[Senate Hearing 111-209]
[From the U.S. Government Publishing Office]
S. Hrg. 111-209
EMERGENCY PREPAREDNESS, AGING AND SPECIAL NEEDS: PREPARED VS. SCARED!
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HEARING
before the
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
JUNE 24, 2009
__________
Serial No. 111-9
Printed for the use of the Special Committee on Aging
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
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SPECIAL COMMITTEE ON AGING
HERB KOHL, Wisconsin, Chairman
RON WYDEN, Oregon MEL MARTINEZ, Florida
BLANCHE L. LINCOLN, Arkansas RICHARD SHELBY, Alabama
EVAN BAYH, Indiana SUSAN COLLINS, Maine
BILL NELSON, Florida BOB CORKER, Tennessee
ROBERT P. CASEY, Jr., Pennsylvania ORRIN HATCH, Utah
CLAIRE McCASKILL, Missouri SAM BROWNBACK, Kansas
SHELDON WHITEHOUSE, Rhode Island LINDSEY GRAHAM, South Carolina
MARK UDALL, Colorado
KIRSTEN GILLIBRAND, New York
MICHAEL BENNET, Colorado
ARLEN SPECTER, Pennsylvania
Debra Whitman, Majority Staff Director
Michael Bassett, Ranking Member Staff Director
(ii)
C O N T E N T S
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Page
Opening Statement of Senator Mel Martinez........................ 1
Opening Statement of Senator Herb Kohl........................... 3
Panel of Witnesses
Statement of Richard E. Besser, M.D., Director, Coordinator
Office for Terrorism, Preparedness and Emergency Response,
Centers for Disease Control and Prevention, Atlanta, GA........ 4
Statement of Timothy Manning, Deputy Administrator for National
Preparedness, Federal Emergency Management Agency, Washington,
DC............................................................. 20
Statement of Douglas Beach, Secretary, Florida Department of
Elder Affairs, Tallahassee, FL................................. 28
Statement of LuMarie Polivka-West, Senior Vice President of
Policy, Florida Health Care Association, Tallahassee, FL....... 40
Statement of Sandy Markwood, Chief Executive Officer, National
Association of Area Agencies on Aging, Washington, DC.......... 50
(iii)
EMERGENCY PREPAREDNESS, AGING, AND SPECIAL NEEDS: PREPARED VS SCARED!
---------- --
WEDNESDAY, JUNE 24, 2009
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 11:20 a.m. in
room SD-562, Dirksen Senate Office Building, Hon. Mel Martinez
presiding.
Present: Senators Martinez [presiding] and Kohl.
OPENING STATEMENT OF SENATOR MEL MARTINEZ, RANKING MEMBER
Senator Martinez. Good morning. We'll call the hearing to
order and thank the Chairman for allowing us to hold this
hearing today.
We are pleased to have an excellent group of witnesses with
us. So, I want to thank all of you for joining us as we discuss
how emergency preparedness relates to seniors, and those
seniors living with special needs, particularly. We're looking
forward to hearing perspectives of some of our Federal, State,
and local partners about the unique needs of elderly Americans
to better prepare for when a disaster strikes.
As we begin the 2009 hurricane season, I am reminded how
older Americans are often the hardest hit when Mother Nature is
at its worst. A prime example of this occurred during Hurricane
Katrina, where nearly half of all storm-related deaths involved
residents 75 years and older, and the average age for
fatalities was 69. In hurricanes and other disasters, no
Americans should be in endangered by virtue of their age,
living situation, or physical situation. As we have learned,
threats vary from State to State, from regional to region.
Whether it's a flood, blizzard, earthquake, fire, or even a
pandemic emergency, responders at every level ought to be
prepared to assist our most vulnerable citizens.
We know from past experiences with natural or manmade
disasters that all Americans, especially those with special
needs, suffer when there is a lack of preparation, information,
and coordination. That's why we as public servants, have a
responsibility to help inform the general public about the
value of being personally prepared.
For seniors and seniors living with special needs, this
includes having something as simple as a communications plan,
an emergency kit, an extra pair of reading glasses, or even a
hearing aid. Such a preparation may mean the difference between
life or death.
Emergency responders in my home State of Florida have taken
significant steps to address these unique needs of seniors. It
is not an overstatement to say that our model can serve as a
model for our nation. One innovation sets up the incident
command center model in nursing homes. Those go a long way in
ensuring nursing home employees are trained in emergency
preparedness procedures and can coordinate a response in the
event of an emergency. It will also help to avoid mistakes like
those made during Hurricane Katrina, where many long-term care
providers were simply untrained and unprepared.
Another concern has been what to do for seniors in the
event of a national pandemic. We have all read about the H1N1
swine flu outbreak. Although the elderly were not at great
risk, we must be prepared for the upcoming flu season, where
seniors are among the most vulnerable, along with the
possibility of a return of a mutated H1N1 flu strain.
In many instances during pandemics, caregivers may be more
vulnerable to the flu than patients, so we must ask ourselves--
how do we ensure that there are enough doctors, nurses, aides,
and other medical personnel in the event that these caregivers
are infected?
Most seniors do not receive formal care in their homes,
communities, or in the 24-hour facilities. For these elderly,
and for those living at home and in need of a long-term care,
the State Units on Aging and Area Agencies on Aging are
invaluable.
Area Agencies and State units actively seek to reach all
seniors to help them plan and prepare for a natural disaster.
They are the key connector to the array of government and
private entities offering senior services and recovery before,
during, and after a disaster. In Florida, Area Agencies are on
the forefront of innovation and planning, preparing, and
responding to disasters and emergencies.
I'm proud to note that the Florida Department of Elder
Affairs is seen as a model in disaster response and recovery
throughout the country, and is often consulted by other State
Units on Aging for guidance and experience. Florida has the
highest proportion of elderly of any State, and also a high
incidence of disasters and emergencies, so it is expected that
Florida would have a first-rate preparedness and response
system. But, each year, new threats emerge, and old threats
largely remain. We must not forget the special needs of our
seniors residing in any State facing natural, manmade, or
public health emergencies.
I want to thank our witnesses for joining us today. I look
forward to hearing your thoughts and ideas on innovations and
challenges for emergency preparedness and response for seniors
across the nation.
