[Senate Hearing 117-136]
[From the U.S. Government Publishing Office]


                                                       S. Hrg. 117-136

                     INCLUSIVE DISASTER MANAGEMENT:
                        IMPROVING PREPAREDNESS,
                         RESPONSE, AND RECOVERY

=======================================================================

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS


                             FIRST SESSION

                               __________

                             WASHINGTON, DC

                               __________

                           NOVEMBER 18, 2021

                               __________

                           Serial No. 117-10

         Printed for the use of the Special Committee on Aging
         
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        Available via the World Wide Web: http://www.govinfo.gov
        
                              __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
46-553 PDF                 WASHINGTON : 2022                     
          
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                       SPECIAL COMMITTEE ON AGING

              ROBERT P. CASEY, JR., Pennsylvania, Chairman

KIRSTEN E. GILLIBRAND, New York      TIM SCOTT, South Carolina
RICHARD BLUMENTHAL, Connecticut      SUSAN M. COLLINS, Maine
ELIZABETH WARREN, Massachusetts      RICHARD BURR, North Carolina
JACKY ROSEN, Nevada                  MARCO RUBIO, Florida
MARK KELLY, Arizona                  MIKE BRAUN, Indiana
RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                     MIKE LEE, Utah
                                     
                              ----------  
                              
                 Stacy Sanders, Majority Staff Director
                 Neri Martinez, Minority Staff Director
                         
                         C  O  N  T  E  N  T  S

                              ----------                              

                                                                   Page

Opening Statement of Senator Robert P. Casey, Jr., Chairman......     1
Opening Statement of Senator Tim Scott, Ranking Member...........     3

                           PANEL OF WITNESSES

Sue Anne Bell, Ph.D., Assistant Professor, School of Nursing, 
  University of Michigan, Ann Arbor, Michigan....................     6
Wanda Spurlock, Ph.D., Professor, College of Nursing and Allied 
  Health, Southern University and A&M College, Baton Rouge, 
  Louisiana......................................................     7
Randy Creamer, Vice Chairman, South Carolina Voluntary 
  Organizations Active in Disaster (VOAD), Columbia, South 
  Carolina.......................................................     9
Danielle Koerner, Volunteer Management Coordinator, Delaware 
  County Department of Emergency Services, Rutledge, Pennsylvania    11

                           CLOSING STATEMENT

Closing Statement of Senator Tim Scott, Ranking Member...........    30

                                APPENDIX
                      Prepared Witness Statements

Sue Anne Bell, Ph.D., Assistant Professor, School of Nursing, 
  University of Michigan, Ann Arbor, Michigan....................    35
Wanda Spurlock, Ph.D., Professor, College of Nursing and Allied 
  Health, Southern University and A&M College, Baton Rouge, 
  Louisiana......................................................    43
Randy Creamer, Vice Chairman, South Carolina Voluntary 
  Organizations Active in Disaster (VOAD), Columbia, South 
  Carolina.......................................................    52
Danielle Koerner, Volunteer Management Coordinator, Delaware 
  County Department of Emergency Services, Rutledge, Pennsylvania    54

                        Questions for the Record

Sue Anne Bell, Ph.D., Assistant Professor, School of Nursing, 
  University of Michigan, Ann Arbor, Michigan....................    59
Wanda Spurlock, Ph.D., Professor, College of Nursing and Allied 
  Health, Southern University and A&M College, Baton Rouge, 
  Louisiana......................................................    63
Randy Creamer, Vice Chairman, South Carolina Voluntary 
  Organizations Active in Disaster (VOAD), Columbia, South 
  Carolina.......................................................    67
Danielle Koerner, Volunteer Management Coordinator, Delaware 
  County Department of Emergency Services, Rutledge, Pennsylvania    67

 
                     INCLUSIVE DISASTER MANAGEMENT:
                        IMPROVING PREPAREDNESS,
                         RESPONSE, AND RECOVERY
                         
                              ----------                              


                      THURSDAY, NOVEMBER 18, 2021

                                       U.S. Senate,
                                Special Committee on Aging,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:32 a.m., via 
Webex and in room SD-562, Dirksen Senate Office Building, Hon. 
Robert P. Casey, Jr., Chairman of the Committee, presiding.
    Present: Senators Casey, Gillibrand, Blumenthal, Rosen, 
Kelly, Warnock, Tim Scott, Braun, and Rick Scott.

                 OPENING STATEMENT OF SENATOR 
                 ROBERT P. CASEY, JR., CHAIRMAN

    The Chairman. The hearing will come to order. Today's 
hearing will examine gaps in disaster management that cause 
people with disabilities and older adults to be overlooked. 
Whether it is hurricanes or wildfires or the next pandemic, 
people with disabilities and older adults must have a seat at 
the planning table.
    This hearing is particularly timely for a state like 
Pennsylvania which has suffered through devastating floods and 
tornadoes just this summer, spawned by the remnants of 
Hurricane Ida, of a record-setting Atlantic hurricane season, 
part of a record-setting hurricane season. This hearing also 
comes after more than 190 nations reaffirmed their commitment 
to take into account the needs of people with disabilities at 
the Glasgow Summit on Climate Change.
    People with disabilities and older adults are often the 
ones hardest hit by disasters, but they are not given a voice 
in the management process. The 2018 Camp Fire in California 
serves as a stark reminder of this fact. The Los Angeles Times 
reported shortly after that fire that 53 of the 69 deaths--53 
of 69 deaths--were to people over the age of 65.
    To ensure the safety of people with disabilities and older 
adults, they must be included in each phase of disaster 
management. That means in the preparation phase, response 
phase, the recovery and mitigation efforts that are undertaken.
    That is why I have introduced a piece of legislation to 
deal with some of these issues. It has got a long name, the 
Real Emergency Access for Aging and Disability Inclusion for 
Disasters Act, or the REAADI Act, R-E-A-A-D-I, REAADI. This is 
Senate Bill 2658.
    This bill would ensure that people with disabilities and 
older adults have a voice at every stage of disaster 
management. It would require accessible information about 
planning for disasters, making sure that that information is 
available to everyone, including those with disabilities. It 
would make sure that shelters and temporary housing are 
accessible to older adults and people with disabilities.
    It is not only natural disasters we need to be concerned 
with. The COVID-19 pandemic has made it clear that disasters 
are not limited to weather events. Roughly one quarter of the 
760,000 deaths during this pandemic have been in nursing homes 
or other long-term care facilities, where most residents are 
older adults or people with disabilities.
    The bottom line is we must continue to invest in bold 
policy solutions to save lives and strengthen communities. The 
Build Back Better Bill will include a once-in-a-generation 
expansion of home-and community-based services. It is based 
upon a bill that I introduced, the Better Care Better Jobs 
Bill. What we are trying to do there is to create better jobs 
for those who are doing this important work, home-and 
community-based services work, better care for seniors and 
people with disabilities who are served, and better support for 
family caregivers. These investments will mean better 
preparation for disasters and emergencies.
    Today we will hear testimony how better access to home-and 
community-based services can help save lives during a disaster. 
We will also hear crucial testimony that people affected by 
disasters need to maintain their health care throughout the 
response and recovery phases of disaster management.
    The Build Back Better legislation and the recently passed 
Infrastructure Bill will make historic investments in reducing 
the speed and effects of climate change. All of these bills are 
a recognition of what the science is telling us, that climate 
change is causing natural disasters the likes of which we have 
never seen before.
    Unprecedented weather, health, and manmade disasters make 
it necessary to have a whole-community approach to emergencies. 
People with disabilities and older adults must have a seat at 
the table when we are doing that planning. As we often hear, 
representation matters, and in disability and aging communities 
there is an old expression, ``Nothing without us that is about 
us.'' ``Nothing about us without us.'' That should hold true 
for disaster planning as well.
    I want to say to the Ranking Member, Ranking Member Scott, 
before I turn to him, I am happy to join you, Senator Scott, on 
your bipartisan FEED Act, Senate Bill 19, which would make it 
easier for small and mid-sized restaurants to provide 
nutritious meals to people during disasters.
    Senator Tim Scott. Thank you, Mr. Chairman.
    The Chairman. I thank you and thanks for introducing the 
bill. With that, I will turn to Ranking Member Scott for his 
comments.

