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26–545 PDF 2006

S. HRG. 109–339

PREPARING EARLY, ACTING QUICKLY:

MEETING THE NEEDS OF OLDER AMERICANS

DURING A DISASTER

HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

WASHINGTON, DC

OCTOBER 5, 2005

Serial No. 109–15

Printed for the use of the Special Committee on Aging

(

SPECIAL COMMITTEE ON AGING 

GORDON SMITH, Oregon, Chairman 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

JAMES M. TALENT, Missouri 

ELIZABETH DOLE, North Carolina 

MEL MARTINEZ, Florida 

LARRY E. CRAIG, Idaho 

RICK SANTORUM, Pennsylvania 

CONRAD BURNS, Montana 

LAMAR ALEXANDER, Tennessee 

JIM DEMINT, South Carolina 

HERB KOHL, Wisconsin 

JAMES M. JEFFORDS, Vermont 

RUSSELL D. FEINGOLD, Wisconsin 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

THOMAS R. CARPER, Delaware 

BILL NELSON, Florida 

HILLARY RODHAM CLINTON, New York 

CATHERINE FINLEY, Staff Director 

JULIE COHEN, Ranking Member Staff Director 

(II) 

C O N T E N T S 

Page 

Opening Statement of Senator Gordon Smith ....................................................... 1

Opening Statement of Senator Elizabeth Dole ..................................................... 3

Opening Statement of Senator Mel Martinez ....................................................... 4

PANEL OF WITNESSES

Keith Bea, specialist, American National Government, Government and Finance Division, Congressional Research Service, Washington, DC ................. 6

Maria Greene, director, Division of Aging Services, Georgia Department of 

Human Resources, Atlanta, GA .......................................................................... 37

Jeffrey Goldhagen, director, Duval County Health Department; and associate 

professor of Pediatrics, University of Florida, Jacksonville, FL ...................... 45

Leigh E. Wade, executive director, Area Agency on Aging of Southwest Florida, Inc., Fort Myers, FL ..................................................................................... 63

Carolyn S. Wilken, Ph.D., M.P.H., associate professor and cooperative extension specialist, University of Florida, Gainesville, FL ...................................... 80

Susan C. Waltman, senior vice president and general counsel, Greater New 

York Hospital Association, New York, NY ......................................................... 95

APPENDIX 

Prepared Statement of Senator Herb Kohl ........................................................... 117

Additional material submitted by Carolyn Wilken ............................................... 118

(III) 

(1)

PREPARING EARLY, ACTING QUICKLY: MEETING THE NEEDS OF OLDER AMERICANS 

DURING A DISASTER 

WEDNESDAY, OCTOBER 5, 2005

UNITED STATES SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The committee met, pursuant to notice, at 10:30 a.m., in room 

SH–216, Hart Senate Office Building, Hon. Gordon Smith (chairman of the committee) presiding. 

Present: Senators Smith, Dole, and Martinez. 

OPENING STATEMENT OF SENATOR GORDON SMITH, 

CHAIRMAN 

The CHAIRMAN. Good morning, ladies and gentlemen. We welcome all of you to this hearing. It’s entitled, ‘‘Preparing Early, Acting Quickly: Meeting the Needs of Older Americans During a Disaster.’’ It is probably one of the most important topics our committee will consider this year. 

Over the last several weeks, we in Congress have devoted much 

of our time to helping our fellow Americans who have been displaced by Hurricanes Katrina and Rita to get back on their feet. 

We have also begun the long process of rebuilding those areas of 

the Gulf region that have been so ravaged by these terrible storms. 

Now that the work is underway, however, we must begin to examine the preparedness of our federal, state and local governments to 

deal with such disasters in the future. 

We will hear from our witnesses older Americans have special 

needs that make them particularly vulnerable during an emergency. Today’s hearing will seek to determine what those needs are 

and how those who are charged with formulating our nation’s responses can incorporate best practices so these concerns are specifically addressed. 

A key lesson learned in the aftermath of the recent hurricanes 

is that government at all levels must do more to ensure the health 

and safety of older Americans during a disaster. Many in this population are extremely vulnerable, and it is the government’s responsibility to ensure that adequate steps have been taken to identify those in need, evacuate them to safety, and provide appropriate 

care once they are displaced. 

There is no doubt that this poses a daunting challenge, but as 

we will hear from many of today’s witnesses, states, localities and 

provider groups have instituted outstanding systems that have 

2

proven effective. I hope the testimony from today’s distinguished 

witnesses allows this committee to learn about best practices in 

disaster preparedness, and enables us to move forward with concrete recommendations for how best to protect our most vulnerable 

citizens during emergencies. 

As we have learned, once a disaster strikes, it is too late to begin 

deciding the appropriate course of action. Rather, we must be prepared well before the crisis is upon us in order to give our responders the best opportunity to identify those most at risk and to get 

them to safety. 

