
statement. We appreciate it very much.
Mr. Frisella. OK. Don't think I haven't been nervous.
Senator Kohl. You did great. You did absolutely great.
Mr. Frisella. Thank you.
Senator Kohl. Before we turn to Mrs. Cefalu, I would like
to ask our Chairman, Gordon Smith, for his statement.
The Chairman. Well, thank you, Senator Kohl.
Out of respect for our witnesses, and with apology for the
vote that has delayed myself and Senator Carper for being here,
I will put my statement in the record so we don't hold them any
longer. I want to hear from them.
[The prepared statement of Senator Smith follows:]
Prepared Statement of Senator Gordon Smith
Good morning.
Senator Kohl, I appreciate being here today to revisit one
of the most important topics this Committee has looked into
during the past year.
Since the tragic events on the Gulf Coast last year, we in
Congress have devoted much of our time to helping our fellow
Americans who were displaced by Hurricanes Katrina and Rita get
back on their feet. We are continuing the long process of
rebuilding those areas of the Gulf region that have been so
ravaged by these terrible storms.
The Baltimore Sun on Sunday examined difficulties that the
200,000 people currently living in New Orleans are facing when
assessing medical care from the city's devastated health care
system. Damage from Hurricane Katrina has reduced the number of
hospital beds in the city from 2,300 to 500, and Charity
Hospital, the city's hospital for the uninsured, is not
expected to reopen for years. Meanwhile, the uninsured rate in
the city has increased from about 20 percent to 40 percent,
largely because many people have lost jobs that provided health
insurance. In addition, out of 4,500 physicians who worked in
New Orleans before Katrina, only about 1,200 have returned.
While we must continue to work to ensure New Orleans is a
safe city to return to, the past few months have also been a
time to examine the preparedness of our federal, state and
local governments to deal with such disasters in the future.
Last October, this Committee held a hearing entitled
Preparing Early, Acting Quickly: Meeting the Needs of Older
Americans During A Disaster. We heard from witnesses who
described older Americans' special needs that make them
particularly vulnerable during an emergency. A key lesson that
came out of our hearing was that the government at all levels
must do more to ensure the health and safety of older Americans
during a disaster. Many in this population are extremely
vulnerable and it is the government's responsibility to make
certain that adequate steps have been taken to identify those
in need, evacuate seniors to a safe place and provide
appropriate care once displaced.
The October hearing also pointed out that there are other
substantial issues that still need to be addressed. Issues of
specific concern are the double-counting of emergency services,
trouble identifying individuals who have special needs and
making sure that funding is flexible for an all hazards
approach to disaster preparedness.
As we listen to the testimony of our witnesses today, we
will hear details about the responses to hurricanes Katrina and
Rita. However we must also consider the myriad of other natural
and man-made disasters a frail senior may face. Seniors in the
Midwest may need to prepare for tornadoes, while in the West
seniors may need to prepare for earthquakes. This is why during
our last hearing I found the ``all-hazards'' approach to
disaster preparedness so valuable.
Simply put an ``all-hazards'' approach focuses more on
coordinating efforts toward any disaster rather than preparing
for a specific disaster. By doing this, an agency can be
prepared to provide for:
Effective coordination of activities among the
organizations having a management/response role;
Early warning and clear instructions to all concerned
organizations and individuals if a crisis occurs; and
Continued assessment of actual and potential consequences
of the crisis at hand.
As I stated in October, there is no doubt that disaster
preparedness for older Americans poses a daunting challenge.
However, I believe hearings like this one will shed light on
the difficulties we have had in the past to find solutions for
future disasters.
Large-scale natural disasters like the hurricanes that
struck the Gulf Coast stretch our federal, state and local
response capabilities to their absolute limits. I hope the
testimony today from our distinguished witnesses allows this
Committee to learn about disaster preparedness and enables us
to move forward and protect our most vulnerable citizens during
emergencies.
I thank all of you for coming to share your expertise and
look forward to your comments.
Thank you.
Senator Kohl. Thank you.
Senator Carper.
OPENING STATEMENT OF SENATOR THOMAS CARPER
Senator Carper. I would like just to make a very brief
statement.
Welcome. We are delighted that you are here and happy to
have this hearing today.
I am a Navy veteran and have been, as my colleagues, have
very, very active on behalf of veterans in my State and across
the country.
In the wake of Katrina, when thousands of veterans were
evacuated from the gulf coast and taken to veterans nursing
homes and VA hospitals in other States, when they arrived in
those places, the folks who received them in the new nursing
homes and hospitals had the medical records because of the
electronic medical records for all the veterans.
They knew what medicines they were taking. They knew what
their medical histories were. They knew what their MRIs or X-
rays or lab tests were. They were able to provide in the new
homes, receive in their new homes excellent care right away.
For a lot of folks who were civilians who were evacuated
from the gulf coast, they ended up in other States, in other
hospitals, and other nursing homes. They had in many cases
paper medical records, which were largely destroyed. Those who
received them did not know the medical histories, the
prescription medicines that needed to be taken and so forth.
One of the things that someone's been working on--my
colleagues and, too, our guests--is to increase the likelihood
that we are going to have electronic medical records, health
records for ourselves and for others in this country. Not just
to help out in emergencies like Katrina, but also in other
instances just to provide better health care.
So this is, I think, an important hearing for the cause for
which it is slated. But there is also another reason that we
need to provide electronic health records that goes beyond
emergencies.
Thanks very much.
Senator Kohl. Thank you very much, Senator Carper.
The hearing is very much focused on some of the points that
you have just made.
Now we would like to hear from Mrs. Cefalu.
STATEMENT OF JEAN CEFALU, SLIDELL, LA
Ms. Cefalu. Senator Smith, Senator Kohl, and honorable U.S.
Special Senate Committee on Aging members, thank you for the
opportunity to allow me to share my experiences relative to the
elderly in both the community and the long-term care
populations that were affected directly or indirectly by
Hurricane Katrina.
While I was not practicing nursing at the time of the
hurricane, the devastation caused by Katrina produced severe
labor shortages, especially at nursing homes in the peripheral
areas of New Orleans, Baton Rouge, and Shreveport. That is why
I and many other nurses came out of retirement to help out.
It was at one of these nursing homes that I met and
informally adopted ``Uncle Buzzy'' and Maurice, who is with me
here today.
Several John and Jane Does came from New Orleans area
nursing homes that were unprepared for the storm. They were
evacuated at the last minute without identification, health
histories, or medications. Many couldn't tell us who they were
or where they were from. Many were acutely ill on arrival and
had to be shipped to the hospital.
As I speak to you today, hundreds of evacuees are literally
trapped in nursing homes around the State and probably other
States. Since it is still undetermined when or if they can
return to their homes, the vast majority of them are now
helpless and don't have the physical ability and/or the
financial resources to rebuild their lives.
The seniors who have returned are regular targets for
unscrupulous individuals who prey on their trusting ways. Other
evacuated seniors are having to pay out of their own back
pockets to finance their nursing home stay, using up all of
their savings and rendering it impossible to get back on their
feet.
In some cases, as with Maurice, they had large sums of
money and personal possessions stolen at the very places that
they sought shelter and protection. The experience I had after
Katrina made me realize how delicate and fragile this
population of advanced age seniors really is. Unlike you and I,
they don't bounce back.
One organization that provided tremendous support and
leadership to our area nursing homes that were either evacuated
or took in evacuees is the Louisiana Health Care Review's
Nursing Home Quality Improvement Committee, authorized by CMS.
They met regularly after Katrina via teleconference and
onsite to the nursing home staff. My personal and heartfelt
thanks goes out to one member in particular, Debbie Serio, who
made herself available to meet day and night, along with
regular visits to my nursing home after we lost the
administrator, the director of nurses, and the medical
director. I was the only RN in the facility for several weeks,
and I couldn't have done it without her.
Over the last several months, this group has formulated a
series of workforce recommendations, which is attached to my
report. These recommendations are the culmination of several
facilities' experiences before, during, and after Katrina. This
list is intended to assist nursing homes relative to evacuation
procedures, as well as nursing homes who serve as evacuation
shelters.
One recommendation that I would like to make, based on my
personal observation, is that elderly evacuees who are placed
in nursing homes outside of a disaster area be granted a waiver
of determination of eligibility for a period of at least 6
months. Any personal or financial assets accompanying the
evacuee be secured in a safe place at the accepting facility to
prevent financial abuse until conditions stabilize.