                 OPENING STATEMENT OF SENATOR 
                   TIM SCOTT, RANKING MEMBER

    Senator Tim Scott. Thank you, Mr. Chairman, first for your 
leadership on this Committee and second for joining the FEED 
Act, a very important piece of legislation that will help us 
tackle the challenges of food insecurity, especially during the 
height of disasters.
    Thank you to our witnesses for being with us today.
    Older Americans and people with disabilities are more 
vulnerable to natural disasters, and we must do everything we 
can to protect them.
    Mr. Chairman, I recognize how hard Hurricane Ida hit your 
State in September and how Pennsylvanians responded as they 
always do, with courage and with strength.
    The Palmetto State, we are all too familiar with floods, 
hurricanes, and other natural disasters. Like so many other 
South Carolinians, I will never forget the 1,000-year flood in 
2015. After those floods, we were hit the next year by 
Hurricane Matthew. We experienced tragedy and triumph.
    Folks like Janice and Gene Davis, a wife and husband in 
Hilton Head, represent the strength of South Carolinians during 
a response to a natural disaster. Gene owned an auto painting 
business. Janice was a caregiver to Jo Scott, an 88-year-old 
widow. When it became unsafe for Jo to stay home, Janice and 
Gene drove through the storm to pick her up. With the power 
out, streets flooded, and trees down, they drove Jo to her 
son's home in St. Louis, Missouri, more than 800 miles away.
    South Carolina has proven a leader in disaster management. 
The University of South Carolina's Hazards & Vulnerability 
Research Institute developed a tool that estimated a county's 
vulnerability to disaster. The tool, the Social Vulnerability 
Index, includes elderly persons and individuals with special 
needs. The Index now includes all counties in the United 
States, and FEMA has adopted in it in their National Risk 
Index.
    The first step in effective disaster management is, of 
course, prevention. That is why I introduced bipartisan 
legislation with Senator Schatz, the Repeatedly Flooded 
Communities Preparation Act. This seeks to provide more 
resources to those areas of our Nation that consistently and 
continuously flood. They are flood-prone communities. The 
legislation would break the costly cycle of repeated flooding 
and building by providing our communities with the tools to 
take proactive steps to reduce flood risk and safeguard homes 
and businesses.
    Even the best preparation cannot stop every disaster. Once 
a disaster happens, we also need solutions to assist in those 
communities. That is why I introduced the FEED Act with Senator 
Murphy from Connecticut. I am very thankful that our Chairman 
has joined the FEED Act. The FEED Act would increase food 
security for older Americans and others during emergencies by 
opening up a pathway for food producers, restaurants, and 
nonprofits to partner with their State and local governments to 
meet the needs on the ground. It is through reforms like the 
FEED Act that we are able to assist local communities in the 
midst of a disaster.
    Last, we must also continue to work to improve post 
disaster recovery. In South Carolina, as in many southern 
states, heirs' property is passed down by inheritance. In the 
wake of disasters, FEMA regulations have reflected unjust 
discrimination against those heirs who are disproportionately 
poor and minorities because they simply cannot afford to clean 
the titles. Clear the titles. These homeowners have been ruled 
ineligible for the disaster assistance they should receive. 
This resulted in FEMA denying twice as many requests for 
disaster aid in majority minority counties as the national 
average.
    In August, Senator Ossoff and I sent a letter to Homeland 
Security Secretary Mayorkas, urging FEMA to review and revise 
its practices. As a result, FEMA changed its policies in 
September. FEMA will now accept a broader range of 
documentation to prove home ownership and occupancy, such as 
receipts for home repairs or improvements, a long overdue 
correction of something that was simply not right. I am pleased 
with this progress and urge FEMA to do more to better support 
people in rural areas.
    The poorest homeowners, often in rural America, receive 
half of what wealthier homeowners do in home repair assistance. 
There is a l7-point gap between the denial of aid for higher 
income owners versus poorer homeowners, who tend to live in 
rural places like rural South Carolina.
    FEMA accepts 90 percent of disaster requests of $7.5 
million or more compared to just 6 percent for requests of $1.5 
million or less. While damages in more urban areas often easily 
reach $10 million, larger amounts of damage in rural areas do 
not often meet that total.
    I look forward to working with you, Mr. Chairman, as we 
look for ways to help our seniors weather the storm and be 
better prepared for the outcome that will be positive, 
especially for those who are also with special needs and 
disabilities. Thank you, Mr. Chairman.
    The Chairman. Thank you, Ranking Member Scott.
    It is Thursday, because we have got a lot going on, there 
will be Senators in and out of this hearing and juggling 
hearings. I know the Ranking Member is one of those Senators 
having to juggle two big hearings.
    We were joined, and have been joined, by Senator Braun of 
Indiana, Senator Rosen of Nevada, and Senator Rick Scott of 
Florida.
    Let me turn now to our witnesses. I will introduce them one 
after another before their testimony, but our first witness is 
Dr. Sue Anne Bell. Dr. Bell is an assistant professor at the 
University of Michigan, where she focuses her research on how 
disaster preparedness at the Federal, State, and local levels 
can affect individual health outcomes following disasters. She 
is also a nurse, scientist, and family nurse practitioner who 
has worked on the ground responding recently to Hurricane Maria 
and, of course, the COVID-19 pandemic.
    Thank you, Dr. Bell, for being with us today and sharing 
your expertise with the Committee.
    Our second witness is Dr. Wanda Spurlock, a professor in 
the College of Nursing and Allied Health and Southern 
University and A&M College in Baton Rouge, Louisiana. Dr. 
Spurlock recently served as co-chair of a national policy 
expert roundtable on emergency preparedness for older adults. 
Her research focuses on disaster preparedness, response, and 
recovery for older adults, including the role of family 
caregivers and skilled nurses in disaster management.
    Thank you, Dr. Spurlock, for being with us today and 
sharing your expertise with the Committee.
    For witness number three, I will turn to Ranking Member 
Scott to introduce our next witness.
    Senator Tim Scott. Thank you, Mr. Chairman. It is my 
pleasure to introduce today Randy Creamer of Columbia, South 
Carolina. Randy is Vice Chairman of the South Carolina 
Voluntary Organizations Active in Disaster, known as VOAD. He 
is also the Director of Disaster Relief for the South Carolina 
Baptist Convention and member of the VOAD in the Palmetto 
State. For over three decades, Randy has served on the front 
lines to help respond to disasters in South Carolina and around 
the country.
    Randy serves with the South Carolina VOAD Executive 
Committee to enhance coordination among dozens of voluntary 
organizations including Habitat for Humanity, the Salvation 
Army, and the American Red Cross. South Carolina VOAD is an 
affiliate of the national VOAD, which is an association of 
nonprofit and voluntary organizations striving to mitigate and 
alleviate the impact of disasters. Many American companies and 
corporations are partners and supporters of this network. South 
Carolina VOAD member organizations cover a broad range of 
missions and technical expertise. Volunteers lead in many 
aspects of disaster response and recovery, from preparing meals 
and starting amateur radio operations to removing debris and 
building new homes.
    Randy's testimony today will discuss the role of voluntary 
organizations in disaster relief and lessons learned from his 
decades of experience.
    Randy, we appreciate your leadership and hard work to help 
improve disaster relief for South Carolinians and your 
neighbors. Thank you for being with us here today. We look 
forward to your testimony.
    The Chairman. Thank you, Ranking Member Scott. Our final 
witness is Ms. Danielle Koerner from Rutledge, Pennsylvania. 
Ms. Koerner has experience with disaster management in many 
different ways. She is, first of all, the mother of Joseph, a 
9-year-old who lives with a disability, and previously she 
cared for her mother with early onset Alzheimer's. Ms. Koerner 
is also the Volunteer Management Coordinator for the Delaware 
County Department of Emergency Services in Pennsylvania, in 
southeastern Pennsylvania.
    I want to thank Ms. Koerner for being with us today and for 
sharing her expertise with the Committee.
    Now we will proceed to our witness statements. We will 
begin with Dr. Sue Anne Bell.
    Dr. Bell, you may begin.

          STATEMENT OF SUE ANNE BELL, Ph.D., ASSISTANT

            PROFESSOR, SCHOOL OF NURSING, UNIVERSITY

                OF MICHIGAN, ANN ARBOR, MICHIGAN

    Dr. Bell. Chairman Casey, Ranking Member Scott, and 
distinguished members of the Committee, it is an honor to 
testify before you today regarding inclusive disaster 
management. I am grateful for the opportunity to address this 
Committee and appreciate your continued support of this 
critical issue that affects older adults and people with 
disabilities.
    Let me state at the outset that the way we currently 
mitigate, prepare for, respond to, and recover from disasters 
is not inclusive or equitable. In this testimony, I will 
describe that older adults and people with disabilities remain 
disproportionately affected by disasters, that disruptions in 
access to health care and necessary supports are a critical 
need to be addressed in inclusive disaster management, that 
strategies to promote aging in place throughout the phases of a 
disaster can better support older adults, and that a whole 
community approach to disasters is essential.
    I am a researcher who studies disasters and health, 
focusing on how to promote healthy aging in the face of an 
increasing number of disasters. I am also a nurse practitioner 
by training, and I regularly deploy to disasters across the 
U.S. I witness firsthand the effects of the disasters I study, 
the challenges of healthy aging during and after a disaster, 
and the consequences of these events on individuals and 
communities. Much of my work is focused on supporting 
individuals with health care needs throughout a disaster.
    In my experience providing health care in Puerto Rico after 
Hurricane Maria, you might think that I treated injuries or 
provided some kind of emergency care. In actuality, though, the 
majority of the patients I treated were there for basic primary 
care and management of chronic health conditions--diabetes, 
high blood pressure, and kidney disease, for example, 
conditions that require and benefit from regular and sustained 
access to health care.
    When communities are disrupted by a disaster, so are the 
supports for those that live there and the normal patterns of 
functioning in those communities. The loss of basic 
infrastructure such as electricity or transportation can cause 
serious care interruptions, especially access to health care, 
which can have long-lasting health effects, especially for 
those with chronic conditions.
    Our team published a study that looked at how this 
disruption affects long-term health through the lens of cancer 
care, and we found that people with a cancer diagnosis who 
lived through Hurricane Katrina died at a significantly higher 
rate than people with the same characteristics and types of 
cancer who did not live through a hurricane. Our takeaway was 
that it was not the hurricane itself but, rather, the lack of 
access to health care and normal patterns of healthy living 
after the disaster that contributed to the greater rate of 
deaths.
    Inclusive disaster management should include promoting 
aging in place throughout the phases of a disaster, with the 
goal of supporting older adults to stay in their preferred 
living environment. In our study of home health agencies 
affected by Hurricane Harvey in Texas, 76 percent reported a 
disruption in services despite that 99 percent of agencies 
reported having the required emergency preparedness plans in 
place. Nearly half of the disruptions of care services lasted 1 
week or longer.
    We have also studied older adults' preparedness through a 
large national poll. Participants reported feeling confident 
that they were ready to address a disaster but also reported 
low levels of preparedness actions, the actual steps to be 
ready for a disaster, like having an evacuation plan or putting 
together a disaster preparedness kit. Critically, among older 
adults who rely on electrical medical devices, that is, 
nonbattery-operated medical devices such as an oxygen 
concentrator, only one in four had an alternative power source 
such as a generator.
    I and my colleagues have also learned from home-based care 
providers who have worked through recent disasters, including 
Hurricanes Harvey and Irma and now the COVID-19 pandemic. Some 
of our findings are that home-based care represents an 
excellent insertion point to support readiness and to provide 
older adults with the tools they need to protect their health 
during an emergency.
    We also found that home-based care is frequently not 
included as part of the health care response to disasters, 
where the focus is on hospitals and nursing homes. Home-based 
care organizations reported feeling left on their own to care 
for patients after disasters, where patients would be left on 
their own if home-based care was not available. Including home-
based care organizations as a partner in emergency preparedness 
planning is essential.
    Inclusive disaster management must include systems for 
continuity of care throughout all phases of a disaster, and 
that starts with strengthening relationships in the whole 
community among emergency managers, health care coalitions, 
aging organizations, home-based care providers, to name a few, 
and most importantly, including the voices of older adults and 
people with disabilities centered as the key stakeholders.
    Thank you again for the opportunity to participate in 
today's hearing.
    The Chairman. Dr. Bell, thank you for your statement.
    Before we introduce our next witness, I also want to 
acknowledge we have been joined by Senator Warnock of the State 
of Georgia.
    Next we will turn to Dr. Spurlock.
    Dr. Spurlock, you may begin.