As we will also hear from our witnesses, no two older persons are 

alike. The diversity of need is vast, ranging from those who are 

cared for in a nursing home or hospital to an active person living 

on their own and still able to drive. However, when a disaster 

strikes, we are all vulnerable, and extra care must be taken to ensure that older persons are able to get out of harm’s way. 

As members of this committee, I believe we are protectors of 

older Americans, charged with ensuring that our government is 

taking appropriate care of those in need. Therefore, as we contemplate policies to improve our country’s disaster preparedness, 

we must consider the special needs of this older population; namely, how do we identify people who have health or mobility challenges who cannot evacuate on their own; how do we safely transport people with various levels of healthcare needs out of an impacted area; how do we identify or create special-need shelters; how 

do we ensure emergency medications are available and accessible; 

how do we provide meals for people with special dietary needs; how 

do we provide personal care aids for those who are unable to care 

for themselves; and finally, how do we assess the long-term needs 

of older persons and provide assistance in making arrangements 

for appropriate care? 

As we listen to the testimony of our witnesses today, we will 

hear details about the considerable work they have done in their 

communities to address these important concerns. All provide some 

excellent examples of positive results that can be achieved with 

thorough planning and early preparedness. Large scale natural disasters like the hurricanes that struck the Gulf Coast stretch our 

federal, state and local response capabilities to their absolute limits 

and we must be prepared. 

I am hopeful today’s witnesses will give our committee members 

valuable insight on the special needs of older Americans to help us 

ensure that no lives are needlessly lost during future emergencies. 

Again, I thank you all for coming and sharing your expertise with 

us. 

Now, let me turn to my colleagues, Senator Dole and Senator 

Martinez.

3

OPENING STATEMENT OF SENATOR ELIZABETH DOLE 

Senator DOLE. Thank you, Mr. Chairman, for calling this hearing 

today on such timely and critical issues. As a former president of 

the American Red Cross and as a senator from North Carolina, obviously, I have witnessed firsthand how easily hurricanes and other 

disasters can strip away property and possessions, threaten lives, 

and leave folks displaced. 

As everyone in this room knows all too well from the events of 

recent weeks, disasters can be especially devastating for our elderly 

citizens. Many factors make our seniors more vulnerable in their 

daily lives—lack of mobility, chronic medical conditions that require daily medications and other treatments, isolation from family 

and friends, and limited financial resources—and it is the very 

vulnerabilities that put the elderly at extraordinary risk when disaster strikes. We must be ever mindful of the limitations that put 

our seniors at higher risk in a disaster, and prepare and plan accordingly. 

Public and private partnerships at all levels of government are 

vital to reducing disaster suffering and damage. No single organization has the time, the people, or the financial resources to do all 

that needs to be done. Government agencies and organizations like 

the American Red Cross emphasize the importance of personal responsibility, urging businesses, schools and families to have an 

emergency plan in place. 

Seniors, and the ones who care for them, also must be strongly 

encouraged to have such a plan. Like everyone else, they readily 

need emergency phone numbers, blankets, cash and a first-aid kit, 

but many seniors also need oxygen, prescription drugs, and extra 

batteries for hearing aids and wheelchairs. We need to encourage 

personal preparation for our seniors, as this would greatly minimize their stress and trauma in a disaster situation. 

Of course, communication and information access are critical in 

a disaster, not just to facilitate response and recovery efforts, but 

also to assist the victims. That is one of the reasons that I am a 

strong supporter of 211, an easy to remember phone number that 

those who need assistance or want to volunteer can use to connect 

with community services and volunteer opportunities. 211 is currently available in 22 states, and I have co-sponsored legislation 

that would expand this service nationally. 

When someone calls 211, trained staff and volunteers analyze 

what services are needed from nonprofits, government agencies, 

and other organizations, and then they quickly connect the caller 

with those services. In the Gulf Coast, 211 has served as a valuable 

resource for people devastated by Katrina and Rita. For example, 

in Louisiana, an elderly caller desperately needed his medication. 

He did not have a doctor’s prescription, but he did have empty 

medicine bottles. The 211 call specialist got in touch with his local 

pharmacy and verified that it would supply his medicine. The call 

specialist then quickly called the man back and gave him the information he needed to get his medication. 

Like the elderly man in Louisiana who needed that medication, 

many of our older Americans have special needs that must be addressed before, during and after a disaster. This committee has a 

unique responsibility to carefully consider these issues, and I apVerDate 0ct 09 2002 12:49 Apr 04, 2006 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 H:\DOCS\26545.TXT SAGING1 PsN: JOYCE
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preciate the presence of each and every witness here today, and I 

want to thank each of you for all that you do to protect our older 

Americans when disasters strike. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator Dole. 

Senator Martinez. 

