But for those to bridge the gap [inaudible conversations] the committee will come to order good morning recently the hurricanes left a path of destruction along the gulf coast of texas and florida and throughout the caribbean. Homes and businesses and entire communities were destroyed and lives were lost then we learned the tragic news that eight seniors ranging in age from 71 through 99 died in a florida nursing home that lacked airconditioning because power had been knocked out. Those that describe the facility as a death trap because the elderly are particularly susceptible to heat related illness is. Last month in this photo of those that were trapped in waist deep water went to viral as these made clear they were vulnerable before and during so when Hurricane Katrina slammed into the gulf coast 12 years ago more than half of those who died were seniors. As the then chair along with senator lieberman i let a lead the bipartisan investigation at the federal state and low levels our investigation which resulted in the report to reveal in those weaknesses with the nations Emergency Response system it does have an excellent summary and it was evident to me that we have learned many of those lessons of katrina but we have a long way to go. One of the of resources included the failure to planproe and provide for timely and effective evaluation for the most will burble seniors since then we have expanded our efforts across the country and to emphasize the protection of the vulnerable. As Mother Nature continues to on the shipper period as the meet another hurricane, maria is battering the region that is still struggling to recover from this expected to get puerto rico particularly hard. This morning we will discuss how the Emergency Response efforts have been critical and we will identify where work is needed. And with the Emergency Response efforts centers for Medicare Medicaid services to identify those who require relocation to maintain dialysis. But one of the of problems is that the demand was so great people were not able to have that complete dialysis manini that far longer period of time so in addition the local a Emergency Response teams to identify those most in need to provide designated shelters for necessary medical care and support but tragically that was notno always the case. Sandoz death of seniors and the nursing home so that its is suggesting a troubling lack of preparedness and while we are making many strides we must ask ourselves can be better protect the most for honorable members of our community . Those that could jeopardize in the next catastrophe weather a storm or earthquake or other unanticipated events. We should not have to wait for the next hurricane for that and named a disaster to strike. We will have concrete solutions to maintain those resources to relocating during the recovery period. To consider those challenges whether it is better to a shelter in place or evacuate and relocate looking into this issue it is a very difficult decision to make to ma particularly with dementia. Just one day after Hurricane Irma went into slammed into florida a reporter walked into waste water contaminated to knock on the of mobile home door. He was told an elderly couple lived inside and did not heed the warning of officials to evacuate. Now this was surrounded by water had an 88 yearold woman and 93 yearold husband who suffered from parkinsons and diabetes. Orter when asked why they did not evacuate she simply reply we have everything we need medications and it is easier so i am grateful they were found safe that they must expand efforts not only those living in the of facilities as assisted living or longterm care but it their own homes. For many of those it is sent as the sea as packing of bed gore jumping into a car. Some of these homebound adults are frail and suffering from disease many have lived but they dont want to leave it behind and are fearful of what would happen if they these. I will conclude by offering by a condolences as a result of these violent hurricanes. Rt for all of those that are set for suffering facing those challenges in the weeks and months ahead. I want to extend my gratitude to the First Responders including the volunteers including that medical team and everyone that has reached out to help a neighbor in need they too are dealing with the devastation caused by these terrible storms. We must improve the Emergency Response so these steps do not happen in the future we should not overlook the heroic act of so many. Thanks for being with usdeli today i am pleased to recognize the Ranking Members. And i joined the chairman for those who dunny Emergency Response with the task over many days we are grateful for that work and be joined to thank them for that work. Together working endless hours of people in texas, florida, u. S. Virgin islands with those san puerto rico with thenu difficult days ahead we are praying for them to save these actions are heroic is an understatement there is no way to adequately describe the kind of commitment or heroism but unfortunately we are here because despite the greathe efforts Older Americans with those extraordinary challenges and a disaster so many were outraged and a enraged when we saw what happened in florida. Seniors died in the midst ofof this crisis and were also heartbroken for loss of life and the loss that they suffered in this case something as simple as a lack of air conditioning that we take for granted. Even on a day like today. And the sadness that will involve those families and communities that is a challenge that we speak toerday today and senator nelson who was done great work dealing with these issues said one life lost is one too many and i know that chairman collins as well will join him to introduce legislationg to require the secretary of hhs to establish a National Advisory committee and apa panel by the secretary of hhs. At and with Health Care Professionals with Disaster Response. It is bipartisan. And so that is one paying we can do together with these challenges in the future. But every american was stunned by that photo the chairman just showed of those nursing home residents with of water rising around the seniors in the assisted living facility in houstonaiting waiting to be rescued. These are folks to say our greatest generation doesnt adequately capture. Wa they worked in the factories and built the middle class class, and give us life and sacrifice so much to in live lives of dignity. We have an obligation for what is depicted in that photograph never happens again. So all of those lessons that are learned in the aftermath of katrina to implement better and best practices to learn from those recent disasters as well. We to make sure were doing Everything Possible and make sure we are focused on a day like today that is why we gather with a great panel of witnesses. Not just experience from the recent past but from years of experience from Hurricane Katrina to Hurricane Harvey with the double whammy of to back in 2011 and four hurricanes in six weeks ravaging florida in 2004. And learning from each of these says we hear from the witnesses infrastructure isde more robust that is good news to implement those changes. There is more comprehensive response requirements to be implemented for Nursing Homes so seniors are better protected. We