         STATEMENT OF WANDA SPURLOCK, Ph.D., PROFESSOR,

         COLLEGE OF NURSING AND ALLIED HEALTH, SOUTHERN

       UNIVERSITY AND A&M COLLEGE, BATON ROUGE, LOUISIANA

    Dr. Spurlock. Thank you, Chairman Casey, Ranking Member 
Scott, and distinguished members of the Senate Special 
Committee on Aging for affording me the opportunity to speak 
with you today. My name is Dr. Wanda Raby Spurlock, and I am a 
professor of nursing at Southern University and A&M College 
located in Baton Rouge, Louisiana.
    For over 2 years following Hurricane Katrina, my School of 
Nursing delivered primary health care services at one of the 
largest FEMA transitional trailer sites in the State. Based on 
our unique experiences, I will highlight a few of the important 
issues that were evident and that impact the well-being of 
older adults and persons of disabilities when confronted with 
major disasters.
    Timely access to medical and support services following a 
disaster is critical. However, treatment for chronic 
conditions, such as hypertension and diabetes, can often be 
delayed for period of time, leading unfortunately to poor 
health outcomes. Many older adults had lost their assistive 
devices and home equipment needed to monitor and treat various 
medical conditions. In addition to being separated from prior 
systems of health care, these evacuees were also separated from 
their social support networks, including family and friends, 
some of whom had been evacuated to other states. Our work has 
revealed that most evacuees did not have an emergency plan in 
place in the event of a disaster, highlighting the need for 
more targeted work in this area.
    Detailed information about the School of Nursing's role in 
delivering health care following Katrina can be found in the 
publication by Spurlock, Brown and Rami, ``Delivering Primary 
Health Care to Hurricane Evacuees: The Role Schools of Nursing 
Can Play,'' published in the American Journal of Nursing.
    Based on my experiences in the disaster arena, the 
following key issues are paramount regarding older adults and 
persons with disabilities and should be addressed in disaster 
planning, funding, and policy decisions:

    1. Effective and holistic planning is critical to the 
success of disaster response and recovery, the full inclusion 
of older adults, disabled persons, and others with access and 
functional needs is necessary to mitigate the impact of 
disasters on these vulnerable populations.
    2. Access to health care and other supportive services is 
critical following a major disaster, especially when evacuees 
are forced to relocate to other states, thereby risking the 
loss of desperately needed long-term care services and 
supports.
    3. Training and resources must be made available to support 
community-based organizations to ensure equitable access to 
services and programs, to prepare and support vulnerable 
populations during and after disasters, including integration 
back into the community.
    4. Prioritization in disaster research funding to inform 
evidence-based action and policy decisions that support the 
needs of older adults and persons with disabilities across 
diverse ethnic and minority groups is warranted.

    As a Nation, we must continue to seek solutions to overcome 
the unique challenges that older adults and persons with 
disabilities face when preparing for, responding to, and 
recovering from disasters. I was pleased to read about several 
recently introduced legislation that addresses many of the 
issues that I have presented.
    The passage of the Real Emergency Access for Aging and 
Disability Inclusion, REAADI Act, will ensure that the life 
experiences and voices of persons with disabilities, older 
adults, and others with access and functional needs are 
included in the preparation, response, recovery, and mitigation 
of disasters. This inclusion is paramount to ensuring the best 
possible outcomes for these vulnerable populations.
    The Disaster Relief Medicaid Act, DRMA, ensures that 
Medicaid-eligible persons forced to relocate from an area under 
a Presidential disaster declaration to another State will be 
able to maintain their Medicaid-supported services, including 
home-and community-based services. Passage of DRMA will address 
many of the issues that impacted the health and wellbeing of 
evacuees following Hurricane Katrina and also will impact their 
health in future disasters.
    As the Nation continues to recover from the COVID-19 
pandemic and in preparation for future disasters, the FEMA 
Empowering Essential Deliveries, FEED, Act allows the 
government to pay 100 percent of the cost to states and 
localities so that they can partner with restaurants and 
nonprofits to prepare nutritious meals for vulnerable 
populations desperately in need.
    In closing, I would like to thank you again for this 
opportunity to share my thoughts and experiences as a nurse 
clinician, educator, and researcher.
    I once read a quote by Mahatma Gandhi, ``The true measure 
of any society can be found in how it treats its most 
vulnerable members.'' Progress has been made in disaster 
planning, response, and recovery although there remains work to 
be done to ensure the best possible outcomes for older adults. 
Passage of these legislations will present a significant step 
in solving many of the issues that I have presented, and I 
commend the Senate Special
    Committee on Aging for shining a national spotlight on this 
important issue.
    Thank you.
    The Chairman. Dr. Spurlock, thank you for your testimony.
    We will turn next to Mr. Creamer.

        STATEMENT OF RANDY CREAMER, VICE CHAIRMAN, SOUTH

           CAROLINA VOLUNTARY ORGANIZATIONS ACTIVE IN

           DISASTER (VOAD), COLUMBIA, SOUTH CAROLINA

    Mr. Creamer. Good morning, Chairman Casey and Ranking 
Member Scott and members of the Committee. My name is Randy 
Creamer. I am a native and resident of South Carolina. Over the 
past 35 years, I have served as a volunteer and a professional 
assisting those affected by natural and manmade disasters. 
Bringing health and healing and hope to individuals and 
families and communities has been the most rewarding work of my 
life. Thank you for the opportunity to share a brief testimony.
    National VOAD, as already mentioned, is an organization 
that provides cooperation, communication, coordination, and 
collaboration, and fosters more effective delivery of services 
to communities affected by disasters. Founded over 50 years 
ago, National VOAD is a coalition of 70 of the Nation's most 
reputable national organizations. They are faith-based, 
community-based, and other nonprofit organizations as members.
    Our South Carolina VOAD is committed to the ``4 C's,'' with 
a strong focus on communication amongst members engaged in a 
specific response. Our VOAD in South Carolina is not 
operational in the sense of telling any organization what they 
can or cannot do, or where they can or cannot serve. We strive 
to enhance effectiveness in assisting those who are hurting.
    Many volunteer organizations are involved in the initial 
response only. Others may not be involved for weeks or even 
months, but each organization brings its strengths to the 
table. Few, if any, of those organizations are engaged from the 
first hours of an event to the complete recovery, which can 
take several years.
    The South Carolina Baptist Convention became involved in 
disaster relief in 1990 following Hurricane Hugo. Today we have 
2,500 volunteers who have attended our training, completed 
background checks as part of our credentialing process, and 
prepared to assist others affected by disasters in South 
Carolina, across the U.S., and occasionally even 
internationally. We are part of the larger Southern Baptist 
Disaster Relief Network that encompasses all 50 states. This 
year we sent 19 teams to the Hurricane Ida event. Those teams 
went to both Louisiana and Pennsylvania, serving.
    Our primary task is to provide immediate assistance after 
various wind events like tornadoes or hurricanes or 
thunderstorms or flood events that can occur after a tropical 
system or some heavy rain event. Our volunteers typically sleep 
in church buildings on cots or blowup mattresses, and they 
bring along mobile showers and laundry trailers and volunteer 
cook teams and all the logistical support that they need.
    Another major task is to partner with the Salvation Army 
and the American Red Cross when mass feeding is required to 
support those who have been evacuated and support those who are 
unable to prepare meals for themselves.
    Aside from myself and two coworkers, all South Carolina 
Baptist disaster relief is provided by volunteers, most of whom 
are retired. Our volunteers are motivated by their personal 
faith in Jesus Christ and the desire just to love God and love 
others. They are our most valuable resource.
    The American Red Cross and the Salvation Army lead the way 
in providing mass care. United Methodist congregations provide 
much of the same kind of service as Baptist. The Presbyterian 
Disaster Relief and Adventist Community Services Disaster 
Response are other major partners that lead the way in the 
long-term recovery. We are blessed with numerous partners.
    Over the years, we have learned a number of critical 
lessons. We have learned the disaster impacts increase 
substantially on structures and houses that have preexisting 
deferred maintenance issues.
    We have also learned that we cannot do everything. You have 
to find your niche and really do it well.
    We have learned that we cannot help everyone. We have to 
prioritize and identify the most vulnerable. Our priority is on 
those who are unable to help themselves. They lack financial 
resources, have no one else to help them, for example, widows, 
single adults, certainly retired folks or grandparents raising 
grandchildren, single parents.
    We also strive to help our body of first responders that 
are often neglecting their own personal needs and family needs 
because they are serving the community.
    Finally, we have learned that we have to allow our 
volunteers a great deal of leeway in the ways that they 
respond, like if they discover a lady lost her refrigerator and 
all of her food and we are just there to take trees off the 
roof, but in turn they buy her a refrigerator and restock her 
pantry.
    In closing, I am pleased to say that for 54 years we have 
been involved in and depended on retirees for most of our 
volunteers within the Southern Baptist Network. As one 
generation ages out, the next one steps up. Today we are 
excited with the number of college students that join us. We 
look forward to serving our neighbors in disaster relief for 
years to come, and we do appreciate the opportunity to share a 
little bit about our story.
    The Chairman. Mr. Creamer, thank you for your statement. We 
appreciate you being here.
    We will next turn to our fourth and final witness, Ms. 
Koerner.

