[Senate Hearing 118-44]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 118-44

                        BEFORE DISASTER STRIKES:
                      PLANNING FOR OLDER AMERICANS
                      AND PEOPLE WITH DISABILITIES
                      IN ALL PHASES OF EMERGENCIES

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

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS


                             FIRST SESSION

                               __________

                             WASHINGTON, DC

                               __________

                             JUNE 15, 2023

                               __________

                           Serial No. 118-05

         Printed for the use of the Special Committee on Aging
         
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]         


        Available via the World Wide Web: http://www.govinfo.gov
        
                               __________

                                
                    U.S. GOVERNMENT PUBLISHING OFFICE                    
51-780 PDF                 WASHINGTON : 2023                    
          
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                       SPECIAL COMMITTEE ON AGING

              ROBERT P. CASEY, JR., Pennsylvania, Chairman

KIRSTEN E. GILLIBRAND, New York      MIKE BRAUN, Indiana
RICHARD BLUMENTHAL, Connecticut      TIM SCOTT, South Carolina
ELIZABETH WARREN, Massachusetts      MARCO RUBIO, Florida
MARK KELLY, Arizona                  RICK SCOTT, Florida
RAPHAEL WARNOCK, Georgia             J.D. VANCE, Ohio
JOHN FETTERMAN, Pennsylvania         PETE RICKETTS, Nebraska

                              ----------                              
               Elizabeth Letter, Majority Staff Director
                Matthew Sommer, Minority Staff Director
                        
                        
                        C  O  N  T  E  N  T  S

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                                                                   Page

Opening Statement of Senator Robert P. Casey, Jr., Chairman......     1
Opening Statement of Senator Mike Braun, Ranking Member..........     2

                           PANEL OF WITNESSES

DeeDee Bennett Gayle, Ph.D., Professor of Emergency Preparedness, 
  Homeland Security, and Cybersecurity, SUNY, Albany, New York...     4
Annie Lloyd, Disability Policy Advocate, Darlington, Pennsylvania     6
Jonathan Bydlak, Director of the Governance Program, R Street 
  Institute, Washington, D.C.....................................     7
Mahshid Abir, M.D., Emergency Physician and Health Services 
  Researcher, RAND Corporation, Ann Arbor, Michigan..............     9

                                APPENDIX
                      Prepared Witness Statements

DeeDee Bennett Gayle, Ph.D., Professor of Emergency Preparedness, 
  Homeland Security, and Cybersecurity, SUNY, Albany, New York...    31
Annie Lloyd, Disability Policy Advocate, Darlington, Pennsylvania    36
Jonathan Bydlak, Director of the Governance Program, R Street 
  Institute, Washington, D.C.....................................    39
Mahshid Abir, M.D., Emergency Physician and Health Services 
  Researcher, RAND Corporation, Ann Arbor, Michigan..............    48

                        Questions for the Record

DeeDee Bennett Gayle, Ph.D., Professor of Emergency Preparedness, 
  Homeland Security, and Cybersecurity, SUNY, Albany, New York...    61
Annie Lloyd, Disability Policy Advocate, Darlington, Pennsylvania    64

                       Statements for the Record

Alzheimer's Association and Alzheimer's Impact Movement Statement    67
Healthcare Leadership Council Statement..........................    71
Laura M. Stough, Ph.D., Statement................................    82
National Partnership for Women and Familes Statement.............    86
Tara N. Heagele, Ph.D., RN, EMT Statement........................   109

 
                        BEFORE DISASTER STRIKES:
                        PLANNING FOR OLDER AMERICANS
                        AND PEOPLE WITH DISABILITIES
                        IN ALL PHASES OF EMERGENCIES

                              ----------                              


                        Thursday, June 15, 2023

                                        U.S. Senate
                                 Special Committee on Aging
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:29 a.m., Room 
106, Dirksen Senate Office Building, Hon. Robert P. Casey, Jr., 
Chairman of the Committee, presiding.
    Present: Senator Casey, Blumenthal, Kelly, Braun, Rick 
Scott, Vance, and Ricketts.

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

    The Chairman. The hearing will come to order. Thank you for 
being here everyone. The Senate Special Committee on Aging will 
come to order today. We welcome those who are here for our 
fifth hearing of the 118th Congress, and this hearing will 
focus on including older adults and people with disabilities in 
emergency management and response. In the two years since the 
Committee held a hearing on this topic, we have witnessed 
devastating emergencies and disasters across the country.
    While all Americans are affected by disasters and 
emergencies, older adults and people with disabilities are 
disproportionately affected. The most devastating of recent 
disasters, of course, is the COVID-19 pandemic.
    More than 75 percent of COVID-19 deaths, some 850,000 
Americans, were adults over the age of 65, so 75 percent of the 
deaths were in the age category over the age of 65, and while 
those with--and at the same time, I should say, those with 
developmental disabilities were nearly three times more likely 
to die from COVID-19 than those without a disability.
    While the pandemic has had a disastrous effect on older 
adults and people with disabilities, natural and man-made 
disasters also have a disproportionate effect on them, as well. 
Last year, Hurricane Ian killed at least 150 people in Florida 
and North Carolina, with nearly two-thirds of those who lost 
their lives were over the age of 65.
    As you will hear from one of our witnesses, the train 
derailment in East Palestine, Ohio, which caused about 5,000 
people to flee their homes in both Ohio and Pennsylvania, had a 
profound impact on people with disabilities. In this 
Committee's recent joint report with the Senate Finance 
Committee, this is a copy I am holding up entitled, "Left in 
the Dark", we recommended that older adults and people with 
disabilities be included as an essential part of the entire 
emergency planning process.
    In the report, we stressed the importance of making the 
resources to prepare and respond to emergencies available to 
all who need them, including, of course, older adults and 
people with disabilities.
    As we will hear from our witnesses today, one of the most 
essential resources during an emergency is, of course, 
information. People with disabilities and older adults need 
accurate, accessible, and comprehensive information to plan for 
and to respond to emergency situations.
    That is why I, along with 11 of my colleagues, including 
Senators Gillibrand, Blumenthal, Warren, and Fetterman from 
this Committee, have introduced the Real Emergency Access for 
Aging and Disabilities Inclusion for Disasters Act, for short, 
thank goodness we have an acronym, the REAADI for Disasters 
Act, R-E-A-A-D-I, REAADI for Disasters Act.
    This Bill would ensure that people with disabilities and 
older adults are included in both disaster preparation, and 
that their needs are considered during both response and 
recovery efforts. It would also ensure that the civil rights of 
older adults and people with disabilities are not violated 
during disaster emergencies, so whether it is a pandemic, a 
natural disaster, or a human made emergency, older adults and 
people with disabilities need to be considered in both planning 
and response. I look forward to hearing recommendations from 
our witnesses about how we can ensure disaster planning, 
response, and recovery are truly, truly inclusive.
    I will now turn to Ranking Member Braun for his opening 
statement.