have a long way to go. So they do not suffer for days and then died nobody should have trouble following the evacuation orders and it should go without saying no senior should fear drowning in f their own home but those witnesses will explain how to do better because we must do better and have a sacred obligation to do better to bring better experience and passion to these issues and also thanks to the chairman for a gathering as. I am delighted we havelighted senators here with us today and to appreciate their participation and with that Judiciary Committee to offer the opportunity for any comments you would like to make. Once i get there i cannot come back but i want to thank you for coming the building is of little empty because be returned last night that the focus of these numbers. Thanks for being here. We will immediately look at what is happening and puertoo rico with 175mile per hour sustained wind and talk about the recent storm of cardiac and irma also the enormous impact it named matthew one year ago. Nd to ha i have a story to tell because our staff had to help a senior who was lost in the process and went to her home as she should have a we had 20 inches of rain in a 24hour period. So much so that shelter was closed down so i will submit questions for the record but that raises the of question paul wong be tracked through the life cycle. Until there is day resolution there is a challenge with the evacuating seniors with a fear of the unknown. If we did a better job of communicating how we will be still words, many that feel like the safest thing to do is to shelter in place with what they will take care of to get them back into their home living independently how do we better educate . So i think that could be instructive for what we need to do differently but our governor and Emergency Management altered to get her medication and be connected to her family. That is the life cycle of disaster until we know that senior is safe and sound that would be helpful to see how we can work at the local and state level to make that happen. Thanks for making that happen and they give for your work on the subject. I will introduce our excellent panel of witnesses first karen is a physician and Public Health expert where she works hard azine were less to restore health care after they were devastated by Hurricane Katrina. And also assistant secretary for health and health and human services. Then we will hear from the director of the florida arabro policy seemed to center forfl the aging and to research extensively with the structure of the Emergency Response system. And with that Recovery Process continues as president of that inclusive disaster strategy in South Carolina and despite that mouthful he is a leader inn the field the Disaster Preparedness for those who are aging with disabilities. I am pleased to introduceceem fire chief and Emergency Management coordinator and pennsylvania. With those response efforts that became clear with hu hurricane irene could cause i the susquehanna river to overwhelm our levees in pennsylvania. With the clock ticking and though waters rising. And just in the hospitals and Nursing Homes. Now we will start with dr. Good morning. And tha thank you for making time with a busy agenda and to better support in times of disaster. I am a physician and was formally Health Commissioner in new orleans but i want to a talk about what we share a leader. Standing with myself and the Emergency Operations center why we had a power restoration for our community that was august and it was hot. We were getting reports of seniors struggling in the heat throughout our community. We had offered evacuation assistance to many of the seniors who had been registered in our medicalre special needs registry, but they wanted to shelter in place and didnt take theno opportunity to voluntarily t evacuate. We knew some about them, we didnt know who was at highest risk and electricity dependent. We went doortodoor to try a to help our restoration. We were able to help a lot of people because we did this with the support of First Responders, but it was not a great feeling and why was it very efficient. We didnt want to repeat that experience of being haphazard in restoring power to our community. We worked with hhs and new technologies like geo mapping to create a map of where seniors who were electricity dependent lived. We did a drill with fire and Police Volunteers and went doortodoor to knock on this map. They said were from the government and we are here to help. The people willingly open their doors and learned we were trying to find out if there electricity dependent and how we could be helpful to them in a disaster and every day. We learned that of the 600 people who were on the list as electricity dependent for their oxygen, we only knew of 15 of them in the medical special needs registry. That system, called in power, has been taken to scale and is available to be used across the country, not only in Disaster Response but also in preparedness. Its an example of how we can o use technology and local experiences with federal resources to really do betterusd in preparedness and response. This tool was recently used in, and harvey. We do tend to focus on those disasters that make the headlines and on those were most frail in Nursing Homes. I just want to take a moment to talk about additional work we need to do beyond supporting those who are most frail. When i went doortodoor after isaac, the bulk of the people i saw were individualsiv living independently in communitybased settings, highrises and what i thought was really heartbreaking. Heartbe these are People Living on the edge every day and are not likely to be broken only by a major disaster but all the little disasters that touch their lives on a regular basis. Tools like in power are great way to get them on a special needs registry so we know how to find them. They require human touch as well and thats part of the resiliency building that we all need to do. I agree since katrina we made a great deal of progress and hardening are infrastructure and building relationships necessary to help us better prepare and respond but there is so much we need to do to support our seniors. I offer actions in three areas to build a stronger infrastructure. I will just highlight a few today. Tools like in power remind us that we have technology that its only as good as the data in it. If we expand it to include medicaid, we could do more good for more people. Congress needs to support action on the ground. Its one thing to have information in a box but we also have to act upon it on the front lines and that requires training exercises with local Public Health and Public Health core. We need to support the infrastructure. They are under resourced to meet their statutoryes obligations. This includes Public Health and the private sector who is trying to help seniors and Older Americans every day. Finally we need to do more to protect. The Emergency Preparedness rule is strengthening the infrastructure but it requires robust implementation. Its really drilling and paying attention in an ongoing fashion to fuel supplies and generators and finally come the administrations of think about creating best practices to and policy and regulation. I look forward to your questions. Thank you very much. Good