It is my opinion that the evacuation process for nursing
home residents in New Orleans was not adequate. It is a known
fact that 75 percent of those who died during and after Katrina
were 75 years of age or older. Appropriate and tested
evacuation plans for seniors is a key to the prevention of
elderly deaths in any disaster. But the evacuation plans can
only go so far if we are not educated relative to geriatric
issues.
Every 5 minutes, information was broadcast all over the
television and the radio where and when to evacuate. All you
had to do was pick up the phone, and someone would come and
pick you up. That wasn't the problem.
Why didn't our seniors get on the bus to leave? The reason
is our frail elderly would rather die in familiar surroundings
than spend days in uncertainty and fear.
Education of geriatric health care professionals in the
State of Louisiana and the Nation should be a priority with
aging baby boom upon us now. My husband, Dr. Charles Cefalu, is
the chief of geriatrics at LSU Health Science Center in New
Orleans. His program was located at Charity Hospital, which was
damaged beyond repair.
Thanks to the immediate and generous support of the
American Geriatrics Society, the Gerontological Society of
America, and the John A. Hartford Foundation, he was able to
relocate his program to another LSU teaching hospital in
Lafayette, LA, to serve the many immediate needs our seniors
faced during the aftermath of Katrina.
It is a shame that our State has only one teaching facility
to train physicians and nurses in geriatric medicine. That is
not the case in other States, where geriatric education is the
norm and not the exception. Louisiana's own congressmen and
senators should be taking note of this.
My final recommendation is that Congress reinstate Title 7
funding of geriatric education centers across the United States
to address the need for educating geriatric health care
professionals. Such centers can serve two unique purposes.
The first is to train geriatric health care professionals
relative to emergency preparedness, and the second would be to
serve as a multi-institutional consortium. Depending on the
effect of a disaster in a particular area, each of the members
could serve as a coordinating center for the evacuation, post
disaster assistance, and safe return of our senior citizens to
their communities.
Thank you.
[The prepared statement of Ms. Cefalu follows:]
[GRAPHIC] [TIFF OMITTED] T8924.003
[GRAPHIC] [TIFF OMITTED] T8924.004
[GRAPHIC] [TIFF OMITTED] T8924.005
Senator Kohl. Thank you very much for your excellent
testimony.
Mr. Frisella, we will start with a question for you. It is
very important for us to learn from seniors like yourself, who
have experienced such a disaster. As a senior living
independently, do you feel that you were given appropriate
information to help you prepare for Hurricane Katrina before it
struck?
Mr. Frisella. No, I wasn't fully aware of it. But I knew
the hurricane was coming. But as I said, we survived other
hurricanes, and I didn't give it that much attention.
Senator Kohl. Did you get any information in advance at
all?
Mr. Frisella. Some on the television or the radio, but I
didn't keep the television and the radio on constantly.
Senator Kohl. So there was no preparation that was given
out to you to be aware of the fact that disasters may happen,
and when they happen, the following things should be done? That
kind of advance preparation was not in evidence at all?
Mr. Frisella. No, Senator. No, sir.
Senator Kohl. Tell us, in the months since Hurricane
Katrina, Mr. Frisella, have you been given direction and
assistance that you need to get back to where you were before
the storm occurred?
Mr. Frisella. Well, I would like to see the old house
repaired. It didn't have water damage. It had wind damage. When
they constructed that house, it probably had an outhouse on the
side of it. So the bathroom was built on the side of the house
and attached to the house.
So when the wind came from that back alley, it blew the
bathroom back this way in the downpour, and it collapsed. That
is all I can tell you.
Senator Kohl. All right.
Mr. Frisella. That is enough.
Senator Kohl. Thank you.
Mrs. Cefalu, I didn't get that percentage figure on the
number of seniors----
Ms. Cefalu. Seventy-five.
Senator Kohl. Who were----
Ms. Cefalu. Seventy-five percent of the people who died in
Hurricane Katrina were 75 years or older, either during or in
the aftermath.
Senator Kohl. Seventy-five percent?
Ms. Cefalu. Mm-hmm.
Senator Kohl. Wow. In your opinion, what were the
Government's greatest shortcomings in responding to the needs
of seniors during Katrina?
Ms. Cefalu. Not laying blame on anybody because I am not
sure how the Government really works, but it was too late. Next
time, immediate help. Not waiting 3 or 4 days. That was a big
thing.
Senator Kohl. Would you say that there is an urgent need
for advance preparation----
Mr. Frisella. Yes.
Senator Kohl [continuing]. Considering that we will be
having additional catastrophes in the future?
Ms. Cefalu. Oh, yes. Definitely. But we also have to
realize because of the ages of our older citizens, we have to
prepare that they are not going to leave in the event of
another disaster, and we must be prepared to move in quickly
after the disaster and locate where they are.
Just because of the reasons of not leaving their cat or----
Mr. Frisella. The cat, yes.
Ms. Cefalu [continuing]. Food, medicines, clothing, doctor,
their familiar surroundings. That is a reality. Unless we drag
them out, they are not going to go.
Senator Kohl. That is a good point.
Mr. Frisella.
Mr. Frisella. Could we do something about the pets? I had
to leave my pet there. People, if you have a pet, it is like a
child, and you love that thing.
Senator Kohl. Very well said.
Mr. Frisella. Yes. May I be so egotistical as to read my
poem?
Senator Kohl. Certainly. Go right ahead, sir.
Mr. Frisella. OK. It is called the ``Curve in Crisis
Care.'' The curve is in Mississippi. The curve is the Crescent
City.
O immortal day, let us pray. Swamp of that mighty stream.
The suffering of that horrible dream. The matters of the wind
as cruel as the lash before his cross, the bewailing of our
loss.
We sigh, cry with the angels. Beg powers that be, help us.
Peter, open paradise. How that storm has cast that fatal dice.
Our curve and that stream is holy. Holy is joyful. Joyful
is no sin. We wait for those saints to come to begin.
Clean up, buck up. Swagger in high style, old pal, down
bright-lighted canal. Dear old South land, how grand. No tears,
no cheers. Time for jubilation. New Orleans is the doorway to
our Nation.
What do you think?
Senator Kohl. I think that is beautiful.
The Chairman. That is great.
Senator Kohl. That is beautiful. We thank you.
Now we turn to our Chairman, Senator Smith, for his
questions and comments.
The Chairman. Jean, you had a remarkable statement in your
testimony that seniors would rather die than evacuate, and it
is a shocking thing that 75 percent of the deaths in Katrina
were among the elderly.
Do you think that that decision that they would rather die
than evacuate, would that change if there were better
preparation, better education, better certainty that the
seniors knew they had a place to go and that there was a home
to return to?
Ms. Cefalu. Actually, yes. But I am not an expert in that
area.
A lot of people and a lot of the seniors evacuated had the
questions of the pets. They are like children. A mother
wouldn't leave her child. An elderly person is not going to
leave their pet.
They have medications. It was on August 29 right?
The Chairman. Yes.
Ms. Cefalu. On the 1st, the Social Security checks come in.
Many disadvantaged, you know, elderly wait for those checks. If
they don't get them when they come in the mailbox, somebody
else is going to take them.
One month without a check, they can't pay for food. They
can't pay their light bills. Not they couldn't think that there
is not going to be any lights any way, but they need that
money. They can't leave without their money. They don't have
high finances.
Where were they going to go? A lot of seniors, you know,
your parents, they can't sit in cars for long periods of time.
There is no bathrooms on school buses. If anyone has had any
more than three children, the women in here, you will know that
when you have got to go, you have got to go. It would be highly
humiliating to people to have an accident on a crowded school
bus.
There are many reasons. So I am not really an expert on
that, but these are the reasons that they are not going to go.
A lot of them did. But most of our frailest elderly, they
didn't.
The Chairman. But did they make, in the face of the
evacuation order, was there a conscious decision made that ``I
am just going to ride this out?'' Ms. Cefalu. I believe so.
The Chairman. Maybe that question should be asked to
Maurice, and I loved your poem. But Maurice, you made the
decision to stay based on your previous experience in
hurricanes. You had survived them all, and yet I suspect you
decided to stay in face of an evacuation order because your
experience, your place, your pet, all of these things, you just
said, ``I will--'' Mr. Frisella. The house was so strong. I
wasn't aware that the storm was that severe until I heard the
crash of the bathroom going down, and I had to investigate what
is going on.
The Chairman. Is there anything that the government at the
local, State, and Federal level could have done to cause you to
make a decision to evacuate?
Mr. Frisella. I wouldn't know how to answer that. Please,
honestly. I wouldn't know how to answer that.