                 OPENING STATEMENT OF SENATOR 
                   MIKE BRAUN, RANKING MEMBER

    Senator Braun. Thank you, Mr. Chairman. Disaster can strike 
anyone anywhere. Just this past April, we had over 20 tornadoes 
hit the ground in Indiana, causing damage and devastation in 
communities across the State. I witnessed the disaster 
firsthand in Sullivan, Indiana, not too far from where I live, 
when I met families that lost their homes and offered Federal 
assistance to the mayor in that case.
    Older adults and people with disabilities were particularly 
vulnerable in the aftermath. We must do more to plan ahead, 
before disaster strikes. When I ran a business for 37 years, we 
budgeted for things outside the ordinary. We didn't go on a 
kind of disorganized spending spree. We had it in place.
    That is why you have insurance. That is why you have rainy 
day funds. This isn't something special because most other 
places do it, and the scale, even to the size of the ones that 
attract Federal attention, you could still be doing the same 
thing.
    Most Americans are very practical. They try to save and 
prepare for that rainy day, for that unforeseen event. My home 
State of Indiana has had over $2.5 billion in reserves. We are 
always prepared, and if you don't do that, you have to dig your 
hole even deeper, because right now this Federal Government is 
borrowing, borrowing $0.30 on every $1.00 we spend, and it is 
going the wrong way because it was just $0.20 when I got here 
four and a half years ago. It was $18 trillion in debt, now $31 
trillion. That is a terrible business plan for the future, 
including how you confront disasters. We talked about COVID 
earlier. You are throwing money at the problem does not 
necessarily stop the course of a tornado or the spread of 
viruses.
    This is an expensive lesson that we have learned, and we 
have--Chairman Casey mentioned how it ravaged senior citizens. 
Always senior citizens seem to be in that place of most peril 
when there is a disaster that comes along. We spent $4 trillion 
on COVID alone. We borrowed every penny of it.
    We lost more than 1.1 million lives to it. Instead of 
prioritizing the highest risk groups, which we should have 
because we knew the science of the disease very quickly, we 
ended up just following the political science, and what did it 
do? More money borrowed, more money spent, and it really didn't 
do a great job on protecting those that needed it most.
    The record inflation that we are dealing with now does not 
bode well for putting emergency funds together, which we need 
to. At the heart of this is big government. From 2019 to 2023, 
the Federal spending grew by 40 percent. We cannot adopt the 
model of panicked crisis governance as a standard response for 
emergencies.
    After three years, it took two measures by Congress to end 
the COVID-19 national emergency. Why should Congress have to 
fight to end an emergency? We should have to fight to keep it 
in place. The American people are simply looking for things 
that make more sense, like they see in their own lives, in 
their State Governments.
    They see a place here run by bureaucrats that generate 
generally decisions that are counterproductive. Last week, I 
joined Sanders, Lee, Blumenthal, Crapo, Risch, and Murphy as a 
broad bipartisan effort to introduce the Article I Act. This 
Bill would automatically terminate national emergencies if 
Congress does not renew them. The Federal Government should do 
more to plan ahead for emergencies and change the trajectory of 
emergencies, especially to protect older Americans and those 
with disabilities.
    I look forward to learning from you, advice on your end in 
terms of what to do, but generally it is going to have to be 
housed within a system that doesn't take us deeper in debt, 
that actually would do a big rainy day emergency fund here and 
quit borrowing money from future generations for whatever we 
do.
    The Chairman. Thank you, Senator Braun. Now we will 
introduce our witnesses. Our first witness is Dr. DeeDee 
Bennett Gayle, who is an Associate Professor at the University 
of Albany's College of Emergency Preparedness, Homeland 
Security, and Cyber Security at the State University of New 
York at Albany.
    Her research focuses on emergency management, socially 
vulnerable populations during disasters, and communications 
during emergencies. Thank you, Dr. Bennett Gayle for being with 
us today and for sharing your expertise and experience with the 
Committee. Our second witness is Annie Lloyd from Darlington, 
Pennsylvania, in Beaver County. She lives roughly five miles 
from East Palestine, Ohio.
    Ms. Lloyd and her family were directly affected when a 
train carrying dangerous chemicals derailed in East Palestine 
just a few months ago. Thank you, Ms. Lloyd, for sharing your 
experience and your story with us today, and now I will turn to 
Ranking Member Braun to introduce our third witness.
    Senator Braun. Mr. Jonathan Bydlak is the Director of the 
Governance Program at the R Street Institute. He is focused on 
fiscal budget and legislative branch policy. Jonathan received 
his bachelor's degree in Economics, with Minors in Finance and 
Political Economy from Princeton.
    In May, Mr. Bydlak published "the Known Unknowns, Planning 
for the Next Emergencies". The report calls for planning ahead 
for emergencies rather than relying on off budget emergency 
spending. Thank you for agreeing to testify today, Jonathan. I 
Appreciate it.
    The Chairman. Thanks very much, Senator Braun. Our fourth 
witness is Dr. Mahshid Abir. Dr. Abir is a Senior Physician 
Policy Researcher at RAND Corporation and a practicing 
Emergency Physician.
    During the pandemic, she led COVID-19 related projects, 
including identifying strategies to increase critical care 
capacity in intensive care units and strategies to boost COVID-
19 vaccine acceptance.
    Thank you for sharing your expertise with us, Dr. Abir. We 
will start with our first witness, Dr. Bennett Gayle for your 
opening statement.

      STATEMENT OF DEEDEE BENNETT GAYLE, PH.D., PROFESSOR

         OF EMERGENCY PREPAREDNESS, HOMELAND SECURITY,

           AND CYBERSECURITY, SUNY, ALBANY, NEW YORK

    Dr. Bennett Gayle. Good morning. Thank you, Chairman Casey 
and Ranking Member, Senator Braun, for having me here today. It 
is an honor to testify before the Committee. This is such an 
important issue.
    Most marginalized members of our society are often 
disproportionately impacted during disasters, and negatively 
so. These populations include older adults and people with 
disabilities, racial and ethnic minorities, low-income 
populations, LGBTQ communities, among others, and in fact, 
there is some research that estimates the marginalized members 
of our society or socially vulnerable populations account for 
nearly 50 percent of our population or more. Some of the 
concerns for older adults and people with disabilities are the 
lack of inclusion across the life cycles of a disaster, lack of 
understanding about the social conditions that contribute to 
their vulnerability, a focus on agent specific rather than an 
all-hazards approach, trying to change our culture of 
preparedness and a dearth of sponsored research to address many 
of these concerns.
    We are aging, healthier, longer, and more independently 
living. Our older adult population is also more racially and 
ethnically diverse, overwhelmingly women, and is rapidly 
increasing. For example, my grandmother lived to be just over 
96 before she passed away just this past October.
    Though her mobility slowed as she aged, her health was far 
superior than most in my family, without common physical 
ailments outside of arthritis. Plus, her memory was completely 
intact. The vulnerability of older adults is not merely the 
result of their pre-disaster health or direct injuries 
sustained.
    Social factors that contribute to their increased 
vulnerability. These factors include being left out of 
emergency planning, preparedness, response, recovery, and 
mitigation efforts. This also includes the increased isolation 
that many older adults and people with disabilities face in the 
aftermath of a disaster.
    Our culture of disaster preparedness is more reactive than 
it is proactive. Legislation often follows an extreme event and 
is agent specific. However, we see very similar 
disproportionate impacts across all hazards concerning are more 
vulnerable populations. Federally sponsored research has 
underscored the importance of investments in infrastructure 
related studies, and more recently, health related medical 
studies to tackle disaster preparedness.
    Research should also proactively fund social, human 
behavioral factors, and workforce related studies pertaining to 
disaster vulnerability. The Real Emergency Access for Aging and 
Disability Inclusions for Disasters Act has the potential to 
focus our attention on fixing known challenges and ensuring the 
inclusion of older adults and people with disabilities.
    With potential investments in research centers, this Act 
can fund necessary empirical studies related to the impacts of 
our marginalized populations, and I have some recommendations. 
We need to address how our citizenry rethink about and 
understand disasters. For one, disasters are not natural.
    The term natural disasters can be misleading, encouraging 
individuals to dismiss the notion that there is something they 
could actually do to reduce their risk. To empower individuals, 
we need to encourage people to be aware of their local hazards 
and to prepare for them appropriately.
    The whole community approach to disaster requires a 
dedicated focus on building capacity. However, we often focus 
on the deficiencies of our marginalized populations instead of 
understanding their strengths and capabilities. This leads us 
to talking at people instead of listening to people.
    Our focus on deficiencies is likely related to our 
preconceived notions about aging and ability. We must shed 
these biases. With older adults living longer, healthier, and 
independent lives, it is important to consider their unique 
needs, include them in developing preparedness plans, listening 
to their experiences, and learning from them.
    We need to also consider the heterogeneity of these 
populations, as older adults do not all reside in nursing homes 
and may have informal caregivers who are members of their 
family or spouses of a similar age, or they very may well live 
alone. This is similar to every older adult in my family 
currently.
    People with disabilities are often also discussed as a 
homogenous group of people, however, they are of all ages and 
have differing abilities. Furthermore, these populations also 
vary in their racial, ethnic, and cultural background.
    As we plan for and study populations, we must factor in 
that we are not all just a member of one group. We must make 
investments before a disaster occurrence. We should proactively 
induce--introduce legislation to increase preparedness, such as 
the REAADI For Disasters Act.
    Additionally, these investments should follow an all-
hazards approach rather than an agent specific one. The issues 
and lessons learned across most of our major disasters are 
similar. After action reports tell a particular story where 
communications, coordination, community engagement, and 
reaching vulnerable populations are significant issues.
    This means that sponsored research should also focus on 
remedying these challenges and increasing knowledge transfer 
with the workforce. We are only as resilient as our most 
vulnerable populations. Again, thank you for inviting me to 
speak before the Committee, and I welcome your questions.
    The Chairman. Thank you, Dr. Bennett Gayle.
    Ms. Lloyd, you may begin your testimony.