Now, I'd turn to Chairman Kohl for your comments, sir.
OPENING STATEMENT OF SENATOR HERB KOHL, CHAIRMAN
The Chairman. Good morning. I'd like to thank Senator
Martinez for holding today's hearing on emergency preparedness
and the elderly.
This issue has been of great concern to me since we learned
of the many tragedies that occurred when Hurricane Katrina
struck, now nearly 4 years ago.
One of today's witnesses will tell us that, when Katrina
hit, only 15 percent of the population in New Orleans was age
60 or older, and yet 70 percent of the hurricane-related deaths
were seniors. We did see then that more needed to be done to
evacuate seniors and the disabled in the face of an impending
disaster. As a result, I included provisions in the 9/11
Commission Act of 2007 to train public transportation workers
to meet the evacuation needs of seniors during an emergency.
While legislative steps such as these have been taken since
2005, more work remains ahead.
Last year, I released a GAO report on how prepared the
Government is to evacuate vulnerable populations, such as
nursing-home residents, in the event of an emergency. The study
found that the Department of Homeland Security needs to improve
requirements for evacuation planning by State and local
entities that receive DHS funding.
Last month, I followed up with DHS Secretary Janet
Napolitano, and, although progress has been made under the new
administration, it still does not appear that emergency
preparedness requirements have been strengthened.
As we all know, disaster can strike at any time. Just last
week, parts of Wisconsin experienced heavy flooding, leaving
some of my constituents stranded. We cannot hope to be ready
for these kinds of emergencies tomorrow; we have to be ready
today.
So, we thank you, Senator Martinez, once again, for holding
this hearing, and we thank all of our witnesses for being here
today. I think we all understand that it's clear that there's
more work to be done.
Thank you.
Senator Martinez. Thank you, Mr. Chairman.
Let me now introduce the witnesses we have with us today.
Again, we're grateful that you all are here.
First, we have Dr. Richard Besser, M.D., the Director of
the Coordinating Office for Terrorism, Preparedness, and
Emergency Response, at the Centers for Disease Control and
Prevention. Dr. Besser was the Acting CDC Director during the
recent H1N1 influenza outbreak. His current office is charged
with protection for the Nation from all threats to the public's
health.
We also have with us Timothy Manning, Deputy Director of
the National Preparedness Directorate for the Department of
Homeland Security's Federal Emergency Management Agency, FEMA.
Prior to FEMA, Mr. Manning served as Director of the New Mexico
Department of Homeland Security and Emergency Management and
homeland security advisor to the Governor.
We, next, have Doug Beach, Secretary of Florida's
Department of Elder Affairs. On February 13, 2007, Governor
Crist appointed Dr. Beach as the Secretary for the Department
of Elder Affairs in Florida. He has worked on the Aging Network
for more than 12 years, most recently serving as the Chief
Executive Officer of the Seniors Resource Alliance, the Area
Agency on Aging of Central Florida, where we had an opportunity
to work together.
LuMarie Polivka-West is Senior Vice President of policy of
Florida Health Care Association. Ms. West is responsible for
the planning and implementation of long-term care related
policies and programs and staffing of the Quality Credentialing
Program and serves as the principal investigator for a John A.
Hartford Foundation Disaster Preparedness Grant.
Sandy Markwood is the Chief Executive Officer of the
National Association of Area Agencies on Aging. She has more
than 30 years' experience in the development and delivery of
aging health, human services, housing, and transportation
programs in counties and cities across the nation.
Welcome, all. We'll hear from you, Mr. Besser, first, your
statements.
STATEMENT OF RICHARD E. BESSER, M.D., DIRECTOR, COORDINATOR
OFFICE FOR TERRORISM, PREPAREDNESS AND EMERGENCY RESPONSE,
CENTERS FOR DISEASE CONTROL AND PREVENTION, ATLANTA, GA
Dr. Besser. Thank you. Good morning, Chairman Kohl, Ranking
Member Martinez, and other distinguished members.
I am Dr. Rich Besser, Director of the Coordinating Office
for Terrorism, Preparedness, and Emergency Response at the
Centers for Disease Control and Prevention. I want to thank you
for the opportunity to discuss our work to better protect the
health of older adults during emergencies, such as the current
influenza pandemic. Many of us have parents and grandparents
who rely on the help of families and communities during
emergencies. This help is critically important at this time.
The risk to older adults is serious. As was stated, more
than 70 percent of the people who died in Louisiana as a result
of Hurricane Katrina were older than age 60. Most died in their
homes, in hospitals, or nursing homes. The increased risk faced
by older adults occurs for a variety of reasons, such as health
status, reliance on supportive services, and the need for
assistance with transportation. More than 80 percent of older
adults have at least one chronic condition, such as diabetes or
heart disease. Disruptive medical and supportive services
during emergencies put older adults with chronic conditions at
especially high risk.
The Nation has made progress in protecting the health of
older adults during emergencies. For example, during the 2008
hurricane season response, many nursing homes and hospitals
were evacuated before hurricanes hit. A marked improvement
compared to the evacuation that occurred during Hurricane
Katrina.
I'd also like to mention some progress at CDC. We've
developed guidelines on the H1N1 influenza pandemic for
vulnerable populations, including older adults, and for the
clinicians who care for them. We've also engaged with tribal
nations to learn from them how to better reach older adults in
their communities to prepare for an influenza pandemic. We
support State and local public health departments in their
efforts to protect older adults during emergencies, such as
through the Public Health Emergency Preparedness Cooperative
Agreement.
Although we've made progress, more still needs to be done
to improve our ability to assist older adults during
emergencies. I'd like to highlight three main areas.
First, we must assure that healthcare is available. Public
health emergencies can cause disruptions in healthcare system,
leaving to negative health effects for older adults. We need to
enable older adults and their caregivers to have the necessary
medications to avoid exacerbations of chronic diseases and
other conditions.
Moreover, emergency shelters need to have the necessary
capabilities, supplies, and other resources to respond to the
needs of older adults and other vulnerable evacuees.
Implementing electronic health records nationwide could
help greatly. This could make it easier for older adults to
identify their medications and renew prescriptions during an
emergency, even if they're in a different city or State.