The Chairman. That is really, I mean, I guess our
responsibility--not I guess. Our responsibility of Government
is to make sure that you have a decision to make that is
informed, and you have some certitude as to what is going to
happen to you in the evacuation. How your most treasured
aspects of life, maybe even a pet--I don't know--can be saved
in all of this.
Mr. Frisella. My family lived in that house for over 60
years, 100 years in that parish. I didn't want to leave the
house. I growed into the house and grow young with the house.
The Chairman. So you might have made the decision, even if
the Government had done everything perfectly, you would have
made the decision to stay?
Mr. Frisella. Stay put.
The Chairman. Thank you, Mr. Chairman.
Senator Kohl. Yes. Just to follow up on that with Mrs.
Cefalu. If, in fact, seniors are determined to ride it out even
in the face of catastrophe, what can the Government do?
Ms. Cefalu. Well, I was talking with some of the other
people that are going to be on the panel in just a little bit
about ideas. If it wasn't for the HIPAA laws that maybe
something--I am not an expert. Maybe anyone on Social Security
disability, their names could be given to local fire districts
so that you would at least know geographically where they were
located. So that after the storm, you could pinpoint in
priority areas to search first, to check to help them out. I
don't know.
Senator Kohl. Would you say that if we were going to make
meticulous preparation, we need to pinpoint where our seniors
are, each and every one? Then, in the immediate aftermath of a
catastrophe, go to each----
Ms. Cefalu. I was thinking local fire departments. This is
just off my head. Local fire departments in their fire
districts, if they had the information on where the seniors
were, maybe it is possible that once a year, there could be
some contact. Do you have a place to go? Are you going to stay?
Do you have family?
We could locate, you know, the people like Maurice that
aren't going to leave. Because there was also several other
people, elderly people in his neighborhood that didn't leave
either and are still there to this day, and they lived it out.
So at least we would know where they were, where to go look
for them.
Senator Kohl. Very good.
Well, we thank you both for being here today, and you
provided--oh, Senator Collins is here. I am sorry.
Before we move on, we would like to hear from Senator
Collins for her comments and whatever thoughts, questions you
have.
Senator Collins. Thank you.
I thought I showed up today in yellow, you know, so that
people would see me.
But first, let me thank you both for holding this hearing.
The Homeland Security Committee, which I chair, spent 7 months
looking at the preparation for and response to Hurricane
Katrina, and we held 22 hearings. Of all those hearings, the
one that bothered me the most was when we heard about nursing
homes not being evacuated, and we learned that those left
behind were primarily elderly and people with special needs.
That troubled me so much.
There was a real contrast between Mississippi and Louisiana
in that regard because Mississippi forced the nursing homes to
evacuate their patients. Louisiana chose not to. The result in
Louisiana--and let me say I recognize that it is very difficult
to evacuate fragile patients from nursing homes, and there are
risks in that.
But if you look at the outcome, you did not have the deaths
among nursing home patients in Mississippi that you had in
Louisiana. So, Ms. Cefalu, I wanted to start my questioning
with you. Because you mentioned in your written statement, and
I apologize for not being here earlier, that the evacuation
process for nursing homes was inadequate.
Have you seen a change post Katrina at the facility level
in the area of emergency preparedness and response? For
example, have there been discussions at the Ascension Care
Center, and has the staff worked out what you think is a
feasible evacuation plan for the facility?
Ms. Cefalu. Absolutely not, Senator. Nothing.
We have a book. Most nursing homes have a book. The
evacuation book. When the State surveyors came in, they asked
me where the book was. Since I was just filling in for the
director of nurses, we found the book. Thank God. Never read
the book. Embarrassing as it is, that is a reality.
I live in St. Tammany Parish. St. Tammany Parish nursing
homes have a volunteer emergency preparedness coordinator, Kim
Harbison. We didn't lose anyone in St. Tammany Parish. We were
evacuated like Mississippi because St. Tammany Parish evacuated
as a parish to one school. It was pre-prepared, and everything
was there.
New Orleans, however, I believe it leaves it up--I am not
the expert. I believe they leave it up to the individual
nursing homes.
Senator Collins. They do.
Ms. Cefalu. In a large metropolitan area, you can't do
that. You can't call them 72 hours before a disaster is in the
Gulf or anywhere, mudslides, anything, and say you need some
help because everybody is busy with their own preparedness.
Also, that quick in New Orleans, you lose your employees.
Without employees, you have no manpower to move everybody. So,
no, New Orleans is far behind.
Senator Collins. One of the recommendations that we have
made in our report is that not only should every nursing home
and hospital be required to have an evacuation plan, but that
there should be an audit of it by the State once a year to make
sure it exists, to make sure that people have read it, trained
for it because this isn't something that does you much good if
it is just on paper. You have to do the exercises and the
training as well.
But I think this is a huge issue. Of all the issue we
looked it, it was the one that troubled me so much. So I am so
glad you are doing follow-up on this issue. The more attention
we can have, the better.
I also want to follow up on the issue that both Senator
Kohl and Senator Smith and our witnesses have raised about how
do you know where those individuals with special medical needs
or who our elderly are? We, again, have recommended exactly
what you have instinctively suggested, and that is that there
be lists of special needs patients, individuals who rely on,
who need electricity----
Ms. Cefalu. Oxygen.
Senator Collins [continuing]. For their medical needs and
that first responder agencies--the police, the firefighters--
have those lists, and that is a lot of work. It takes a lot of
updating, obviously.
But I think it would make a real difference so that when
disaster strikes, we know who the vulnerable are, and we can
send first responders. There has been so much discussion in the
response to the Gulf that it was somehow race based on who got
left behind. It wasn't. It was age based is what it was.
It was those who were elderly, regardless of their race,
who were left behind. It was those with special medical needs
who were left behind, and it was those who could not evacuate
themselves, for whatever reason, who were left behind.
So I don't mean to take up too much time here, but thank
you for holding this hearing. Thank you both for your
testimony.
I also want to say that Mr. Frisella's point about the pets
was another issue that we found was very important. We had a
mayor of a town in North Dakota come before us and say that you
have to tell people to bring their pets, their pillows, and
their pills. I thought that was a wonderful way----
Ms. Cefalu. Pampers.
Senator Collins [continuing]. To sum up, and we have got to
be realistic about that. We have got to make sure that there
are shelters that are prepared to take people with pets and to
take people with special needs, and that wasn't the case with
Katrina.
So thank you for the work you are doing.
The Chairman. I think the sound bite of the day is ``pets,
pills, pillows, and pampers.''
Senator Kohl. That is great. Well, we thank you, Senator
Collins.
You know, your point that it was age based and not race
based was made dramatically by Mrs. Cefalu in her testimony.
She said that of those who perished, 75 percent----
Ms. Cefalu. Yes, sir.
Senator Kohl [continuing]. Were 75 years or older.
Ms. Cefalu. My husband gave me those statistics. Don't hold
me to them.
Senator Collins. That is stunning. It really is.
Senator Kohl. It is stunning.
Senator Collins. Thank you.
Ms. Cefalu. Thank you very much.
Senator Kohl. Well, we thank you both for coming. As you
can see, you have made a big difference, and you have made an
impact on us all.
Ms. Cefalu. Thank you very much.
Mr. Frisella. Thank you very much.
Senator Kohl. So we turn now to our second panel. Our first
witness will be Dan Sutherland of the Department of Homeland
Security. Mr. Sutherland is the officer for the Office of Civil
Rights and Civil Liberties. He also heads up DHS's Interagency
Coordinating Council on Emergency Preparedness and Individuals
with Disabilities.
Mr. Sutherland is here to tell us of the department's
efforts to prepare for the needs of seniors in the event of a
national emergency.
Second witness will be Cindy Bascetta of the Government
Accountability Office. Ms. Bascetta is director of the health
group at GAO and will be telling us about GAO's findings and
recommendations on senior emergency preparedness.
Next we will hear from Amy Aiken, the assistant director of
the Miami-Dade Office of Emergency Management. Ms. Aiken is
here to tell us about the initiatives her office is conducting
to meet seniors' needs in an emergency.
Finally, we would like to welcome Carmel Dyer of the Baylor
College of Medicine. Dr. Dyer is a geriatrician and directs the
geriatrics program for the Harris County Hospital District. She
is here to tell us about her research and her recommendations
on emergency preparedness for seniors.
We thank you all for being here. Mr. Sutherland, we will
hear from you first.
