Disaster Preparedness: Preliminary Observations on the Evacuation
of Vulnerable Populations due to Hurricanes and Other Disasters 
(18-MAY-06, GAO-06-790T).					 
                                                                 
Hurricane Katrina struck near the Louisiana-Mississippi border	 
and became one of the worst natural disasters in U.S. history,	 
affecting a large geographic area and necessitating the 	 
evacuation of people from parts of the area, including vulnerable
populations, such as hospital patients, nursing home residents	 
and transportation-disadvantaged populations who were not in such
facilities. The disaster highlighted the challenges involved in  
evacuating vulnerable populations due to hurricanes. GAO was	 
asked to discuss efforts to plan and prepare for the needs of	 
seniors in the event of a national emergency. GAO describes its  
ongoing work on evacuation in the event of emergencies, such as  
hurricanes, and provides preliminary observations on (1)	 
challenges faced by hospital and nursing home administrators that
are related to hurricane evacuations; (2) the federal program	 
that supports the evacuation of patients needing hospital care	 
and nursing home residents; and (3) challenges states and	 
localities face in preparing for and carrying out the evacuation 
of transportation-disadvantaged populations and efforts to	 
address evacuation needs. This testimony is based in part on a	 
prior GAO report, Disaster Preparedness: Preliminary Observations
on the Evacuation of Hospitals and Nursing Homes Due to 	 
Hurricanes, GAO-06-443R (February 16, 2006).			 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-790T					        
    ACCNO:   A54200						        
  TITLE:     Disaster Preparedness: Preliminary Observations on the   
Evacuation of Vulnerable Populations due to Hurricanes and Other 
Diasasters							 
     DATE:   05/18/2006 
  SUBJECT:   Disaster planning					 
	     Disaster recovery					 
	     Disaster recovery plans				 
	     Elderly persons					 
	     Emergency preparedness				 
	     Evacuation 					 
	     Evacuation procedures				 
	     Health care facilities				 
	     Health care planning				 
	     Hospitals						 
	     Hurricane Katrina					 
	     Hurricanes 					 
	     National disaster medical system			 
	     Natural disasters					 
	     Nursing homes					 
	     Program evaluation 				 
	     National Disaster Medical System			 

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GAO-06-790T

     

     * Facility Administrators Face Several Challenges Related to E
     * NDMS Is the Primary Federal Program That Evacuates Patients
     * States and Localities Face Challenges in Addressing the Evac
     * Concluding Observations
     * Contacts and Acknowledgments
     * GAO's Mission
     * Obtaining Copies of GAO Reports and Testimony
          * Order by Mail or Phone
     * To Report Fraud, Waste, and Abuse in Federal Programs
     * Congressional Relations
     * Public Affairs

Testimony

Before the Special Committee on Aging, U.S. Senate

United States Government Accountability Office

GAO

For Release on Delivery Expected at 10:00 a.m. EDT

Thursday, May 18, 2006

DISASTER PREPAREDNESS

Preliminary Observations on the Evacuation of Vulnerable Populations due
to Hurricanes and Other Disasters

Statement of Cynthia Bascetta

Director, Health Care

GAO-06-790T

Mr. Chairman and Members of the Committee:

Thank you for inviting me here to discuss our preliminary observations on
ongoing work on the evacuation of vulnerable populations due to hurricanes
and other disasters, including patients in hospitals; residents in nursing
homes; and transportation-disadvantaged populations, such as the elderly,
persons with disabilities, and people who, by choice or circumstances, do
not own or have access to a personal vehicle.