OPENING STATEMENT OF SENATOR MEL MARTINEZ 

Senator MARTINEZ. Mr. Chairman, thank you very much, and 

thank you for holding this important hearing today. It is important 

that we focus on the unique needs of the elderly in times of natural 

disasters. As Congress continues to exercise proper oversight in examining the response by government at all levels—local, state and 

federal—to the damage caused by Hurricane Katrina and what the 

appropriate federal role in responding to natural disasters should 

be, I want to call to your attention a piece written by Florida Governor Jeb Bush, which published in The Washington Post on September the 20, of this year. I would like to, with your concurrence, 

make it a part of the record of today’s hearing. 

The CHAIRMAN. We will include it in the record. 

[The information follows:]

In the wake of Hurricane Katrina, Americans are looking to their leaders for 

answers to the tragedy and reassurances that the mistakes made in the response 

will not be repeated in their own communities. Congressional hearings on the successes and failures of the relief effort are underway. 

As the governor of a state that has been hit by seven hurricanes and two tropical 

storms in the past 13 months, I can say with certainty that federalizing emergency 

response to catastrophic events would be a disaster as bad as Hurricane Katrina. 

Just as all politics are local, so are all disasters. The most effective response is 

one that starts at the local level and grows with the support of surrounding communities, the state and then the federal government. The bottom-up approach yields 

the best and quickest results—saving lives, protecting property and getting life back 

to normal as soon as possible. Furthermore, when local and state governments understand and follow emergency plans appropriately, less taxpayer money is needed 

from the federal government for relief. 

Florida’s emergency response system, under the direction of Craig Fugate, is second to none. Our team is made up of numerous bodies at all levels of government, 

including state agencies, the Florida National Guard, first responders, volunteer organizations, private-sector health care organizations, public health agencies and 

utility companies. Once a storm is forecast for landfall in Florida, all these groups 

put their disaster response-and-recovery plans into high gear. 

Natural disasters are chaotic situations even when a solid response plan is in 

place. But with proper preparation and planning, it is possible—as we in Florida 

have proved—to restore order, quickly alleviate the suffering of those affected and 

get on the road to recovery. 

The current system plays to the strengths of each level of government. The federal 

government cannot replicate or replace the sense of purpose and urgency that unites 

Floridians working to help their families, friends and neighbors in the aftermath of 

a disaster. If the federal government removes control of preparation, relief and recovery from cities and states, those cities and states will lose the interest, innovation and zeal for emergency response that has made Florida’s response system better than it was 10 years ago. Today’s system is the reason Florida has responded 

successfully to hurricanes affecting our state and is able to help neighboring states. 

But for this federalist system to work, all must understand, accept and be willing 

to fulfill their responsibilities. The federal government and the Federal Emergency 

Management Agency are valuable partners in this coordinated effort. FEMA’s role 

is to provide federal resources and develop expertise on such issues as organizing 

mass temporary housing. FEMA should not be responsible for manpower or a first 

response—federal efforts should serve as a supplement to local and state efforts. 

Florida learned many lessons from Hurricane Andrew in 1992, and we have continued to improve our response system after each storm. One of the biggest lessons 

in that local and state governments that fail to prepare are preparing to fail. In 

5

Florida, we plan for the worst, hope for the best and expect the unexpected. We understand that critical response components are best administered at the local and 

state levels. 

Our year-round planning anticipates Florida’s needs and challenges—well before 

a storm makes landfall. To encourage our residents to prepare for hurricane season 

this year, for 12 days Florida suspended the state sales tax on disaster supplies, 

such as flashlights, batteries and generators. Shelters that provide medical care for 

the sick and elderly take reservations long before a storm starts brewing. To ensure 

that people get out of harm’s way in a safe and orderly manner, counties coordinate 

with each other and issue evacuation orders in phases. Satellite positioning systems, 

advanced computer software and a uniform statewide radio system allow all of these 

groups and first responders to communicate when the phones, cell towers and electricity go out. 

The Florida National Guard is deployed early with clear tasks to restore order, 

maintain security and assist communities in establishing their humanitarian relief 

efforts. Trucks carrying ice, water and food stand ready to roll into the affected communities once the skies clear and the winds die down. Counties predetermine locations, called points of distribution, that are designed for maximum use in distributing these supplies. 

Florida’s response to Hurricane Katrina is a great example of how the system 

works. Within hours of Katrina’s landfall, Florida began deploying more than 3,700 

first responders to Mississippi and Louisiana. Hundreds of Florida National Guardsman, law enforcement officers, medical professionals and emergency managers remain on the ground in affected areas. Along with essential equipment and communication tools, Florida has advanced over $100 million in the efforts, including more 

than 5.5 million gallons of water, 4 million pounds of ice and 934,000 cases of food 

to help affected residents. 