            STATEMENT OF DANIELLE KOERNER, VOLUNTEER

            MANAGEMENT COORDINATOR, DELAWARE COUNTY

               DEPARTMENT OF EMERGENCY SERVICES,

                     RUTLEDGE, PENNSYLVANIA

    Ms. Koerner. Chairman Casey, Ranking Member Scott, and 
members of the Committee, my name is Danielle Koerner, and I 
will be speaking today as an advocate, former unpaid caregiver, 
and as a first responder and emergency planner. Thank you for 
this invitation to share my professional and lived perspectives 
on this topic.
    I sit before you a circumstantial expert. For the past 20 
years, I have volunteered and worked in the field of emergency 
services in Pennsylvania, first as an EMT and paramedic 
providing direct patient care and advocacy, then in education 
regulatory compliance.
    In 2012, my husband and I were blessed with the arrival of 
our first son, Joseph. He was born healthy but with multiple 
deformities and congenital amputations in his extremities, 
requiring surgical intervention, ongoing therapy, and adaptive 
equipment. In 2015, my 54-year-old mother was diagnosed with 
early onset Alzheimer's and dementia, and my husband and I 
became her primary live-in caregivers while my father continued 
to travel for work. I became an expert at anticipating needs, 
adapting everyday situations and tasks to the physical needs of 
my son and cognitive and behavioral needs of my mother.
    I had binders of bills tabulated with notes about insurance 
coverage and payment plans, calendars full of appointments. I 
gained a new vocabulary and set of skills specific to advocacy 
for my child and mother, and began to think 10 steps ahead for 
every task to assure that the needs of my loved ones would be 
met in everything that we did, both in non-emergency ``blue 
sky'' situations and ``dark sky'' emergencies. I built 
contingency plans for care, kept outgrown medical equipment in 
case something broke, and kept extra comfort items in strategic 
areas to soothe fears and calm erratic behaviors.
    To say that I received a crash course in accessibility and 
advocacy would be an understatement. I became a survivor before 
an emergency had occurred.
    In 2018, my mother lost her fight. I was both devastated 
and grateful that she had found peace. It was that same year 
that I was offered the job of Outreach and AFN, or Access and 
Functional Needs, Coordinator for the Delaware County 
Department of Emergency Services. I leapt at the opportunity, 
hoping to integrate my lived experience with professional 
knowledge of emergency services, both to honor my mother and 
assure that people like my son were considered before, during, 
and after disasters and emergencies happened.
    Very quickly I learned that my primary function in this new 
professional role was to be the voice in the room reminding 
planners and responders that one size never fits all, that 
accessibility means more than wheelchair ramps, that not all 
disabilities are physical, and that all of us will likely have 
an access need at some point in our lives.
    I also found myself regularly educating planners and 
responders that individuals who live every day with 
disabilities, seniors who have access needs, and individuals 
who are unpaid caregivers or survivors, a good way to describe 
them is ``pre-survivors'' even before the emergency has 
happened. Often, they are surviving against the odds, outliving 
expectations and resources, making due with inadequate 
services, living situations or equipment, and recovering from 
medical, financial or emotional setbacks because of their 
personal normal. We, as responders, planners, emergency 
managers and as policymakers, cannot begin to plan for the 
whole community without first embracing this knowledge.
    The reality is that if we want to be successful in disaster 
mitigation the work must also be done in the fields that 
operate independent of emergency management, the everyday 
``blue sky'' supports. We must focus on assuring that 
circumstances that make individuals pre-survivors are addressed 
well before the disaster occurs and stop limiting our 
conversations on inclusive disaster practices to the disaster 
itself.
    Working to enhance accessibility to government services by 
streamlining technologic and paper platforms, useful resources 
and applications, simplifying processes and terminology, 
expanding regular operation hours for services, and assuring 
that resources are known to those who most need it through 
multi-outlet and media messaging are all just as important as 
ensuring physical accessibility to buildings.
    Investing in workforce development and support for direct 
care and medical professionals, as well as case managers and 
social workers, is another critical piece of the puzzle.
    Addressing our Nation's housing crisis through the lens of 
accessibility and bolstering programs designed to increase 
independent and supportive living for individuals who need it 
most, expanding the criteria for Medicaid and Medicare 
reimbursement and coverage, assuring financial support to 
unpaid caregivers, and increasing programs that offer respite 
services will help.
    These examples only begin to scratch the surface of this 
topic. The best way to ensure optimal outcomes for pre-
emergency survivors is to ensure that they have unobstructed 
access to the supports that they require daily and to include 
individuals with personal knowledge of these requirements to 
guide the process.
    The frequency and intensity of natural disasters are 
increasing, and the emergency response workforce is decreasing. 
Paid and volunteer workers are harder than ever to find in my 
field of work. If we can improve the lives of individuals with 
disabilities, seniors with access needs, and unpaid caregivers 
before the emergency happens, we will exponentially increase 
the resiliency when it does.
    Thank you for your time today.
    The Chairman. Ms. Koerner, thank you for your testimony. I 
will start a round of questions with you. I want to say with 
regard to your testimony, as well as our other witnesses, all 
four witnesses, it is especially heartening when witnesses can 
bring to a hearing not just professional lived experience but 
also personal experience, and that is true of all of our 
witnesses today, and that is certainly true of you, Ms. 
Koerner.
    In your testimony, you said you leaped at the opportunity 
to work in disaster management to, quote, integrate your lived 
experience with professional knowledge of emergency services, 
both to honor your mother and assure that people like your son 
were considered before, during, and after disasters happen.
    Unfortunately, not every community is as fortunate as your 
community to have an expert with lived experience to serve that 
community, in your case, to serve in Delaware County in the 
emergency services department. For those communities without a 
person with lived experience at the planning table, national 
services like technical assistance, like a technical assistance 
center, can help State and local governments with inclusion, in 
other words, to do the work that you and others have done 
locally.
    The question I have for you is: How would enhanced 
representation and technical assistance programs like those 
included in my legislation, the REAADI Act--how would that help 
to save lives during disasters?
    Ms. Koerner. Thank you for that question. First, I have to 
advocate that every community strive to include local 
stakeholders who have disabilities, caregivers, advocates, and 
seniors who have access need at their local process wherever 
possible, understanding that these individuals may not have a 
background in emergency management.
    That being said, having access to individuals who have both 
personal, lived, and professional experiences through national 
technical assistance programs will connect these communities 
with critical information during planning, expert guidance 
during the response and then later during the recovery process. 
While knowing that needs truly are in the community and knowing 
what those needs are in the community is the first step, having 
the access and expertise to address them strategically is what 
will ultimately increase life-saving communications and 
operations.
    The Chairman. I was noting on the second page of your 
testimony one paragraph that, at least for me, summarized a lot 
of your testimony and what we have got to focus on in terms of 
a list of priority areas for our work. You indicated in the 
middle of the page, quote, working to enhance accessibility to 
government services by streamlining technologic and paper 
platforms; second, simplifying processes and terminology; 
third, expanding regular hours of operation for services; and 
fourth, assuring that resources are known to those who most 
need them through multi-outlet and media messaging that are 
just as important as assuring physical access to buildings. 
That is a good summary of what we would hope every community 
would be able to avail itself of.
    Ms. Koerner, thank you for your testimony.
    I will move my second question to Dr. Bell. In your 
testimony, you talked about the research you had done on the 
health effects of disasters on people with chronic conditions, 
which is more than 80 percent of seniors. You found that 
survival rates were lower for people exposed to Hurricane 
Katrina than for those that did not experience a storm likely 
due to a disruption in access to health care.
    You noted, quote, the loss of basic infrastructure can 
cause serious care interruptions, especially access to health 
care, which has long-lasting effects for those with chronic 
conditions, unquote, quoting again from your testimony. Going 
without health care is, of course, for all of us unacceptable.
    I introduced a particular piece of legislation called the 
Disaster Relief Medicaid Act to ensure that people affected by 
disasters can keep their Medicaid coverage. People are 
uprooted, and they move, and we want to make sure they can 
still access Medicaid if they have had to move.
    Can you discuss how policy solutions like this act would 
help people access their medical care and, indeed, even save 
lives following a disaster?
    Dr. Bell. Thank you for that question, Chairman Casey. I 
think one important thing to consider is that disasters do not 
respect State lines and neither do health care needs. Thinking 
about how to access for people--thinking about how people can 
access health care needs who have Medicaid, the ability to 
access their health care needs in a different State where they 
may have evacuated to is crucial. We have to think about ways 
to meet health care needs, and this is a solution that feels or 
seems fairly straightforward if we can eliminate unnecessary 
delays and red tape that have characterized past disasters.
    The Chairman. Well, Dr. Bell, thanks very much for that 
answer and also for your testimony. I was noting in your 
testimony at one point something that--and I hope I can get 
back to this later, but it really kind of jumped off the page. 
This is on page three. You start the paragraph by talking about 
older adults and people with disabilities are 
disproportionately affected by disasters. The next sentence is 
``Disasters are not natural.'' That is, for a lot of people, 
counterintuitive.
    You explain by talking about hazards such as hurricanes, 
wildfires, and tornadoes are weather events that occur as 
natural processes but that we know that the impacts of climate 
change advance is driving this, and then you say, and I am 
quoting, ``The impact these events have on communities is 
largely human-made and influenced by social, economic, 
geographic, and political processes.'' I will get back to you, 
I hope, a little later about that, to have you walk through 
that, but that was an interesting formulation for me to read 
and to give me a better perspective on what we are up against.
    I will turn next to Dr. Spurlock. You have a unique 
perspective in that you research disaster management and you 
live in southeastern Louisiana, which has seen--to say that you 
have experienced severe weather events, extreme hurricanes over 
the past two decades, of course, is an understatement. Not many 
regions of the country have had as much in the way of disasters 
and challenges as the State of Louisiana and that section of 
the State.
    In your written testimony, you noted that ``populations are 
not equally impacted by a disaster.'' How would equitable 
representation through the programs that we outline in the 
REAADI for Disasters Act--how would that equitable 
representation create life-saving approaches during disasters?
    Dr. Spurlock. Yes. Thank you, Chairman Casey. We know from 
our research, and it is widely accepted, that certain 
populations will experience a disproportionate burden when 
confronted with disasters and those populations mainly include 
older adults and persons with disabilities of all ages. We know 
in terms of some of the changes that occur with aging, 
including impaired sensory functioning, impaired vision, 
hearing, especially impaired mobility and changes in cognition 
and chronic medical problems that necessitate ongoing treatment 
with medications and sometimes lifesaving equipment, can put 
those populations at a greater risk when it comes to response 
to hurricanes or any type of disaster, including recovery 
phase.
    I was pleased to learn about legislation that has been 
introduced that will bring representatives from vulnerable 
populations to the table to actively participate in disaster 
planning because we know that the success of the recovery and 
the response phases will largely depend on the efficacy of 
plans that have been put in place to mitigate some of the 
negative disaster outcomes that can occur. Not only bringing 
them to the table is important, but also including a diverse 
representation of older adults and persons with disabilities in 
recognition that their life experiences and needs can widely 
vary. These represent significant steps toward solutions to 
improve our disaster response.
    The Chairman. Well, thanks for making the point about not 
only representation but equitable representation and 
highlighting some of the legislative approaches and even 
solutions we can bring to bear.
    I am going to jump back Dr. Bell to highlight another 
segment of your testimony. In your testimony, you indicated 
that, quote, inclusive disaster management should include 
promoting aging in place throughout the phases of a disaster, 
with the goal of supporting older adults to stay in their 
preferred living environment, unquote.
    You also noted that in your study of over 2,000 older adult 
respondents that although the majority felt confident in their 
ability to address a disaster they actually have taken low 
levels of preparedness actions, like having a disaster plan and 
kit. This highlights, of course, the need for support in 
turning intention into action.
    Your research has also shown that home-based care providers 
are an excellent starting point for disaster management.
    Can you discuss how investing in home-and community-based 
service will improve the ability of older adults and people 
living with disabilities to remain healthy and safe leading up 
to, during, and after disasters?
    Dr. Bell. Thank you for that question. We know already that 
people want to stay in their preferred living environment and 
having home-and community-based services are the kind of 
supports that can help them stay in these settings. Home-based 