On August 29, 2005, Hurricane Katrina struck near the
Louisiana-Mississippi border and became one of the worst natural disasters
in U.S. history. The hurricane affected a large geographic area and
necessitated the evacuation of people from parts of the area. Among those
needing to be evacuated were hospital patients, nursing home residents,
and transportation-disadvantaged populations who were not in such
facilities. The disaster highlighted the challenges involved in evacuating
these vulnerable populations. For example, administrators of hospitals and
nursing homes must make decisions about the best way to care for their
patients or residents, including whether to evacuate if the facility
becomes unable to support adequate care, treatment, or other services.
Although both hospital patients and nursing home residents were evacuated
during Hurricane Katrina, in the aftermath of the event, congressional
reports have raised questions about how health care facility
administrators plan for hurricanes, how they implemented their plans, and
how the federal government assisted health care facilities and state and
local governments with facility evacuations.1 Hurricane Katrina also
pointed out the challenges of evacuating transportation-disadvantaged
populations who are not in such facilities during a disaster. State and
local governments are primarily responsible for responding to disasters
that may result in evacuations. When state and local governments are
overwhelmed in their response to a disaster, the federal government can
assume a greater role.

You asked me to discuss issues related to efforts to plan and prepare for
the needs of seniors in the event of a national emergency. My remarks
today will describe our ongoing work on evacuation in the event of
emergencies and will provide preliminary observations on (1) the
challenges faced by hospital and nursing home administrators that are
related to hurricane evacuations, (2) the federal program that supports
the evacuation of patients needing hospital care and nursing home
residents, and (3) challenges states and localities face in preparing for
and carrying out the evacuation of transportation-disadvantaged
populations and efforts to address evacuation needs.

1See U.S. House of Representatives, A Failure of Initiative: Final Report
of the Select Bipartisan Committee to Investigate the Preparation for and
Response to Hurricane Katrina (Feb. 15, 2006). See also Committee on
Homeland Security and Governmental Affairs, U.S. Senate, Hurricane
Katrina: A Nation Still Unprepared (May 2006).

My testimony today is based on our February 2006 interim report2 as well
as our ongoing work on the evacuation of hospitals and nursing homes due
to hurricanes, and the evacuation of transportation-disadvantaged
populations due to hurricanes and other disasters. Our work in this area
is being conducted under the Comptroller General's authority to conduct
evaluations on his own initiative.3 In conducting the work for our interim
report, we interviewed officials in Florida in areas that experienced
hurricanes in 2004, including officials from three hospitals and three
nursing homes that experienced Hurricane Charley,4 state officials, and
local emergency management officials in two counties. In addition, we
interviewed officials from national hospital and nursing home associations
and Florida hospital and nursing home associations. For our ongoing work
related to the evacuation of hospitals and nursing homes, we interviewed
officials in Mississippi in areas that were hit by Hurricane Katrina,
including officials from five hospitals, officials from three nursing
homes or assisted living facilities, state officials, and local officials
in two counties. For our ongoing work on evacuating
transportation-disadvantaged populations, we have visited communities in
California, Florida, and New York, and we plan to visit communities in
Louisiana and Washington, D.C. We have interviewed or will interview state
and local emergency management agencies, state and local transportation
departments, local and regional transit agencies, and local and regional
planning organizations. In addition, we interviewed entities that
represent transportation and emergency management officials, entities such
as the Federal Interagency Coordinating Council on Access and Mobility,
and others. We also interviewed officials from the Department of Defense
(DOD), the Department of Health and Human Services (HHS), the Department
of Homeland Security (DHS), the Department of Veterans Affairs (VA), and
the Department of Transportation (DOT) about federal efforts to support
evacuation of hospitals and nursing homes and transportation-disadvantaged
populations not in such facilities. In addition, we reviewed documents,
including emergency management plans from the states of Florida,
Mississippi and other states, local governments, hospitals, and nursing
homes; and federal documents such as the National Response Plan.5 Finally,
we reviewed the recommendations on evacuations contained in several
recently issued reports on the Hurricane Katrina response prepared by the
U.S. House of Representatives, U.S. Senate, the White House, and DOT and
DHS. We discussed the facts contained in this statement with officials
from DOD, HHS, DHS, DOT, and VA, and incorporated changes as appropriate.
Our work began in December 2005 and is being performed in accordance with
generally accepted government auditing standards.6

2GAO, Disaster Preparedness: Preliminary Observations on the Evacuation of
Hospitals and Nursing Homes Due to Hurricanes, GAO-06-443R (Washington,
D.C.: Feb. 16, 2006). See related GAO products later in this statement.

