Died in a florida nursing home that lacked air conditioning because the power had been knocked out. One press account described the facility as, quote, a death trap, end quote, because the elderly are particularly susceptible to heat related illnesses. Last month, this photo of residents of an assisted living facility in texas, who were trapped in waist deep water went viral. As these recent disasters made clear, Older Americans are particularly vulnerable, before, during and even after a storm. In fact, when Hurricane Katrina slammed into the gulf coast 12 years ago, more than half of those who died were seniors. As the then chair of the Senate Homeland security committee, along with senator Joe Lieberman of connecticut, i led a bipartisan investigation into the response to Hurricane Katrina at the federal, state and local levels. Our investigation, which resulted in this some would say weighty report, revealed many weaknesses in our nations Emergency Response system. And although i doubt very many people read the whole report, it does have an excellent summary that i was just discussing with the chief, and it was evident to me in rereading it, that weve learned many of the lessons of katrina, but we still have a long ways to go. One of the weaknesses in our nations Emergency Response system included the failure on the part of all levels of government to plan and provide for timely and effect evaluation of our most vulnerable seniors. Since then weve expanded our efforts to improve Emergency Preparedness and response across the entire country and emphasized the protection of the most vulnerable. Meanwhile, Mother Nature continues to unleash her fury. Today, even as we meet, yet another hurricane, maria, is battering a region still struggling to recover and is expected to hit puerto rico particularly hard. This morning we will discuss how our federal, state and local Emergency Response efforts have been critical in limiting the scope of these recent tragedies and we will identify where more work is still needed. On the positive side, improvements in Emergency Response efforts at the centers for medicare and Medicaid Services have helped to identify those seniors who require relocation in order to maintain their dialysis. I was talking with the head of cms just yesterday about this, but she said one of the problems was that the demand was so great, that people were not able to have complete dialysis. They were hooked up to the machines for two hours when they needed a far longer period of time, but the demand was such that they were just trying to maintain people. In addition, local Emergency Response teams implemented strategies to identify those most in need and provided designated shelters that offered necessary medical care and support. But that tragically was not always the case. The lack of electrical power apparently contributed to the deaths of those seniors in the nursing home and to the worsening Health Condition of others, suggesting a very troubling lack of preparedness in some health care centers. While we have made many strides since Hurricane Katrina 12 years ago, we must ask ourselves, can we better protect the most vulnerable members of our community . What gaps exist that could jeopardi jeopardize lives in the next catastrophe, whether its a storm, an earthquake or some other unanticipated event. We should not have to wait for the next irene, sandy, harvey, irma, or unnamed disaster to strike. Today we will discuss concrete solutions to protect and stabilize vulnerable seniors from maintaining necessary resources and connections during emergencies, to relocating and returning to safe and secure homes during the recovery period. We will consider the challenges of making the correct choices of whether it is better to shelter people in place or evacuate and relocate. And as ive looked more into this issue, ive learned that that is often a very difficult decision to make. Particularly if youre dealing with people with some sort of dementia. Just one day after Hurricane Irma slammed much of florida, a cnn reporter waded about a mile in waste deep water contaminated with oil and garbage, to knock on the door of a mobile home in bonita springs. He had been told that an elderly couple lived inside and that they did not heed the warnings of local and state officials to leave prior to the storm. Inside this mobile home, which was now surrounded by water, lived an 88yearold woman and her 93yearold husband, who suffered from parkinsons disease and diabetes. When the reporter asked the woman why they didnt evacuate, she simply replied, we have everything we need here. We have his medications, its just easier. Now, im very grateful that this couple was found safe, but to me the story illustrates how we must expand our efforts to protect vulnerable seniors, not only those who are living in facilities such as assisted living or longterm care facilities, but instead, are living in their own homes. For many of those seniors, evacuation is not as easy as packing a bag and jumping into a car. They may not be able to drive, for example. Some of these homebound older adults are alone and frail and they may suffer from diseases and many of them have lived in their homes for so long, they just doesnt want to leave it behind and are fearful of what will happen if they leave. Let me conclude by offering my condolences to all those who experienced losses as a result of these violent hurricanes. My heart goes out to all of those who are suffering and now face the considerable challenges in the weeks and months ahead. I also want to extend my gratitude to the