and community support services, investing in these is a good 
idea in general. We already know that the population of older 
adults is increasing, and home-based care needs and the home-
based care industry will have to increase as well to be able to 
meet these needs, so investments in this area in general are an 
important need.
    During a disaster, if staying at home is the safest option, 
then let us give providers and older adults and people with 
disabilities the tools to be able to stay at home and live 
through a disaster safely in their preferred living 
environment. We can start by investing in home-based care and 
community supports, disaster preparedness, and response 
capabilities.
    Another thing that we can do is to encourage that whole 
community approach that we have already talked about, where 
home-based care organizations, community supports, emergency 
managers, and the stakeholders themselves, older adults and 
people with disabilities, can better interact together around 
inclusive disaster management.
    The Chairman. Well, thanks very much for that and 
highlighting the kind of setting we are talking about, that if 
you are in a home-based setting that allows for the caregiver 
to be obviously more present and potentially more able to do 
the kind of planning with that older adult or that person with 
a disability.
    Just a brief follow-up, Dr. Bell. One thing we are trying 
to do now is to allocate time for Senators as they come back 
from other hearings in the next 10 minutes or so. I will be 
asking a few additional questions, but as a follow-up, one of 
the central elements of the Build Back Better legislation will 
be an investment in home-and community-based services. It is 
predicated on a piece of legislation I introduced, the Better 
Care Better Jobs Act, with which I know you are familiar.
    Doctor, in regard to that legislation, I wanted to ask, how 
much would the policy that is embedded in the Better Care 
Better Jobs Act--how would that support both homecare workers 
and family caregivers to improve the prospects for dealing with 
disaster management for those that the individual worker is 
serving, in this case, a person with a disability or an older 
adult?
    Dr. Bell. Well, I think what it comes down to is we need 
the kind of investments that can better support this industry, 
the home-based care industry. By home-based care, I think it is 
important to define that this is not--this includes an array of 
health care that is provided in the home. That could be skilled 
nursing services, physical therapy, other types of 
rehabilitation therapy, and also homecare, which is support and 
assistance with activities of daily living that are necessary 
to allow for individuals to come--to continue living in their 
home.
    Advancing policy that can better support these industries 
and these providers themselves to provide the kind of care that 
can support individuals and communities is really critical. I 
think it is very important that we start thinking of this as 
mitigation measure, if we are thinking about inclusive disaster 
management, that health care occurring at the home is a new 
normal going forward, and we need to make investments that 
support that.
    The Chairman. Well, Doctor, thanks very much.
    I want to turn next to Mr. Creamer. I was particularly 
impressed by the scale of the volunteer efforts that you made 
reference to in your testimony and the number of communities 
you and so many others have served. It is remarkable.
    I noted as well that you made reference to one of a number 
of your teams going throughout the country, including to 
Pennsylvania. As a Senator from Pennsylvania, as a citizen, I 
appreciate the help that was provided in those terrible 
circumstances in communities that we faced. A lot of the 
communities this summer and fall were communities in the 
southeastern part of the State, where Ms. Koerner is doing her 
work, so it is entirely possible that they were crossing paths 
with folks that she was working with.
    My question for you, Mr. Creamer, is you provided a fulsome 
description of how the volunteer workforce can address many of 
the immediate needs that people experience in a disaster. The 
work that the South Carolina VOAD does is critically important. 
Can you tell us how the volunteer workforce coordinates with 
community needs in more formal supports such as Ms. Koerner's 
emergency management program?
    Mr. Creamer. Yes, sir. Thank you for the question. When we 
go into communities like Horsham, Pennsylvania, where we were 
north of Philadelphia just a few weeks ago----
    The Chairman. Right.
    Mr. Creamer. We seek to connect with officials in those 
counties and those communities immediately. We will go to a 
fire chief, police chief, emergency manager for a county or 
parish. Sometimes it is pastors in local communities. They can 
steer us in the right direction, where the most vulnerable 
populations are concentrated, that need the most help. Here are 
the things that we can offer, and then you direct us to where 
we can be most effective to help and assist you in your time of 
need. We are looking very much at the local officials there to 
give us that guidance and direction. That is our point of 
connection.
    The Chairman. Well, it is noteworthy in your testimony 
about the challenges that volunteers face. Sleeping in church 
buildings on cots and blowup mattresses, that could be 
challenging for someone at any age, and we are grateful for the 
work that they do and that you and others have made apparent 
today in your testimony.
    I will now turn again to an additional question as we wait 
for one or two Senators who are on their way.
    Ms. Koerner, I will turn back to you now that we have made 
reference to, as Mr. Creamer did, southeastern Pennsylvania. 
Appreciate the work that you have done in our State and in a 
big county like Delaware County. For those of you who do not 
know, it is a suburban Philadelphia county. It is, gosh, I 
think about our fourth or fifth largest county in the State 
after Philadelphia, Allegheny, Montgomery, and Bucks. Delaware 
County I know is well more than half a million people, so there 
is a lot of challenges when a disaster hits in a high 
population, suburban community.
    Ms. Koerner, you talked in particular about your personal 
circumstances being a ``crash course in accessibility and 
advocacy'' and preparing to be ``a survivor before an 
emergency.'' So that kind of crash course is not only a good 
preparation for you and your family. It is, of course, of great 
value to the people of Delaware County and our State generally.
    The REAADI for Disasters Act and the recently implemented 
Pandemic and All Hazards Preparedness and Advancing Innovation 
Act, another long name which we use the acronym PAHPA. Then 
that word ``innovation'' was added when we reauthorized the 
legislation, the preparedness legislation which has been--was 
first acted on way back in 2006 and has been reauthorized 
several times since then.
    In both of those bills, part of the focus of both of those 
bills is the creation of advocacy, I'm sorry, the creation of 
advisory councils with a high level of aging and disability 
representation to inform disaster management planning. If you 
are going to have a strategy in place at a national or State or 
regional level, and you make it a priority to address the 
impact of a disaster on an older American or a person with a 
disability, you have got to have representation, as Dr. 
Spurlock made reference to earlier, representation on those 
advisory councils.
    The good news is we have advisory councils. The bad news is 
they need to be put into action. It has been far too slow. We 
will get to that later.
    The question I have for you, Ms. Koerner, is: How have your 
experiences as a family caregiver shaped your approach to 
disaster management at a very local level?
    Ms. Koerner. Thank you for the question. I learned very 
quickly from my mother and from my son that needs should never 
be assumed but always anticipated. Assuming needs was a really 
good way to offend my mother, who was, prior to her diagnosis, 
probably the most capable woman I have ever known, so instead, 
anticipating her needs and taking her lead was a much better 
approach.
    Now as the mother of a budding preteen who happens to have 
physical differences, the same applies. He has far more to 
teach me when it comes to what he needs than I have to teach 
him.
    Working with, and seeking out, input from individuals who 
have access and function needs is the only way to learn what 
the needs of our community really are and how best to 
anticipate areas where assistance may be needed during and 
after the disaster emergency has occurred, as well as gain 
invaluable insight as to how we can work to overcome challenges 
by taking their lead. Really striving to make sure that we are 
coming into the situation knowing that we are there to take 
their lead and we are there to serve them I think is the best 
way to approach the situation, and that is what I have tried to 
bring into my work.
    The Chairman. Well, it has to help enormously to have 
personal experience in addition to professional lived 
experience. That combination I can only imagine. I have never 
done this kind of work myself, but I can only imagine the 
positive impact it must have on someone who is challenged by, 
or even overwhelmed by, a disaster, to be able to talk to 
someone who can relate to them on a very personal level, being 
able to say I have some experience with this kind of 
circumstance or my in your case, your mom and your son and 
other family experiences that you can relate to them as opposed 
to someone without that experience who might have the expertise 
but may not have the personal experience and the understanding 
that you can bring to bear when you encounter someone who is 
really in jeopardy and not knowing what the next hour or the 
next day will bring, when they are overwhelmed by a disaster.
    I have often told the story about my own experience as a 
legislator, having some sense of what people undergo when they 
experience a natural disaster, but not really fully 
understanding it at least in my own case until 2011. We had 
terrible, devastating flooding in several parts of our State. I 
live in northeastern Pennsylvania, and I remember visiting 
rural communities in northeastern Pennsylvania and seeing the 
devastation but also just seeing how violated individuals felt, 
in a very deeply personal way.
    I tell the story often about a friend of mine who is a 
lawyer in a neighboring county, and he was the most confident, 
upbeat, even cocky person you would ever want to meet. Never 
down. Always upbeat. Always ready to tackle any problem. Full 
of self-confidence.
    When I said hello to him at a stop at a disaster site, 
where there was terrible flooding and a lot of families had 
their homes either flooded out completely or badly damaged, his 
was one of the homes. I remember walking up to him, you know, 
putting my hand out to shake his hand, thinking that he would 
say, you know, I had some flooding, but I am good. As soon as I 
shook his hand and looked in his eyes, he started to cry. I 
never thought I would ever see this very strong, confident 
person be so devastated, so it gave me an insight I did not 
have before. I can only imagine, Ms. Koerner, the number of 
times you have been able to draw upon your own experience.
    Dr. Bell, I will jump back to you for an additional 
question. We know that this kind of preparedness, emergency 
preparedness, is a top concern of several government agencies. 
In the Federal Government, the Department of Health and Human 
Services Inspector General just released an annual report. I 
will not make detailed reference to it but just holding it up. 
This is a Health and Human Services Inspector General report 
which is a report of management challenges for the Department. 
This was just released earlier this week.
    It comes after our Nation has spent 2 years living with a 
pandemic, that as I made reference to earlier, that terrible 
number that keeps going up of 760,000 lives lost in the grip of 
the pandemic. COVID-19 has been a lesson in preparedness 
shortfalls, reinforcing why the Department's independent 
watchdog says that HHS must do much more to prepare for these 
emergencies.
    Dr. Bell, the Obama Administration updated emergency 
preparedness rules for both Medicare and Medicaid providers for 
the first time in a quarter century. These were implemented in 
2017. In light of the pandemic and the Inspector General's 
concerns as expressed very recently, are Medicare's emergency 
preparedness rules sufficient--sufficient--to address the needs 
of people with disabilities and older adults in nursing homes 
and other congregant settings during disasters?
    Dr. Bell. Thank you for that question. You mentioned the 
COVID-19 pandemic, and over the course of the past 18 months of 
the pandemic I have had the opportunity to visit a number of 
nursing homes where I provided training in personal protective 
equipment use and conducted voluntary infection control 
assessments in order to support staff, their own safety and the 
safety of the residents of those homes, so definitely an area 
that is near and dear to me.
    You mentioned the CMS emergency preparedness rule, which I 
believe was introduced in 2016 and put into effect in 2017. The 
goal of the emergency preparedness rule was to implement 
national standards for healthcare organizations that are 
receiving Medicare and Medicaid funding. This was introduced, I 
believe, largely to avoid the kind of tragedies that have been 
seen in nursing homes and other health care settings prior to 
2017, but unfortunately, we are still seeing many of those 
challenges and lack of preparedness even after the 
implementation of the rule.
    I think a couple things about the Inspector General's 
report and the emergency preparedness rule itself. One is that 
the rule was implemented now between four and 5 years ago, and 
we do not have a substantial amount of evidence to understand 
if the rule is working in the way that it should be working.
    I think it is important to note that the intention of the 
rule is an important and a good one. Facilities should be--
should have emergency preparedness plans, and they should be 
preparing their employees using a set of standards, so that is 
an important one.
    The rule was implemented with a fair bit of leeway, 
allowing healthcare organizations to determine the type of 
training and drilling and plans that they wanted to do. I think 
that there is a balance between allowing this leeway and being 
overly prescriptive. That really matters for low performing 
settings that do not have good training, drilling, and plans in 
place. It may unnecessarily penalize, or not--maybe penalize is 
not the right word. It may be unnecessarily prescriptive for 
organizations that do put a fair bit of emphasis on being 
prepared.
    I think what my recommendation or solution is, is to 
provide better opportunities for tailoring of emergency 
preparedness planning for organizations for thinking about 
older adults and people with disabilities. How can we better 
tailor emergency preparedness plans to the organizations that 
are providing care for those individuals? How can we do a 
better job of supporting organizations in their emergency 
preparedness planning without providing new--or without taking 
away some of that leeway that has been successful.