I am proud of the way Florida has responded to hurricanes during the past year. 

Before Congress considers a larger, direct federal role, it needs to hold communities 

and states accountable for properly preparing for the inevitable storms to come.

Senator MARTINEZ. He illustrates the way that local and state 

governments most effectively prepare for a crisis and the proper 

role of the federal government. A senator from that state, Florida, 

which has experienced seven hurricanes and two tropical storms in 

the last 13 months. I urge the consideration of the successes and 

the challenges that Florida faces very uniquely when disasters 

occur. 

Mr. Chairman, I can remember last year in the aftermath of 

Hurricane Charley, which was the first one to ravage Florida last 

year, a group of elderly citizens who had been transported from the 

Port Charlotte area to Tampa. The building where they lived had 

been completely destroyed. They had been relocated to a hotel and 

it appeared they were going to live there for several months. 

The thing that struck me the most about that was the spirit of 

these people. They were all displaced, all in need of their medication, their routine, their doctors, the things that become a part of 

the daily life of elderly American, and yet their spirit was incredible. They were determined to get on with life, grateful for every 

little thing that was done for them, and understanding that they 

were going to be displaced for a period of time, but determined not 

to let this completely alter and change their lives. I think that incredible spirit is what we need to try to encourage while providing 

the necessary and vital services. 

When I was in local government I know how hard we worked to 

provide the special-need shelters that Senator Dole was discussing, 

and would have them available to all of the special needs population that may be medically dependent, but particularly our elderly population and the special needs that they would have. 

The thing that I find that is so in need is for us to look at the 

long-term recovery from storms. I think in spite of the Katrina exVerDate 0ct 09 2002 12:49 Apr 04, 2006 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 H:\DOCS\26545.TXT SAGING1 PsN: JOYCE
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perience, that we do reasonably well in the short term. I think we 

have to analyze and examine how we improve all that we do. I am 

not just suggesting federal governmental intervention, but I am 

talking about all levels of community, whether it be the not-forprofits like the Red Cross, or whether it be the involvement of the 

faith community, or local and state government, all of that working 

together to see how we impact the long-term recovery. 

When we look at this vulnerable population, I think one of the 

most difficult things is the issues that linger beyond the immediate 

aftermath of a storm when one with advanced age, already in medical need, faces long-term displacement from a home or from their 

usual surroundings. So I look forward to the hearing and the testimony of your witnesses today and very much thank you for calling 

this hearing. Thank you. 

The CHAIRMAN. Thank you, Senator Martinez. 

To the points that each of you have made, this will be the first 

hearing of a number that we will hold, continuing to focus on different aspects that we may yet hear, even today, about how the 

governmental response at all levels can be tightened up and improved. 

We will now turn to our first witness, our first panel. That consists of Mr. Keith Bea. He is a specialist in American National 

Government at the Congressional Research Service. He is here to 

discuss the framework that governs how government entities work 

together to plan for a respond to disasters. 

Thank you, Keith for coming here today. 

STATEMENT OF KEITH BEA, SPECIALIST, AMERICAN NATIONAL GOVERNMENT, GOVERNMENT AND FINANCE DIVISION, CONGRESSIONAL RESEARCH SERVICE, WASHINGTON, 

DC 

Mr. BEA. Good morning, Chairman Smith, Senators Dole and 

Martinez. It is a pleasure to be here. On behalf of the director of 

CRS, I thank you for the invitation to participate in this important 

hearing. As you know, all CRS analysts who testify before a 

congressional committee are prohibited from making policy recommendations, and must confine their remarks to their field of expertise. 

Pursuant to the committee’s letter requesting my participation 

today I will provide information in three areas. First, overview of 

federal emergency management policies; second, a reference to federal evacuation policies; and third, a summary of the interactions 

of the federal government with non-federal entities in implementing emergency management policies. 

My responsibilities in CRS do not include coverage of the evacuation policies pertinent to care facilities, health institutions, or the 

elderly in communities. My colleagues in CRS, some of whom have 

already provided material to the committee, are prepared to continue to assist you on these in-depth policy matters as your inquiry 

proceeds. 

My first task is to provide a brief overview of federal policies. 

The Department of Homeland Security administers many, but not 

all, of the federal emergency management policies. The Homeland 

Security Act of 2002, which established the Department of HomeVerDate 0ct 09 2002 12:49 Apr 04, 2006 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 H:\DOCS\26545.TXT SAGING1 PsN: JOYCE
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land Security, consolidated many of the functions and missions of 

the component legacy agencies. 

As shown in Table 1, attached to my testimony, 13 departments, 

other than DHS, 8 agencies, the executive office of the President, 

and the House of Representatives implement statutory authorities 

that touch upon some element of federal emergency management. 

Many of these authorities focus on specific types of emergencies or 

conditions. 