STATEMENT OF DANIEL W. SUTHERLAND, OFFICER, OFFICE OF CIVIL
RIGHTS AND CIVIL LIBERTIES AND CHAIR, INTERAGENCY COORDINATING
COUNCIL ON EMERGENCY PREPAREDNESS AND INDIVIDUALS WITH
DISABILITIES, DEPARTMENT OF HOMELAND SECURITY, WASHINGTON, DC
Mr. Sutherland. Thank you. I want to thank Senator Kohl and
Senator Smith and the members of the Senate Special Committee
on Aging for inviting me to testify on this extremely important
topic today.
The oversight in this area is very important and very
welcome, and I just wanted to start by saying that we are
enthusiastic about the recommendations that you outlined today.
We will aggressively pursue them and will be very glad to sit
and talk with you in the upcoming weeks and months so that you
can be assured that we are really aggressively pursuing those
recommendations.
I am testifying today in my capacity as the officer for
civil rights and civil liberties at the Department of Homeland
Security. Our office is responsible for advising the leadership
of our department on issues at the intersection of homeland
security and civil rights and civil liberties.
But I am also testifying in my capacity as the chair of the
Interagency Coordinating Council on Emergency Preparedness and
Individuals with Disabilities. Our council was created by an
executive order that the President signed in July 2004. We have
over 20 Federal agencies who are working aggressively on these
issues. We have divided our work into nine key areas, such as
emergency communications issues, transportation issues,
evacuation issues.
For the purposes of our work as a council, ``disability''
applies to a broad range of people, including individuals who
use wheelchairs, crutches, or walkers because of physical or
mobility impairments. Individuals who are blind or who have low
vision. Individuals who are deaf or hard of hearing or deaf/
blind. Individuals who have arthritis and diabetes. Individuals
who need oxygen because of respiratory conditions. Individuals
with cognitive disabilities, dementia, including Alzheimer's
disease and other mental illnesses. Individuals who live in
nursing homes and assisted living centers and those with other
physical or mental impairments that substantially limit a major
life activity.
We recognize that there are certainly many seniors who
don't fall in these categories. However, the most vulnerable
older Americans do fall within these categories and are a
primary subject of our interagency council's work. In our first
2 years of operation, almost 2 years of operation, our council
has met several significant milestones.
For example, we are participating now in the national plan
review, which is a review of the emergency preparedness plans
of all the States and the largest urban areas in the country.
We are also participating in a number of hurricane preparedness
exercises with experts, specifically focused on disability and
aging issues. We have developed a Web-based resource center of
educational materials, which I can refer to you later. We have
also published a report on evacuation issues.
When the hurricanes made landfall, our council immediately
became a focal point for pleas for help and offers of support.
We quickly formed what we call an incident management team of a
number of people across the Federal Government who work on
these issues, and we met regularly day after day with people in
the region, by telephone or in person, and as a Federal
incident management team.
So, I would just take a few minutes to identify for you
what we saw as the major issues that resulted from the
hurricanes as they affected seniors in the disability
community. First, the availability of durable medical equipment
was a major issue. In other words, people who had wheelchairs,
crutches, walkers, hearing aids, even hearing aid batteries,
these things were lost during the evacuation.
Second, evacuation was a major issue, and we have already
heard and discussed that. That was particularly true of those
who lived in institutional settings.
The third major issue we saw was access to life-sustaining
medications. People had to evacuate without adequate supplies
of insulin, heart medicines, drugs for epilepsy, medicine for
mental illnesses, and other things.
The council's incident management team received a lot of
calls about pharmacies out of State that would not respect or
honor requests for medicines that came from people who had
cards from the States of Louisiana and Mississippi.
One of the leaders in our interagency council is Dr. Peg
Giannini, who is sitting here in the front row. She leads the
Department of Health and Human Service Office of Disability
Policy. Because she was involved in our council and saw the
issue, she was able to go to the leadership of the Centers for
Medicaid and Medicare Services, who immediately issued guidance
instructing pharmacies to respect those cards and honor those
cards, and that they would be able to reimburse for those
expenses.
The next major issue is shelters, and the final issue I
wanted to point out was accessible housing was a major issue.
We began to realize that mobile homes, the manufactured homes
that were being provided were not accessible. A person with a
significant mobility impairment often could not get into the
front door of many of these types of mobile homes they were
making available. Once there, you may not be able to reach
faucets, closets, or even get into bathrooms or bedrooms.
Secretary Chertoff directed us to send an expert on
disability issues to Admiral Allen's staff in Baton Rouge and
to Admiral Hereth's staff in Austin. We sent an expert there
who worked for several weeks primarily on these accessibility
issues. Along with colleagues from HUD and the Department of
Justice, we were able to change the specifications that FEMA
was writing for the mobile homes to incorporate a number of
accessibility features.
Now let me just turn to some ways that the department and
our interagency council is trying to address some of the issues
with regard to seniors. The Departments of Homeland Security
and Health and Human Services are co-sponsoring a large,
Nation-wide conference on emergency management and individuals
with disabilities and the elderly.
This conference is going to be held here in Washington,
June 28 through 30th. I personally have done probably 10
conferences since Katrina, and we are all tired of conferences.
So we decided, though, what we needed to have was we needed to
get the people who do emergency planning and the people who are
responsible for the aging community and the disability
community in the room at one time.
So what we have asked each Governor to do is send a
delegation--someone from the State homeland security advisor;
someone from the emergency planning or management officials,
whoever they would want to designate; someone from the State
aging committee; and someone from the Governor's special needs
committee--and sit as a delegation.
We have asked the Governors to expect that delegation to
come back with concrete work products that will show that they
are making changes.
Second, we have included an expert on aging and emergency
preparedness in our national plan review team. We expect that
that NPR report, which will be issued to Congress and to the
States, will be a catalyst for some very significant
improvements on these issues.
Third, we participated in a roundtable on seniors and
emergency issues held by the AARP. I saw that outside they have
issued a report on that conference that they held. We have
contacted AARP in hopes of working with them.
Senator, you referred to materials, technical assistance
materials. We have created a resource center at
www.disabilitypreparedness.gov. There we have tried to
accumulate a lot of disability or senior aging specific
documents and guides there.
We have got documents from a lot of different
organizations. But specifically on seniors, we have one page
there, and there are documents from the U.S. Fire
Administration, a report written by the International Longevity
Center of the USA, and materials from AARP. We are anxious to
find additional materials.
The department's ready.gov initiative focuses or includes
materials on seniors, and we are working on additional
materials that ready.gov will be preparing, focusing
specifically on the aging population.
Finally, the Citizen Corps gives training to seniors all
over the country, and our Community Emergency Response Team
(CERT) training includes instruction on identifying and
assisting seniors.
In conclusion, I just want to say again that the
Committee's oversight of these issues is very much welcomed.
These are issues that Secretary Chertoff personally is very
interested in and focused on and asked for direct reports from
me on how we are making progress on specific items on a very
regular basis.
So, we welcome your oversight and your interest in this,
and I appreciate the chance to testify. Thank you.
[The prepared statement of Mr. Sutherland follows:]
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Senator Kohl. Thank you very much, Mr. Sutherland.
Now we will hear from Ms. Bascetta.
STATEMENT OF CYNTHIA BASCETTA, DIRECTOR, HEALTH CARE, U.S.
GOVERNMENT ACCOUNTABILITY OFFICE, WASHINGTON, DC
Ms. Bascetta. Senator Kohl and Senator Collins, thank you
for the opportunity to discuss our ongoing work on the
evacuation of vulnerable populations due to hurricanes and
other disasters.
As you know, Hurricane Katrina highlighted the dire
situation of hospital patients and nursing home residents who
needed to be evacuated, as well as the vulnerabilities of
transportation-disadvantaged people living in their own homes,
especially the elderly and persons with disabilities.
My remarks today focus on the challenges faced by States
and localities and hospital and nursing home administrators
facing evacuations, as well as a limit that we identified in
the design of the National Disaster Medical System.
My testimony is based onsite visits to Florida,
Mississippi, California, and New York; numerous interviews with
local, State, and Federal officials; and reviews of documents
such as State emergency management plans and recently issued
reports on the response to Hurricane Katrina.
Our early work shows that States and localities face
challenges in identifying transportation-disadvantaged
populations, determining their needs, and providing for and
coordinating their transportation. Compared to the general
population, the elderly are more likely to have a disability,
low income, or to choose not to drive. Meeting their diverse
needs requires additional planning, time, and resources.
For example, evacuating seniors with special medical needs
could necessitate additional pickup routes, extra time to load
and unload vehicles, and special resources, such as buses
equipped with wheelchair lifts.