    The Chairman. Doctor, thanks very much.
    I will turn next to Ranking Member Scott.
    Senator Tim Scott. Thank you, Mr. Chairman.
    Let me ask a question of Mr. Creamer as it relates to 
heirs' property and the importance of the changes that have 
been made based on the request that we submitted, Senator 
Ossoff and I. When recovering from disasters, how big a problem 
was the lack of a title to heirs' property for rural, majority 
minority counties in South Carolina?
    Mr. Creamer. Thank you. Thank you for the question, Senator 
Scott. In our role going in, in the early hours, the first few 
days of doing what we do in helping that initial recovery and 
mitigating continued damage, that was not that big of an issue.
    The issue really becomes huge when we start the rebuilding, 
long-term recovery process, or if that resident is trying to 
access different sources of financial assistance, be that 
particularly the FEMA assistance for damage to a homeowner. 
That proof of title is almost a deal-breaker in those 
instances. It does not stop us from doing what we do, but when 
it moves into long-term recovery it is a huge obstacle.
    The work that the organization we have down in the 
Charleston area, that is helping with that, has been huge to 
help those families that have owned property for upward--well 
over 100 years, but there is no proof of title, and they do not 
have the resources to go do a title search many times.
    Senator Tim Scott. I see. In other words, the work that you 
do, which is excellent work by the way--thank you for doing it. 
It is not impeded by the heirs' property challenges that we see 
across the country and specifically throughout the South.
    When it comes to receiving the resources from FEMA, the 
heirs' property, the lack of a clear title--I should be clear. 
I am so used to saying ``heirs' property'' as if everybody 
listening to us knows what heirs' property really is. In fact, 
they may not. As land is passed down within families, you have 
so many heirs. Sometimes no individual person within that 
family has clear title. Therefore, heirs' property is property 
really held in common in many ways. That common property being 
held in common does not give any specific person the right to 
advocate on behalf of that property, so that also stops that 
family of individuals from being able to receive assistance 
from FEMA. Is that what I heard you say, sir?
    Mr. Creamer. FEMA and other sources of assistance. It can 
be from faith-based organizations. Everybody wants proof of 
property ownership.
    Senator Tim Scott. Yes, sir. Thank you very much.
    Dr. Spurlock and Dr. Bell, do you agree that we need more 
flexible funding to support local restaurants cooking fresh, 
healthy meals during disasters? In other words, the FEED Act 
that we have spent a lot of time working on, that both the 
Chairman and I are now co-sponsors of. Would it not be helpful 
to have more funding support for local folks who understand and 
appreciate the severity of the challenges faced by those 
communities where the disasters happen within?
    Dr. Spurlock. Yes. Thank you for that question and 
statement. As a resident of Louisiana, having experienced 
numerous disasters, namely hurricanes and floods, I know 
firsthand of the importance of having those types of resources 
available. Recently following Hurricane Ida in my community, we 
experienced power outages. I did personally for over five days 
or so. Myself, and other individual households lost all of 
their perishable goods from the refrigerator and freezer.
    A larger percentage of persons with disabilities reside in 
southern states. States that border the Gulf of Mexico are more 
prone to these types of disasters.
    Poor communities oftentimes where older adults live are 
considered food deserts.
    Senator Tim Scott. Yes, ma'am.
    Dr. Spurlock. Yes. Just having the availability of 
resources on the ground to be able to offer a warm, nutritious 
meal, served with a smile, in a person's local community, so 
they aren't faced with additional hardships such as having to 
seek transportation to drive miles to perhaps locate a 
restaurant that is open, only to find that the line is several 
blocks long. Still having to leave hungry and not having access 
to a nutritious meals, so that's a really win-win, I think for 
all parties involved.
    Senator Tim Scott. Thank you, ma'am. If you are waiting in 
a line that long, Mr. Chairman, you are going to be hungry and 
frustrated. Yes, so that is a fact. Thank you, ma'am.
    The Chairman. Mr. Creamer, Mr. Scott, thank you very much. 
We will turn next to Senator Braun.
    Senator Braun. Thank you, Mr. Chairman. You know, when it 
comes to something this important, to where it is random in its 
occurrence and we know that it is inevitable over time, I think 
we ought to do something that puts better processes into place. 
It would mean that you have got to make sure that when you do 
have to be quick and be responsive that you have got the 
funding in place, number one, and then also guidelines where 
you are not wasting any time before you can actually get to the 
issue at hand because so often it seems like we are ill 
prepared in terms of the immediacy of it, in terms of whatever 
structure and processes that should be in place, where there is 
fumbling around.
    The bigger issue is probably how we pay for it in the long 
run. For things of this significance, most places would have a 
designated rainy-day fund, to where it would be funded 
separately, where it would be ready to go. Ideally, it would be 
in the context as we become more fiscally responsible over 
time, borrowing money to pay for our operating budget currently 
to the tune of about 25 percent and soon to go up even to a 
higher percentage. I think there really needs to be some reform 
on general fiscal issues here.
    I would like to direct my question here to Mr. Creamer. 
Tell me what you think the current status is on the guidelines, 
the processes, the things that are needing to be in place, to 
where you know what to do when the tragedy, the event, occurs?
    Then what are your thoughts on establishing a rainy-day 
fund? I have got legislation that would like to do that, to 
where we are not then on an ad hoc basis having to put funds 
into play, to where we have better, ready-to-go functions and 
processes, number one, and then number two, a rainy-day fund 
that will support it, where we are not scrambling around in 
terms of how to fund something in the immediacy of the 
incident. Mr. Creamer?
    Mr. Creamer. Thank you sir. A great question. Yes, I agree 
wholeheartedly the second question, the part dealing with 
funding, to have a rainyday fund in your back pocket, so to 
speak, that you can draw from would be a huge asset because 
funding does become such an issue for everything that we are 
doing. Even in our role of volunteers, we cannot do what we 
cannot fund, so having that as a backup is certainly warranted 
as such.
    Looking at the ways that we can be prepared and how we do 
it is just positioning both the professional, if you will, 
response as well as utilizing some of the volunteer respond 
groups across the country as a huge asset and just both working 
together, having those communicate closely. Our VOADs enable us 
to do that through our states as well as the national level. 
That is the best way we have is to have those relationships, to 
know each other, and to work and be ready prior to any kind of 
event, any kind of challenge that we experience.
    Senator Braun. Well, thank you. As a closing comment in 
general, for anyone watching out there, we currently have a 
Federal budget that runs around $4.5 trillion, and we currently 
raise revenues to the tune of $3.5 trillion. That is a 
structural trillion-dollar deficit that we have come to accept 
and kind of shrug off as not being important. That does not 
work in any other place. All State governments live within a 
framework, to where they generally have cash reserves and 
rainy-day funds set up.
    It also brings to light that in the amount of money that we 
are currently wanting to spend, and that remains to be seen how 
much of that will be borrowed versus paid for, I think 
certainly it is clear that the financial stress on the country 
and for all the places that look to the Federal Government, 
including the Medicare Trust Fund, which is about ready to go 
kaput here in four and a half, 5 years, due to high health care 
costs and putting too benefits in there. Our elderly depend on 
it for their health care. Social Security, it has got about 
another 10 or 11 years. We have been paying into that since the 
FDR days.
    I think this idea of taking care of natural disasters and 
doing it in a responsible way also begs the question: When are 
we going to get our financial house in order here in D.C., 
generally?
    Thank you.
    The Chairman. Thank you, Senator Braun. I will turn now to 
Ranking Member Scott.
    Senator Tim Scott. Thank you, Mr. Chairman. This is a 
question for all the panelists. Working with local emergency 
management is such a critical component of disaster relief and, 
frankly, the response or the coordination.
    In an earlier life, Mr. Chairman, I was the Chairman of the 
Emergency Operations Center for Charleston County during 
hurricanes and natural disasters, and so I spent a number of 
24-to 36-hour days in the command center where we had an 
opportunity to try to coordinate the response teams' efforts on 
behalf of communities before, of course, the hurricanes or 
natural disasters happened. We would have meetings every year, 
praying and hoping that we did not have to mobilize a team, but 
realizing that is always an ``if,'' not a ``when.'' Or, a 
``when,'' not an ``if.''
    One of the things that I realized during that time was the 
importance of having everybody on the same page, whether that 
was the voluntary efforts, the law enforcement, the EMS, the 
fire, the councils themselves. Then we, in Charleston County, 
had 17 different municipalities. We had to have all 17 heads of 
government working with the county, plus the volunteer 
apparatus and all the fire departments, all the law enforcement 
agencies and all the nonprofits that we wanted to be a part of 
that process. The importance of that local coordination cannot 
be usurped or replaced by a Federal top-down approach to 
natural disasters.
    My question for the panel is: What are the best practices 
voluntary organizations and local emergency managers should 
follow to ensure volunteers are included--and I want to 
emphasize ``included''--in all phases of disaster management? 
That really, from my perspective, means from the beginning. The 
beginning is not the day before the disaster. It is all year 
long as we all know that we are going to have to face them in 
the future.
    What are the best practices that we should embrace and be 
aware of?
    Dr. Spurlock. Yes, thank you. This is Dr. Spurlock. I think 
that is an excellent point that you make because really the 
planning has to be ongoing. We know that hurricane season ends, 
fortunately, in 2 days, on November----
    Senator Tim Scott. Yes, ma'am.
    Dr. Spurlock. Yes. Our work in terms of increasing our, you 
know, preparedness and ability to be able to respond to these 
unforeseen disasters is ongoing. As you mentioned, it is 
really--I think it is a community, you know, based support 
because when disasters ensue it is going to be at the level of 
the local and the communities that are going to need to 
initially respond to meet the needs of their populations.
    I think that is also when it is really critical to have 
overall knowledge of the overall health of the various 
communities because that has to be taken into consideration 
because it will determine more or less the scope of services 
that will have to be deployed and also in terms of the disaster 
response as well. We know that many of our communities 
throughout our Nation exist today in poor health status, and 
all of those statistics are readily available to us through the 
America's health care rankings. We know in terms of the 
various, you know, social determinants of health and how they 
can drive more or less a community's ability to be able to 
respond to a disaster, so all those have to be taken into 
careful consideration.
    By bringing all the individual organizations to allow them 
to become stakeholders, to have a voice, and then not to 
overlook sometimes organizations that can really play a 
critical role at the community level, namely, faith-based 
organizations. I witnessed this firsthand following Hurricane 
Katrina, how those faith-based organizations immediately 
stepped up the plate and started to open what we sometimes 
refer to as pop-up, you know, type of shelters. That gave 
tremendous support, you know, to the community at large.
    Sometimes also, overlooking the resources that academic 
settings can bring, you know, to the table as well because they 
are, you know, embedded in the community. Persons who are 
employed in those, you know, organizations have a really good, 
you know, mindset and viewpoint in terms of the overall needs 
of the communities.
    Once we can pull all of those resources together, as we 
were able to do as a school of nursing following Hurricane 
Katrina, to get involved in that health care for extended 
periods of time, we realized that no one institution can go at 
it alone. It is really the whole of the community--academic 
settings, public and private partnerships. That is incumbent 
upon us to garner out resources and to step up when disasters 
do hit our communities and also to have an ongoing plan and 
dialog.
    Senator Tim Scott. Thank you.
    Dr. Spurlock. Thank you.
    The Chairman. Senator Scott, thank you very much. We will 
turn now to Senator Gillibrand.
    Senator Gillibrand. Thank you, Mr. Chairman.
    Dr. Spurlock, thinking about the dedicated staff who care 
for older adults in nursing homes, what is the most critical 
piece or lever that we can use to ensure that they are prepared 
for the next disaster. What is the best way we can ensure that 
the needs of older adults and people living with disabilities 
are known and anticipated in a disaster?
    Dr. Spurlock. Thank you. I am really so pleased to be able 
to participate in this hearing today because it really shines a 
national spotlight on this issue.
    Of course, nursing homes might oftentimes lack the 
resources that are in place in private institutions, other 
larger healthcare industries or acute care hospitals may have 
access to. I think there is an ongoing need for funding in 
terms of resources and for ongoing education for disaster 
preparedness, to be able to make decisions regarding evacuation 
compared to sheltering in place. These are critical decisions 
that must be made in long-term care settings.
    I think mainly to support the staff is to give them the 
necessary resources in terms of education and preparedness, as 
we saw with the COVID-19 pandemic, for the staff to have the 
necessary personal protective equipment available to them to be 
able to use on a day-to-day basis.
    Senator Gillibrand. In the current and escalating climate 
crisis, we will continue to see and experience extreme weather 
events. Climate change, together with other natural and human 
made health stressors, influence our health and well-being in 
numerous ways. From the pandemic, our experiences can be vastly 
different within the same State, city, and even same house, 
depending on a person's age and their physical and mental 