My comments this morning will center on the most significant 

policies that relate to the functions of the Department of Homeland 

Security, particularly the Emergency Preparedness and Response 

Directorate, also known as the Federal Emergency Management 

Agency, or FEMA. 

Two principal statutory authorities appear pertinent to the committee’s request for a general overview. These are the Homeland 

Security Act and the Robert T. Stafford Disaster Relief and Emergency Assistance Act, often referred to as the Stafford Act. 

First, the Homeland Security Act of 2002 vests in the Department of Homeland Security a seven-part mission, which includes 

preventing terrorist attacks; serving as a focal point regarding natural and man-made crisis in emergency planning; and other functions as set out in my written statement. 

Title V of the Homeland Security Act established the Emergency 

Preparedness and Response Directorate within the department; set 

forth the responsibilities for the undersecretary for emergency preparedness and response; and for the first time, elucidated the mission of FEMA in a single statutory provision. 

The responsibilities of the Undersecretary of Emergency Preparedness and Response, who has also been referred to as the director of FEMA, include managing the response to attacks and 

major disasters by positioning emergency equipment and supplies 

and evacuating potential victims; aiding recovery from attacks and 

disasters; and consolidating federal emergency management response plans into a single, coordinated National Response Plan, 

among other functions. I will provide information on the National 

Response Plan later in my statement. 

Title V of the Homeland Security Act assigns two large categories of responsibilities to FEMA. First, the agency is to implement the Stafford Act and, second, protect the nation from all hazards by leading and support the nation in a comprehensive, riskbased emergency management program. 

The second principal federal statutory authority that I will refer 

to you is the Stafford Act, which authorizes the President to issue 

declarations that direct federal agencies to provide assistance to 

states overwhelmed by disasters. Through executive orders, the 

President has delegated to the Secretary of Homeland Security responsibility for administering provisions of the Stafford Act. Assistance authorized by the statute is provided through funds appropriated by Congress to the Disaster Relief Fund. A history of funds 

appropriated to the Disaster Relief Fund since 1974 is presented in 

Table 2 of my written statement. 

Under Stafford Act authority, the President or his designees may 

take specified actions as summarized in my written statement. The 

President may direct, at the request of a governor, that DepartVerDate 0ct 09 2002 12:49 Apr 04, 2006 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 H:\DOCS\26545.TXT SAGING1 PsN: JOYCE
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ment of Defense resources be committed to perform emergency 

work to preserve life and property in the immediate aftermath of 

an incident that may eventually result in the declaration of a major 

disaster or emergency. 

Also, the Secretary of Homeland Security may preposition supplies and employees. The Act also authorizes the President to issue 

a major disaster declaration or an emergency declaration at the request of a government. Major disaster declarations may be issued 

after a natural catastrophe or, regardless of cause, after a fire, 

flood or explosion. The President may exercise broader authority 

when issuing an emergency declaration, generally but not always, 

at the governor’s request. Information on the different types of assistance authorized to be provided after a major disaster or emergency declaration is summarized in my written statement. 

A number of administrative policy documents and guidances 

have been issued to implement these and other federal statutory 

policies. Presidents have issued directives, including executive orders, that set out responsibilities for different aspects of emergency 

management. 

Following the terrorist attacks of September 11, President Bush 

issued Homeland Security Presidential Directives, or HSPDs, that 

have established emergency management preparedness and response policies. Section 16 of Homeland Security Presidential Directive-5 required the Secretary of Homeland Security to develop 

and administer a National Response Plan. The directive mandates 

that the plan integrate federal domestic prevention, preparedness, 

response and recovery plans into one all-discipline, all-hazards 

plan. 

On January 6, 2005, former Secretary Tom Ridge released the 

National Response Plan. The National Response Plan includes 

emergency support functions assigned to federal agencies and to 

the American Red Cross; sets out the interagency organizational 

frameworks, and includes annexes for certain types of catastrophes 

and activities. Figure 2 of the National Response Plan, also attached to my written statement, identifies the responsibilities of 

federal agencies under the NRP for certain missions. 

Moving from this overview discussion of statutory authorities, 

presidential directives and the NRP, I would like to address a second requested topic, a general discussion of federal evacuation policies that have been enacted by Congress. 

A database search of the U.S. Code revealed 15 statutory provisions pertaining to evacuations. Table 3, attached to this testimony, summarizes the provisions and identifies statutory citations. 

These statutory provisions range from very general authority to 

specific requirements with which agencies must comply. In general, 

federal policy acknowledges state authority pertinent to evacuation, 

and local officials generally work with state officials to enforce 

those laws. 

An example I would like to bring to the committee’s attention is 

recent congressional action that occurred after I submitted my 

written testimony to the Committee. The conference report, filed on 

September 29, that accompanied, the appropriation for the Department of Homeland Security—that’s H.R. 2360—addresses the issue 

of evacuation procedures. 