331 U.S.C. S: 717(b)(1) (2000).

4Hurricane Charley struck the Gulf Coast of Florida on August 13, 2004,
and continued across the state to exit on the Atlantic Coast on August 14,
2004.

In summary, hospital and nursing home administrators face challenges
related to evacuations caused by hurricanes, including deciding whether to
evacuate their facilities and obtaining transportation. Although state and
local governments can order evacuations, health care facilities can be
exempt from these orders. Facility administrators are generally
responsible for deciding whether or not to evacuate, and if administrators
decide not to evacuate, they face the challenge of ensuring that their
facilities have sufficient resources to provide care or other services
until assistance can arrive. If facilities evacuate, administrators face
the challenge of securing transportation; according to hospital and
nursing home officials, contractors providing transportation for hospitals
and nursing homes would be unlikely to provide facilities with enough
vehicles during a major disaster, such as a hurricane, because local
demand for transportation would likely exceed supply. According to nursing
home administrators, they face unique challenges during evacuations. For
example, when a nursing home evacuates, the administrator must locate
receiving facilities that can accommodate residents who may need a place
to live for a long period of time.

5The National Response Plan describes how the federal government assists
in managing incidents of national significance.

6We anticipate completing our work and issuing reports on the evacuation
of hospitals and nursing homes and on the evacuation of
transportation-disadvantaged populations later this year.

The National Disaster Medical System (NDMS) is the primary federal program
that supports the evacuation of patients in need of hospital care during
disasters such as hurricanes, but the program was not designed nor is
currently configured to move nursing home residents. NDMS is a federal
partnership of DOD, HHS, DHS, and VA that supplements state and local
emergency response capabilities with federal resources and services. The
program helped evacuate about 2,900 people during recent hurricanes,
including Hurricane Katrina. NDMS supported evacuation efforts during
Hurricane Katrina that included nursing home residents, although officials
explained that NDMS does not have agreements with nursing homes that could
receive evacuated nursing home residents. In contrast, NDMS has agreements
with participating hospitals to receive patients needing hospital care.

In preparing for and carrying out the evacuation of
transportation-disadvantaged populations who are not in institutions
during a disaster, states and localities face challenges in identifying
these populations, determining their needs, and providing for and
coordinating their transportation. Identifying these populations and
determining their needs present challenges because their overall size,
location, and composition can be difficult to determine in advance of an
emergency. For example, while transportation-disadvantaged populations
include the elderly, low-income individuals, and persons with
disabilities, during disasters these populations can also include people
who do not own or have access to cars and people who do not permanently
reside in the community, such as tourists. The elderly are particularly
likely to be represented among the transportation disadvantaged because
they are more likely, compared with the general population, to have a
disability, have a low income, or choose not to drive. Providing for and
coordinating the transportation of transportation-disadvantaged
populations presents challenges because evacuating them requires
additional planning, time, resources (for example, evacuating seniors with
special medical needs from their homes), and communication efforts (such
as communicating with the vision or hearing impaired). In the course of
our review, we observed mixed efforts at the state and local level to
address the evacuation needs of the transportation disadvantaged. For
example, emergency management officials in two locations we visited
indicated they did not yet have a good understanding of the size,
location, and composition of the transportation disadvantaged in their
communities. However, we also observed efforts in some locations to
address the evacuation needs of the transportation disadvantaged by
encouraging citizens to voluntarily register with their local emergency
management agencies, integrating social service providers into emergency
planning, and other measures.