health.
    We need to do better to support and anticipate how 
disasters can affect different groups of Americans and 
marginalized Americans, and we can do better by including 
people with diverse capabilities and experiences in planning 
discussions.
    I am proud to support Chairman Casey's Real Emergency 
Access for Aging and Disability Inclusion for Disasters Act, or 
the REAADI Act, which would really work toward ensuring that 
older adults and people with disabilities are involved in the 
preparation and response and recovery and mitigation of 
disasters.
    Dr. Bell, how would a National Commission on Disability 
Rights and Disasters help ensure the gaps in inclusive disaster 
planning and response and recovery are closed?
    Dr. Bell. Thank you so much for that question. I think the 
National Commission, which by my understanding will have a 
large makeup of people with disabilities, will center the needs 
of the disability community and the aging community. I think 
the Commission itself is made up of--or, the mandate of the 
Commission is to draw from a diverse group of stakeholders, 
which is really when we talk about a whole community, what we 
really do need is to understand--I understand there is a local 
coastal emergency manager that, for example, will be on the 
committee versus a non--you know, area--from a noncoastal 
region. There is disability advocates and representatives that 
are making up the Commission.
    I think that it is--the goals of the Commission are 
important and needed and will advance inclusive disaster 
management.
    Senator Gillibrand. Thank you.
    Ms. Koerner, thank you for sharing your professional and 
lived experience on the importance of including people with 
diverse capabilities in the disaster planning process. What are 
the significant gaps in inclusive disaster planning response 
and recovery that you noticed through your experience? What 
resources did you find most helpful?
    Ms. Koerner. Thank you so much for that question. Here in 
southeastern Pennsylvania, we are part of a really fantastic 
team of individuals made up of multiple backgrounds and diverse 
capabilities, areas of expertise, called the Southeast Regional 
Task Force Access and Functional Needs Subcommittee.
    During the pandemic response, during the response post-Ida, 
and even back with Isaias, one of the things that we did was 
turn to this group of individuals to determine where the gaps 
were and make sure that nothing was being left out and really 
looking to that group of individuals to make sure that when we 
were forming our response and forming our communications, it 
was really through a whole community lens.
    I think one of the things that we noticed early on was, you 
know, a need to improve communication. We worked with a lot of 
our community partners to make sure that everything was 
accessible from multiple language perspectives, from written 
and nonverbal communication perspectives, and making sure that 
we were getting the message out through multiple different 
sources, so that was something that we saw early on and were 
able to respond to specifically because we had individuals with 
that background, with that personal experience, and with that 
area of expertise.
    I really think that the value that individuals from all 
different backgrounds that they bring to the community and 
bring to this topic really cannot be devalued at all.
    Senator Gillibrand. Thank you, Mr. Chairman.
    The Chairman. Thanks very much, Senator Gillibrand. We have 
three Senators awaiting questions: Senator Rosen, Senator 
Blumenthal, and Senator Kelly.
    Senator Rosen. Thank you, Chairman Casey, Ranking Member 
Scott. It is a really important hearing, and I appreciate 
everyone who is here and all the witnesses today.
    I want to talk a little bit about something happening in my 
State and across the West is extreme heat and wildfires because 
around the world and, of course, here in the United States 
climate change has worsened and the devastating impacts of 
wildfires and extreme heat, particularly in western states like 
mine, Nevada, has just been devastating. Already this year, we 
have seen over 49,000 wildfires burn over 6.5 million acres of 
land, including several recently affecting Nevada, like the 
Tamarack and Caldor Fires, which forced residents in parts of 
Douglas County to evacuate their homes amid a declared State 
emergency.
    Worsening wildfires not only pose a serious threat to human 
life, to our health, to personal property, to wildlife, and of 
course, our seniors, some of the vulnerable. That is why I 
recently introduced the Fire Information and Reaction Act. It 
is bipartisan legislation that directs NOAA to establish a new 
program to improve wildfire forecasting and detection because 
more accurate predictions and warnings, they really can protect 
lives and livelihoods, not just of Nevadans but for everyone.
    Dr. Bell, as someone who has been deployed to provide 
clinical nursing care in response to western wildfires, what 
can you tell us about what you have seen about the frequency 
and severity of the fires as they are impacting our most 
vulnerable, of course, seniors, rural Americans, people of 
color?
    Dr. Bell. Thank you for that question. I have had the 
opportunity to deploy to western wildfires and was at the 
Paradise, California wildfires, working in a shelter to provide 
primary care and emergency care. You know, one important thing 
to think about is that these wildfires displace broad swaths of 
populations from their homes and from their communities.
    I know I have talked a lot about the importance of aging in 
place and the importance of staying, you know, in the preferred 
living environment, and that is not possible when evacuations 
are in order after wildfires. We really have to be thinking 
about, for older adults and people with disabilities, how can 
we better improve our planning around short notice and no 
notice evacuation and sheltering needs, as these needs, we can 
expect them to increase in the future.
    Senator Rosen. Thank you. I appreciate that. I look forward 
to working with you on that, for sure, to be sure we have the 
right places to put people in emergency and beyond.
    I want to move on to speaking of emergencies and during 
disasters, mobile clinics. We know how mobile clinics, and of 
course during COVID, what a difference they made.
    Dr. Spurlock, you know, your testimony. You discussed how 
in the aftermath of Hurricane Katrina Southern University and 
local FQHCs, they made use of these mobile health units to 
deliver regularly scheduled care to displaced residents, 
emergency care and the like. Mobile units have been doing this 
for COVID-19, of course, across the country and in my State of 
Nevada throughout the pandemic. Susan Collins and I have 
bipartisan legislation to provide communities greater access 
and flexibility to use Federal funds to deploy mobile health 
units, particularly in rural areas and underserved areas of 
Nevada and Maine that we have a lot of.
    Dr. Spurlock, can you tell us more about the vital role 
mobile health units can play in serving seniors, of course, 
during a disaster? We know they serve other times. How can we 
use these mobile health clinics that play that important role 
to deliver health care?
    Dr. Spurlock. Yes. Thank you for that question. Little did 
we know when our School of Nursing acquired our mobile unit 
that we would deploy it in actual hurricane response efforts. 
Prior to that, we were already within the community, trying to 
reach our vulnerable populations who otherwise would not have 
accessibility to health care services. We had already engaged 
in outreach to rural areas to seniors, to homeless populations, 
to battered women's shelters, and we had a health care 
infrastructure already in place that would allow us to be able 
to have a rapid response to meet the needs of the hurricane 
evacuees.
    Mobile units are really irreplaceable because the mobile 
units, of course, are clinics on wheels. When a clinic is on 
wheels, you can actually deploy it to diverse settings and 
actually go to where the health care needs are.
    Those mobile units, when they are staffed with health care 
providers, in our instance, we used family nurse practitioners 
and an advanced practice nursing model in collaboration with a 
family practice physician and also called upon our many years 
of partnerships with other healthcare agencies and 
organizations throughout the community, many of whom served the 
needs of older adults and persons with disabilities and, as you 
mentioned, the federally Qualified Healthcare Centers. We could 
bring all of those services to what I would refer to as a one-
stop shopping, so to speak.
    They were all deployed into, you know, central areas to 
where the hurricane evacuees would have immediate access to our 
services and then also to promote continuity of care to reduce 
the likelihood of fragmentation and the hurricane survivors 
could also receive the services and follow-up care at the same 
site.
    Thank you.
    Senator Rosen. Well, thank you. I really think that mobile 
health care, telehealth, whether it is an emergency or not, 
they really provide and expand access and improve and save 
lives, so thank you.
    My time is over. Thank you, Mr. Chairman.
    The Chairman. Senator Rosen, thanks very much. I will now 
turn to Senator Blumenthal.
    Senator Blumenthal. Thank you very much, Mr. Chairman. I 
want to thank all our witnesses for their testimony today, very 
helpful and informative.
    In Connecticut, we have 845,000 adults over the age of 60. 
We have serious storms, like every other State in the country, 
often causing flooding, transportation failures, roads 
devastated. We often have these superstorms, which are becoming 
the new normal, that can be devastating for seniors, causing 
them to evacuate and then even more depressing when they try to 
return to their homes because there is serious property damage, 
everything from downed trees to holes in roofs and the litany 
of problems that can be caused to homes.
    I am grateful to Chairman Casey for the Disaster Relief 
Medicaid Act, which I have co-sponsored, which ensures that 
individuals eligible for Medicaid who are forced to relocate 
during a disaster are able to continue access to Medicaid 
supported services.
    We focus a lot on the service aspect of disaster relief, 
but I want to ask our witnesses about the property aspects and, 
most particularly, access to property insurance, the money that 
is needed to repair the roofs and the windows and remove the 
trees and make homes again livable.
    I have found many of our elderly have trouble accessing 
insurance, more trouble than others, because, they number one, 
may not keep records that are necessary for accessing 
insurance, number two, they can be confused by the litany of 
criteria and technical requirements, and number three, they may 
not have the access to communication, whether it is internet or 
cell phones, especially if cell phone service is down, that 
others may because they can do it from work.
    Let me ask all of our witnesses whether you think that 
property insurers and insurance needs to be made more 
accessible, more easily available to seniors in the wake of 
these natural disasters.
    Dr. Bell. I will take that one. I think that is a great 
question that comes with a lot of complexity.
    Of course, we want our most vulnerable of our citizens to 
have the resources they need to live through a disaster and to 
return to their homes and be safe. We also have a lot of 
complexity involved in how we can support individuals through 
Federal funding, to access Federal funding to recover from 
disasters. I think that is a key point to think about is how 
can we reduce some of the complexity around insurance and 
access to insurance and also accessing the benefits that 
insurance payments provide.
    I also think that--you know, that is a fairly complex 
question to even tackle and one that needs, you know, probably 
its own hearing if I do say, you know, when we think about the 
National Flood Insurance Program and the challenges that 
individuals have in living in, you know, communities affected 
by climate change and accessing insurance in the future.
    Senator Blumenthal. It may be worth its own hearing, but I 
really think it is a vital part of this picture because the 
seniors or elderly trying to go back to where they live, and 
often they have lived there for a very long time and they have 
emotional connections, often find it very difficult to deal 
with insurance companies. Trying to aid them, as my office 
often does, is also made more difficult because they may not 
have prepared for this kind of disaster as long as they may 
have lived in their homes.
    They deserve relief from the property insurers. They need 
and deserve the reimbursement for making their homes livable 
again, but often the insurance companies fail to provide the 
kind of aid that they should.
    I welcome your interest, and I hope the other witnesses are 
interested as well.
    Thank you, Mr. Chairman.
    The Chairman. Thank you, Senator Blumenthal.
    I want to thank everyone who made this hearing possible 
today. I am going to start with Ranking Member Scott and his 
team as well as my staff and so many others who made it 
possible. On top of that list are the witnesses who appeared 
today, Dr. Bell, Dr. Spurlock, Mr. Creamer, and Ms. Koerner, 
for their testimony and for both the personal experiences they 
bring to bear on these issues as well as their professional 
experience, and we are grateful they are with us today.
    As we have heard today, natural disasters are increasing in 
both frequency and severity. The COVID-19 pandemic has shown us 
that we need to prepare for the compounding effects of both 
disasters and public health emergencies. People with 
disabilities and older adults are disproportionately at risk 
for negative health outcomes and death due to these disasters. 
We know that. We have got to do something about that, and these 
disparities must be remedied. I think we have made some 
progress today in recommending some of those remedies.
    We need to prioritize the voices of seniors and people with 
disabilities, especially from communities that are too often 
left behind. The REAADI for Disasters Act legislation I have 
introduced will mandate that people with disabilities and older 
adults will be included in all phases--all phases---of disaster 
management and provide resources for communities to plan more 
inclusively. That is what that bill will do.
    Our witnesses' research that they have summarized today 
shows that the majority of seniors and people with disabilities 
prefer to live in their own homes, in their own communities, 
and emergency planning should reflect that preference.
    I want to turn just to the--finally to the mechanics of our 
hearing in addition to reiterating our thanks to all the 
witnesses for contributing both their time and their expertise. 
If any Senators have additional questions for the witnesses or 
statements to be added, the hearing record will be kept open 
until next Monday, November 29th.
    Ranking Member Scott was pulled away a couple of times to 
other hearings. He will submit a statement for the record, 
which will be made part of the hearing record.
    The Chairman. With that, we want to thank all who 
participated today, and this will conclude our hearing.
    [Whereupon, at 11:20 a.m., the Committee was adjourned.]