morning. On behalf of my colleague doctor david who cannot be here today, i want to thank all of you for being here and for giving me the opportunity to testify on a topic ive studied since 2004 when four hurricanes traversed florida in four days. We have studied the effect of disasters on disabled or frail the vigils living in nursing home or assisted living. Myra remarks reflect a decade of the research thats been carried off from several foundations, specifically the National Institute on aging. Senator collins alluded no Nursing Homes only became part of the local Emergency Response system after repeated hurricanes. They crisscrossed the stateiz and Emergency Personnel finally realize that Nursing Homes were taken care of frail elders and needed help getting generators and power restored and they were part of the system and they were ignored until them. Finally, following katrina, we interviewed nursing home administrators about their experience during katrina. Across the board, these nursing home administrators revealed that they wrestled with the important decision about whether to evacuate prior to the store. They cited pressure from Emergency Managers, urging them to evacuate despite the difficulty of evacuation, having elders pushed on buses, having them evacuateo ese to gymnasiums and adequate materials and mattresses, and they recognized these patients declined and saw their staff hurt trying to help in move residence and they believe they would be better served staying where they are. This initial work became the impetus for the National Institute of aging study that we did, looking at the effect of Hurricane Katrina, rita and icon nursing home. There are about 36000 nursing home residents exposed to the gulf hurricanes. S. The 30 and 90 day mortality and hospitalization rates increased considerably compared to the non hurricane controlled years. Regardless of whether they evacuated or sheltered in place. In total there were 277 extra tests and hospitalizations within 30 days after exposure to the storm. Natural disasters result in bad outcomes. Our research asked a second question. We asked whether or not it was better to evacuate or sheltered place. Using the same data from the four storms that are in the appendix that we provided, it concluded that the evacuation prior to the storm increase the probability and increase the risk of hospitalization independent of all other factors. It should be noted that our data took into account the fact that certain Nursing Homes did not evacuate where there were tragically many deaths. Despite these deaths, our evacuations proved to be more dangerous than sheltering in place. E followin based on our research and experience, we have the following recommendations. We need generators to support medical needs and airconditioning to cool reasonable temperatures, as well as fuel for both Nursing Homes and assisted living. These generators didnt be elevated to ensure continued operation. Emergency plans for both nursing home and assisted living must be publicly and easily available for all to see and for residents and families to understand before they enter nursing home. Nursing home surveyors and Emergency Managers also need to be sure all plans are actually tested and that,e this means real drills and actual implementation. Assisted Living Communities require much more oversight. They routinely accept patients who wouldve received care and a nursing home only a decade ago. Waiver payment for resident with medicaid have also increased, thereby making the federal government, at least an Interested Party and assisted living regulations. Evacuations should not be all or nothing. Senator collins already talked about the importance of dialysis rather than being evacuated. We need Better Research understanding of who should evacuate and how people can be sustained appropriately. Nursing homes and assisted livings must be built in places that minimize flooding and they have to be built to standards that allow administrators to shelter in place. Place every state and local Management Organization mustard and a fee to identify and prioritize Nursing Homes and assisted Living Communities for restoration of Power Services and other services. Some degree of litigation protection must be considered for facilities that abide by regulations and provide heroic care during disaster scenarios. There are many people working very hard to try to care for elders and disabled people all over florida, continuing as we speak. Older adults matter. I am the pi on this. We need continued commitment to geriatric Education Programs and training programs. I can only provide the evidence im providing today because research and training was approved and was allowed, but it dried up in the years following katrina. R we need ongoing geriatric training. We need Consistent Research funding to evaluate disaster. We know disasters will continue to occur and we must be prepared. Thank you for allowing my testimony and i look forward to questions. Thank you very much. Thank you and good morning. This is the nations only ngo with a specific mission to serve the Disaster Relief needs of people with disabilities and Older Americans. The 20yearold Grassroots Organization with a proud history of serving on the ground in virtually every Major National disaster since Hurricane Katrina. Our partnership for inclusive disaster strategies leads andeg coordinates over 100 disability emergency Public Health, Public Safety and other stakeholder groups including fema and the red cross with a shared commitment to the Emergency Preparedness and disaster related needs of the nations 59 Million People with disabilities and 67 million americans over the age of 60. Convenin weve been convening stakeholder calls daily to identify problems and finding solutions and operating our hotlines to assist disasters of drivers from harvey and irma and were currently preparing our dedicated volunteers for hurricane maria. At given the people with disabilities and older adults are two to four times more likely to die or be seriously injured, the urgency of our work cannot be understated. This is due to poor planning and inadequate accessibility and the assumption that people with disabilities andia older adults are vulnerable, special or particularly at risk simply because of a diagnosis or stigmatizing police about disability and aging. In fact, we are extremely valuable experts on emergency problemsolving with far more practice than younger people. The appropriate approach focuses broadly on the functional needs of people with and without legal disability protections. In a disaster, providing equal access and functional needs makes a difference time again for individuals, timing and communities. That phrase has been codified by dhs and is the working term among Emergency Management professionals and fits our discussion here. Hospitalization, nursing home admission and separate strategies for assisting millions of people with access and functional needsen might look great on paper however its a deeply flawed approach and practice and must be stopped. Its been clearly proven story after story to be worse than we expected. There are a few examples of the consequences and shortfalls in the disproportionate and impact. A man, quadriplegic using a wheelchair was separated from his