We need to focus on prevention and wellness. A healthy
community will be more resilient to the negative impact of
public health emergencies. Only about one-third of older adults
are up to date on all recommended preventive services.
Increasing the use of immunizations and other key clinical
preventive services will make our older--will make our elderly
population more healthy and better able to withstand and
recovery from the added stress of a public health emergency.
Finally, we need to better address the needs of older
adults in preparedness and response. Despite recent
improvements, community healthcare delivery systems and
supportive services still need to be better integrated into
emergency planning efforts. Protecting the health of older
adults during emergencies requires cross-sector partnerships,
strong community engagement, and a committed focus on
integrating the needs of older adults in all preparedness and
response activities. Progress is difficult, because the
economic crisis has led to job losses in public health
departments and budget shortfalls among hospitals and
healthcare systems.
In closing, preventing illness and disease are, not only
essential components of health reform, but are also critical to
our nation's overall health protection and preparedness
efforts. As Dr. David Satcher, a former CDC director and U.S.
Surgeon General, has noted, the same things that lead to health
disparities on a day-to-day basis in the United States also
lead to disparities in the negative impacts of public health
emergencies, especially for older adults and other vulnerable
populations.
We've made progress, but we still need to do more. I
believe that our nation is only as prepared as our ability to
care--to take care of older adults and other vulnerable members
of our community. We look forward to working with you to
continue to prepare the Nation to protect older adults during
emergencies.
I want to thank you again for the opportunity to share this
information with you today, and I look forward to questions.
[The prepared statement of Dr. Besser follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Martinez. Mr. Manning, we'll hear from you now.
STATEMENT OF TIMOTHY MANNING, DEPUTY ADMINISTRATOR FOR NATIONAL
PREPAREDNESS, FEDERAL EMERGENCY MANAGEMENT AGENCY, WASHINGTON,
DC
Mr. Manning. Thank you. Chairman Kohl, Ranking Member
Martinez, good morning.
I'm Tim Manning. I'm the Deputy Administrator of the
Federal Emergency Management Agency. It's a privilege to appear
before you today on behalf of FEMA and the Department of
Homeland Security. We appreciate your interest in, and
continued support of, emergency management and the unique
disaster planning requirements for those with unique needs.
Throughout history, and throughout the history of emergency
management, considerations for specific populations have been
inadequate. From the 1930's, when disaster response was largely
an ad hoc mission focused on the repair of damaged
infrastructure, through to the present day, special-needs
populations were often given insufficient consideration. This
fact is evident in the 2003 California wildfires and the--when
Hurricane Katrina devastated the Gulf Coast in 2005. During
these events, a substantial number of individuals with special
needs did not receive the appropriate warning, were unable to
access shelters, went without medical intervention, or, at
worst, perished. A subsequent review of emergency plans around
the Nation concluded that a substantial improvement is
necessary to integrate people with disabilities into emergency
planning and readiness. Indeed, the needs of all populations of
all people must be considered in planning and response.
Numerous lessons learned reported, that followed Katrina,
also identified a large segment of the U.S. population that may
not be able to successfully plan for, and respond to, an
emergency with resources typically accessible to the general
population. Our population is one that is diverse, aging, and
focused on maintaining independence as long as possible. The
popularity of living situations that provide an as-needed level
of care in the least restrictive manner is fast becoming the
norm, and consideration must, therefore, be given to people who
may not be able to function independently under normal
situations, but who may need assistance in an emergency
situation.
FEMA's working hard to ensure that its own basic planning
addresses special-need populations and that we are supporting
and assisting States, tribes, and localities in this regard. We
are also reinforcing the critical and enduring need for
personal preparedness, encouraging individuals to adequately
prepare themselves for disaster events, recognizing that better
individual preparedness translates into better community
preparedness and stronger resilience.
FEMA's directly engaged in activities that will address
special-needs populations, including the elderly, in
coordination with FEMA's Office of Equal Rights, DHS's Office
for Civil Liberties and Civil Rights, and the National Advisory
Council, as well as State, tribal, and local agencies. The FEMA
disability coordinator has built a viable network to ensure
that the needs of the elderly and persons with disabilities are
addressed during and following disasters. We are also
developing disability and special-needs subject-matter teams to
work with States during disasters in order to assure
accommodation for people with disabilities and other special
needs.
Citizen Corps is FEMA's grassroots initiative to actively
involve citizens in the security of their communities through
planning and personal preparedness. At the national level,
Citizen Corps promotes inclusion and a focus on disabilities
and the community by integrating these priorities into our
homeland security policies.
Emergency management takes into consideration planning for
the safety of every person in the community during and
following a disaster. Taking into consideration populations
historically considered vulnerable, at risk, or special needs,
ultimately improves the overall community's post-disaster
sustainability. FEMA assists States and localities with
planning guidance for State and local preparedness efforts, and
will shortly issue guidelines on these populations through its
comprehensive preparedness guide number 301, Emergency
Management Planning Guides for Special Needs Populations. This
guide, developed in collaboration with the Office for Civil
Rights and Civil Liberties, is currently available to all of
the Nation's responders and communities as an interim document.
It addresses many of the issues that will confront us in
providing care to the elderly, ensuring that our plans and our
procedures take all requirements, all needs into account.
Mr. Chairman, Ranking Member Martinez, Secretary
Napolitano, FEMA Administrator Craig Fugate, and I are
committed to advancing our Nation's preparedness. Our efforts
must begin with personal preparedness and a process of
individual thinking in consideration of basic steps that each
of us must take to help prevent and prepare for the next
disaster. All Americans must take responsibility for preparing
themselves and their families and their communities for the
next disaster. In times of crisis, government plays a critical
role in coordinating the response-and-recovery efforts,
especially in protecting and providing for our most vulnerable
populations. A government's first responsibility is to ensure
the safety and well-being of the public. We believe that that
is the cornerstone of our strategy, moving forward, and, with
the continued support of Congress, we believe that considerable
progress is within reach.
Mr. Chairman, Ranking Member, thank you, and thank you,
members of the committee, for allowing me to testify today, and
I look forward to any questions you may have.
[The prepared statement of Mr. Manning follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Martinez. Thank you very much, Mr. Manning--
Secretary Manning.