So far in our review, we have noted that some emergency
management officials did not yet have a good understanding of
the dimensions of their transportation-disadvantaged
populations. They, themselves, also acknowledged the need to
better integrate them into emergency response planning.
On the other hand, in some locations, emergency management
officials have tried to better prepare vulnerable populations
through community outreach activities or by working with home
health organizations, physicians, and the Red Cross. Notably,
one location with a very well developed program encouraged
citizens with special medical needs to voluntarily register,
and they also involved social service providers in emergency
planning.
Hospital and nursing home administrators face challenges
whether they decide to evacuate or to shelter in place. Because
of the risks associated with moving sick and frail people,
sheltering in place is their preferred alternative. But this
requires ensuring sufficient staff and resources are available
to provide care during and in the aftermath of the storm until
help can arrive.
Evacuation is always a last resort and requires securing
sufficient and adequate transportation. In the event of
widespread disaster, we learned that local transportation
contractors would be unlikely to have adequate capacity to meet
the demand or might not have appropriate vehicles.
One nursing home administrator told us, for example, that
its contractor supplied regular buses, but its residents needed
power lifts to accommodate their wheelchairs. A particular
challenge for nursing homes that must evacuate is finding
receiving facilities that can take their residents for
potentially very long periods of time.
One Florida nursing home had to relocate its residents for
over 10 months while its facility was being repaired. We also
found that nursing home administrators can't reduce the number
of residents in their facilities because these residents have
no other home in the community, and they can't care for
themselves. In contrast, hospitals discharge as many patients
as possible before an anticipated emergency.
In our review, we also examined NDMS the National Disaster
Medical System, a partnership of DOD, HHS, VA, and DHS that
supplements State and local emergency response capabilities
with Federal resources and services. NDMS supports the
evacuations of patients needing hospital care by assisting in
efforts to move patients from a mobilization center, such as an
airport near the incident, to reception areas in other
locations away from the disaster.
NDMS agreements with participating hospitals give them the
opportunity to be assured that the patients that they are
moving can be put into an NDMS hospital and receive the
continuing hospital care that they need.
However, we found that NDMS was neither designed nor is it
currently configured to assist in the evacuation of nursing
home residents. While NDMS supported evacuation efforts that
included nursing home residents during the recent hurricanes,
it does not have agreements with nursing homes to receive
evacuees.
Our ongoing work will continue to examine ways to reduce
the vulnerabilities of hospital patients, nursing home
residents, and transportation-disadvantaged people. The need
for improvement is obviously urgent with hurricane season just
around the corner.
I would be happy to answer any questions that you might
have.
[The prepared statement of Ms. Bascetta follows:]
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Senator Kohl. We thank you very much for your testimony.
We would like to hear from Amy Aiken right now.
Senator Nelson. Mr. Chairman? Before----
Senator Kohl. Senator Nelson, go right ahead.
Senator Nelson. If I could say, because Ms. Aiken is from
Florida, and we have a little bit of experience in hurricanes
in Florida, and it is starting very shortly with the season
starting June 1. I just want to say, before she testifies, that
they have really gotten ahead of this down there.
Now we had a painful experience a long time ago, 1992. A
mega hurricane, Hurricane Andrew. There were a lot of mistakes
made. We learned from those mistakes. Then we were hit with 4
hurricanes within a 6-weeks period just 2 years ago in 2004.
So, Florida, of necessity, has had to get out in front of
this. What they do is they map out where senior citizens are so
that they have a location that by the time that they are ready
to evacuate, they have predetermined locations to take buses
to, to get senior citizens evacuated.
I wanted to compliment Amy and Miami-Dade County and what
they have been doing. That is why I wanted to come over here. I
have got to run back to another committee meeting right now,
but I wanted to state that for the record.
Senator Kohl. We thank you very much, and that is a very
important point in this whole question of preparedness is
advance work, as you are pointing out, to be sure. Once the
hurricane hits, if we haven't prepared, it is really too late,
isn't it?
Senator Nelson. Especially in a peninsula like Florida,
where you have 6 million people living in south Florida, and
here comes the hurricane. Of course, the natural tendency of
people are is to wait until the last minute because they are so
accustomed to thinking that it is suddenly going to veer and go
off in a different direction, and then people wanting to get
out of Dodge. Then, of course, it is gridlock with the few exit
routes that are available.
You know, even in north Florida back in the late 1990's--
and I lived through all of this because, at the time, I was a
member of the Florida cabinet, which also, as State treasurer,
was insurance commissioner. So I was involved in this up to my
eyeballs.
We had an evacuation with a storm headed toward north
Florida, Jacksonville. It ultimately veered off. But in an
evacuation 2 days before, it was total gridlock. People could
not move.
That finally prompted the Florida Highway Patrol to work
out a plan where they could make the interstate all one way.
But you can imagine the frustration of sitting in gridlock not
going anywhere for 12 hours on 2 lanes of the interstate while
the other 2 lanes, there is no traffic whatsoever.
So, there are a lot of things that we have had to confront
but, fortunately, are finally getting our arms around it.
I would just say, Mr. Chairman, as we approach June 1 of
this year, hurricane season, thank goodness I am not insurance
commissioner anymore. [Laughter.]
Senator Kohl. Great. Thank you so much, Senator Nelson.
Amy, we would like to hear from you.
STATEMENT OF AMY B. AIKEN, ASSISTANT DIRECTOR, MIAMI-DADE
OFFICE OF EMERGENCY MANAGEMENT, MIAMI, FL
Ms. Aiken. Thank you, Senator.
Good morning, Mr. Chairman and members of the Committee. I
would like to thank you for this opportunity to share some of
Miami-Dade County's disaster preparedness initiatives,
particularly as they relate to our seniors.
I would also like to commend you, Senator Kohl and Senator
Smith, and the members of this Committee for convening this
hearing that is seeking to move forward disaster preparedness
for seniors.
During the 2004 hurricane season, Miami-Dade County
activated its emergency operations center four times for
hurricanes. We did it again four more times in 2005. So we have
had some practice.
While many of the initiatives about which I will speak
today were developed because of our experience with hurricanes,
Miami-Dade County utilizes an all-hazards approach for
emergency management. It must be ready for any disaster, not
just hurricanes.
One of the principal lessons learned from the 2005
hurricane season was that no matter what happens in the county,
it is and will ultimately be the county's responsibility to
respond to and recover from any disaster that affects its most
vulnerable residents.
Back-to-back storms within a matter of weeks and widespread
extended power outages in 2005 raised our awareness that the
programs Miami-Dade County already had in place were inadequate
to care for our most vulnerable residents, particularly our
seniors during a disaster.
Many nongovernmental agencies and individuals seek to
assist, but if this assistance is not well coordinated, it may
lead to duplication of efforts and gaps in services. Volunteer
Organizations Active in Disaster, or VOAD, a national program,
exists to coordinate such efforts. Miami-Dade County is
reestablishing its VOAD program.
Many of the calls received by our 311 call center during
activation came from residents, particularly seniors who simply
needed reassurance. Miami-Dade County has since established a
telephone reassurance program, letting individuals know that
they are not alone during times of disaster.
Florida law mandates that all assisted living facilities
and nursing homes have disaster plans in place that are
reviewed by their respective county's office of emergency
management and are enforced by the Agency for Health Care
Administration.
Florida law also mandates that each county maintains a
special needs registry. These are data bases of homebound
seniors who may need assistance with daily living, require
skilled nursing care, or need life-saving medical equipment
dependent upon electricity.
Realizing that many residents, in particular seniors, will
not evacuate without their pets, Miami-Dade County opened its
first pet-friendly shelter last year and is working with Miami-
Dade County Public Schools to identify additional locations for
pet-friendly shelters throughout the county.
Low-income elderly residents in Miami-Dade County can take
advantage of the county's residential shuttering program. This
program enables homeowners to receive custom-made shutters at
no cost and assistance, if needed, to put up and take down the
panels.
South Florida has the most stringent building codes in the
Nation for wind storm protection. Other hurricane-prone areas
should be encouraged to revisit their building codes and
consider replicating south Florida's. Areas prone to other
types of disasters, such as earthquakes, wildfires, or
flooding, should consider a review and possible strengthening
of building codes specific to the disasters most likely to
occur in that particular area. Building codes work.
In addition to its stringent building codes, Miami-Dade
County's local mitigation strategy has completed $36 million in
wind storm mitigation projects and another $128 million in
flood mitigation. Hundreds more projects are already in
progress or under development.