First Responders, including the volunteers, such as the medical team from maine, and everyone who has reached out to help a neighbor in need, even as in many cases they, too, are dealing with the devastation caused by these terrible storms. While we can and must continue to improve our Emergency Response so that the tragic deaths in floridas Nursing Homes do not happen in the future, we should not overlook the heroic actions of so many. I want to thank our witnesses for being with us today and im delighted to now recognize the Ranking Member. Chairman collins, thank you very much for having this very important hearing, especially at this time. I join the chairman in thanking the work of those who have done Emergency Response, tasks over many, many days now, the countless volunteers who help them throughout these many days of challenge. Were grateful for that work. And we join in thanking them for doing that great work. Together, theyve worked endless hours offer these last several weeks to save the lives of people in texas, in florida, the u. S. Virgin islands and now, of course, folks in puerto rico are facing a difficult number of days ahead and were thinking of them and praying for them at this time. To say that these actions have been heroic is an understatement. Theres no way to adequately describe that kind of commitment, that kind of heroism, but unfortunately, today were here because we know that despite great efforts by a lot of good people across the country, Older Americans and individuals with disabilities face extraordinary challenges in a disaster and again, thats an understatement. So many of us were both outraged and enraged when we saw what happened in florida, that people died, seniors died in the midst of this crisis. Were also heartbroken for loss of life and also the loss that those families suffered. In this case, it was apparently something as simple as a lack of air conditioning, something that many of us take for granted, just even on a day like today in this building. Its hard to comprehend the sadness that will engulf those families and those communities. So thats one of many challenges we will speak to today. Just yesterday, senator nelson, who has done great work in his home state of florida dealing with these issues said the following, he said, one life lost is one too many, unquote. And im proud and i know that chairman collins as well is proud that weve joined him in introducing legislation that would do the following. It would require the secretary of health and Human Services to establish a National Advisory committee on seniors and disasters, a 15member panel would be appointed by the secretary of hhs and made up of federal and local Agency Officials as well as nonfederal Health Care Professionals with expertise in disaster response. It its a good bill, its bipartisan and we should pass it. Both he and senator nelson and senator rubio have introduced it. Thats one thing we can do together to better plan for and respond to these challenges in the future. But like all americans, and i think every american was stunned by the viral photo that the chairman just showed about one nursing home and the water, the water that was rising around those seniors. In this case, an assisted living facility in houston where they were sitting in waist deep water waiting to be rescued. These are folks who, indeed, to say theyre our greatest generation doesnt adequately capture. These are folks who fought our wars, they worked in our factories, they built the middle class. They gave us the kind of liao i have life that we take for granted sometimes. Theyve sacrificed so much and lived lives of quiet dignity. We have a sacred obligation to them, to make sure those scenes that were depicted in that photograph and what happened in florida never happens again. Just as the chairman said, all the good lessons that were learned in the aftermath of katrina, we have to implement better practices, best practices, to make sure that we learn from these recent disasters as well. So we need to ensure that were doing Everything Possible to learn from these tragedies and we also have to make sure that were focused on a day like today, on better policy. And thats why we gathered today with such a great panel of witnesses. These witnesses bring not just experience from the recent past, but in many cases from years of experience, from Hurricane Katrina to hurricane harvey, they face the double whammy, so to speak, of hurricane lee and irene back in 2011, as well as the four hurricanes in six weeks that ravaged florida in the year 2004. Weve learned, and theyve learned even more from each of these experiences. So as we hear from our witnesses, incident management infrastructure is more robust in some important areas like hospitals. Thats good news, that means weve learned lessons to implement those changes. Coordination in response of storms have been improved and more Emergency Response requirements implemented for Nursing Homes so that seniors will be better protected. We have a long way to go, to make sure that we get this right. Older citizens should not suffer for days, and then die, die, in the unbearable heat. No person with a disability should have trouble following evacuation orders because of inaccessible transportation or shelters and it should go without saying, no senior should fear drowning in their own home no matter where they live. Our witnesses here today will explain how we can do better. Because we must do better. We have a sacred obligation to do better. I want to thank the witnesses for bringing their experience, their expertise and