          STATEMENT OF ANNIE LLOYD, DISABILITY POLICY 
               ADVOCATE, DARLINGTON, PENNSYLVANIA

    Ms. Lloyd. Good morning. My name is Annie Lloyd, and I 
would like to tell you about my family's experience with the 
East Palestine train derailment. We moved to Darlington, 
Pennsylvania, after my husband served in the Navy.
    My toddler son, Teddy, was showing signs of developmental 
delays, so we felt a quiet rural life would be beneficial. He 
would later be diagnosed as being on the autism spectrum with 
additional symptoms of anxiety and ADHD. Now, nine years old, 
he is incredibly active, imaginative, and very funny.
    He can land a punch line like no one I have ever met. He is 
also dependent on special education services that include 
access to his school's autism resource room, a special 
education teacher, a paraprofessional, therapies, and special 
transportation.
    Immediately after news broke that a train derailed in East 
Palestine five miles from our house, it became very clear to me 
that finding reliable information to keep our family out of 
harm's way would be difficult. You see, I have a journalism 
degree and I have worked at multiple media outlets over the 
last 15 years.
    Living in a rural area places us in a news media barren 
desert. Residents of my community often end up relying on 
social media neighborhood watch groups to try to figure out 
what is going on, and as you can guess, the posts and comments 
can be riddled with rumors and false information.
    The pressure building up in the derailed train cars was 
becoming increasingly concerning. At the time, I concluded that 
the major concern was shrapnel from the anticipated explosion, 
so sending my kids to school that day, to a school that was 
further away from the derailment than our home seemed to be the 
sensible thing to do.
    Not long after we got the call that our kids were being 
evacuated, and officials blocked off all westbound roads at my 
street, something I didn't realize until I saw the barricades. 
My son arrived home with a note from his special education 
teacher that she told him he was being evacuated because a 
train was stuck.
    She often responds to Teddy's anxiety and meltdowns, and 
her precise, subtle explanation met Teddy's needs and was 
greatly appreciated by all of us. He was totally stoked to be 
off school early, so he immediately took to running in the 
yard, as he often does after school, to help him regulate his 
emotions, anxiety, and need for movement.
    Today, I said, would not be a day he could get his running 
in because we have to stay safe from the stuck train. It wasn't 
long after that the black cloud erupted from the controlled 
explosion, igniting concern of chemical contamination.
    Those concerns continue to this day as no testing has been 
available to us and no one has told us about the conditions of 
the air, well water, and soil around our property. Senator--
Senators, we desperately need more reliable information.
    We needed clear communication from authorities with 
intimate knowledge of the train derailment, of what the danger 
was, and who needed to take active steps in protecting 
themselves. Evacuating disabled kids from their schools and 
hoping that they will navigate their way out of harm's way in 
an emergency is simply not enough.
    No disaster is ever truly expected, but everyone should be 
prepared for by our local and county emergency response 
authorities, and first in those preparations should be the 
needs of our most vulnerable.
    At moments like these, I am reminded as my child's 
caretaker that I will not live forever, and there will be a day 
where he will be navigating emergencies on his own. It is a 
perpetual feeling in the pit of my stomach, having struggled 
myself, a non-disabled person, with figuring out what to do to 
stay safe during the explosion, to know that someday my son 
will be doing this without me.
    Senators, I am asking you, as a mother of a son with a 
disability and a friend of many disabled people, all of whom 
make unique, remarkable contributions to our communities, to 
put forth a comprehensive accommodation plan for our disabled 
citizens for times of emergencies and disasters.
    There is nothing more fundamental to a dignified life than 
the capability of preservation. What is freedom, if not equal 
ability to survive. Thank you for your time.
    The Chairman. Ms. Lloyd, thank you very much for your 
testimony. We are grateful you bring your own personal story. 
Next, Mr. Bydlak, for your opening statement. Thank you.

             STATEMENT OF JONATHAN BYDLAK, DIRECTOR

              OF THE GOVERNANCE PROGRAM, R STREET

                  INSTITUTE, WASHINGTON, D.C.

    Mr. Bydlak. Thank you. Chairman Casey, Ranking Member 
Braun, and Members of the Committee, very much appreciate 
today's hearing and the opportunity to testify before you.
    My name again is Jonathan Bydlak, and as I mentioned, my 
specialty is in budget policy and improving Government 
efficiency to better serve constituents. The pandemic and its 
response imposed significant hardship on Americans, 
particularly the older and disabled.
    Being better prepared for the next crisis, whether public 
health or otherwise, can help ensure that no Americans are left 
behind. Smart planning preserves resources and ensures that any 
Federal response benefits those who need it rather than 
furthering waste and abuse. Emergency events affect vulnerable 
segments of the population the most, and so do the unintended 
consequences of poor planning and irresponsible budgeting.
    In everyday life, we understand that a car accident is an 
emergency. It requires a rapid response and temporarily special 
powers like letting ambulances run red lights or speed on their 
way to the hospital, but increasingly, in the context of 
national emergencies, the Executive continues to use special 
powers long after the crisis.
    Just as we don't let injured drivers run red lights on 
their way to physical therapy, so too, must we limit emergency 
powers to the time of actual crisis. In recent years, the 
number of federally declared emergencies has increased 
dramatically, and so has Federal spending in response.
    Officially designated emergency spending has totaled more 
than $3 trillion since 2000, but the true impact on the U.S. 
economy and the Federal budget is much greater. The Federal 
response to the COVID-19 pandemic costs more than $5 trillion. 
Spending overseas expanded dramatically during the two decades 
after 9/11, and disaster supplementals in our response to the 
financial crisis in 2008 also contributed to our increasingly 
tenuous Federal balance sheet. Put simply, emergencies have 
added up, especially since this spending is typically enacted 
without any offsets. There are also substantial private costs, 
and I am thinking of closed businesses, on and underemployment, 
and more recently, higher inflation and interest rates.
    Many economists at the Federal Reserve and others have 
written about the relationship between expansive pandemic 
related spending and persistent inflation. I have with me an 
article from CBS News, the headline of which reads, "Inflation 
is Slamming U.S. Seniors". "It is a scary time", one disabled 
widow said.
    Unchecked spending poses real costs to Americans who are 
lower income or on a fixed income. With each additional 
unexpected expenditure, vulnerable populations are threatened 
further by trust fund insolvencies, crowding out other 
budgetary priorities, and potential benefit cuts if nothing is 
done.
    As a recent Social Security trustees report warned, the 
odds are rising of a 23 percent benefit cut as soon as 2033 
without a change in the status quo. Fortunately, there are 
reforms that Congress should consider. These include limiting 
the length of emergencies and restoring the proper role of 
Congress.
    The executive branch must often act quickly, but the 
legislature should not allow emergencies to extend unchecked 
for months and years. The recent bipartisan effort to end 
emergency declarations after 30 days absent congressional 
action is a good idea, and when an emergency has been declared, 
Congress should target funds and demand transparency.
    For example, instead of trying to claw back pandemic 
funding after the fact, Congress could have required States to 
publish how they spent funds as a condition of aid in the first 
place. Most States were able to respond to the pandemic thanks 
to the strength of their budget stabilization funds.
    We should explore such options at the Federal level to 
alleviate fiscal strain in times of crisis. As we now reenter a 
world of Federal spending limits, such mechanisms could ensure 
that adequate funding for emergencies is immediately available, 
rather than relying on off budget spending and gimmicks.
    Well-designed fiscal rules in other countries should also 
be considered. Sweden's entitlement program guardrails have 
become a worldwide model, just one example, instituted to 
safeguard their safety net programs, and finally, we should 
help people continue to save. The Federal Government can 
incentivize individuals to prepare for emergencies and make 
existing savings vehicles more flexible.
    Efforts enacted in last year's omnibus, including the 
chairman's Able 2.0, should be expanded to further increase 
savings opportunities for Americans with disabilities. Thank 
you again for holding today's hearing and for your 
consideration of these important issues, and I look forward to 
any questions that you may have.
    The Chairman. Thank you, Mr. Bydlak. We will turn next to 
Dr. Abir.