9

The conferees recognize that state and local governments must 

develop multi-state and multi-jurisdictional evacuation plans and 

direct the Department of Homeland Security to develop guidelines 

for state and local governments to follow in the development of 

those plans. To my knowledge, this legislation awaits the President’s signature. 

Finally, I would like to provide the Committee with insight regarding the complex, intergovernmental and intersectoral relationships involved in federal emergency management. 

The National Response Plan, like the Stafford Act, is premised 

upon the involvement of non-federal entities. Federal emergency 

management involves federal agencies, and as noted by the Senators in your opening comments, state and local governments, tribal organizations, voluntary organizations, the private sector, and 

individuals and families. The Stafford Act also requires that federal 

assistance be predicated upon the maintenance of insurance and 

that federal aid provided under the act not duplicate such assistance. 

In addition, the preparedness of families and individuals, the 

planning and practices conducted by private organizations, and the 

exercise of state and local authorities all converge at the scene of 

a significant catastrophe, often, as you know, under the klieg lights 

of CNN and other broadcast media. Some sources of information on 

activities undertaken by state and nongovernmental entities, 

brought to my attention by my colleagues in CRS, are identified in 

my written statement. 

In summary, the federal role, as established by statute, administrative direction and tradition is bifurcated. One mission is to coordinate the activities of federal and non-federal responding agencies and the other is to provide assistance, whether through financial means, technical aid, or the transfer of material or supplies. 

Federal emergency management is based upon policies that concentrate some authority in the Department of Homeland Security 

and disperse other authorities to other federal entities. Federal authorities include some provisions on mass evacuation that acknowledge state authority and rely upon a complex mix of governmental 

and non-governmental actors. 

I appreciate the opportunity to address the committee and stand 

ready to respond to questions on the general matter of federal 

emergency management policies and practices. Thank you, Mr. 

Chairman. 

[The prepared statement of Mr. Bea follows:]

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The CHAIRMAN. Thank you, Mr. Bea. I suppose my overriding 

question to you is, is the Stafford Act sufficient? Does it need enhancement, strengthening? I don’t want this to be a finger-pointing 

session, but did it work? Did it work in Florida last year? Did it 

work in Mississippi, Louisiana and Texas? Does the federal component need to be strengthened? 

Mr. BEA. Well, Senator, as I pointed out in my opening comments, we are prohibited from making policy recommendations. 

They surgically removed that gland when I came to work for CRS. 

But I will tell you that questions have been raised about the adequacy of the Stafford Act. The Stafford Act is based upon 1950 

authority that has been amended several times over the decades. 

It certainly seems pertinent for Congress to look at the implementation of the Stafford Act, and whether the emergency management 

needs of the 21st century are met by not only the Stafford Act, but 

by other federal emergency authorities I identify in Table 1. 

The CHAIRMAN. I think the American people, generally, when 

these things occur, they want government to be responsive and efficient, and I do not think they are much focused on whether it is 

local, state or federal; they just want the system to work. 

Mr. BEA. True. 

The CHAIRMAN. Obviously, so do we. One of the points of this 

hearing is to find out what more we need to do statutorily, 

regulatorily, to make this response more seamless than it was, at 

least in one state. 

Mr. BEA. It is a rich area for congressional action, Senator 

Smith. 

The CHAIRMAN. No question about it. 

As you have focused on this hearing, in which our focus is to look 

at the needs of the elderly, is there a sufficient way to identify 

them, their special needs, and their mobility challenges? Do we 

have the right kinds of data about them, where they are, and what 

their needs are to be responsive? As I listened to your testimony, 

obviously, there are lots of lists. The government is good at making 

lists, but are they workable, are they duplicative, are they being 

utilized properly? 

Mr. BEA. The concept of the National Response Plan and, in general, the Stafford Act, is to coordinate federal responses and nonfederal resources. Clearly, there are improvements to be made. I 

am not an expert in the data on elderly population. My colleagues 

in CRS can better address that. But, Senator, I will comment that, 

generally, the federal emergency management policies do not address particular populations, and that may be one area that the 

Senate may wish to pursue. 

The CHAIRMAN. You mentioned the double counting by ambulance companies and other emergency providers when establishing 

contracts with facilities that need evacuation plans. Does this 

work? Is there double counting? Is the complexity too great? Have 

there been efforts to ensure that if and when a provider double 

counts that they have contingency plans in place? 

Mr. BEA. Thankfully, my colleague, Sarah Lister, suggested that 

I include that in my statement. It is an indication of the complexity 

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ating procedure, under a normal circumstance, something should 

happen; police should be there. 