    Facility Administrators Face Several Challenges Related to Evacuations,
       Including Deciding Whether to Evacuate and Securing Transportation

Administrators of hospitals and nursing homes face several challenges
related to evacuations caused by hurricanes. Among these challenges,
administrators must decide whether to evacuate their facilities or stay in
facilities and "shelter in place." Although state and local governments
can order evacuations of the population or segments of the population
during various emergencies, health care facilities can be exempt from
these orders.7 Facility administrators are generally responsible for
deciding whether to shelter in place or evacuate, and administrators told
us they generally see evacuation as a last resort. However, to shelter in
place, facility administrators face the challenge of ensuring that their
facilities have sufficient resources to provide care or other services
during the disaster and then in its aftermath until assistance can arrive.
For example, during hurricanes Katrina and Charley, facility
administrators said they had to ensure that their facilities had staff who
could stay for longer shifts until the storms passed and relief staff
could arrive. One hospital in Mississippi had prepared staff to stay for
approximately 3 days; however, staff had to stay 2 weeks before
replacement staff could arrive. The administrator also said they had to
have 3 days of food and supplies stocked and enough fuel to run generators
for 1 week. Destruction of communications capabilities due to hurricanes
can complicate the decision to evacuate. For example, during Hurricane
Katrina, the destruction of communications systems left hospital and
nursing home administrators unable to receive information about how long
it would take before assistance would arrive.

If hospital and nursing home administrators decide to evacuate, they face
the challenge of securing sufficient and appropriate transportation to
move their patients or residents. Hospital and nursing home association
representatives told us that facilities are likely to have local
arrangements for transportation services, but the facilities are less
likely to have arrangements in other localities or states, as was
necessary for the evacuations during Hurricane Katrina. According to
hospital and nursing home administrators, their contractors providing
transportation would be unlikely to provide them with vehicles during a
major disaster because local demand for transportation would exceed
supply. For example, during Hurricane Katrina, two counties in Mississippi
had to secure vehicles that were located in other states.8 Facility
administrators also face the related challenge of obtaining appropriate
vehicles. One nursing home administrator told us the facility had a
transportation agreement with a bus company, but the company supplied only
regular buses and most of the facility's residents needed vehicles with
power lifts to accommodate electric wheelchairs.

7For example, officials in two counties in Florida told us they can
recommend that hospitals and nursing homes evacuate their facilities, but
the final decision is made by each facility's administrator.

While hospital and nursing home administrators face many of the same
challenges during evacuations, there are some challenges nursing home
administrators in particular must address. According to nursing home
administrators, one challenge results from the fact that people in nursing
homes may reside there for a long time. As a result, these administrators
explained that nursing homes cannot reduce the number of residents in
their facilities for whom they are responsible because nursing home
residents may have no other home and cannot care for themselves. In
contrast, hospital administrators told us that it is common to discharge
as many patients as possible before a hurricane in order to reduce the
number of patients who need to be sheltered or evacuated. In addition,
when a nursing home evacuates, the administrator must locate receiving
facilities that can accommodate residents for a potentially long period of
time. For example, a nursing home administrator in Florida told us that
the facility had to relocate its residents for over 10 months until the
facility could be fixed.

8The two counties contract with a national ambulance company, which is
able to obtain vehicles from its fleet located in other states.

  NDMS Is the Primary Federal Program That Evacuates Patients Needing Hospital
          Care, but It Is Not Designed to Move Nursing Home Residents

NDMS is the primary federal program that supports efforts to evacuate
patients who need hospital care during disasters such as hurricanes by
moving them from an area affected by the emergency to reception areas in
other locations. Formed in 1984 to care for casualties that could result
from a domestic disaster or an overseas conventional war, NDMS is a
federal program that supplements state and local emergency response
capabilities with federal resources and services. DOD, HHS, DHS, and VA
are federal partners in NDMS, and DHS has the authority to activate NDMS
in response to public health emergencies, including but not limited to
presidentially declared major disasters or emergencies.9 Among its various
functions,10 NDMS supports the evacuation of hospitals by assisting in
efforts to move patients from a mobilization center, such as an airport
near the incident, to reception areas in other locations where patients
can be placed in a hospital participating in NDMS to continue receiving
medical care. NDMS officials told us that Hurricane Katrina was the first
time that the patient evacuation component of NDMS was used to evacuate a
large number of patients. In response to state requests for assistance due
to recent hurricanes, about 2,900 people were transported from NDMS
mobilization centers to NDMS patient reception areas.11