girlfriend and discharged with any assistance other than to return to his destroyed dwelling. He slept outside until the temperature caused him to have a heat stroke. We have assisted in obtaining temporary sheltering in a Wheelchair Accessible hotel room. A woman called from a nursing home, she had been transferred to after evacuating from houston to dallas. She told us a nursing homee wanted to sign over her Social Security and fema benefits which would make leaving the nursing home impossible. We connected her with Legal Assistance to protect her rights and address her need to return to houston as soon as housing can be found. Many older adults and people with disabilities in other locations have been disconnected from the resources and still are. Power theyve had no food waterpower. Our communitybased partnerships have been the saving grace time again. In my written testimony submitted for the record ive got a short list ofmm recommendations to improve our approach to emergencysa preparedness and Disaster Response. In summary we are calling for the establishment of a National Commission on disability and aging Emergency Preparedness and Disaster Management, to take the many lessons observed and turn them into whole Community Inclusive action. For the 59 million americans with disability including over 2 million in Nursing Homes in the 67 million americans over age 60, providing equal access to Emergency Services andse programs is not just the right thing to do or smart business, its also a legal obligation. The ensuring the federally mandated civil rights with people with disabilities were well served everyone with access and functional needs. The National Commission on disability and aging Emergency Preparedness and Disaster Management will serve to leverage the priceless expertise of those of us most impacted and will manifest the mantra of the disability rights movement. Thank you very much. Chief delaney. Members of the u. S. Senate special committee on aging, thank you for inviting me here today to discuss how cities and towns across the country can ensure the health, safety and resilience of Older Americans and individuals with disabilities during and after disasters. Sters i am the fire chief for the city of wilkesbarre pennsylvania. Ive served the city for 12 years and have 36 years in Emergency Services. Im also the emergencycy coordinator and a certified paramedic. Over 40000 people reside in the city. 90 of the county residents are over 65 which is 3 higher than the average in the state. He many of the older residents are concentrated within the city limits. Like any fire chief or Emergency Management chlorinator, i feel a great sense of responsibility for these older citizens. My concern is heightened whenever theres a threat ofgh a severe storm or weather event. The river threatens to flood our streets and neighborhoods. As the east coast braced for hurricane lee and irene to make landfall, what transpired explains why early weather tracking, data, surveillance and the flow of information against all levelth is available. We heard from ellen National Weather service about seven days before the storm was scheduled to hit. They started sending regularhe updates about the pattern and rainfall. They disseminated critical t data to the county Emergency Management officials and coordinators for each municipality. Its protected by u. S. Army corps of engineer levy to a river level of approximately 42 feet. It was the responsibility of the u. S. Geological survey, senator casey led the charge to secure the resources to replace our broken gauges. Its because of senator casey that we could track in real time, the possibility of a flood and river level data. This provided the needed data to make riskbased decisions for possible evacuations. Using maps of flooding that took place in 1972 after hurricane agnes, we created an evacuation zone. In 2011 we successfully evacuated residents in ten hours. This evacuation included city hall, please headquarters, fire headquarters as well as the entire downtown including Kings College and wilkes university. They safely executed 250 seniors we would send ambulances and personnel to help if needed. But, it was the older pennsylvanians, the seniors and those with disabilities that still lived in their home in the community that i worried most about. Mr. And mrs. Smith and mr. Jones have lived in their homes 50 for 50 years. In preparation for a possible evacuation, we develop a grid designating areas of responsibility for the fire department, the Police Department and members of the National Guard. We were making announcements from our vehicles, knocking on doors and posting evacuation orders. We knocked on every door. We left notes on doors of the home where no one answered and made an additional check to ensure evacuation. Most people heeded the request on the first try but if anyone resisted, they took their names, wrote down the address and we spent additional time working to get them out of their home. But after every major event, we look back and say how can we improve. If we ever need to evacuate again, we now have a contactha in place for the local bus company that agreed to drive roots and take them for safety. I hope the congress will conduct its own action review after they did after Hurricane Katrina in august 2005. Its it was put into action after Hurricane Katrina and is now the model for how all level of government manage all types of emergencies and disasters. Er as part of that review, i hope they will commit to fully funding the National Weather service and fema and invest in surveillance tools that we have the most comprehensive Information Available before during and after two tied our decisionmaking. I am grateful for the opportunity to add my voice to the conversation and i think you. Thank you very muchnk chief. Thank you for reminding us that while our neighbor toof the south tend to be disproportionately affectedfectd by weather disasters that we live in the northeast are not immune to either, how well i remember the historic ice storm of 1998. I had been in the senate for years which left so many constituents without power for so long. The point is, it can happen anywhere. All of us need to be prepared. Cs thank you for recounting your experience as well. I was very interested in learning about the empower program, which you have been so instrumental in setting up and sharing with the other states. Obviously, electrical power is key whether we are talking about airconditioning in florida or keeping warm in maine. What other things do you see that seniors and disabled citizens need. A tool like in power that uses medical claims data can identify not only people who are electricity dependent of people who are dialysis individual and have ambulatory challenges and in new orleans, when i was Health Commissioner, theres a way that there is a boil water advisory and we can target individuals that might be on special feedings are dialysis. We want to forewarn them inde advance. It has to be used. I cant emphasis that enough. We want to use data in respect for ways to identify people at risk. There has to be humans on the other and that can take that information to make use of it by making phone calls and going to peoples doors, but the opportunity is pretty great, not only big disasters