      STATEMENT OF MAHSHID ABIR, M.D., EMERGENCY PHYSICIAN

              AND HEALTH SERVICES RESEARCHER, RAND

                CORPORATION, ANN ARBOR, MICHIGAN

    Dr. Abir. Thank you, Chairman Casey, Ranking Member Braun, 
and distinguished Members of the Committee for the opportunity 
to testify today. In addition to being a health services 
researcher at RAND, I am a practicing emergency physician and 
worked on the frontline during the COVID-19 pandemic.
    The views I share today reflect my clinical experience in 
the emergency department for nearly two decades and an 
expertise as a health services and public health researcher. On 
a typical day in the emergency department, many older adults 
and individuals with chronic diseases present for care.
    Many of these patients have multiple co-morbidities and 
long list of medications, and some are dependent on life 
sustaining medical devices. The process of getting to the 
emergency department itself can be a massive feat for these 
individuals, often necessitating transfer by ambulance or 
dependence on family or transportation services.
    During emergencies, these population's challenges in 
seeking health care are compounded by the uncertainties 
presented by these events. Disruptions in access to food, 
shelter, transportation, electricity, health services, and 
medications can put older adults and people with disabilities 
in an even more vulnerable position.
    Any one of these disruptions can lead to acute 
exacerbations of chronic illnesses and the need for care in the 
emergency department and inpatient settings. The routine 
challenges faced by health systems and social services in the 
U.S. are also amplified during these events.
    For example, during the COVID-19 pandemic, health care 
workforce shortages strained the emergency department and 
hospital capacity, and emergency department boarding of 
hospitalized patients, where admitted patients may stay in the 
emergency department for days waiting for an inpatient bed 
worsened.
    This strained health system capacity during emergencies can 
adversely affect outcomes among older adults and people with 
disabilities, because of this two prong exacerbation of 
vulnerabilities among these populations and in the health and 
social services systems, Mitigating the needs of older adults 
and people with disabilities requires special consideration 
distinct from the rest of the population.
    Given that preparedness, response, and recovery is likely 
most challenging in the context of these groups because of the 
intensity of their health care and social services needs, 
framing related policies and practices based on them are likely 
to improve the processes for all Americans.
    In order to effectively plan for the response and recovery 
needs of older adults and people with disabilities, a data 
driven approach and leveraging technology is imperative. For 
example, the size of these populations and the nature and 
degree of their health care and social services needs need to 
be routinely measured in every community across the United 
States to inform mitigation plans and anticipating the needed 
resources.
    Paired with a national all-hazards surveillance system, 
such data could inform planning for the needs of these groups 
based on the nature of the event. Further, because many older 
adults may live alone and may not have a reliable source of 
communication with response entities, advanced knowledge of the 
locations of these individuals and plans for outreach during 
emergencies will be critical.
    Beyond leveraging data and technology, Congress could take 
steps to advance the health and safety of older adults and 
people with disabilities in emergency contexts, such as 
requiring Medicaid payments to be made out of State for older 
adults and people with disabilities during public health 
emergencies and disasters.
    Extending Medicare 20 percent increase for inpatient COVID-
19 care to all Medicare eligible adults and people with 
disabilities during future incidents. Requiring the development 
of resources and capabilities within public health departments 
to address the needs of older adults and people with 
disabilities.
    Another opportunity is the currently in progress 
reauthorization of the Pandemic and All Hazards Preparedness 
Act, otherwise known as PAHPA. PAHPA reauthorization offers an 
opportunity to modernize preparedness, response, and recovery 
capabilities at all levels of Government through investing in 
more effective and efficient strategies.
    Part of redefining our preparedness, response, and recovery 
framework is planning for the worst case scenario that affects 
the most vulnerable in our communities, including older adults 
and people with disabilities. I thank you again for this 
opportunity and look forward to your questions.
    The Chairman. Thank you, Dr. Abir. I Appreciate your 
testimony and your experience. I wanted to start a round of 
questions. I will start with Ms. Lloyd. You are a journalist, 
and you have to get the facts right, and you know the 
importance of accurate information, especially in the context 
of an emergency.
    I am sure you are also sensitive to how, and you made 
reference to this in your testimony, about how disinformation 
or rumors or other misleading information can put families at 
risk and put a whole community at risk in the aftermath of the 
train derailment in Ohio.
    News organizations got facts wrong. You shared in your own 
testimony that you and your neighbors could only find 
information through local Facebook groups and that these became 
rumor mills, to use your words, that cause unnecessary panic.
    Why is it important for families like yours that include 
people with disabilities and older adults to have access to 
accurate, trustworthy information about both emergencies and 
disasters as they are occurring, and of course, in their 
aftermath?
    Ms. Lloyd. Yes, I think not everybody has discernment. I 
think a lot of people who are new to technology, especially in 
our rural area, think because it is printed on a website, that 
it is official, and it is true, and in this case, it obviously 
was not necessarily the case.
    I know of people who lived 20 miles out that were getting 
hotel rooms that probably the people who lived within the one 
mile radius of the explosion desperately needed. There seemed 
to be no information czar or no information manager who was 
managing the information coming out from our, like town 
supervisors, our local State representatives. It just seemed to 
be a free for all.
    The Chairman. Nothing that was centralized?
    Ms. Lloyd. Not that I could find.
    The Chairman. That is one of the challenges in this area of 
policy to get--to try to improve that. We will talk more about 
that. I wanted to turn to Dr. Bennett Gayle. In your testimony, 
you talk about the importance of the whole community approach 
to emergency preparedness.
    The REAADI For Disasters Act will create a commission that 
will have on the commission people with disabilities, older 
adults, and experts to provide guidance on inclusion, inclusion 
of those Americans on such a commission so that they are 
prepared and were prepared during disasters.
    These particular citizens of ours have specific needs 
before, during, and after disasters that are often ignored. Dr. 
Bennett Gayle, what specific challenges do older adults and 
people with disabilities face after a disaster strikes? Why is 
it so important that they have a seat at the table throughout 
all phases of emergency preparedness?
    Dr. Bennett Gayle. Thank you for the question. I believe it 
is not just in response and recovery that they have their 
challenges.
    What happens during preparedness, and I think we should 
invest more money in preparedness, is that they are often left 
out of the exercises and simulations when we are thinking about 
and planning for people with disabilities. There needs to be 
some proper inclusion, so sometimes you may see someone without 
a disability being a mock actor trying to figure out what their 
needs might be, and that doesn't necessarily cause anyone to 
figure out what their actual needs are. They should be included 
in planning.
    In response during warnings and emergency messaging, there 
needs to be consideration for American Sign Language and 
prominent languages in the area. Reaching out to populations 
only gets us halfway there. Did they understand the message, 
and can they actually comply with that message is something 
that we really haven't looked at as much.
    We are starting to think about that, but we are doing a lot 
of research on making sure that we have clear, consistent, 
clear, and accurate messaging going out, and trying to reach 
the populations, but often just having numbers on how many 
people that receive the message doesn't actually get us to know 
if they are able to understand the message and if they are able 
to take the necessary precautions. In evacuation, we can figure 
out how to maintain their social connections and social 
networks.
    That is extremely important because if they are unable to, 
then they fare way worse than if they actually are able to keep 
up with their social connections, and then in search and 
rescue, we have problems with trying to figure out where people 
are located. These groups are not necessarily geographically 
located all together.
    How do you figure out where they are? Registries have not 
worked in the past. Registries only pick up about five percent 
of our population in a particular area, and--at best, and then 
when we do have registries, you have a number of people who 
don't want to be on them, especially those who are people with 
disabilities and some older adults, and we have to take that 
into consideration.
    With recovery, there is early evidence, especially even 
recently from Hurricane Harvey, of the paperwork being very 
detailed and being very difficult to navigate, and that also 
hinders people from filling out the paperwork or getting 
information so that they can recover, and it may not consider 
unique household dynamics.
    Some of the paperwork does not consider the fact that 
families living in a particular area have passed on their 
houses from person to person and then you don't have a deed, or 
it doesn't consider the fact that you may have grandparents, 
and a number of them are, taking care of young children and how 
do they actually navigate that system, and then mitigation, it 
is costly at the individual level. A lot of our older adults 
are on fixed incomes, and it is not easily explained. That 
takes some time to do. We have evidence of it working where 
people have been able to mitigate and do it at the household 
level, but that has taken way more than 30 days. It has taken 
quite--like a year or so.
    A good example of that is in Greensburg, Kansas, after 
tornadoes. They did get a chance to get individuals to start 
thinking about green living or changing their household 
structure so that it would be better off, but that took a lot 
of community engagement and explaining to individuals what was 
happening so that they can buy into the system.
    The Chairman. Doctor, thanks very much. I will turn to 
Ranking Member Braun.
    Senator Braun. Thank you, Mr. Chairman. Mr. Bydlak, 