While NDMS supports the evacuation of patients in need of hospital care,
the program was not designed nor is currently configured to move nursing
home residents. As stated in the memorandum of agreement among the NDMS
federal partners, the patient evacuation function of NDMS is intended to
move patients from a mobilization center to a reception area so they can
be admitted to NDMS-affiliated hospitals-typically nonfederal hospitals
that have agreements with NDMS-to receive medical care. Although during
Hurricane Katrina NDMS evacuated nursing home residents who were brought
to mobilization centers, program officials told us that NDMS was not
designed to evacuate this population and the program did not have
agreements with nursing homes that could receive evacuated nursing home
residents. NDMS officials noted the challenge of meeting the needs of
nursing home residents in an NDMS report prepared after Hurricane
Katrina.12

9A presidentially declared major disaster or emergency can be declared
under the Robert T. Stafford Disaster Relief and Emergency Assistance Act,
42 U.S.C. S:S: 5121-5206, which establishes the programs and processes by
which the federal government supplements state and local resources in
major disasters and emergencies.

10NDMS consists of three functions. One is medical response, which
includes medical equipment and supplies, patient triage, and other primary
and emergency health care services provided to disaster victims at a
disaster site. Another is patient evacuation, which includes communication
and transportation to evacuate patients from a mobilization center near
the disaster site, such as an airport, to reception areas in other
locations. The third is "definitive care," which is additional medical
care-beyond emergency care-that begins once disaster victims are placed
into an NDMS inpatient treatment facility (typically a nonfederal hospital
that has an agreement with NDMS). NDMS functions are included in the
Public Health and Medical Services Annex of the National Response Plan.

11This figure represents the approximate number of people moved during
Hurricane Katrina and Hurricane Rita, which struck the Gulf Coast several
weeks after Hurricane Katrina.

  States and Localities Face Challenges in Addressing the Evacuation Needs of
                    Transportation-Disadvantaged Populations

In preparing for and carrying out the evacuation of
transportation-disadvantaged populations due to a disaster, states and
localities face challenges in identifying these populations, determining
their needs, and providing for and coordinating their transportation.
Identifying these populations and determining their needs present
challenges because their overall size, location, and composition can be
difficult to determine in advance of an emergency. For example, while
these populations include the elderly, low-income individuals, and persons
with disabilities, during disasters transportation-disadvantaged
populations can also include people who either by choice or circumstance
do not own or have access to cars. They can also include people with
limited English proficiency and people who do not permanently reside in
the community, such as tourists, temporary workers, and the homeless. In
addition, transportation-disadvantaged populations may have specialized
medical needs; people may move within the community, and these populations
may harbor beliefs about privacy and fears of discrimination that
discourage participation in outreach efforts. The elderly are particularly
likely to be represented among the transportation disadvantaged because
they are more likely, compared with the general population, to have a
disability, have a low income, or choose not to drive.

Providing for and coordinating the evacuation of
transportation-disadvantaged populations also present challenges because
evacuating these populations requires additional planning, time, and
resources. For example, evacuating seniors with special medical needs who
are residing in their own homes may require additional planning of pick up
routes; extra time to load and unload evacuation vehicles; and special
resources, such as buses equipped with wheelchair lifts. In addition,
communicating evacuation information to these populations during disasters
may be challenging because they may be vision or hearing impaired or have
limited English proficiency.

12See National Disaster Medical System, National Disaster Medical System
(NDMS) After Action Review (AAR) Report on Patient Movement and Definitive
Care Operations in Support of Hurricanes Katrina and Rita (Jan. 12, 2006).