but the smaller ones that communities face everyday. Fa i try to target limited resources to reach those who have the highest risk. Thank you. Doctor, you gave an excellent explanation of the dilemma that many longterm care facilities, administrators face when deciding whether or not to evacuate, and i remember reading the controversy over the mayor of houstons decision to not order an evacuation, and yet in other cases more people died in automobile accidents trying to get out of the area. I can see you nodding in agreement so for a Court Reporter here. The active evacuation, while totally appropriate in many cases, can actually be more dangerous than sheltering in place. You talked about what is needed for people to safely shelter in place. Weve also talked about seniors that may be very fearful or unable, give us some advice on how you would advise Public Officials or nursing home administrators to make the critical decision between sheltering in place and evacuation. There were 22 people were killed in the bus as a evacuated in rita. And he gets a very, located question. Emergency management people that i work with say that you run from the water. If you expect there will be water and you cant evacuate, you cant sustain the water, then you should leave leave, but you hide from the wind. I think we think about having buildings built in places that are appropriate and consist unusual disasters. If you have a hurricane category five, im not sure nursing home should stay, any nursing home in a category five hurricane coming in directly at them. Its just devastating. For the most part many will evacuate and shelter in place. Countries in taiwan build watergate and thats exactly what they did in houston. We will evacuate up. E buildi it will be sheltered on a different floor. That requires a lot of planning and forethought. Those have been in existence for a long time. One of my colleagues in florida always says you shelter in place until you cant shelter in place. There were 40 evacuations in florida of Nursing Homes after irma. Ri some of those are because trees fall and wins rip open groups and the place is not safe and habitable. Many of those evacuations. There werent a generator or they were appropriately created or built in a way that they can sustain. There wasnt fuel. Those regulations have been changed. Ou i think the answers you want to have people stay in the buildin building. They cant be built in flood areas that routinely continue to flood. There are building codes that allow that to occur. We also need to have them hardened and have generator capacity. Many generators are very old and we have to take about if we are going to allow Capital Capital capital to be used to replace them or fix them. I think New Buildings have to have generators to run airconditioning support systems for a period of time. Thank you very much. Senator casey. Thank you very much. Ill start with chief delaney. N what we have all seen in 2011 in the stern county, we had northeastern, central and almost half the state affected. H the combination of both storms was terrible. For me it was an eyeopenerficii because i had never been affected personally by terrible storm or flood. Even as a public official and not sure had ever been as i close to it as i was in 2011. We were walking through those areas in just hours after the storm. What i learned from our is just how violating that is. And how devastating that is in a personal and emotional way. A friend of mine who was the ultimate tough guy, another bollard by anything and cocky about everything, i walked up to him. His house had been flooded. I said hows it going and he just started dissolving in tears, this really tough guy. He was absolutely devastated. I gives me an idea of the horror of it and what were seeing in all these other places may be even worse than what i found 2011. The one point you made was the importance of good data to inform decisionmaking. We work together, as you mentioned to gather information. Talk to us about what data you have used to inform your decisionmaking when you have an impending hurricane. What they did you use . This is not really hard. We start with the Clinical Data from the National Weather service. That agen agency is critical for the information they send to fema, the Pennsylvania Emergency Agency down to luzern county and that flow of data to us. They have some of the best scientists available that can predict what the rainfall will be, was the river testing will be, and that data used for riskbased analysis michael to decide whether were going to evacuate or not. The river gauge that didnt work almost triple the we didnt know what the river was doing. I think from an Emergency Management and. , we can prepare for a lot of these disasters because we haveca some of the best scientists in the world that can predict whats going to happen so we take that data, we make sure we have our Emergency Operation plans and write a plan with our municipal officials, in particular for lee and irene, luzern county opened early on because of this prediction which sent the National Guard there in place so we needed to evacuate. That tool was there to help us. I think a lot of the Surveillance Data is critical that flow of information to come down, and number two, the National IncidentManagement System and unified command is used to make decisions. On. I have a boss and hes the merrier and we have an administrator and Department Heads and in Emergency Management, one person doesnt make the call. You talk about sheltering in place, we had a small fire in a nursing home two weeks ago and we decided it was only ay really small fire, we decided we had ten decisionmakers there to help make the decision on what the best t wellbeing would be for the 166 residents who live there. E. We have systems in place, we really need to use them and use them adequately. , for the time. I was going to ask you, sometimes we think of response tools being things, equipment, whether its to remove down trees, but the challenge you had was having enough personnel, enough manpower or Human Capacity to be able to go doortodoor. Talk to us about that. Sure. On a daily level, we have 12 or 14 firefighters and paramedics working in maybe the same amount of police. By getting the surveillance information data we can go to g our boss, our elected officials and say listen, we need to prepare. We need to have all 80 firefighters at work the next three days. We did that during the disaster, the Winter Weather event, the blizzard we had this past year, we utilize that. To make these decisions that information early on, i always have to put my request in for the federal programs that help us have the proper staffing. My department does about 11000 calls. Year. We are set up for all hazards but we deliver babies, we put the fire out, we rescue people from the river, we take the tree branches, we do all those things so staffing is critical. This early information early on helps us to have the right amount of people to handle the event. Thank you. Thank you very much. Senator cortez casto. Thank you, first of all let me say thank you to chairwoman collins andyo Ranking Member casey and all of you here. Its such an important topic and we so appreciate the conversation. I have the opportunity toto work in state and local government