earlier, we talked about on all emergency spending, we 
basically borrow the money, done nowhere else through 
insurance, through any other Government entity.
    They have to deal with emergency funds and rainy day funds, 
and I think you said that over the last two decades, it is 
north of maybe $10 trillion that have been added to the Federal 
debt. Can you explain why a rainy day fund, an emergency fund, 
would actually be a better way of doing it?
    Mr. Bydlak. Yes. Thank you for the question. I think if I 
start I mean, if you just consider, you know, a quick back of 
the envelope calculation, I mean the cost of war project at 
Brown University estimates that we have spent around $8 
trillion in total on the war on terror, and that was spending 
that was not expected pre-2001.
    If you consider the money that we spent on the pandemic, 
that is another $5 trillion. That was obviously not really 
expected prior to early 2020, and then if you consider the $3 
trillion in sort of officially designated emergency spending, 
that is alone, is you know, $15, $16 trillion out of an 
increase in the national debt of $26 trillion over that time.
    You are talking well north of 50 percent, so I think that 
the impact, you are correct to point out, of emergency 
spending, whether officially designated or otherwise, has been 
very significant. You know, in the context of emergency funds--
and I think to some degree it speaks for itself.
    I mean, if we look at how States were able to respond in 
the pandemic, they had, you know, their emergency funds were 
pretty much flush with cash in the early stages, and, you know, 
that put them in a very strong position. I think that there has 
been a lot of sort of, you know, misinformation maybe that it 
was a requirement that they get funds from the Federal 
Government to replenish their emergency funds, but their 
emergency funds were in very strong shape early on, and the 
same was true even going back to the 2008 financial crisis, and 
so the value here is that, you know, you have actual funds put 
aside for these types of expenditures, which look is the kind 
of thing that we all do in our own private lives and that we 
expect even businesses to do to plan for unforeseen events, and 
the other underappreciated part, I think, of emergency funds is 
just the speed. You know, as we learned in the context of the 
pandemic, the ability to respond quickly to an emergency or 
disaster situation is incredibly important.
    It is not just that you have money, it is that you also are 
able to respond in a much quicker fashion, and so, I think it 
is something that we should definitely consider at the Federal 
level, especially when we consider that, you know, in many 
points in time, the Federal Government has served as sort of a 
de facto backstop.
    It is very important that we have our Federal finances in 
as strong of a position as possible, and an emergency fund 
could very well be an important component of that.
    Senator Braun. I think sooner or later, when you have any 
understanding of fiscal policy and macroeconomics, you are 
going to pay the piper with inflation and other things that 
happen due to that approach, so when it comes to, how would 
you--what policy proposals are out there? Is or anything else 
other than creating a rainy day fund, which is probably 
unlikely here?
    I don't think we will do that until you hit the ditch 
fairly hard. Any other policy proposals that would make it a 
more sane approach rather than--we know the need is there, but 
it is the approach in this place that defaults to the, to me, 
shameful process of just putting more and more debt on to 
everybody that is in a future generation, kids and grandkids.
    Mr. Bydlak. Yes. I mean, I like to be a little bit more 
optimistic perhaps, and hope that we might be able to go and 
implement an emergency fund. Look, I think there are a lot of 
lessons from the States and from other countries.
    I mean, I referenced in my written testimony the Swedish 
case where Sweden was actually found themselves in a very 
similar situation in the 1990's. They had a generous social 
safety net. They don't sit on a large amount of oil reserves 
like their neighbor to the West, and they had to really think 
about, how can we ensure the sort of programs that many people 
are reliant on, and they implemented statutorily, you know, 
budget caps that put some level of restraint on their 
expenditures, and you see very effectively that countries like 
Sweden or Switzerland, perhaps being the other example that is 
often used, those countries have tended to respond far more 
effectively to crises and done so in a way that didn't result 
in just blowing up their budgets.
    Senator Braun. They have a fairly--they have got somewhat 
larger central Government, probably budget, but they don't 
borrow money to spend what they want to spend, and they are 
taking the responsibility of putting savings into emergency 
funding, which again, is what all other places have to do. This 
is the only place that seems to try to violate that rule 
routinely.
    Mr. Bydlak. Yes. I mean, you know, in this country, we just 
went through the debt limit fiasco, crisis, whatever you want 
to call it, and I think there is a lot of acknowledgment from 
people on both sides of the aisle that the way that we deal 
with our sort of expenditures in this country is not ideal.
    There are virtually no other countries that have this exact 
same process. I think Denmark is the only other one, and 
instead, what they do is they cap their expenditures as a 
function of expected revenue, which is itself a function of 
what they have taken in recently and what they expect in the 
short term, and that is a much smarter way of doing it, and it 
gives you a lot more flexibility to respond to unforeseen 
events. I mean, in the Swiss case, they don't have a--they 
don't have an emergency fund explicitly, but they are able to 
engage in emergency spending, and then it sort of--that impacts 
what they are able to spend in the coming five or six years, 
and so, again, these types of lessons, I think are very 
important and big picture, have wide ranging implications for 
both the finances of the country and how we deal with them.
    Senator Braun. Thank you.
    The Chairman. Thank you, Ranking Member Braun. We will turn 
to our next Senator in a moment. I just want to mention, as 
many of you know, follow the work of this Committee and the 
schedule on Thursdays, we are going to have Senators in and 
out, some appearing and having to leave and come back, some 
appearing and being able to ask questions, so we have had 
Senator Kelly here and Senator Blumenthal, and we will now turn 
for questions to Senator Ricketts.
    Senator Ricketts. Great. Thank you very much, Mr. Chairman, 
and thank you to all of our witnesses for being here this 
morning. I was the Governor of Nebraska from 2015 till just 
this year, and we dealt with a number of disasters, and 
including the COVID pandemic, but also tornadoes, wildfires, 
flooding, you name it, and appreciate all your comments, 
specifically with regard to older Americans and Americans with 
disabilities, because they are disproportionately impacted for 
all the reasons that you have just outlined, whether it is 
burden of paperwork or just people not thinking through how to 
be able to handle folks who have additional needs, and frankly, 
one of the things I also want to hit upon--well, two things I 
want to hit upon. One is, just making sure that we are doing 
the planning ahead of time and how important that can be, but 
also not having a one size fits all answer.
    According to the Surgeon General Advisory, one of the 
things I also want to hit upon in that second part is with 
regard to loneliness, but I will talk about planning first. One 
of the things that we did in Nebraska is we got a CDC grant 
that allowed us to establish in 2015 the Infection Control 
Assessment and Promotion Program, and that was a training 
program, in conjunction with the University of Nebraska Medical 
Center, to be able to actually go to our skilled nursing 
facilities and assisted living facilities to train them in 
infection control, and this is one of the things that allowed 
us to be able to perform relatively better with regard to those 
congregate living situations where we knew for older adults in 
particular were so dangerous with the COVID pandemic. Now, how 
you actually get States to make those kinds of decisions ahead 
of time, I don't have a good answer for.
    I would love to say, I was so smart and told people to do 
that. That was not the case. It was somebody in my Department 
of Health and Human Services who made the decision, working 
with the University Nebraska Medical Center, to establish that 
program well in advance of the COVID pandemic, to allow us to 
train our health care professionals in those facilities so that 
they had a leg up when the pandemic hit, and then, of course, 
we really ramped those programs up, so advanced planning can 
make a difference.
    We have demonstrated it here in Nebraska, where some other 
States, which, for example, made some of the horrible decisions 
about sending people who had COVID back into those types of 
facilities that led to additional problems.
    Another thing is just how we have to avoid having one size 
fits all answers coming from the Federal Government, because 
that is one of the things that really leads to bad outcomes and 
poor health outcomes for our senior citizens and so forth.
    This is what I was going to--read this one, according to 
the Surgeon General Advisory, loneliness and isolation have 
detrimental effects on public health. The National Academies of 
Sciences, Engineering, and Medicine reports loneliness and 
isolation in older adults are strongly associated with greater 
incidences of morbidity, cognitive decline, depression, 
anxiety, and a decreased quality of life, and increased risk of 
early death of all causes.
    I know that specifically, I have had a number of providers 
in Nebraska talking about this. One in particular is Papillion 
Manor, a skilled care nursing facility that has expressed 
strong dissatisfaction with CMS's COVID-19 regulations, and 
some facts on parents.
    Residents report a loss of quality of life as a result of 
the isolation, which kept residents from events with other 
residents, and their families--Mr. Bydlak kind of gets to your 
point about having emergencies too long. Well after we didn't 
need to have the restrictions in Nebraska on, say, communal 
dining, CMS still had those regulations in place which really 
contributed to this loneliness, and of course, Mr. Bydlak, like 
you also mentioned, all the $5 trillion in spending which has 
helped contribute to inflation, which also hurts our older 
Americans, but what I would like to do is just hit upon, Dr. 
Abir, what sort of things did you see, or what sort of 
experience did you have with regard to kind of a one size fits 
all answer coming from regulations that may give us an 
opportunity to look for some flexibility down the road in the 
future so we can have more of a flexible response to be able to 
help, whether it is the amount of paperwork for older Americans 
or Americans with disabilities, or other sorts of rules that we 