In the course of our review, we observed mixed efforts at the state and
local level to address the evacuation needs of the transportation
disadvantaged during a disaster. In some locations we visited, emergency
management officials indicated they did not yet have a good understanding
of the overall size, location, and composition of the transportation
disadvantaged in their community and acknowledged the need to better
integrate transportation-disadvantaged populations into emergency response
planning. For example, emergency management officials in one city stated
that their participation in the February 2006 National Plan Review alerted
them to the fact that they should better provide for and coordinate the
needs of transportation-disadvantaged populations in their evacuation
planning.13 One state official described coordination challenges and
evacuation delays that occurred for transportation-disadvantaged
populations in one community during an approaching wildfire and attributed
these problems to coordination difficulties between emergency management
and other agencies.

However, we also observed efforts underway in some locations to address
the evacuation needs of the transportation disadvantaged. In three
locations, local governments and regional organizations have conducted or
were conducting studies to identify the number and location of
transportation-disadvantaged populations in their jurisdiction. This
information has been or was to be used to facilitate evacuation planning
on resource use and deployment during disasters. Also, in three locations,
emergency management officials were using preexisting citizen networks and
community outreach activities to help inform and prepare
transportation-disadvantaged populations for disasters. For example, in
one city, emergency management officials used an existing neighborhood
watch network to facilitate community outreach to
transportation-disadvantaged populations, better preparing them for a
disaster. In another city, emergency management officials worked with home
health organizations, doctors, and the Red Cross to inform
transportation-disadvantaged populations about evacuation preparedness.

13The National Plan Review is a DHS review of the emergency plans,
including catastrophic planning and mass evacuation planning, of the 50
states and 75 largest urban areas.

In one location that had a well-developed program for evacuating the
transportation disadvantaged, we observed that emergency management
officials did the following:

           o  Had emergency plans that clearly articulated methods of
           providing for and coordinating the evacuation of
           transportation-disadvantaged populations, including the roles and
           responsibilities of various agencies. This plan clearly
           articulated how local and state emergency management, school
           boards, and transit agencies would work together to evacuate
           transportation-disadvantaged populations. Emergency management
           officials stated that this level of coordination enabled them to
           successfully conduct several evacuations.
           o  Encouraged citizens who have special medical needs to
           voluntarily register with their local emergency management agency.
           This registry placed individuals into categories, including those
           who would need special transport, such as an ambulance. According
           to emergency management officials, in several recent evacuations,
           the voluntary registry assisted emergency personnel in efficiently
           evacuating transportation-disadvantaged populations. However, the
           same emergency management officials also pointed out challenges
           that exist for voluntary registries including the administrative
           costs of keeping the information up to date, the limited number of
           participants, and a surge in the number registrations immediately
           prior to an approaching storm.
           o  Involved social service providers in the emergency response
           planning process. Social service providers' transportation
           resources were used to evacuate many of the clients on a voluntary
           registry administered by the city. These social service providers
           have expertise and ongoing contact with the
           transportation-disadvantaged populations, and are familiar with
           their day-to-day and nonemergency needs.
           o  Established formal agreements that alleviate legal liability
           and reimbursement concerns when securing transportation resources
           to assist in evacuating transportation-disadvantaged populations
           during any type of disaster.
           o  Conducted regular exercises of emergency response plans in
           order to test coordination between agencies involved in
           evacuations and their resources, and the integration of social
           service providers.

           In addition to these efforts by state and local governments,
           recent reports released by the federal government have put forth
           recommendations that address evacuation preparedness and response
           generally and for transportation-disadvantaged populations in
           particular. The White House report14 recommends that DOT be the
           primary federal agency responsible for developing the federal
           government's capability to conduct mass evacuations and that DHS
           require that state and local governments to conduct evacuation
           planning and exercises as a condition for receiving Homeland
           Security grants. The Senate report15 recommends that DOT should,
           in coordination with DHS and the states, plan, train and exercise
           for evacuations, including provisions for those populations that
           do not have the means to evacuate.