Clearly, what we have seen in the Gulf states is that what happens is the first responders are so devastated and the people you 

are counting on to respond are so devastated that they cannot respond. What happens next? What is plan B? Therefore, the double 

counting issue, apparently, according to my colleague, is an issue 

that has been identified and is just one example of specific issues 

that add to the complexity of the mix, that require attention to 

some of the details, and also the flexibility to develop responses 

with plans B, C and D if necessary. 

The CHAIRMAN. Obviously, we care about the safety of first responders. As you have evaluated this system, first responders, do 

they have a place to be protected in the event of a hurricane, and 

what happens if they run away? 

Mr. BEA. The first responders, as often is pointed out to me, are 

the people at the scene. If a bomb were to explode in a federal 

building, the staff, the Members, the people who are there in addition to the capitol police, would be the first responders. The backup 

systems that you have, whether they are federal or non-federal, are 

key in ensuring an adequate response if our initial first responders 

are not available, whether they departed or whether they were impaired. That is part of the system of planning that should take 

place largely through state planning, and the federal guidances are 

there to set the framework for state plans. 

The CHAIRMAN. I think it would be important also to say, as 

much as we want government to get it right—I am reminded of my 

wise, old mom that used to say, ‘‘The Lord helps those who help 

themselves.’’ Obviously, personal preparation is very important. I 

think we live in a day and age where at both the government and 

the individual level, we have to assume the worst and plan for it. 

All Americans ought to look to their own security and safety in the 

event of catastrophe and engage in provident living because that 

will lead to better preparation for the unexpected, which these days 

seems to be more expected than ever. 

Senator Martinez, do you have questions? 

Senator MARTINEZ. I was only going to just inquire as to the 

Stafford Act, whether you thought in the recent events there were 

clear flaws in it that you could make a recommendation that they 

should be amended or changed. Are you prohibited from doing 

that? 

Mr. BEA. I am, Senator. 

Senator MARTINEZ. I guess that is why I did not hear that from 

you. 

Mr. BEA. I will also tell you I am very respectful of people who 

are on the ground there. I have been up here. I watched the news 

media; I spoke with people involved. I would be very hesitant to assert my position as a third party evaluator, at this point, in examining what happened down there. Clearly, it was a tragedy; clearly, 

mistakes were made. 

Senator MARTINEZ. Yes, it does seem to me that it ought to be 

reviewed with eyes towards modernizing it and maybe making it 

more compatible with today’s real situations and the real world. 

Mr. BEA. Absolutely. 

37

Senator MARTINEZ. Sometimes it does take a cataclysmic event 

like we had happen to awaken to us the need for reform. 

I do go back to the Florida experience where Governor Bush has 

very clearly come on the side of maintaining the preeminence of 

local government as it relates to evacuations, responsibilities, and 

things like that. I am not so sure that there should be anything 

done to change that. I think at the end of the day, the federal government’s role has always been a secondary role, a role of assistance, prepositioning supplies and things that would come in, in the 

second wave. But my own experience in local government is that 

those difficult decisions of when to evacuate, and preparing shelters for evacuation that are adequate, and taking into account the 

special needs population really squarely falls under the responsibility of state and local government. I am not sure that anything 

federally we can do ought to change that. 

Mr. BEA. I understand. Absolutely. 

Senator MARTINEZ. Thank you. 

The CHAIRMAN. Mr. Bea, thank you very much. You have been 

a great witness, and you have added measurably to the record and 

given us some things to work on. 

Mr. BEA. Thank you, Senator. 

The CHAIRMAN. Our second panel consists of Ms. Maria Greene, 

who is the director of the Division of Aging Services in the Georgia 

Department of Human Resources. Ms. Greene will discuss how her 

agency works with the Georgia Emergency Management Agency to 

ensure the safety of older Georgians during a disaster. 

Also on this second panel is Dr. Jeffrey Goldhagen. He is the director of the Duval County Health Department, which is home to 

Jacksonville, FL. He will be giving us an overview of the system 

his health department has instituted to assist the elderly and other 

special needs individuals in preparing for and evacuating during a 

disaster. 

Ms. Greene, thank you for being here. 

STATEMENT OF MARIA GREENE, DIRECTOR, DIVISION OF 

AGING SERVICES, GEORGIA DEPARTMENT OF HUMAN RESOURCES, ATLANTA, GA 

Ms. GREENE. Good morning, Chairman Smith and distinguished 

members of the committee. I am the director of the Division of 

Aging Services, designated as the state unit on aging. It is my 

pleasure to talk with you today about Georgia’s emergency preparedness plan as it relates to older adults and people with disabilities. 

The organization of the Department of Human Resources is 

unique in its ability to respond to the needs of citizens. We have 

integrated and coordinated plans that have been tested and improved upon. Georgia responded quickly and resourcefully in assisting people fleeing from hurricane-ravaged states, and we have new 

lessons learned to incorporate into our planning. 