might be able to take a look at to be able to get better 
outcomes.
    Dr. Abir. Thank you so much for this question, so I think 
that one of the most important things is to understand the 
specific needs and vulnerabilities of these populations, and 
yes, planning in advance, and preparedness is one of the major 
paradigms of, again, preparedness, response, and recovery. The 
problem is that historically we have treated, whether it is 
older adults or people with disabilities, almost similar to 
everyone else. Whereas given all the vulnerabilities, the needs 
are going to be different. The intensity of both social 
services and health services is going to be quite different.
    Advanced planning is the key. However, that is also 
extremely expensive, but it is an investment that is 
worthwhile, and comparisons with Denmark or Sweden or 
Switzerland, which are socialist countries that invest 
tremendously in their health system and social system 
infrastructures, have healthier populations as a result, and 
it's not the United States.
    I think that we need to think differently because we have a 
significantly aging population. We have a population that in 
many instances does not have appropriate access or enough 
access to social services and health care, so I think that we 
need to think very hard and look back at the COVID-19 pandemic, 
which is, you know, not just the pandemic of 100 years, but is 
the worst case scenario.
    Who would have planned for a three-year public health 
emergency that touched every corner of our Nation and cost us, 
who knows. For decades to come, we are going to be measuring 
the impact on lives, on health in general, on loss of 
workforce, on loss of income, on loss of education, and so many 
other aspects of society.
    We need to take a nice, long look at this pandemic, and the 
way that we didn't prepare for it, and how we responded to it, 
and how are we going to recover from it, and step back and say, 
how can we do better, particularly for the most vulnerable 
populations, because if you do it right for those populations, 
you are going to get it right for everyone else as well.
    Senator Ricketts. Thank you, Dr. Abir. I would point out 
again, in Nebraska, we did take some steps ahead of time in 
preparing, like our ICAP program to do it. Again, that wasn't 
mandated, but that is just shows how we chose to do with our 
CDC grant. I am sorry, Dr. Gayle, I was looking at you and I 
said Dr. Gayle--or Dr. Abir, but I wanted to ask you the same 
question, if I may. Mr. Chairman, can I have a few extra--a 
little bit extra time to give Dr. Gayle a chance?
    The Chairman. Sure, sure.
    Senator Ricketts. Again, in your experience, were there 
things that we could do to provide more flexibility to help us 
address populations that are older or with disabilities?
    Dr. Bennett Gayle. Sure. I think we can't forget about the 
social context.
    I think my fellow panelists here also mentioned it, but 
when we consider what happened in COVID, right, in the 
beginning, it wasn't pharmaceutical that we went in terms of 
response. It wasn't infrastructural, it was a social mandate, 
right. It was to self-isolate, physical distance, or increase 
our use of technology to kind of continue our tasks, but that 
caused some problems, and I don't think we really understood 
what that was going to cause, and the reason why is because we 
don't actually fund a lot of the studies to study that.
    If we are going to increase spending around planning and 
preparedness, we actually need to know what we are planning and 
preparing for, and we actually need to know the individuals who 
are going to be impacted, and we need to invest in the research 
to do so.
    That research can't be focused solely on pharmaceutical 
outcomes because that is not--that wasn't our first step. That 
wasn't our first response. The other thing is, I have lived in 
your State, and I lived in your State during the time that you 
were Governor, and having visited Nebraska Medical Center, a 
lot of the things they had in place for infectious disease were 
because they also were dealing with--I think they dealt with an 
Ebola outbreak at one point, and they already had a lot of 
stuff in place to deal with infectious disease where other 
States may not have, so that could be one of the things that 
made you guys a little bit, you know, better in terms of 
preparing for this, and that is you had some space in having to 
deal with it before, so that is also very unique.
    When we were thinking about vulnerability, we have to be 
cautious when we are trying to compare against different 
societies, not just because the societies are different, but 
because vulnerability is different across different societies. 
What makes us more vulnerable in one than another can also be 
because of social context.
    Our vulnerability as an older adult here could be very 
different in another country, and we have to take that into 
consideration as well.
    Senator Ricketts. Yes. Dr. Gayle, thank you very much. You 
are exactly right with regard to UNC. They are a leader in 
infectious disease control. We do have one of only three 
federally funded containment--isolation places and the only 
actually quarantine space that was federally funded, and we did 
handle the Ebola patients who were coming out of West Africa.
    We did have the expertise on hand to be able to do things 
like the ICAP program, and I agree 100 percent that that was 
kind of my point is, it is not going to be a one size fits all 
answer. What may work in New York, may not work in Nebraska and 
vice versa, so we do have to be flexible about it.
    Thank you very much to our witnesses again, and Mr. Bydlak, 
I was just going to say one last thing. When we started our 
emergency response in Nebraska, we did use our rainy day fund 
to be able to start funding before the Federal Government 
actually got their, you know, program in place and start 
passing it, so anyway, thank you, Mr. Chairman, for being so 
patient with me as I take up all the time in your Committee.
    The Chairman. Senator Ricketts, sometimes there is a reward 
for being at every hearing, I think so that is--you get extra 
time. I wanted to turn back to a question for Annie Lloyd. 
Annie, in your testimony, among--so much detail about those 
hours after the derailment and what your experience as a as a 
mom and as someone who was not the recipient of a lot of 
information, like so many in the community.
    You made reference to Teddy's school and the accommodations 
and help he get to school. You made reference to the--his 
school's autism resource room, a special education teacher, a 
paraprofessional for his time in general education classes, 
speech therapy, occupational therapy, and special 
transportation, all of which are important to note, and then 
you also talked about his teacher.
    I am just reading directly from your testimony. You said 
his special education teacher often responds to his anxiety 
with, ``brilliance and expertise, and her precise, subtle 
explanation met Teddy's needs and was greatly appreciated by 
all of us.''
    I sometimes think as much as we are often frustrated of 
when there isn't planning and there isn't planning that 
includes people with disabilities or older adults, there are 
some real heroes out there that step up and not only do their 
job but go beyond their job, and I thought it was important 
that you share that insight into his teacher.
    What we have got to do here, among other things, is to 
learn from good behavior and good practices, best practices. 
Her response is something that we should replicate or imitate 
and use as a foundation for good policy. I introduced another 
piece of legislation that is relevant here, the so-called PREP, 
P-R-E-P, For Students Act, that would ensure that schools have 
the tools they need to develop inclusive emergency preparedness 
protocols.
    Annie, when there is an emergency or a disaster, what kind 
of information and resources do you think schools need? There 
is so many places that need good information, but just in the 
context of schools, and maybe ever more so in the context of 
schools that have a number of children in that have a 
disability of one kind or another, what information and 
resources do think schools need to ensure that children like 
Teddy are safe?
    Ms. Lloyd. One thing I can't help thinking about of that 
day, once a week I go and I work downtown--in downtown 
Pittsburgh, an hour away.
    I can't help but think if I happened to be in the office 
that day, an hour away, when all that was happening, I do 
think, especially in the needs, in terms of students with 
disabilities, there needs to be a way for the school to be able 
to communicate with each and every individual parent to make 
sure that when they are evacuating kids in an emergency, that 
not only will someone be home, but someone capable, a capable 
caretaker will be home to continue the process of caring for 
that disabled person.
    That is what stood out to me the most, and I would also add 
to that is, to this day, I actually have no idea why they were 
evacuated from school. I think a followup would have--it still 
is--would be appreciated. I have the feeling there is some--
there might be some legal, you know, things that--reasons why 
they sent the kids home, but at one point, all the--you know, 
my son rides the small bus and the disabled kids right before 
this controlled explosion were driving toward the explosion to 
get these kids home, and it did not seem right to me.
    The Chairman. Well, as you said, I am looking at page two 
of your testimony, that word navigated--navigate, jumped out of 
me where you said, when evacuating a child with a disability 
from school, and absent good policy, we are just hoping that 
they will, ``navigate their way out of harm's way.'' Hoping for 
that is not the right approach. We have got to have--we have 
got to do a lot better than that. Senator Scott from Florida is 
here, and I will turn to him for his questions.
    Senator Rick Scott. Thank you, Chairman. First, I thank you 
all for being here, so I come to the State that has hurricanes, 
as you probably know.
    We unfortunately have lost in the last--we had a hurricane 
last year and we lost 150 people, and many of them elderly, so 
I have been traveling the State, I have been in seven cities in 
the last three weeks trying to get people ready for and prepare 
for hurricane season, which started June 1st.
    The--as we know, many elderly don't feel comfortable 
evacuating, whether it is because they like to be where they 
are, whether it is because they have pets, whether they are not 
comfortable they will have the right food or medicine, all the 
all these issues, so for each of you, what do you do--do you 
have any recommendations to make sure that our elderly citizens 
actually listen to evacuation orders and evacuate early enough?
    Dr. Abir. I think that leveraging the networks in the 
communities, for example, faith based community, health 
services, EMS, law enforcement, and ensuring that these 
networks are aware of these older adults' locations and their 
needs in advance will be really important, and to communicate, 
and whoever is the trusted messenger in those communities to 
communicate in advance to those communities and populations the 