           Hospital and nursing home administrators generally face multiple
           challenges in weighing the risks of sheltering in place or
           evacuating. Although evacuation is a last resort, Hurricanes
           Charley and Katrina resulted in both hospitals and nursing homes
           having to evacuate. When evacuating, administrators faced problems
           specifically related to transportation, including securing
           vehicles. Hurricane Katrina, the first emergency in which NDMS was
           used to evacuate a large number of people, brought to light that
           NDMS was not set up nor is currently configured to provide
           assistance to nursing homes. As a result, it does not have
           agreements with nursing homes to accept evacuated patients. In
           addition, states and localities face multiple challenges in
           ensuring that transportation-disadvantaged populations who are not
           in such facilities are evacuated. We will be monitoring federal
           efforts to improve preparing for and carrying out evacuations of
           these populations. Our ongoing work will continue to examine the
           vulnerabilities posed by disasters for hospital patients, nursing
           home residents, and transportation-disadvantaged populations
           living in their communities.

           Mr. Chairman, this concludes my prepared remarks. I would be happy
           to respond to any questions you or other members of the committee
           have at this time.

           For further information regarding this statement, please contact
           Cynthia Bascetta at (202) 512-7101 or at [email protected]
           regarding issues related to the evacuation of hospitals and
           nursing homes. For issues related to the evacuation of
           transportation-disadvantaged populations, please contact Katherine
           Siggerud at (202) 512-2834 or [email protected] . Contact points
           for our Offices of Congressional Relations and Public Affairs may
           be found on the last page of this statement. Key contributors to
           this statement were Steve Cohen, Assistant Director; Linda T.
           Kohn, Assistant Director; La Sherri Bush; Krister Friday;
           Christopher Lyons; Nkeruka Okonmah; Laina Poon; Tina Won Sherman;
           and William Simerl.

           Hurricane Katrina: Status of the Health Care System in New Orleans
           and Difficult Decisions Related to Efforts to Rebuild It
           Approximately 6 Months After Hurricane Katrina. GAO-06-576R .
           Washington, D.C.: March 28, 2006.

           Hurricane Katrina: GAO's Preliminary Observations Regarding
           Preparedness, Response, and Recovery. GAO-06-442T. Washington,
           D.C.: March 8, 2006.

           Disaster Preparedness: Preliminary Observations on the Evacuation
           of Hospitals and Nursing Homes Due to Hurricanes. GAO-06-443R .
           Washington, D.C.: February 16, 2006.

           Transportation Services: Better Dissemination and Oversight of
           DOT's Guidance Could Lead to Improved Access for Limited
           English-Proficient Populations. GAO-06-52 . Washington, D.C.:
           November 2, 2005. (This report is also available in Spanish,
           Chinese, Vietnamese, and Korean.)

           Transportation-Disadvantaged Seniors: Efforts to Enhance Senior
           Mobility Could Benefit from Additional Guidance and Information.
           GAO-04-971 . Washington, D.C.: August 30, 2004.

           Transportation-Disadvantaged Populations: Federal Agencies Are
           Taking Steps to Assist States and Local Agencies in Coordinating
           Transportation Services. GAO-04-420R . Washington, D.C.: February
           24, 2004.

           HHS Bioterrorism Preparedness Programs: States Reported Progress
           but Fell Short of Program Goals for 2002. GAO-04-360R .
           Washington, D.C.: February 10, 2004.

           Transportation-Disadvantaged Populations: Some Coordination
           Efforts Among Programs Providing Transportation Services, but
           Obstacles Persist. GAO-03-697 . Washington, D.C.: June 30, 2003.

           Transportation-Disadvantaged Populations: Many Federal Programs
           Fund Transportation Services, but Obstacles to Coordination
           Persist. GAO-03-698T. Washington, D.C.: May 1, 2003.

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           Gloria Jarmon, Managing Director, [email protected] (202) 512-4400
           U.S. Government Accountability Office, 441 G Street NW, Room 7125
           Washington, D.C. 20548

           Paul Anderson, Managing Director, [email protected] (202)
           512-4800 U.S. Government Accountability Office, 441 G Street NW,
           Room 7149 Washington, D.C. 20548

                            Concluding Observations

14Assistant to the President for Homeland Security and Counterterrorism,
The Federal Response to Hurricane Katrina: Lessons Learned (February
2006).