Now, we hear from Secretary Beach.
STATEMENT OF DOUGLAS BEACH, SECRETARY, FLORIDA DEPARTMENT OF
ELDER AFFAIRS, TALLAHASSEE, FL
Dr. Beach. Thank you. Good morning, Chairman Kohl, Ranking
Member Martinez. My name is Doug Beach. I'm Secretary of the
Florida Department of Elder Affairs.
Thank you, I was looking for the button.
I appreciate this opportunity to discuss ways we can best
serve older Americans before, during, and after a disaster.
As many of you know, earlier this decade Florida faced an
unprecedented onslaught from nature. We had to contend with
eight hurricanes and several additional tropical storms, all in
a 14-month period. At that time, I served as CEO of the Senior
Resource Alliance, which is the Area Agency on Aging,
stretching from Orlando to Cape Canaveral. With communications,
transportation, and just about everything else disrupted, our
team had to scramble to address the special needs of elders.
Working with Governor Crist for the last 2\1/2\ years as Elder
Affairs Secretary, I have come to appreciate that no emergency
is too small, no threat too remote, to dismiss it without doing
some planning and preparation.
The latest numbers tell us that Florida is home to 4.4
million residents 60 years of age and older. We have the
largest percentage of seniors of any State in the Nation. A
common myth is that many of these Florida elders live in
nursing homes, when, in fact, 95 percent of elder Floridians
live in the community.
Plans and procedures designed to support emergency
operations for the general population are not always
appropriate for seniors. We encourage each elder to help by
taking personal responsibility for his or her own safety.
That's why, each year, the Department of Elder Affairs
publishes a Disaster Preparedness Guide, which we've--I've
given the staff, and they can hand out. The guide offers tips,
procedures, contact numbers, and even a disaster supply
checklist, so the elders we serve, and their caregivers, can
create a plan for any kind of hazard.
It is vitally important for people to understand that they
must be prepared to survive on their own for the first 72 hours
of an emergency. Supplies and services may not be available
until first responders complete their search and rescue
missions and the community begins restoring critical services.
For seniors, being ready for a disaster is a key part of
maintaining independence. If elders and vulnerable populations
are prepared ahead of time, they will be better able to cope
and recover more quickly.
As soon as we determine that a threat is out there, the
Department of Elder Affairs establishes regular contact with
the 11 Area Agencies on Aging. The Area Agencies then work with
their local networks, everyone working together to make sure
the communities most likely to be impacted have the supplies
and resources they need.
Additionally, the Department of Elder Affairs is part of
the State Emergency Response Team, with a permanent seat in our
State Emergency Operations Center. One crucial consideration
for an elder constituency is food and nutrition. Before a
disaster occurs, Meals on Wheels clients receive a 3-day supply
of packaged meals that are specifically designed for seniors.
If evacuations become necessary, they are particularly
difficult for seniors. When seniors are forced to go without
power, they are put at a far greater risk than the average
person. For that reason, every Florida county has a special-
needs registry and special-needs shelters are in place to
accommodate elders. Even self-sufficient elders may require
special assistance during an emergency. A high-rise condo may
remain structurally sound, but a power outage could mean the
elevators don't function and the residents can't access medical
care, appropriate nutrition, and medicine. Florida now requires
that emergency generators be available to operate public
elevators in all high-rise multifamily dwellings, including
condos.
Once Florida enters a recovery phase, seniors will want to
return to their homes, but will they be able to make their way
to grocery stores, doctors' offices, and pharmacies? For that
reason, the Department of Elder Affairs has developed a Rapid-
Needs Assessment and Discharge Planning Form to help make these
determinations. Elders can successfully transition back into
the community as soon as possible, and as safely as possible.
In order to give seniors the greatest chance to come
through a disaster, the best possible physical and emotional
conditions, planners must consider their distinctive needs
beforehand. Under Governor's Crist's leadership, Florida State
agencies stand ready to assist emergency officials in each
community as we constantly strive to improve Florida's Disaster
Emergency Management Plans for elders.
I thank you for the opportunity to present this information
today on behalf of Florida's elders, and I would be glad to
answer questions at any time.
[The prepared statement of Dr. Beach follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Martinez. Thank you, Secretary.
Ms. Polivka-West, welcome, also, and we'll hear from you
now.
STATEMENT OF LuMARIE POLIVKA-WEST, SENIOR VICE PRESIDENT OF
POLICY, FLORIDA HEALTH CARE ASSOCIATION, TALLAHASSEE, FL
Ms. Polivka-West. Good morning. My name is LuMarie Polivka-
West, and I'm Senior Vice President with the Florida Health
Care Association. I also serve as Principal Investigator for
the national effort funded by the John A. Hartford Foundation
focused on hurricane and disaster preparedness and long-term
care facilities. I am here today on behalf of the American
Health Care Association, the National Center for Assisted
Living, and the 1.5 million frail older Americans who reside in
skilled nursing facilities, and the additional 1.2 million who
reside in assisted living facilities, a group particularly at
high risk during disasters.
Thank you, Chairman Kohl and Ranking Member Martinez. We
appreciate this opportunity for a national forum to discuss the
unique challenges faced by older adults in long-term care
facilities during disasters.
Hurricane Katrina focused national attention on the
disproportionate vulnerability and mortality of elders during
disasters. When Hurricane Katrina hit, only 15 percent of the
population at New Orleans were age 60 and older, yet data from
Knight-Ridder found that 74 percent of hurricane-related deaths
were in that age group.
Not all died from the disastrous flooding. Many died from
the heat, where the lack of the electricity to long-term care
facilities spoiled medications, dehydration, or otherwise
negatively impacted critical medical treatments and care
services. Some were evacuated without their life-saving
medications, and some very ill, aged individuals were
transported to other States while their medical records and
medications were left on the tarmac.
In February 2006, the John A. Hartford Foundation responded
to the events of Hurricanes Katrina, Rita, and Wilma by
supporting a Gulf Coast Hurricane Summit that identified issues
critical to improving future nursing home preparedness.
The grant aimed to improve disaster preparedness through
the development of a Disaster Planning Guide and software, and
through the training exercises for nursing homes and assisting
living facilities, and the convening of annual hurricane
summits with national dissemination of material and findings
through the American Health Care Association.