in nevada and i dont think people realize how important Emergency Management at the local and state and federal level is and people are working everyday so hard to get it right. God for bid something should happen, but they want to make sure they get it right. Many times the emergency room Management Services are underfunded or challenged and they need more support. Let me, i have a couple questions because it came to my attention that the department of urban development recommends that they dont establish Emergency Response plans and im curious if you are aware of this and or, in your own communities, how have you brought in some of those vulnerable populations thatti live in some of the housing that is established. Im curious if you are aware of this. Senator, i want to take this opportunity to thank you. Its a great reminder that Emergency Response, but there are a lot of people who haveve roles to play. What youve heard is its a place where we can do a lot and think about building codes and generators and exit lighting thats available. Better communication of whatng they know about disabilities or the special needs of people in housing could be of great benefit to the people who are on the front line, and also in between, building resiliency, making sure people have the support so they can individually be prepared. I just want to point ann example, more recently where hud and didnt quite well and thats in flint michigan when i was trying to understand how to reach kids and families to let them know about opportunities to get screened and treated for lead up poisoning, that the hud agencies were able to get their databases and know whether kids and direct resources. Ive seen it in a slower burn emergency but i think theres a lot of opportunity at the local level to better communicate. I appreciate that because i think just like your interaction and gathering the data and working with medicare to identify a population, hud can do the same thing. Federal agencies have access to this data that can help Emergency Management at the state and local level as well. I think there needs to be more that partnership. Thats why, mr. Timmons, whennda you talk about needing andnd recommending a National Commission, can you talk a little bit more about that . Is that your thought that there is more of that interaction and sharing of data and information with the state and local Management Systems. Thats exactly right. In my mind, this comes down to planning and i differentiate between plans and planning. Plans are worthless, planning is invaluable. Its not a matter of just creating a plan and hitting the print button. I think we need to be in a perpetual state of planning and some sort of National Infrastructure to facilitate that is critical to give us consistency and give us leverage. The disability stakeholder organizations need to be involved in this process from the beginning. We are the experts on what we need him or the experts on how to negotiate getting that in the most efficient fashion. I would like to see each state have an access and functional need coordinator. We have a couple models of that in mississippi in california. Its making a tremendous difference. At the end of the day i think this is a relationship thing where we see this work is where theres preexisting relationships between Emergency Managers and stakeholder organizations, where we did not work so well , i dont think its coincidental. What im suggesting is creating some sort of a framework to do this in an insufficient and effective and impactful manner. My time is up. Thank you so much for the conversation, and the work that you do everyday. Thank you so much. I will follow up on the questions to my colleague. Chief delaney, let me start with you. You had talked about Emergency Preparedness must start with the communities what are some ways beyond looking at hud data, which i thought was an excellent data, that we can involve organizations, im thinking of meals on wheels, area agencies on aging, that have regular contact with seniors and communities and would be aware of who would need help, or whose housing might not withstand the below of a hurricane or an ice storm or flood. Are they involved at your level with the Emergency Preparedness planning that you do. There is a lot of individual programs that are out there, but again, how to engage mr. And mrs. Jones, mr. Mrs. Smith who have lived in their house for 50 years, thats a tough nut to crack because when you have to evacuate 15000 people in ten hours, you dont really have the time to sit and say will heres why you have to go or heres why you have to go. Thats a difficult question. If we can get that answer, i think we would be well on our way, but i did want to address the assisted living facilities, nursing home facilities, that is critical that they have their plan and their plans address how to get out because when we evacuate in 2011, we trusted their judgment. We said you have ten hours to evacuate. They have Strike Forces of ambulances, they have all the Critical Data needed to get out so i think mandating these plans are critical. I just received a 40 page document the other day. It seems that were Getting Better at getting these plans but there needs to bebu Regulatory Agency to say you have to have this plan, local officials need to get this plan and that were aware of whats in the plan. To address you, i think thats a great discussion to have. The organized facilities know what to do. Its the average citizen that kind of doesnt understand it. They havent talked to folks for days or weeks about anything potential that might go on. Its a long time. When we need to get them out we dont have the luxury of all that time. Thats a great conversation half. Thank you. Mr. Timmons i really appreciate you reminding us that this conversation on Emergency Preparedness needs to go beyond seniors and also focus on individuals with disabilities. What is your assessment of the level of Emergency Preparedness in terms of meeting the needs of people with special needs. Do they have shelters that are equipped to take care of people with disabilities . Are they staffed with people who will understand what they need . . This is an area that i dont think has received as much attention so i would love to have you elaborate on. Particularly with the red cross, we made some progress in the past couple of years trying to create an infrastructure. We been working with the community and stakeholders so that all shelters are assessabl assessable. I reiterate that in my mind this is a civil rights issue so the red cross is the primary shelter operator across the country and weve seen a tremendous amount of progress from them in terms of being ready and engaging in planning and engaging in exercise and in a number of places we are seeing a tremendous difference. They are sort of the Industry Leader and its my hope that in areas where perhaps they dont operate the shelters that those who are will learned some lessons from that. We are making incremental gains, its a slow hall but we are beginning to see some understanding from the folksks in the shelter business that this is a civil rights issue, it makes economic sense to make all of the sheltering and all of the servicing assessable to everyone. Its a legal obligation. It just makes sense. Its a