15Committee on Homeland Security and Governmental Affairs, U.S. Senate,
Hurricane Katrina: A Nation Still Unprepared (May 2006).

                          Contacts and Acknowledgments

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Highlights of GAO-06-790T , a testimony before the Special Committee on
Aging, U.S. Senate

May 18, 2006

DISASTER PREPAREDNESS

Preliminary Observations on the Evacuation of Vulnerable Populations due
to Hurricanes and Other Disasters

Hurricane Katrina struck near the Louisiana-Mississippi border and became
one of the worst natural disasters in U.S. history, affecting a large
geographic area and necessitating the evacuation of people from parts of
the area, including vulnerable populations, such as hospital patients,
nursing home residents and transportation-disadvantaged populations who
were not in such facilities. The disaster highlighted the challenges
involved in evacuating vulnerable populations due to hurricanes.

GAO was asked to discuss efforts to plan and prepare for the needs of
seniors in the event of a national emergency. GAO describes its ongoing
work on evacuation in the event of emergencies, such as hurricanes, and
provides preliminary observations on

(1) challenges faced by hospital and nursing home administrators that are
related to hurricane evacuations; (2) the federal program that supports
the evacuation of patients needing hospital care and nursing home
residents; and (3) challenges states and localities face in preparing for
and carrying out the evacuation of transportation-disadvantaged
populations and efforts to address evacuation needs.

This testimony is based in part on a prior GAO report, Disaster
Preparedness: Preliminary Observations on the Evacuation of Hospitals and
Nursing Homes Due to Hurricanes, GAO-06-443R (February 16, 2006).

Hospital and nursing home administrators face challenges related to
evacuations caused by hurricanes, including deciding whether to evacuate
and obtaining transportation. Although state and local governments can
order evacuations, health care facilities can be exempt from these orders.
Facility administrators are generally responsible for deciding whether to
evacuate, and if they decide not to evacuate, they face the challenge of
ensuring that their facilities have sufficient resources to provide care
until assistance arrives. If they evacuate, contractors providing
transportation for hospitals and nursing homes could be unlikely to
provide facilities with enough vehicles during a major disaster such as a
hurricane because local demand for transportation would likely exceed
supply. Nursing home administrators told us they face unique challenges
during evacuations. For example, they must locate receiving facilities
that can accommodate residents who may need a place to live for a long
period of time.

The National Disaster Medical System (NDMS), a partnership of four federal
departments, is the primary federal program that supports the evacuation
of patients in need of hospital care during disasters such as hurricanes,
but the program was not designed nor is currently configured to move
nursing home residents. NDMS supplements state and local emergency
response capabilities with federal resources and services and helped
evacuate about 2,900 people during recent hurricanes, including Hurricane
Katrina. Although NDMS supported evacuation efforts during Hurricane
Katrina that included nursing home residents, according to program
officials it is not designed to evacuate this population. Officials
explained that the program does not have agreements with nursing homes
that could receive evacuated nursing home residents.

In preparing for and carrying out the evacuation of
transportation-disadvantaged populations, such as the elderly or persons
with disabilities, during a disaster, states and localities face
challenges in identifying these populations, determining their needs, and
providing for and coordinating their transportation. The elderly are
likely to be represented among the transportation disadvantaged because
they are more likely, compared with the general population, to have a
disability, have a low income, or choose not to drive. GAO has observed
mixed efforts at the state and local levels to address the evacuation
needs of the transportation disadvantaged. Some emergency management
officials told GAO they did not yet have a good understanding of the size,
location, and composition of the transportation disadvantaged in their
community. However, GAO also observed efforts in some locations to address
the evacuation needs of the transportation disadvantaged by encouraging
citizens to voluntarily register with their local emergency management
agency, integrating social service providers into emergency planning, and
other measures. GAO will continue to examine the extent to which the
transportation disadvantaged are addressed in state and local evacuation
efforts as part of its ongoing work.
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