Hurricanes Charlie, Gustav, and Ike forced nursing homes to
ask an important question, Is total evacuation before
hurricanes best for residents? Preliminary analyses from a
National Institute on Aging grant with Brown University and the
University of South Florida suggests that evacuation is
difficult for nursing home residents. If the study results
continue to indicate that nursing home residents may fare
better staying in buildings that will not flood, the Federal
and State governments should help with the hardening of
physical plants to withstand the force of winds.
Due to the very vulnerable and complex populations that we
serve, it is essential that we work together with policymakers
to better prepare ourselves for a disaster. I would like to
highlight six broad areas for critical review and consideration
and better preparing and responding to large-scale disasters
and evacuations.
First, the National Disaster Medical System should be
reconfigured to support the evacuation and care of nursing home
patients, assisted living residents, and people residing in
residential care facilities for the elderly and developmentally
disabled.
Second, it is essential that we, as a Nation, finally
expedite the development of interoperable electronic health
records.
Third, the Stafford Act excludes for-profit nursing homes
that provide 80 percent of the care for nursing home residents
through publicly funded Medicare and Medicaid from receiving
Federal financial assistance during and after disasters. As a
result, three-fourths of our Nation's nursing facilities are
not eligible for this critical and necessary Federal
assistance, and, at many localities, for-profit nursing
facilities may be the only long-term care provider available.
Amending the Stafford Act through the Nursing Home Emergency
Assistance Act of 2009 would allow all the long-term care
providers access to disaster relief funding.
Fourth, we must address emergency communications and faulty
assumptions that communications in public-service
infrastructure would still be in place in the aftermath of a
disaster.
Fifth, the Federal Government agencies need to work
together in identifying requirements for long-term care
facilities and their all-hazard approaches to disaster
preparedness. For example, preparedness for the H1N1 influenza
pandemic involves the CDC, OSHA, CMS, HHS, DHS, and the State
Departments of Health.
Sixth, new protocols are necessary to improve
communications and coordination between all providers and local
State and Federal Governments with a national response
framework as the guide for planned development at all levels.
The long-term care community alone cannot protect or prepare
effectively for disasters. We must be a part of a larger
unified national response.
I would like to thank the committee for providing this
opportunity to share our thoughts. I, along with the American
Health Care Association, National Center for Assisted Living,
and the Florida Health Care Association, look forward to
continuing a positive, constructive dialog that results in the
only statistic that matters: the number of lives saved by an
intelligent, well-executed disaster plan that includes the
needs of older adults and persons with disabilities in long-
term care facilities.
Thank you.
[The prepared statement of Ms. Polivka-West follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Martinez [continuing]. Now, we hear from you, Ms.
Markwood.
STATEMENT OF SANDY MARKWOOD, CHIEF EXECUTIVE OFFICER, NATIONAL
ASSOCIATION OF AREA AGENCIES ON AGING, WASHINGTON, DC
Ms. Markwood. Thank you. Good morning, Chairman Kohl,
Ranking Member Martinez. My name----
Senator Martinez. I don't think your mike is on.
Ms. Markwood. Is it on now? Can you hear me? Great. It
works? OK.
Senator Martinez. There you go.
Ms. Markwood. My name is Sandy Markwood, and I'm the Chief
Executive Officer of the National Association of Area Agencies
on Aging. n4a represents the 629 Area Agencies on Aging, or
``triple-As,'' as we all them, and 246 Title 6 Native American
programs that, today, and every day, are assisting millions of
older adults and caregivers in communities across the country.
I want to thank the committee for inviting n4a to testify
on the issue of emergency preparedness and the ongoing efforts
of Area Agencies and Aging Services Network to meet the special
needs of older adults in advance of, during, and after a
disaster or an emergency.
As has been pointed out by the other panelists, AAAs have
found that in disasters older adults have distinct needs that
need to be present, and challenges that communitywide emergency
planning and response efforts need to address. Each stage of an
emergency during evacuations and emergency shelters or when
returning to the community needs to be handled differently when
dealing with frail older adults.
During a crisis, frail seniors may need extensive health
supports and services to survive. Many times, their needs are
too complex, serious, and individualized to be treated with a
one-size-fits-all approach that shelters and relief
organizations are able to offer as they work to serve the needs
of the broader population. Volunteers and workers unfamiliar
with older adults' needs may not recognize or know how to deal
with the important signals that would indicate a senior's state
of mind or their body. Addressing the needs of those with
chronic conditions and dementia become particularly difficult
in a disaster situation.
Providing continuity of services to older adults after
disasters as they move from shelters to temporary housing also
poses significant challenges. AAAs have experienced difficulty
locating older adults who they know need gap-filling services
due to regulations that prevent emergency response agencies
from disclosing their new location once they've moved from a
shelter to a temporary housing. AAAs have also found it
difficult to assist disaster victims in making the transition
back into the community, back into their home, due to lack of
post-disaster resources available for such necessities as
temporary housing, home repairs, and chore services.
Pulling your life back together after a disaster is
difficult for anybody of any age, but for older adults, the
challenges can be as life-altering and as life-threatening as
the disaster itself.
During last year's deadly floods in Iowa, nearly 65,000
Iowans age 60 and older requested assistance. Some of these
older adults required a wide range of supports beyond what FEMA
and other entities could offer. What we heard from our members
in Iowa is an example of the thousands of older adults that
sought AAA assistance. A typical request would come from an 88-
year-old woman who had lost everything in the flood. She would
need help securing replacement prescription medications and
other medical devices, navigating the disaster relief channels
and paperwork, including handling personal financial affairs,
especially if a family member wasn't present; managing her
activities of daily living, particularly if her regular
caregiver was displaced by the flood; and identifying
appropriate affordable short-term housing until she can return
home. Without this level of assistance, she would be forced to
move into an unwanted and expensive institutional-care
settings, many times located in another community, and, many
times, for the rest of her life.
In order to succeed as the first line of response for older
adults in disasters, the Aging Services Network must have
better access to decisionmakers to be directly involved in
long-range planning, to be at the table in order to coordinate
emergency services, and to have adequate resources, as well as
the technology and communication tools necessary, to adequately
respond to the needs of older adults.