the passion to these issues and i want to thank chairman collins for gathering us on this day. Thank you very much, senator casey. Im delighted that we have senator tillis and other senators with us today and very much appreciate their participation. I know that senator tillis has to get off to the Judiciary Committee and so i would like to offer him the opportunity for any comments hed like to make. Thank you, madam chair, i do have to chair the Judiciary Committee so once i get there i wont be able to come back, but i want to thank you all for being here. The building is a little empty here because we adjourned last night, but you see the focus that the members have to being here and thank you all for being here. And im glad that weve framed this as really response to disaster. Were going to immediately leave to the disaster occurring right now in puerto rico with maria making landfall at 175 Miles Per Hour sustained winds. We can talk about the recent storms, harvey and irma. And i can talk about North Carolina matthew last year on october the 8th and i have a personal story to tell there because our office, our staff had to help a senior who had gotten lost in the process, who had left her home as she should have. We had almost 20 inches of rainfall in about a 24hour period devastating to the community and river rising so much worse. So much so, they would go to that shelter and that shelter closed down because the water threatened those shelters. And so, it really raised the question, mr. Timmons, im going to submit some questions for you record for you all to potentially respond to, but it raises a question of how well we track evacuees through the life cycle. Not only i think that that life cycle needs to go before the disaster ever occurs and then until theres a resolution that makes us feel that like senior is safe and secure. I think one of the reasons that we have a challenge with evacuating seniors, they just have a fear of the unknown. If we did a better job of communicating what this would look like earlier, where theyre likely to go and how were going to be stewards over the course of the process. I think that many who feel like the safest thing to do is to shelter in place, is to be replaced with a sense of comfort theyre going to be taken care of through the process including getting them living independently again or a facility where theyve been taken care of. So, that life cycle, where needs to start. How do we better link. What we ended up doing in our office is going together and i think it could be instructive for things that we need to do differently, but fortunately our people in North Carolina helped us find the lady and get her medications she desperately needed and get her to her family. That sort of life cycle of disaster that starts before the disaster occurs before that senior is safe and sound. Would be helpful to us how we can work at a state and local level to make that happen. Thank you for being here and focused on helping us for helping get a solution and thank you for your work on the subject. Thank you, senator tillis. Im going to introduce our excellent panel of witnesses. First is dr. Karen desalvo, a physician and Public Health expert. Served as Health Commissioner in new orleans where she worked hard to restore health care to areas of the city devastated by Hurricane Katrina. Has also serves as former assistant secretary for health at the u. S. Department of health and Human Services. Next, we will hear from dr. Kat kath kathy h heyer. She has researched and written extensively about Older Americans and the structure of Emergency Response system. I want to particularly thank you, doctor, for being here today, even as the long Recovery Process in florida continues. We will also hear from paul timmons. Mr. Timmons is president of port life disasters in charleston, South Carolina. Despite that mouthful of an organizations name, he is a leader in the field of Disaster Preparedness and response for people who are aging and those with disabilities. Finally, im going to turn to our Ranking Member to introduce our witness from pennsylvania. Thanks very much. Im pleased to introduce jay delaney, fire chief and Emergency Management coordinator in wilkesbarre in pennsylvania. And when hurricane irene and lee could affect the susquahanna and could impact the levees in wilkesbarre. Chief delaney safely evacuated 15,000 people in just ten hours, including our hospitals and Nursing Homes. I look forward to the chiefs testimony. Thanks, chief. Thank you very much, senator. Well start with dr. Desalvo. Thank you, and good morning chairman collins, and Ranking Member casey and others, and to make time for this priority issue to see that we have an opportunity to better support and protect Older Americans in times of disaster and every day. I am karen desalvo, im a physician and i was formerly the Health Commissioner in new orleans, not during the time of katrina, but subsequently and certainly was in new orleans during katrina. I wanted to share a story that started later. It was 2012 and i found myself standing in the Operations Center in new orleans, asked by the Power Company how to prioritize electricity. I was new to the job, it was august, it was hot. We were seven years after katrina and we heeded the advice. And we didnt have flooding, but from high winds. Wed hardened the infrastructure of our hospital, better relationships, particularly heeding the advice of senator collins not exchanging business cards during disaster, but doing it well before and we had done much better planning. Our hospitals will returned to norma