great business case. We are making progress. Thank you. Senator casey. I wanted to ask you about a related topic. We are in the midst of yet another Health Care Debate and even in the midst of that, we have had some good bipartisan work on healthcare the last number of weeks, more than two weeks. In your testimony, you may clear that you have seen, in real time, both in your clinical practice and as a Public Health leader the devastation that a hurricane can cause to seniors with chronic conditions as well as individuals with disabilities and others. Given that experience, how concerned are you about the latest Health Care Bill that the senate is considering. Senator, louisiana, in 2005 was a state with the unhealthiest population in the country and some of the highest rates of uninsurance and access to care was, for low income, high need people, largely in Emergency Rooms which prevented them from having relationships in primary care. People who knew about their health and could reach out to them in between disasters when they were evacuated, it meant they arrived sometimes without any way to get caree because they didnt have a way to pay for it. The absence of having public or private insurance and having relied in our state on the system, and it was, ill tell you, someone who has been in louisiana for decades and have been telling my colleagues what it was like to practice in an environment where your patients were uninsured and use them them out on the hope and a prayer that they could get the colonoscopy or get the medications they needed, it was really shocking to my colleagues in other states that were on the receiving end of these individuals who had so much medical need andth not a means to pay for it when they arrived in a new state. I think it spotlighted for us and louisiana, but our colleagues around the country that its having a Great Institution or place is not the only solution to access to care. You have to have an affordable way to pay for it, not only in disaster but everyday. We have come so far louisiana in the last decade with recent expansion of medicaid that the opportunity for us is less focused on what can happen to those folks were uninsured or maybe dont have means then how do we make the system really work better for them. I would not want us to take a step back in louisiana but as a country and if i could, i would just like to mention the additional piece thatsto been raised because its also part of the thinking on what may happen in this bill which is cuts to the preventionined b fund which supports Public Health across the country. It literally saves your life every day, make sure you can drink water any food and be rescued in the event of a disaster but struggling already. Much less having additional cuts. Its so pertinent to this thread of conversation about people with disabilities and special needs because you do not want, you dont want to learn about that in the middle of a disaste disaster. You want to know about those folks wellin advance and you need to be able to leverage local Community Organizations , you have connections to those individuals whether its meals on wheels or the faithbased community, like the coronation and mitigation doesnt happen just by happenstance. It requires work and it requires resources and that requires Financial Resources to make sure local communities have thehe bandwidth and time to workt together. I wanted to ask you among your recommendations is the idea of a federal task force or committee to coordinate efforts across not only federal government but state and stakeholder groups as well. What are some of the advantages that communities would see if planning were better coordinated . In this way, i would hope we could optimize our limited resources, reduce duplication of efforts that we see, create and nurture relationships because the time to do that is when the sky is blue so do that in a consistent and meaningful way. Using people with access to force multipliers rather than seeing this as liabilities, planning, perpetual vigorous planning and exercising is something we like to see consistently done around the country. Optimizing health, reducing the need for acute medical care in these situations would be a tangible result that makes business sense. Universal accessibility, ensuring the civil rights of people with disabilities affects the broader access. Doing this and inconsistent, federally mandated, overarching way just makes sense. Its been said all disasters are local. There is truth to that, and in this way i think we could build up the local piece so that folks like the chief are serving their community and people are working together to achieve the goals were all after. Thank you very much. Thank you. Senators quartets. In nevada, and im sure in many of your states, we have rule communities that are challenged. Forget just getting resources there, professionals, you name it, its geographically challenged. Theres no planes or bus service. Im curious how we support estate and the statewide effort to pull over rule communities into this Emergency Preparedness and if you have any thoughts on that. I will start. Maybe i will spark some additional conversation. Im really glad you raised this. When you map the challenges and Rural Community it will overlap with challenges in individual resources, access to transportation and all the things that make them more vulnerable to disaster. It also, in our experience in louisiana, it also is a challenge because those individuals may be less willing to relocate to shelters, particularly if they are living on the coast, for lots of reasons, they want to shelter in place. Its just a good reminder that there has to beth coronation across jurisdictional lines. Our experience locally was that we had a regular babble rhythm where the Emergency Preparedness of each of our local jurisdiction have their own preparedness conversation about their populations, but scaling that across the day to make sure we were thinking about regional and statewide supporting coronation because this is the thing, isaac is a great example. We didnt flood, we had of Power Outages but the county next to us flooded. Because we were hardened and ready for an acute care standpoint and because we were communicating, were also ready to take peopleak from the surrounding parishes and stand up a special needs shelter to support people. Some of those were pretty rule environments on the coast but without the preexisting relationships when the skies are blue, the Communication Infrastructure and everyone knowing what a sister relationship look like, were not really ready to help each other. Though its local, its gotinsh to be coronation that is scaled to help bridge the gap. In some ways i think maybe the paradigm should be that the we let the local communities draws into the way they do this. Theres a lot to be saidid about the power of community. I live in South Carolina. We saw this two years ago and without last week as we experience some of irma. A lot of the things im talking about, the Broader Community engagement, the local nature of this is done really well in our rule communities. There are some challenges but theres also some things to be drawn from this as well. Thank you. Thank you very much. Thank you, senator. I want to thank all of our witnesses for testimony