During the 2004 and 2005 hurricane seasons, not a single
facility mitigated through the LMS incurred any damage other
than a few loose roof tiles or scraped paint. Mitigation works.
Miami-Dade County has learned that the only way to ensure
the prompt coordinated response that our community has come to
expect and deserves is to continue to strengthen partnerships
with local, State, and Federal Government agencies; public and
private agencies; nonprofit organizations; and, most
importantly, our 2.5 million residents. Disaster preparedness
is everyone's responsibility.
However, all cities, counties, and States are not the same,
and these differences must be considered throughout all phases
of emergency management from preparedness and mitigation to
response and recovery.
I invite you, Mr. Chairman, and members of this Committee
to visit Miami-Dade's emergency operations center. Senator
Nelson and Senator Martinez, both from our State, have been
there many times, and we look forward to visits from you and
other members of this Committee.
Miami-Dade County is ready and willing to share and learn
from any efforts that will enhance disaster preparedness for
all.
Thank you again for this opportunity to be a part of a
process that is seeking to move forward disaster preparedness
for our seniors.
[The prepared statement of Ms. Aiken follows:]
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Senator Kohl. Thank you. That is a very fine statement, and
I would like to return to you after we hear now from Dr. Dyer.
STATEMENT OF CARMEL BITONDO DYER, M.D., ASSOCIATE PROFESSOR OF
MEDICINE, DIRECTOR, BAYLOR COLLEGE OF MEDICINE GERIATRICS
PROGRAM AT THE HARRIS COUNTY HOSPITAL DISTRICT, HOUSTON, TX
Dr. Dyer. Good morning, Ranking Member Kohl. I appreciate
the fact that you are holding this hearing and for the
opportunity to testify today.
I am Dr. Carmel Bitondo Dyer, and I am a geriatrician from
Baylor College of Medicine, a member of the American Geriatric
Society, and chief of geriatrics at the Harris County Hospital
District.
You may know that the American Red Cross set up the shelter
facilities for Katrina evacuees in Houston, and the Harris
County Hospital District set up a comprehensive MASH unit for
medical treatment for the Katrina evacuees.
What you may not know is that 56 percent of those seen in
the medical MASH unit were over the age of 65. I had the
privilege of caring for a number of senior Katrina survivors,
and I would like to share with you today an onsite solution we
developed and some recommendations that we have since
formulated.
In Houston, we saw confused, disoriented people who didn't
even know where they were, bilateral amputees and wheelchair-
bound patients who couldn't access the bathing facilities on
the second floor. We saw seniors exploited when their FEMA
checks were stolen, and we saw people promised suitable housing
that wasn't. Also, the cognitively impaired and functionally
impaired people were just interspersed among the 20,000 other
folks that were staying in the shelter.
Now we are not critical of the valiant efforts made in
Houston. The real mistake would be not to learn from those
experiences. So, I would humbly like to recommend a few things.
The first is that in any disaster shelter situation that
there be separate sites for seniors to facilitate service
delivery.
The second recommendation is that we must build in
protections for fraud and abuse. For instance, these special
list patients that are being circulated, they cannot get in the
hands of predators.
The third is that we must develop a common language to use
across jurisdictions. So how do we know that the special needs
persons in Texas are defined in the same way as they are in
Florida? We have developed such a tool called the SWIFT, and
you may have copies of it in front of you, Seniors Without
Families Triage.
What we did onsite in Houston was to categorize the seniors
that were impaired into three groups--mild, moderate, and
markedly impaired--so that we could determine type of services
that they needed. It takes only 5 minutes to administer, and it
was used all across the State in different shelters.
What we are recommending is that this tool be adopted
Nation wide, and it can be used in the pre- and the post
disaster period.
The last recommendation I would like to make is that more
geriatricians and gerontologists be involved in these disaster
preparedness efforts. I mean, nobody would put together a
public health program for children without tapping the
expertise of pediatricians. Nor should we put together
emergency care plans that involve seniors without consulting
geriatricians and gerontologists.
Geriatricians and gerontologists should be involved in
every aspect of emergency care, including planning, care
delivery, and training of the front-line workers. Of course,
there is not quite enough of us to go around.
These and other recommendations are going to be published
by us in just a few weeks in conjunction with the American
Medical Association and the AARP. We support Resolution 25 of
the 2005 White House Conference on Aging, which calls for
coordinated Federal response.
On behalf of the SWIFT team and the American Geriatric
Society, I want to thank you for holding this hearing. Also we
hope that this testimony helps the Federal effort to devise an
emergency preparedness plan that both anticipates and meets the
needs of America's seniors.
Thank you.
[The prepared statement of Dr. Dyer follows:]
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Senator Kohl. Very good statement. We appreciate it very
much, and we will return to you in a minute.
Mr. Sutherland, we understand that the Department of
Homeland Security includes seniors under the umbrella of
individuals with disabilities when planning for emergencies.
Surely you would agree that while some seniors are disabled,
many older people--like Maurice from our first panel--are not.
They might and most probably do live alone, or they need help
with transportation or supplies, and they are not disabled.
So why would the DHS group all seniors into the same
category as disabled? What steps is DHS taking to include those
seniors who are not disabled, but obviously will be in great
need in an emergency?
Mr. Sutherland. Thank you, Senator.
The department looks at preparedness across the entire
population. In our context, www.disabilitypreparedness.gov,
there is a page that relates to seniors. It is the information
that is contained there would not relate just to seniors with
disabilities, but would contain information that relates to all
seniors.
So we need to make sure that that information is available
in other contexts because a senior without a disability
wouldn't necessarily think to go to that particular place. So
ready.gov has information like that--you know, that is specific
to seniors--and is working on some additional work as well.
I will just show you an example of some of the materials
that we have. This is something that was prepared by a
coalition of private disability-focused organizations, and it
is just a small thing. It is tips for first responders. They
put it like this so that it can be easily carried around, and
it is in laminated cards.
But the very first page in here is tips for seniors, how to
deal with seniors. Not necessarily seniors with disabilities,
but seniors in general. Then there are pages on people with
service animals and people with mobility impairment. So it is
more specific.
So I think it is, your point is excellent. We have to
recognize that there are overlaps between seniors and
disability, but there are differences as well, and we have to
recognize that.
Senator Kohl. Mr. Sutherland, if a catastrophe like Katrina
occurred next week or 2 weeks or 3 weeks from now, what would
be different in terms of your response from a year ago?
Mr. Sutherland. Well, Senator, I have been thinking about
that myself, and we are really focused on June 1, the beginning
of the hurricane season, to make sure that we have a number of
deliverables in place. I think a lot of the issues that have
been raised today, in all honesty, are complex and require
long-term solutions.
I can tell you some things would definitely be different.
For example, we have an incident management team that is set up
that is across the Federal Government that will work on and
respond to these issues.
We have the National Response Plan review that is a report
that will be coming to Congress in the first part of June that
we have gone through. As I said earlier in my testimony, about
10, maybe 11 large States and 10 or 11 large cities, and we
have come up with an assessment tool. How do we assess the
emergency operations plan for the State of X to decide whether
it is really adequate or sufficient as it relates to people
with disabilities or people from the aging community in a
variety of subcategories there?
We believe the kind of guidance that is going to come out
of that report will really influence the debate and influence
how State and local emergency planners are writing their plans
and are assessing how to change their plans so that they
accurately react to emergencies.
We created a disability resource center that we think is
going to really significantly help on the preparedness side of
things in terms of both emergency responders and senior
citizens.
I know, just anecdotally, there is quite a bit of thought,
interest, and energy on these issues. For example, the National
Hurricane Conference was just held, and they invited me to come
down and give a keynote address at the National Hurricane
Conference, which they have never done. They have never focused
in the plenary session on emergency preparedness and the aging
community and people with disabilities.
We have meetings on these issues all the time, experts like
these folks who are now focused on these issues. So there is
quite a bit of energy and interest, and I am optimistic that we
would see some dramatic changes in the short run. But this is a
long-term problem that we really have to stay focused on for
many years.
Senator Kohl. Ms. Aiken, you particularize things that have
been done in Miami-Dade County area, and I was very impressed
to hear about all of the things in detail that you put in place
that you fully expect to really mitigate the effect of any
hurricane.
Are you asserting that while nothing is perfect, and
certainly there is no way of avoiding tragedy when hurricanes
like Katrina strike, that within those parameters, do you feel
that you have or you apparently do feel that you have put in
place several things that will make a big difference if and
when a hurricane strikes?