importance of being ready to leave with their medications.
    Let's say they have medical equipment or devices that they 
are dependent on, so that would make a big difference, but I 
think it is really important to leverage the right stakeholders 
and use the right messengers to get through.
    Senator Rick Scott. Anybody else?
    Dr. Bennett Gayle. I would agree. I think additionally, 
beyond just the trust, it is also thinking about the other 
social connections that they have made, so it could be an 
official person, but it could be an informal person. It may be 
someone from their local house of worship, but it could also 
be, you know, their next door neighbor, and it is kind of hard 
to say. That is not some--we know this in general, but we 
haven't done extensive research to think about all the 
different ways to make someone evacuate.
    We have done research on how to get messages to people. We 
have done research on who is left behind. We have thought 
about, you know, all of these different things, but we do need 
to find out more information.
    I think it is going to be unique to each individual, and I 
think that is where we--everything kind of gets lost. We look 
at things in large data sets and we kind of think about people, 
all is the same, but when we get down in the nitty gritty, you 
will figure out, oh, well, if we had some information about 
this or if we can answer specific questions.
    I did last year a national hurricane conference, have a 
panelist who is from Florida, and they were emergency 
management personnel, and during COVID, they said some of the 
things that helped was their, as a local emergency management 
group, going out and talking to the older adults and people 
with disabilities, and then they found information for them. 
They can answer their specific questions and they made the 
relationships ahead of time because they were from fire 
department, and it was, you know, very nice and they were able 
to make those connections. You don't often hear, you know, that 
pivot to, okay, I am just going to go door to door now and try 
to figure out what is going on.
    Sometimes it takes a little personal touch. The robocalls 
don't necessarily work for older adults, so we have to think 
about other ways, and I think there may be some other examples 
out there, but they are going to be localized, and so we 
definitely need to learn more about what emergency management 
personnel are doing so that we can learn from what they are 
doing well.
    Senator Rick Scott. Yes, sir.
    Mr. Bydlak. I will just add one quick additional point, 
which is that I think that we do also need to take sort of a 
long term approach to this as well. I mean, we have plenty of 
Americans who are living in areas that are particularly 
vulnerable, and we know that we have huge problems with the 
National Flood Insurance Program, for example, and a number of 
my colleagues have done work on that topic. I think that we do 
also need to kind of think about some of the long term 
implications and sometimes some of the perverse incentives that 
have been created by poor Federal policy through the years.
    Senator Rick Scott. Have you found--like what we do in 
Florida, we have shelters for people with disabilities, for 
pets, and we have all these different things. Have you found 
around the country that most of the States have shelters for 
specific purposes?
    Dr. Bennett Gayle. Yes. People--and you know, in general, 
there is a shelter that shows up, right. The concerns about the 
shelter situation is that often--well, now we are seeing more 
disasters frequently occurring. Shelters don't stay up long 
enough. You know, minimum time is about two weeks and then they 
are closing, and that is problematic for individuals who 
actually need that space. The other thing about sheltering is 
that everyone doesn't show up to the shelter, so you may have a 
shelter, but it is only for a specific percentage of your 
population. I don't have that information offhand, but I know 
it's not nearing 50 percent, right, of those that are left 
behind.
    When we are thinking about sheltering, we have to think 
that there are also individuals staying in place at their house 
instead of going to the shelter, and it could be for a number 
of different reasons. Maybe there is not enough information 
about the disability accommodations at the shelter, so they 
feel like it will be more comfortable or helpful if they stay 
at home.
    There could be other things similar to that. You know, 
during Katrina, I know you mentioned pets, but we learned a big 
thing, oh, people won't leave without their pets, and then we 
started thinking about putting pets in shelters so that 
individuals will leave.
    There are other things that we haven't learned, and we 
shouldn't be learning them after a disaster, we should be 
proactively doing it and learning beforehand so that we can 
make the right choices and decisions and spend our money wisely 
prior to a disaster.
    Senator Rick Scott. Thank you. Thank you, Chair.
    The Chairman. Thank you, Senator Scott, and we will turn 
next to Ranking Member Braun.
    Senator Braun. Dr. Abir, you earlier were asked by Senator 
Ricketts about kind of one size fits all. You know, as we 
navigated through COVID, we could see that shutting schools 
down didn't make sense when we found out that it had very 
little impact on young people, shutting businesses down, we 
spent a fortune.
    The transmission wasn't occurring there. Hospitals had to 
stop routine stuff, I think, which had a, you know, latent 
negative impact we still probably can't measure, but the one 
thing we did know, it ravaged the community 65 years and older, 
predisposed. I think we focused on such--so many other areas 
and we didn't relent there.
    What could we have done better once the science was clear 
that this disease was aimed at a very small group that got 
disproportionately impacted and we didn't seem to do a very 
good job in preventing that?
    Dr. Abir. Yes. Thank you for this really important 
question, so a couple of things before I answer your question 
directly, so in hindsight, hindsight is 2020. I think that this 
pandemic, the virus was unknown to us, and we will be learning 
about the acute and long term impact of COVID-19 on the human 
body for decades to come, so at the time when those public 
health interventions were implemented, we were operating on the 
best available evidence, but you are absolutely right. When we 
learned that, for example, kids were not a major vector for 
transmission, then we should have pivoted from those policies 
and moved in a different direction--reopen schools, but again, 
this is hindsight, and I think the lesson for future pandemics, 
and there will be future pandemics, is to have a data driven 
approach so that you are measuring the outcomes and 
understanding in real time, and that real time understanding, 
and science is informing policy.
    The willingness to say that this virus is unknown to us, we 
are learning as we are going, and I think that is really a big 
point and tell the public that we--this is what we know now. 
Based on what we know now, this is what we think we should do, 
and it may change because this is a novel virus.
    I think that we need to start, and now, and not waiting 
another decade until the next big one hits, and say, you know, 
how can we have systems in place that track data on outcomes in 
the key population in real time? Once we do that, really 
identify the highest risk communities and invest the majority 
of mitigation and resources to those communities.
    Senator Braun. I think it is great advice and I think that 
data was coming in while we were contending with it, and we 
just were stubborn in not focusing on where we knew the problem 
was the worst with the elderly, and yes, we now know, and I 
think set the framework up in the future to do a better job 
with it. We will probably contend with it again. Thank you.
    The Chairman. Thanks very much. I might have some more 
questions, but I will turn to Senator Vance.
    Senator Vance. Thank you, Mr. Chair. Appreciate you holding 
this hearing, and thanks, as well to the Ranking Member. I want 
to focus--obviously, you know, there are many different kinds 
of disasters that affect folks, and the one that I am most 
focused on is not a natural disaster, but a manmade disaster.
    I know, Ms. Lloyd, you suffered from some pretty 
significant consequences from the East Palestine train 
derailment. I will rehash for those of us who have forgotten 
that on February 3rd, 2023, an Eastbound freight train derailed 
in East Palestine, Ohio, a town of around 5,000 people.
    Now 11 tanker cars and the resulting pile up contained 
hazardous materials, some of which were released into the air, 
soil, and water of East Palestine in what was called a 
controlled burn, but it didn't feel like a controlled burn to a 
lot of people on the ground.
    People were and still are afraid to let their kids play 
outside. They are afraid to drink the water. They are afraid of 
what has happened to their air, and they are afraid of what has 
happened to their long term health.
    Ms. Lloyd, I am so sorry this happened. I am so sorry it is 
something that affected your life, and I maybe thought, just 
given that a lot of us in D.C.--I am an exception. I know the 
chairman is an exception as well, but a lot of us in D.C. don't 
know anybody personally affected by it.
    Maybe you could walk us through what it was like when that 
happened, because am I correct that you were pretty--living 
pretty close and still live pretty close to where the train 
crash happened? Is that right, Ms. Lloyd?
    Ms. Lloyd. I live five miles out.
    Senator Vance. Five miles out. Could you just maybe walk me 
through what happened? Did you see it? Did you hear it? What 
were the effects? How did it affect your family?
    Ms. Lloyd. Yes, we definitely did see it, and you know my 
heart--I am constantly thinking about the people of East 
Palestine. I don't know if they will ever--you know, I worry 
that they will never feel resolved and at home there anymore.
    Five miles out in the way of Pennsylvania, what we dealt 
with was our children being evacuated from school. My kids 
attend the school district in Pennsylvania that was evacuated. 
I will also say that we have six to eight acre property that 
sits at a higher altitude than the train derailment site.
    When there was the controlled explosion, which looked like 
a mushroom cloud to me, we got a clear view of it, and it was--
it was mind blowing. It was very strange.
    Senator Vance. Yes, ma'am, and how many kids are at your 
kid's school? How many children? Do you know, approximate 
number?
    Ms. Lloyd. I am going to guess about 400, but I can't say 
for sure.
    Senator Vance. That is a lot of scared kids, and that is a 
lot of scared parents, and I think it is just important to 
realize that behind these statistics and behind the news 
stories, there are real people who are affected by this. Ms. 
Lloyd, would you be surprised to learn there were more than 
1,000 train derailments last year alone in this country?
    Ms. Lloyd. I am not surprised, no.
    Senator Vance. I--well, it is, you are smarter than I am, 
because I was shocked when I saw that number, and if you think 