today and for the really important work that you are doing at the local, county and state levels, private sector, public sector, nonprofit, youre all making a difference on the front line. I also want to thank our staff which worked hard toan bring this hearing together. We delayed the date of this hearing because we did not want to interfere with the Immediate Response that was occurring in florida and in texas because i know, from the medical team that helped out in both places that First Responders from all over the country were assisted in the response which is a real tribute to the First Responder community. September is National Preparedness month and this years theme is disasters dont plan ahead, you can. But we should take that motto to heart. From this hearing today, i can see the huge amount of progress that has been made since i conducted that investigation so many years ago. That was into the very inconsistent and somewhat failed response of Hurricane Katrina. We have made great progress, but we still have a long ways to go. I love the list of exactly the four things that need to be done. I would note that Governor Scott has issued an order in ore that says that assistedliving facilities also have to have generators and fuel to supply them. We are learning from every disaster and we are learning how being prepared today can make the difference between safety and danger andd literally the difference between life and death. For Older Americans and those with disabilities, there are ways to anticipate aging, mobility impairments. For seniors living at home, for those in assisted living facilities and those in Nursing Homes, there are ways to prepare, even thoughth disasters can strike with little warning. I think we have learned a lot today about the importance of communicating, working together and my favorite expression is to say that you shouldnt be changing business cards when disasterhe strikes. Thats the worst time. You have to prepare in advance. I want to close my remarks by wanting the residence who have been affected by the many scams that have arisen. We have held hearing after hearing on expectations of our elderly. There are two scans in particular that seem to be very prevalent, one is what i would call the charity scam where people are trying to get donations that purportedly are going to the victims of the hurricanes but in fact are lining their own pocket. I would urge people to deal with recognized charities to be very careful and i know the former president s have come together to encourage donations and you can assure that the safe one but that is a scam that is relentless andea heartless, and the other one is an old scam that occurs every time there is a disaster like that. And that is when people are pretending to be qualified to repair homes to make them habitable, habitable again, and as for an upfront payment and then they will do the work and of course they disappear with that upfront payment and are never heard from again. My heart goes out to people who have been affected by the storm, but i also want to give them a caution to be very wary of people who would exploit the suffering of others, and the devastation of these storms in order to line their own pockets. I just wanted to mention that this committee will put out a bipartisan alert to try to raise Awareness Among the victims of the storm. Again, thank you to all of our witnesses, to all of our members who are here today and Committee Members willco have until friday september quet 29 to submit any additional questions for the record. I should s to be here today that they rushed back from their home state as soon as it is understandable as well. We are all and she delaney, were grateful that youre here today and given this testimony. Bringing real expertise and experience to these issues. Special thanks to chief delaney, we live in the same home area, one county away. We are grateful you made the trip down from pennsylvania. I share senator collins commitment to making sure were doing everything within our power to ensure the seniors and people with disabilities are prioritized in Emergency Response limits of these horrific challenges. Not take tf americans for the kind of photos that we saw to cause us to take action. And to move this issue to the top of the agenda, including here in washington. Thats why we are grateful that we now have legislation to begin to address some of these issues. We need to learn from and commit ourselves to the goal they were known for happen again. Ar i look forward to working with members of the committee on the issue. We are grateful for this opportunity today. Thank you. Senator, since youre such a dedicated member of this committee if you have any finalt words, feel free. Thank you for yourrpartic participation. This hearing is now adjourned. [inaudible] [inaudible] [inaudible] today, President Trump announced new economic sanctions against north korea send the countrys Nuclear Program is a threat to peace and security in the world. The president also says that chinas president has ordered chinese banks to stop doing business with north korean entities. President trumps decision to add new sanctions to north korea comes after the fourday visit to the United Nations general assembly. Senate Republican Leaders say they hope to bring the latest gop healthcare proposal to the floor next week for a vote. Tonight, cspan will look at the plan offered by senators bill Cassidy Lindsey graham that would change Current Health insurance funding in the block grants. Also, another proposal to change the current individual insurance market. Coverage begins at 8 00 p. M. And is online at cspan. Org, or listen on the free cspan radio app. This weekend on American History tv and cspan three. Saturday at 8 00 p. M. Eastern on lectures in history Temple UniversityAndrew Eisenberg on the environmental movement. What i want to argue here is that the noble savage environmentalist was a product that was sold to American Consumers just like big macs are car. At 10 30 p. M. , father daughter pilot the United Airlines captain and a former f16 pilot talk about their experiences during 9 11. We take off and had northeast into a serene and peaceful and silent sky. We head out to the northwest and we never find anything. We were not heroes that day, the passengers on flight 93 were the heros. Tour the Harriet Tubman underground railroad visitor center. Theres a horrific physical injury for young Harriet Tubman, but it opened up a new world for her. We think she got epilepsy woods allowed her to have these amazing visions and direct connection to god. She saw these Amazing Things and had very vivid dreams. It was terrible on the physical side but amazing for her faith. At 7 00 p. M. , her series on photojournalists continues with eric. That image that shows bartlett, the Communications Director pointing to the tv, that was the first time we started seeing a replay of the second tower getting hit. American history to become all weekend every weekend on cspan three. Up next on cspan2, the relationship between ideology and terrorism. The discussion was part of a conference hosted by the Bipartisan Policy Center that examine the evolution of terrorism since 9 11. This is 50 minutes. It is not my pleasure to introduce our second and last panel of the day