Ms. Aiken. Yes, Senator. Miami-Dade County, as Senator
Nelson mentioned, we have been forced to kind of get good at
this because we are subjected to many hurricanes.
Every hurricane that comes through, every disaster, every
exercise or drill that we do, we learn from it. No matter how
many times we do it, there are always things that we will
continue to work on to improve.
So, yes, we are hoping that the systems we have in place
are better than the systems last year, but we are not there
yet, and we will continue to move forward.
Senator Kohl. When you look at Katrina, as I am sure you
have, and you have thought about it in great detail, would you
say that they were really totally unprepared to deal with the
disaster?
Ms. Aiken. I can only speak about Katrina from a Miami-Dade
County standpoint. I wasn't in New Orleans. I wasn't in the
Gulf States. So it is unfair of me to take a look at that and
not actually being there. I know that when something major is
impending upon your community, if you don't have systems in
place beforehand, it is very difficult to get those up and
running when it is kind of looming at your door.
Because even when you do have systems in place, it is a
disaster. So, those plans that you have, that you look at and
you have tested, they don't always go forth as well as you
would like them to do.
But it is very important that you do that preplanning and
have some systems in place because when it is all going kind of
haywire, you have to have some things that you can fall back on
and know that your folks are trained and are prepared to deal
with.
Senator Kohl. For the three of you, do you feel that these
issues must be dealt with to a considerable extent at the local
level. That preparedness, in particular, must be tailored to,
and you follow positions that are national in terms of knowing
what the major issues are. But that each community, each
county, each State must take into consideration their situation
and be certain that they have plans in place to deal with these
disasters when they occur.
Ms. Bascetta.
Ms. Bascetta. Yes, I certainly would agree with that and I
think that emergency managers would agree that the first
responders are the locals. Even under the best-laid plans, it
would take a certain amount of time for the State and the
Federal Government to be able to arrive and assist.
But as we pointed out in testimony earlier this year for
Senator Collins, you know, probably the single most important
thing is to have clearly defined and communicated leadership
and lines of authority well in advance of an event, especially
an event that is catastrophic.
Defining that point at which we have a catastrophe, where
the States are overwhelmed, also needs much more attention
because we don't want to be in a position again where we are
waiting for the States to ask for assistance when, in fact, the
Federal Government should be better positioned to lean forward
with its assets.
Senator Kohl. Dr. Dyer.
Dr. Dyer. Well, I agree that some things have to be done at
the local level just depending on the number of people, and how
many are rural, how dense the urban areas are. However, I think
the Federal Government can set standards.
I mean, before Katrina, there was a standard that all
nursing homes had to have--and this was a Medicare
requirement--had to have an evacuation plan. But what did that
mean? What were the specifics of that plan? It was vague.
So, I think it behooves the Federal Government to set the
minimum standards that would provide safety for all residents
and then the individual sites to tailor those requirements, but
at least meet the minimum standards.
Senator Kohl. What is the most important single thing that
the Federal Government must do in order to prepare our seniors
for the next disaster? What would you suggest, Ms. Aiken?
Ms. Aiken. I think it is very important that the Federal
Government continue to support the State and local. Your
earlier question saying do you believe that the locals--all
disasters are local. I mean, when you talk to the locals, they
begin they are all local. However, it needs to continue with a
partnership with the States and with the Federal Government.
As I stated earlier in my testimony about the mitigation,
mitigation does work. So if the Federal Government can continue
to support programs such as those, the local mitigation
strategies that have been proven to make a difference,
obviously, it is going to take funding dollars to do that. But
if the dollars are well spent in advance, they are better spent
dollars than they are spent post event.
Senator Kohl. Mm-hmm. Ms. Bascetta?
Ms. Bascetta. With regard to the elderly living in their
own communities, our ongoing work is identifying best practices
in some communities, such as Florida, which is known as the
gold standard. Getting the word out to other communities about
those best practices is very important.
For those in hospitals and nursing homes, paying more
attention to the role of the NDMS and ensuring that the NDMS is
adequately resourced and able to meet the demands of evacuation
is very important.
I might point out that in the national plan review that Mr.
Sutherland referred to, by far, the evacuation annex was what
both States and cities were still considering most problematic.
I believe that the numbers were 11 percent of States and 9
percent of cities were confident that they would be able to
handle an evacuation, and the rest were not comfortable yet.
Senator Kohl. Hmm, very interesting.
Dr. Dyer.
Dr. Dyer. Well, I think that we need to focus on the most
frail because people that have mental capacity, like Mr.
Frisella, they can make their own decisions. But we have to
help those who cannot fully take care of themselves. Either
they are not able because of functional impairment to evacuate,
or they don't have the cognitive ability to plan and take all
the steps in sequence to get out. We have to focus attention on
those ultra most vulnerable group.
Senator Kohl. Ms. Aiken, how successful is your county's
special needs registry, and do you believe that we could or
should attempt to replicate it in other places?
Ms. Aiken. Yes, I do believe that it can be replicated in
other places, and I believe that it should be. The special
needs registry is a registry for the homebound seniors that may
need that special assistance in daily living, electricity
dependent, or skilled nursing care, the most frail and
vulnerable of our population.
But if you don't know where they are and who they are, we
are not going to be able to get to them. With our registry, we
know exactly who these people are. We know exactly where they
are, and we have very specific plans in place to be able to
evacuate them well in advance of a general evacuation because
it is time consuming to get them out of there.
They know where they are going in advance. Nobody really
wants to leave their home, but it is incumbent upon them to
actually get out of there because it becomes a life safety
issue.
If they know in advance what type of transportation is
going to show up, that the transportation is actually going to
show up at their door, they are going to be called in advance.
They know it is coming. They know the facility that they are
going to. While it is not ideal, at least it gives them some
assurance that they are just not going to be thrown on an
inappropriate bus and stuck somewhere where they are not
comfortable.
So, yes, I do believe that it can be and it should be
replicated.
Senator Kohl. How many people are in that registry? Do you
have an idea?
Ms. Aiken. Right now, we have about 1,500 people in that
registry, which we are continuing to add numbers to it all the
time. It is incumbent upon the individual, though, to register.
FP&L, Florida Power and Light, sends out every year in its
billing at the beginning of June information about the special
needs program. So everybody that is receiving an electric bill
is receiving information about that program, and it says to
call your local office of emergency management to register.
Miami-Dade Office of Emergency Management has a full-time
community preparedness person whose primary function is getting
out there and educating the community, particularly our more
vulnerable population, such as our seniors and those with
special needs, about the initiatives that the county has in
place and about the programs that are out there and available
for them to take advantage of.
So we try to get the information out. But again, it is
incumbent upon that individual sign up for that registry.
Senator Kohl. Any other comments any of you would like to
make?
Mr. Sutherland, you would like to say something?
Mr. Sutherland. Senator, you had asked about the Federal
response, and I wanted to echo that I think this whole area is
a shared responsibility.
We looked back at Katrina and tried to come up with lessons
learned. As we did, we started to note, started on a legal pad
on my desk, and we have turned it into a document that
eventually we will publish publicly, but what needs to change
here?
We came up with certain ideas that FEMA needs to make some
changes. We came up with some ideas that our Preparedness
Directorate needs to make some changes. We came up with some
ideas that my own office, we need to do better at or some of
our Federal partners.
But we also included or noted that there were things that
needed to go better at the State and local level, things that
needed to go better with Red Cross, and some things that the
disability and aging communities need to address themselves.
Things you need to do better. You need to take on this
responsibility.
So there is a shared responsibility there. For our
purposes, I think the three major areas that we are focusing on
is preparedness, preparedness, preparedness. We are trying to
get people prepared. That would be the first area.
Second, stimulating best practices. Identifying places
where things are working and stimulating that and replicating
that and letting people know about that.
The third is getting subject matter experts on these issues
institutionalized into the emergency management structure. For
example, the joint field office, which is set up to respond to
emergencies, did not have a subject matter expert on disability
and aging issues.
After Katrina, Secretary Chertoff recognized we needed
somebody, and he sent a memo to me and Chief Paulison and said
get someone there. We got someone there, and it has now been
institutionalized in the JFO structure. There are other ways
that we need to do that as well.
So I appreciate the chance to just outline maybe where we
are going over the next few months as well.
Thank you.
Senator Kohl. I thank you.
Well, I believe that this panel has been very useful in
many ways. In particular, I am impressed by what local
governments are doing, and we all recognize how important local
governments are in preparing for disasters.