                 CLOSING STATEMENT OF SENATOR 
                   TIM SCOTT, RANKING MEMBER

    Thank you Chairman Casey and all of our witnesses.
    Today we heard from true heroes - experts and local leaders 
on the front lines during disasters.
    We learned that while we are making progress, there are 
still gaps that remain in our nation's disaster mitigation, 
preparedness, response and recovery, especially for older 
Americans and Americans with disabilities.
    When an emergency strikes, it is the local first responders 
who are the first on the scene.
    We must do everything we can to support and empower local 
communities in their most vulnerable times, especially for 
their most vulnerable citizens.
    For South Carolina specifically, and many other coastal and 
southern regions, I am working to: 1) Improve flood mitigation, 
2) Allow locally owned restaurants and nonprofits to 
participate in programs to feed disaster victims, and 3) Ensure 
Black homeowners who lack clear legal title to their property 
have equal access to FEMA disaster recovery funds.
    We must build on previous bipartisan legislation to help 
older Americans and Americans with disabilities before, during, 
and after disasters.
    I look forward to working in a bipartisan manner to make 
this happen.
    Again, thank you to everyone here today.
    Your testimonies help us to do our work to better support 
older Americans.
    I yield back.  
      
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                                APPENDIX

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                      Prepared Witness Statements

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                 Questions and Responses for the Record

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