To strengthen national, State, and local efforts to address
the needs of older adults in emergencies, n4a recommends that
the following steps be taken:
First, we need to promote, Federal, State, and local
information-sharing. There needs to be a consistent policy to
ensure that FEMA registration information for the age-60-and-
older population is shared with State units and AAAs in
federally declared disaster areas.
Second, we need to make community-level special-needs
registries a high priority. Federal grant funding should be
established through the Administration on Aging to support
community-level work by AAAs to develop emergency preparedness
registry systems for older adults and special-needs
populations, utilizing geographic mapping technology.
Third, we need to reinforce existing Federal policies to
formalize coordination plans. Using the great experience of
Florida as a national model, Congress should build on the
emergency preparedness provisions added to the Older Americans
Act in 2006 by requiring that the FEMA and other State and
local emergency preparedness agencies formalize coordination
plans with the Aging Services Network.
Fourth, create a DHS-AOA interagency education program. We
need to encourage the Department of Homeland Security and AOA
establish an interagency program that would facilitate cross-
agency training opportunities and provide the on-the-ground
orientation to both networks on how they can more effectively
work together and better utilize each other's resources during
disaster planning, response, and recovery efforts.
Also, finally, we need to urge Congress to fulfill the
promise of the Older Americans Act by funding its emergency
planning provisions, directing resources to the Administration
on Aging, State Units on Aging, and AAAs to support these
critical efforts.
After the floods in Iowa, AOA only had $50,000 of disaster
aid to distribute to 11 flood-ravaged AAAs, out of the total
disaster allocation of AOA of $300,000. This just isn't enough
resources to meet the need.
As Congress looks ahead to the reauthorization of the Older
Americans Act in 2011, we encourage policymakers to strengthen
the Older Americans Act Disaster Assistance Program.
Thank you, Chairman Kohl, Ranking Member Martinez, for
holding today's hearing and for calling the necessary attention
to the special needs of older Americans during times of
disasters. I'd be happy to answer any questions.
[The prepared statement of Ms. Markwood follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Martinez. Thank you all very, very much for your
enlightening testimony. We will have some questions now.
I want to begin with Dr. Besser. If we could ask you, where
are we on the H1N1? What are the prospects for the fall? I
think, in general, we would all, since we have you here, like
to know about this, for general population. Then if you could,
more specifically, speak to the potential for it to impact
seniors since the virus didn't seem to be affecting seniors
particularly, what are the prospects that it might come back in
a different form? Just where are we with the whole thing?
Dr. Besser. Thanks very much for that question.
Yeah, each Friday we report our domestic case totals, and,
as of June 19, there were more than 21,000 cases reported here
in the United States, and 87 deaths. I mean, as you know, on
June 11, the World Health Organization put us into phase 6 and
declared a global pandemic, which was really not an indication
that this is any more severe, but an indication that this is a
virus that is spreading easily, it's a virus for which people
don't have much in the way of immunity, and it's a virus that
we expect to continue to cause disease around the world.
We base a lot of our assumptions on what's taken place in
pandemics in the past, but it seems that the influenza virus is
extremely cagey and tends to outsmart us when we think we
understand what's happening. We would have predicted that, as
the weather has gotten hotter now, that the virus would have
gone away and that we would--that we'd be looking toward the
fall for a return of this virus. In actuality, we are still
seeing a fair amount of influenza activity around the country.
As you've been reading in the press, there have been a number
of outbreaks at summer camps that are causing a lot of
difficulty in those institutions.
There is some promising information in the area of elderly
individuals, and that is that it appears that there is some
protection. As we look at who has been most impacted by this
strain, we are seeing the--primarily, disease in younger
individuals. Only 1 percent of the cases are in persons 65
years and older; 4 percent of the hospitalizations have been in
that age. We don't know if it's from repeated immunizations
over people's lives or exposure to strains of influenza over
the course of their lives, but there is some degree of
protection.
What we've seen from previous pandemics is that viruses can
change. An influenza virus is--the reason we need a shot every
year is that there tends to be some change in the virus each
year, and we need to be protected in that manner. We're working
with the World Health Organization and other international
organizations to try and see what is happening to this virus
during the flu season that's taking place now in the Southern
Hemisphere. That will help guide a lot of what we recommend for
the fall.
There are a couple of things that we clearly recommend for
seniors for the fall. That's to get their annual flu shot, to
make sure, as well, that they have their pneumonia shot. Each
year, only two-thirds of seniors get their flu shot, and
slightly more than half get their pneumonia shot, or have had a
pneumonia shot. Those are things that, regardless of whether
there's a pandemic, are very important to do. Each year, on
average, 35--36,000 Americans die from influenza, and that's
primarily an issue in those with underlying medical conditions
and the elderly. So, even if this pandemic does not affect the
elderly disproportionally, it's very important that the elderly
are protected against seasonal flu.
Senator Martinez. So, at a minimum, if we can take a
message from your comments for seniors specifically, get a flu
shot and get a pneumonia shot, particularly this season.
Dr. Besser. Yes, sir. Yeah, those are very important. Then,
understand where you need to get your information. Because it
may be that this virus changes in the Southern Hemisphere, and
it may be that seniors are one of the groups for whom the new
vaccine might be recommended. At this point, studies are going
to be done to look at a new vaccine, and then the
administration will determine whether or not to recommend
vaccination for either high-risk individuals or others.
Senator Martinez. Thank you.
Secretary Beach, if we can turn to other types of
disasters, I know we've, in Florida, as you testified, dealt
with the hurricane problem, also--I believe it was Ms.
Markwood--talked about the floods. Can we focus on those issues
now and what level of preparedness you think exists across
Florida that the Nation could also look to as a model, or
benefit from?
Dr. Beach. I think one of the things that we do in Florida
that's particularly unique is, we do a lot of practicing. We
bring together folks--tend to be two or three times a year,
typically led by county Emergency Operations Centers,
bringing--make sure that all the partners for disability
groups, senior groups, and the like, have a plan in place, can
identify who the special-needs folks are on their registry,
and, most importantly, have a way to coordinate with some of
the outreach organizations.