about East Palestine, that is effectively 1,000 potential East 
Palestines happening every single year in our country. Of 
course, most of them aren't that bad, thank God.
    When you crash a train, you don't always control where it 
crashes. Just a couple of months after East Palestine, there 
was a train derailment about four or five miles outside of 
Cleveland that could have been incredibly catastrophic if it 
had crashed a little bit closer to the city of Cleveland.
    Thank God that it didn't, but we can't just rely on luck, 
and we can't just rely on good circumstances to prevent these 
things from happening. You know, I am mindful, of course, that 
while our children are affected by these things in unique ways, 
because their little brains are still developing and they are 
still trying to understand what they see, a lot of our elderly 
folks are the ones who can't get out quickly, who can't move 
quickly, who maybe don't have any alternative when their homes 
become unlivable.
    I encourage members of this body and members of this 
Committee, I know both of you are both working on this with me, 
and I appreciate that we could pass the Railway Safety Act out 
of this body and out of the house later this summer that would 
make these accidents much less common and expose you and your 
family, hopefully to a railway system that is a lot safer and 
doesn't allow this thing to happen again.
    I am sorry, Ms. Lloyd, but I am glad that you are here. I 
appreciate all of you for being here, and I appreciate your 
testimony.
    The Chairman. Thank you, Senator Vance. I am just having 
maybe one or two more. Dr. Abir, we know that older adults and 
people with disabilities suffer the most from the COVID-19 
pandemic. That is so plain from the numbers. As I said before, 
just older adults aged 65 and over were 75 percent of the 
deaths.
    The vast majority of deaths and serious illnesses from 
COVID-19 occurred among those two groups of Americans, both 
seniors and people with disabilities. We also know that in the 
context of a of a particular setting, congregate settings were 
often the place where people with disabilities and older adults 
contracted the virus.
    We know as well that home care is an alternative to 
congregate care and older adults, and people with disabilities 
who receive support at home often had better outcomes during 
the pandemic than those in congregate settings.
    Unfortunately, we have a crisis in home care services in 
our country. Would you consider the development of a more 
substantial homecare workforce and a network part of the, both 
the preparation that is needed here, as well as the mitigation 
for circumstances if we are facing a pandemic?
    Dr. Abir. Absolutely, so I think that would be important 
for preparedness, response, and recovery, and the best thing 
about this idea is that it is relevant for routine care and 
routine circumstances, as well as in the setting of 
emergencies.
    If a person is able to get discharged from the hospital 
sooner because they have a home to go to, and there is home 
care available and scheduled and planned so that the person can 
go home, a nurse can visit, give them their medications, check 
in on them, make sure they are eating, or whatever else that 
may be, that means that that person is spending fewer days in 
the hospital, accruing lower costs for a hospitalization, 
likely not picking up a hospital acquired infection or other 
complication in the hospital.
    I think it is a win, win for everyone, and the current 
system of let's wait everyone--for everyone to get sick enough 
to go to the emergency department and get hospitalized is not 
sustainable, and you know, the population again, is aging, so 
we need to get creative about our solutions.
    The home care and hospital at home solution is really 
something that is, I think should be at the forefront of 
strategies that we consider.
    The Chairman. Well, thank you, and I think that is among 
the many--we have learned so many lessons from the pandemic. 
That is certainly one of them. Maybe just one more question for 
you, Dr. Abir.
    You have been doing this work for a long time, and you have 
done it both from the point of view of a researcher as well as 
a physician. You have carefully studied the response to public 
health emergencies, all the way from COVID-19 to Puerto Rico 
after the devastating hurricanes. We are told that since 
Katrina, the Federal Government has made a concerted effort to 
include the needs of people with disabilities and older adults 
in this emergency planning and recovery processes.
    Can you share with us some of the improvements you have 
seen? We are obviously focused on shortcomings and areas where 
we need to improve, but any improvements or progress we have 
seen--you have seen over the past decade when it comes to 
meeting the needs of those two groups of Americans?
    Dr. Abir. I think that there has been some progress, 
although it is a byproduct of thinking about and planning for 
other populations, not necessarily older adults or people with 
disabilities. I will give you an example, so one thing that was 
for the longest time not part of preparedness plans and 
response plans was planning for people with chronic kidney 
disease.
    People who require hemodialysis, which as I am sure you 
know, is critical for a person, so if they miss enough days of 
hemodialysis, it is fatal, so planning for hemodialysis for 
individuals and where are they are going to get it if they are 
displaced or unable to go to their center because they just 
can't get to the place because of a tornado or hurricane, there 
are plans developed around that.
    The vast majority of folks on dialysis are older adults, so 
that planning has been critical. Another example is that many 
emergency departments, I shouldn't say many--some emergency 
departments in the United States are now certified to 
specifically take care of older adults.
    That just signals to you that how important and different 
it is, that there are certain needs, even during routine care, 
that we need to really consider differently and develop kind of 
practices around this particular population.
    I think we have made some advancement and there are other 
examples, but I think that we really have kind of not 
explicitly focused on these populations, and we have not done 
it in a data driven way.
    I think that the best opportunity now is the hindsight of 
looking at the pandemic, because it did affect these 
populations the most, and we now unfortunately have plenty of 
data to look back at.
    The Chairman. Thank you very much, and I know that we have 
to conclude, so I want to move to my closing statement before I 
turn to Ranking Member Braun, but I do want to start by 
thanking our witnesses for bringing in each case a combination 
of expertise, experience, your personal experience, and your 
own your own perspective to these issues, because we have a 
couple of opportunities.
    The Pandemics All Hazards Reauthorization is one of those 
moments where we can focus on making sure that people with 
disabilities and older adults are part of the planning and 
response, but we have to look for other pathways as well, and 
as we heard today, emergency preparation can only be truly 
inclusive when all stakeholders are invited to the table and 
are committed to meeting the needs of all groups of Americans.
    We heard from Annie Lloyd about the importance of 
accessible and accurate information--how frightening it can be 
to not have up to the day accessible information, especially in 
her case, worrying about her son and her family. This is why it 
is so important that emergency planning explicitly protects the 
health, the safety, and the independence of older adults and 
people with disabilities.
    The legislation that I have introduced, the REAADI For 
Disasters Act will ensure the voices of these individuals are 
included throughout the--throughout every phase of emergency 
preparation. I will continue to work with my Senate colleagues 
on the Committee and in the Senate to make sure that the Ready 
for Disasters Act is included in the reauthorization of the 
Pandemic All Hazards Preparation Act.
    Together, we can protect the health, safety, and 
independence of older adults and people with disabilities, and 
help communities prepare and respond to disasters and 
emergencies in a truly inclusive manner. I will turn next to 
Ranking Member Braun.
    Senator Braun. Thank you, Mr. Chairman. Today we heard from 
experts, practitioners, and those who lived experiences about 
the importance of preparing for emergencies. Prudent budgeting 
and planning are integral for both emergency preparedness and 
response to be successful.
    In planning, we should factor in the needs of older 
Americans and people with disabilities and set aside resources 
accordingly for current and future generations. We cannot 
continue to push our debt on to future generations. We have 
spent, as I said earlier, upwards of $10 trillion on 
emergencies in just the last two decades.
    We know they are inevitable. We need to plan accordingly 
for them. Interest payments on our debt are going to be the 
single most expensive thing we do in the Federal Government on 
an--compared to any discretionary spending, domestic and 
defense. That is a sad prospect.
    We need to enact Article I, which would terminate disaster 
issues without having to do it in a special way. It can't 
linger on forever. Ensuring that emergencies terminate without 
the intervention of Congress, I think is important.
    Finally, the COVID pandemic. Well, in submission, we have a 
golden opportunity. We discussed it to implement lessons 
learned and better prepare for the next inevitable occurrence, 
to some magnitude. We can do it better next time around. It 
just takes some backbone and some foresight.
    Protecting older adults and people with disabilities in 
emergencies is a nonpartisan issue, and planning ahead to do so 
should be nonpartisan as well. I am Eager to work with my 
friends across the aisle to put these solutions into reality. I 
Appreciate all of you coming here today, and thanks, Mr. 
Chairman, for the hearing. I think it was a good one.
    The Chairman. Ranking Member Braun, thank you very much for 
your time in working on this issue and working to plan this 
hearing. I want to once again thank all of our witnesses for 
their testimony and for being with us today, and for 
contributing both time and expertise.
    If any Senators have additional questions for witnesses or 
statements to be added, the hearing record will be kept open 
for seven days until next Thursday, January--June not January, 
June 22nd. Thank you all for participating today. This 
concludes our hearing.
    [Whereupon, at 10:57 a.m., the hearing was adjourned.]
     
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                                APPENDIX
    
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                      Prepared Witness Statements

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                        Questions for the Record

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                       Statements for the Record

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