I have my concerns, as I think all Americans do, post
Katrina about Federal Government's preparedness and ability to
respond this year. You have pointed out, Mr. Sutherland, that
this is a long-term project, and it is. But when disaster hits,
it is a short-term catastrophe that must be dealt with. It
doesn't do any good to have programs that will kick in some
years down the road when a natural disaster hits.
I think we are all worried--I am sure you are--we all are--
that we are even today woefully unprepared for another natural
disaster. That is the purpose of this hearing as it affects our
seniors.
I am looking forward to and very hopeful that we can have
not only an ongoing relationship, but one that is tinged with a
sense of urgency to get prepared. So that when we do have
another natural disaster, we can be proud of the response at
the Federal level as well as at the local level.
So let us all beware and take heed that we do not have
another Katrina. It would be, indeed, a real tragedy if that
occurred, and we want to do everything that we can to prevent
it.
I want to thank you all for being here. I am most impressed
with your comments, and I think you do have a sense of urgency
about doing what needs to be done as quickly as possible
because I think you recognize how bad it will be if we don't do
it. So, your contributions are invaluable, much appreciated.
We thank you all for coming, and we stand adjourned.
[Whereupon, at 11:41 a.m., the committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Senator Susan Collins
Mr. Chairman, thank you for calling this hearing to examine
ways to strengthen our emergency preparedness and response
systems so that they are more sensitive to the special needs of
seniors.
The question posed in the title of this morning's hearing
is clearly rhetorical. Obviously, we not only can do better,
but we must do better if we are to avoid the horrible human
suffering left in the devastating wake of Hurricane Katrina.
While Katrina would have been a terrible national incident
given its strength, size and intensity, it became a far more
devastating disaster because of the failure of preparedness and
response at all levels of government. And tragically, the brunt
of this failure was born disproportionately by our nation's
most vulnerable citizens, including our seniors and the
disabled.
Just a few days after Hurricane Katrina struck, the
Majority Leader asked the Homeland Security and Governmental
Affairs Committee, which I chair, to conduct an investigation
into the government's preparation for an response to Hurricane
Katrina and to make recommendations that would help ensure that
America is better prepared the next time a disaster strikes--
whether it be predicted, as it was in the case of Hurricane
Katrina, or a terror attack for which we have no warning. The
committee's Ranking Member, Joe Lieberman, and I agreed to take
on this task in a thorough and bipartisan manner.
Over the past seven months, our committee held 22 hearings,
where we heard from 85 witnesses, our staffs conducted more
than 325 formal interviews, and reviewed over 838,000 pages of
evidence. Our findings over these seven months of hard work
resulted in an exhaustive report titled ``Hurricane Katrina: An
Nation Still Unprepared.'' The findings of our investigation
are reflected in the very name of our report.
Throughout our investigation, we found clear evidence of
failures of planning; failures in decision-making; a failure to
create a coordinated national response system, and most of all,
a failure of leadership at all levels of government.
One of the most troubling findings of our report was the
failure to evacuate nursing homes in Louisiana. This
undoubtedly led to the loss of dozens of lives of an already
vulnerable population.
As a consequence, one of the key recommendations in our
report calls on the Department of Homeland Security to ensure
that State and local governments have evacuation plans that
address the special challenges posed by hospitals, nursing
homes, and individuals with special needs, like the elderly.
The report also recommends that the State agencies responsible
for licensing hospitals and nursing homes ensure that those
facilities have evacuation plans and audit them annually,
including an evaluation of the availability of transportation
resources.
Mr. Chairman, this morning's hearing will help to highlight
the special challenges that the elderly face during a national
disaster. It will help us in our effort to build and maintain a
true national emergency planning and response system that is
sensitive to the needs of our most vulnerable citizens.
------
Prepared Statement of Senator Mel Martinez
I would like to thank Ranking member Kohl for having this
hearing. It is important to focus on the unique needs of the
elderly in times of natural disasters. I feel strongly that my
state of Florida and Governor Bush illustrate the way local and
state governments most effectively prepare for crises and the
proper role of the federal government. As senator from a state
that has experienced seven hurricanes and two tropical storms
in the last 2 years, I urge you to consider the successes and
challenges Florida faces when a natural disaster occurs.
Florida's Department of Elder Affairs (DOEA) and its CARES
(Comprehensive Assessment and Review for Long-Term Care
Services) staff respond following hurricanes and natural
disasters to assist Florida's elders throughout the state.
CARES staff are trained and certified in completing
assessments, evaluating medical needs and providing placement
recommendations for clients.
CARES staff respond following natural disasters providing
discharge planning services in Special Needs Shelters (SpNS) to
ensure the safe placement of residents. CARES staff also aid
Assisted Living Facilities, Nursing Homes and Emergency
Operations Centers (EOC) with placement of elderly residents.
CARES staff contact existing clients to ensure their safety
and assist local service providers in the delivery of food and
water. During the 2004 hurricane season, approximately 92 CARES
staff completed 5,354 hours of service responding to Hurricane
Charley, Frances, Ivan and Jeanne. In 2005 hurricane season,
approximately 48 CARES staff completed 1,321 hours of services
responding to Hurricane Katrina and Wilma.
I am especially looking forward to the testimony today from
Ms. Amy Aiken, the Assistant Director of the Miami-Dade Office
of Emergency Management, and having her elaborate on some of
the things that the state is doing in regards to emergency
preparedness and have been doing ever since Hurricane Andrew
hit back in 1992.
Again, I thank the committee for its time and attention to
this matter and look forward to the testimonies before us.
Thank you.
------
Prepared Statement of Senator Ken Salazar
I would like to thank Chairman Smith and Ranking Member
Kohl for holding this important hearing. Hurricane Katrina
illustrated to us all that current planning, infrastructure,
and leadership in the event of a national emergency is far from
where it needs to be to adequately protect our citizens.
We must move forward to improve our ability to effectively
prepare for future disasters, we must learn from the mistakes
of the past, and we must pro-actively seek real solutions to
those mistakes to ensure they are not repeated. This hearing is
an important opportunity to identify the specific needs faced
by seniors during a natural or manmade disaster, consider
recommendations, and assess the progress that has been made
thus far in learning from past mistakes to ensure that our
seniors are properly taken care of in the event of future
emergencies.
As we know, the special needs of senior citizens pose
distinct challenges for any national emergency preparedness and
response plan.
In emergency situations, seniors face a terrible risk of
being injured, trapped in their residence or perishing as a
result of disasters. Among those who did not survive Hurricane
Katrina, 75% were 75 years and older, and 65% of those who died
at the Astrodome in Houston were 65 years and older.
Transportation is one of the difficult issues that must be
addressed. In the event of an evacuation, transporting senior
citizens in a manner that is timely and safe can make the
difference between life and death. We know from Hurricane
Katrina that nursing home operators were faced with making a
difficult determination of whether to evacuate, and if so, how
and when. What tools could be provided so that operators in
similar situations in the future are better equipped to act in
the best interest of the seniors in their care?
Almost every year, my home state of Colorado experiences
forest fires that create risks for our Seniors living in
affected communities.
With limited resources, it is often difficult to assist and
rescue our elders living in remotes ranches or homes in the
Rockies. However, with planning and preparation, we can ensure
that the manpower, vehicles, plans, and other necessary
resources are readily available to these Seniors.
Seniors also have diverse medical needs that must continue
to be met during a disaster. As Ms. Cefalu's testimony will
indicate, in the wake of natural disaster in the Gulf, nurses
and doctors were called upon to treat and diagnose seniors
without a knowledge of the patient's medical background,
current diagnoses, or what medication or treatments the patient
requires.
As the gerontologists on this panel will confirm, a one-
size fits-all structure for medical treatment does not meet the
specific medical needs of senior.
Emergency response plans must include first responders and
medical professionals who are trained in geriatric medicine.
Dr. Bitondo's testimony of treating elderly Katrina evacuees at
the AstroDome in Houston is an example of how people with
medical needs can be organized to ensure that seniors, who
often require geriatric specific treatments, receive
appropriate care from someone trained in geriatric medicine.
America has a duty to protect and care for ALL of its
citizens in the event of a national disaster: rich and poor,
healthy and sick, young and old. Over the next 25 years, the
number of Americans over the age of 65 is expected to double.
As the United States continues to age, it is our
responsibility to ensure that federal and local response and
preparedness plans are tailored to meet the specific needs of
our seniors.
I look forward to hearing from today's panel and to working
with my colleagues to ensure our country is prepared to meet
that responsibility.
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