When you were mayor in Orlando, Orange County, you put
together an Interim Commission on Aging, and one of the things
that came out of that Interim Commission on Aging was a 2-1-1
system for Brevard, Orange, Osceola Counties. The advantage of
2-1-1 was how we could disseminate that information over a
broad number of people very, very quickly. I think once you
coordinate the 2-1-1 system with aging and disability resource
centers, which are funded at the Federal level, which we have
in each Area Agency on Aging in Florida, it enables us to get
the process jumpstarted and at least have a plan in place
before anything happens.
Senator Martinez. Ms. Polivka-West, if we can ask you--fit
into the picture of both the potential for a flu pandemic
situation that could impact seniors, as well as just plain
natural disasters, how are we doing? The whole issue of command
management for nursing homes, and how are those going to impact
our preparedness in the future?
Ms. Polivka-West. Well, again, I would use the model of
Florida, in terms of an all-hazards approach to disaster
preparedness planning and response and recovery. At the heart
of that is the inclusion of long-term care in the State's
emergency response system. This is what we recommend for the
national--the Federal system to include--long-term care, the
vulnerable populations that reside in skilled nursing
facilities and assisted living facilities, as a part of the
national response framework. They are not included, at this
time.
So, I go back to how we're doing--our disaster preparedness
planning in Florida--for example, for the hurricane season,
that we've now begun. We have started our drills. We work with
our local Emergency Operations Centers at the--each local
level. We have a seat at the table with the EOC. At the State
level, we have a desk. That's Florida Health Care Association's
desk--at the Emergency Operations Center. This started with
Craig Fugate, when he was at--with the Emergency Management
Operations. We work very closely with our Emergency Support
Function 8, the Health Desk, and we coordinate with other parts
of the emergency management system.
But, what we've learned, after the hurricane season of 2004
and 2005, is that we had to be there, because that was the way
we got to the power companies for power restoration. Long-term
care is not a prioritization for power restoration. We have the
same priority as the convenience store. So--unlike hospitals--
and so, we have to be there. We have to tell them what kind of
vulnerable populations we have on ventilators, on oxygen. They
have--our frail, vulnerable elders have to be served. So, we
know we can do it in Florida, we know we can do it at the
rest--with the rest of the country, but we have to do it State
by State at this point, because we are not a part of that
national response framework, at this time.
Although I would like to give credit to HHS's Assistant
Secretary for Preparedness and Response, because they have
included us through the American Health Care Association in
their gap analysis and planning.
Senator Martinez. That's great. I don't think there's any
question that having a desk at the EOC makes an incredible
difference. I think----
Ms. Polivka-West. It does.
Senator Martinez [continuing]. It really has been--in my
former experience as mayor, you can really see a difference
when someone is at the desk and they are part of the whole
operation. It makes a difference.
Mr. Chairman, I think I'll cede to you and maybe come back
for a question or two.
The Chairman. Mr. Manning, you spoke about the importance
of personal preparedness among seniors prior to a disaster. Can
you describe some of the things that seniors living at home
need to do to be prepared?
Mr. Manning. Thank you, Mr. Chairman. Certainly.
Having a prepared and--having a population that is
expecting a disaster, that has taken those steps around their
home and in their community and working with their neighbors to
ready themselves for a disaster can lead to a community that is
more resilient and may not require the assistance of government
in the first place. If we can prevent a disaster from
becoming--a bad event from becoming a disaster, then we've
solved the problem before we even gotten there.
Some of the specific things that can be done around the
home include having a--having--something as simple as having
communication plans among homeowners--I mean, among the
household members, among neighbors in a higher density living
environment, where people understand that, once they've assured
that they themselves are OK and that their spouses, their
family members are OK, that their first responsibility should
be: check on their neighbors. As we can develop planning and a
capacity of community within a neighborhood, that is something
that will go a long way toward providing a more robust
community resilience.
Other things that could be done in a home is having--we've
said over and over again, having 3 days of food and water,
having supplies prepared in your home, in your facility, so
that you don't need to require--you don't require the
assistance of government, in the short term, which may not be
able to get there. But, it's important to also recognize that
many people aren't able to do that, that having--saying having
food and water for 3 days is a good thing, but many individuals
aren't exactly sure where they're going to get dinner tonight,
much less where--having 3 days on hand. We have to keep--we,
those that plan for disasters, have to keep that in mind, as
well.
The Chairman. Thank you.
Ms. Markwood, whether it's providing a ride to the pharmacy
or delivering meals, local aging service providers are on the
front line, meeting the needs of seniors. You recommend that
DHS and the Administration on Aging work together to include
local entities in planning for emergencies. Can you speak a
little bit more about that?
Ms. Markwood. Senator Kohl, what we see is the need for all
of the coordination--and I do believe that Florida is a
terrific model, because you've had to be, because you've
experienced so many disasters--it's bringing together Homeland
Security, bringing together emergency planning and preparedness
with Health and Human Services to make sure that those critical
needs are met. Oftentimes, that takes cross-training.
Again, in looking at emergency preparedness organizations,
they have to meet the needs of the broader-based population.
What you've heard today in the panel is the needs of older
adults, especially those frail older adults, is different, and
it needs to be--there needs to be cross-training to make sure
that they can recognize the needs of older adults, not only
those physical needs, but also recognizing the dementia, and
there other issues, cognitive needs, that are there, as well,
and also to do the cross-training and coordination so that
those needs get met. In looking at that, it is important to
make sure, as well, that resources are shared among those
agencies at the local level.
Ultimately, it comes down to what happens on the ground at
the local level, and there needs to be cross-training and
coordination to make sure that the needs of older adults are
met in those situations.
The Chairman. Thank you.
Ms. Polivka-West, we all understand that, during mass
evacuation times, the readiness and availability of vehicles to
transport seniors is critical, and, without it, we can't get
the job done. Would you talk about that and what your thoughts
are on whether we're prepared and how we deal with that?
Ms. Polivka-West. We consider transportation to be our
Achilles heel in disaster preparedness for long-term care. In
fact, we've helped two transportation summits at the national
level with the motor carriers--the American Bus Company,
Trailways--the major carriers with the American Health Care
Association and National Center for Assisted Living--to address
the problems, in terms of the lack of transportation when it's
needed. Because of competing priorities with populations to be
served, we know, through Hurricane Charlie, what happened when
that went through Port Charlotte. All of the ambulances were
taken by the hospitals; there were none left for other assisted
living facilities or nursing homes. So, we had to pull in
transportation from the northern part of the State, and it took
many hours to get them down into South Florida. So, we learned
from those experiences, that we had to have a template for
transportation providers. We have to have redundancy in
transportation planning. We have to--we advise facilities to
have three providers with contracts, and to ensure that they
renew those contracts each year. But, even then, we know there
could be problems, because--and you never have enough
transportation potential for a huge disaster. We know this. So,
that's why we're focusing on hardening facilities, the physical
plants. We wish that you would get the banks to let up on some
of that money that we've given so that we could have some
physical plant hardening with facilities--that's just an
aside--in terms of disaster preparedness.
But, the profit margins are very lean with long-term care
providers, because they get primarily Medicare and Medicaid
funding. But, these plants, these physical plants, need to be
hardened in order to shelter in place as much as possible so
you don't need transportation for evacuation, except when you
know you've got surge zones that you have to protect or
during--if the--for example, if you have earthquakes and you
have to move populations, you're going to have to have
transportation to be aware of what the needs are of our
vulnerable elder adults. We're doing that through the American
Health Care Association, the transportation summits that
started in Florida 3 years ago.
The Chairman. Thank you.
Mr. Chairman.
Senator Martinez. Well, I want to come back to the health
issue, and maybe just ask you, Dr. Besser, but others on the
panel, perhaps to comment.
If a health emergency were to arise that really impacted
seniors, how do all of these various agencies that are here
today and all the things that we've done to prepare for natural
disasters, how prepared are we to deal with a health emergency,
as opposed to a natural disaster or--a typical natural-disaster
type of emergency?
Dr. Besser. We have taken an all-hazards approach to
preparedness, as was mentioned earlier. There has been an
enormous investment over the past 5, 6 years, in public health
emergency preparedness. This has led to great improvement in
the ability of public health to engage with the various
communities.
We know that, in the setting of an emergency, whether it's
a natural disaster, whether it's a new emerging infection or
whether it's something deliberate, the coordination that takes
place at the local level is a key success factor. What the
resources that have gone to public health have allowed is for
public health to make those introductions now, to be part of
planning at the local level. We're hearing about some planning
efforts that need to be enhanced. That's true across the
country.
One of my concerns, in terms of that, is that we hear from
public health that the economy is leading to massive layoffs in
public health. Over 11,000 people, according to the Association
of State and Territorial Health Officers, are losing their jobs
at the State and local level in public health. That will have
consequences in the setting of a disaster.
We partner with the American Red Cross. We work very
closely with FEMA and others in DHS on planning. But, the work
that we do at the national level is only as good as the systems
that are in place at the local level.
Florida is clearly a gold standard, and that's because they
have the opportunity to exercise every year and respond every
year because of hurricanes. Other parts of the country don't
have that experience and really rely on the resources that they
get to do the exercising, the planning, the improvements in
their plans on a regular basis.
Senator Martinez. Thank you.
Any other comments? Yes, Secretary Beach?
Dr. Beach. Thank you. We do a lot of tests to see how
responsive we'll be. As an Area Agency on Aging Director, we
did a pandemic flu test of the EOC, Emergency Operations
Center, in Brevard and in Orange County. As Secretary, we've
also had a dry run on a terrorist attack in Tallahassee, as
well as a pandemic flu issue in the State of Florida. What we
find out--much of it came through Craig Fugate's leadership--
but, we find out, just by going through those tests, those dry
runs, so to speak, and making sure that everybody's
coordinated, at the end of the day. We know that 10 minutes
into an emergency, most of our plans will go out the window.
But, in any case, at least we're--we've planned, and at least
we have some sort of idea as to what we want to do and how we
want to do it.
Senator Martinez. Well, one last thing I would say is also
in terms of Florida's success with natural disasters, it's
relying on the local situation for the first 72 hours, because,
you know, Federal response is always going to be coming after.
I know you and I talked yesterday about the importance of that,
and I wonder if you might comment on that, as well.
Dr. Beach. Yes. During Fay, the Surgeon General and I
traveled up and down the East Coast from Port St. Lucy all the
way up to Jacksonville, and we went to each of the EOCs, the
counties that it affected during that tropical storm, terrible
flooding during that tropical storm. The EOC directors were
very kind to us, but we got the feeling that they kind of
wanted to elbow us out there, because they had some pretty
important business to do and we were in the way.
But, at the end of the day, what we find in Florida is
that, during preparation, the State Unit on Aging, Federal
partners, are very, very important in the preparation stage.
But, once the 72-hour period comes into play, it's all county
folks and first responders, as well as local providers, in how
they get out there. Then, after the first 72 hours, then we can
come in with, not only our State resources, but Federal
resources, to try to do the cleanup and make sure that
everybody is in the right place at that time.
Senator Martinez. Do you have anything else?
Well, thank you all very, very much. I think one of the
real takeaways, for me, is the fact that nursing homes are not
prioritized in restoring power. I think that's something that
really ought to be highlighted as a flaw in the system, because
when you restore hospitals, obviously they should be at the top
of the list, but very close thereafter should be nursing homes.
That ought to be way ahead of the convenience store down the
street.
We require generators now at our gas stations in Florida.
Obviously, there are other places that also should probably
have power to be able to take care of themselves for the first
24 hours or so. So, that's another consideration, as well.
But, this is all very important, and I appreciate all of
you highlighting it to us. For us Floridians, this is the
beginning of hurricane season, so this always highlights for us
the need for personal preparedness, for people to take matters
into their own hands, have a personal plan of how they would
cope with an emergency. Then, beyond that, for all our
governmental agencies to continue to do the great job that they
do.
As we talk about our national situation, I do hope that we
will keep an eye on the H1N1 and hope that this fall we will
not be in a bigger problem, but also preparing ahead of time,
and having, particularly, seniors get a flu shot and a
pneumonia shot sounds like good advice, as well.
OK, well, thank you very much.
This concludes the hearing. We're adjourned.
[Whereupon, at 12:17 p.m., the hearing was adjourned.]