Along with Aging Services, the department is an integrated 

human services agency that includes divisions of Public Health, the 

Mental Health State Authority, and Family and Children Services, 

just to name a few. The coordinated efforts of the department, 

38

other state agencies, local governments and private-sector organizations comprise our state’s emergency plans. 

In conjunction with the department, the area agencies on aging 

have county, city, regional and state emergency preparedness 

plans. The plans include the coordination of first-responder tasks 

with the local EMS, law enforcement, and county officials. The area 

agency on aging staff identifies at-risk older adults and people with 

disabilities that receive services through our network. These individuals would need assistance to evacuate in an emergency and 

have no immediate family caregiver to aid them. Citizens who do 

not receive public benefits but are in need of assistance, before or 

after a crisis, are encouraged to register with the local EMS or a 

law enforcement agency. 

Our protocol was put to test during an after-hours chemical accident at a laboratory in the metropolitan area. Citizens in the vicinity needed to evacuate. The local aging service provider had a special needs list of people who receive our services and are in need 

of assistance during an emergency. The client listing is updated 

quarterly and shared with local EMS and law enforcement. The 

care managers had a copy of the client list in their homes, and 

were ready to help when the staff telephone tree was activated. Everyone was assisted to safety, but one lesson learned—just a small 

lesson—from that experience was the need for automobile cell 

phone charges due to the batteries running down and having no 

immediate access to the buildings. 

Most recently, Georgia was able to assist individuals displaced 

from the states impacted by the hurricanes. Governor Purdue, 

Commissioner Walker, and I were at Dobbins Air Force Base when 

people were air lifted from the Gulf states. Many of the people were 

elderly and disabled. 

During the chaos of a disaster of this magnitude, it is understandable that many people arrived and were quickly placed in 

shelters, hospitals, and facilities. It was not immediately known, 

however, where all the individuals were placed. The Long-Term 

Care Ombudsman Program, the Office of Regulatory Services, the 

Georgia Advocacy Office, the community service boards, and all of 

the area agencies on aging have worked tirelessly to identify the 

displaced individuals placed in facilities. These individuals have 

been reunited with families, moved to more appropriate home and 

community services, and assisted in the facilities where they 

choose to remain. 

Many fine examples of emergency response developed from our 

work. Nursing home and personal care home associations and mental health hospitals monitored their bed vacancies. Senior centers 

generously volunteered to be used as rest areas and lunch locations 

for persons regardless of age. The state created resource centers, 

where one-stop access for services could occur. Georgia embraced 

flexibility for benefits and developed assessment teams to go to hotels, where large numbers of displaced persons were staying. The 

team members were comprised of staff throughout the department, 

including aging and the disability networks. 

During a crisis, we all feel that the bulk of our work is happening at that point in time. What we are actually learning is that 

39

assistance after the crisis, especially by human service organizations, is crucial. 

During the time of crisis, so many people are at their best, but 

others are at their worst behavior. Unscrupulous people will use 

disaster to put money into their own pockets, money that was intended for those who were suffering. The Adult Protective Services 

Program and elder abuse prevention specialists were called upon to 

investigate and intervene on cases of suspected abuse, fraud and 

exploitation of the hurricane victims. In the future, our revised 

emergency preparedness plan will include additional planning to 

prevent the abuse before it starts. 

Also as a result of consumer fraud and exploitation, the increased need for elderly legal assistance has become very apparent. 

A special training to lawyers around specific legal interventions for 

displaced persons is occurring this month. 

Another valuable lesson learned is the significant needs of people 

who have cognitive impairments. Mental health professionals were 

available to offer mental health crisis support, but the knowledge 

of someone’s dementia or Alzheimer’s was unknown. Electronic 

medical records and access to basic healthcare information would 

have aided appropriate placements for a special needs shelter. 

Our department is an exceptional, integral part of Georgia’s 

emergency response before, during and after a crisis. Communications, coordination and understanding of older adults and people 

with disabilities are critical to disaster preparedness. Work to modify our existing emergency plans to incorporate these lessons 

learned is currently underway. 

Thank you for the opportunity to share with the committee Georgia’s experience in emergency preparedness. 

[The prepared statement of Ms. Greene follows:]

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The CHAIRMAN. Thank you very much. 

Ms. GREENE. You are welcome. 

The CHAIRMAN. Jeffrey Goldhagen. Thank you. 

STATEMENT OF JEFFREY GOLDHAGEN, DIRECTOR, DUVAL 

COUNTY HEALTH DEPARTMENT; AND ASSOCIATE PROFESSOR OF PEDIATRICS, UNIVERSITY OF FLORIDA, JACKSONVILLE, FL 

Mr. GOLDHAGEN. Well, thank you, sir. It is a pleasure to be here, 

Chairman Smith. Certainly my distinguished Senator from Florida, 

it is a great opportunity to be here. My bias is going to come out 

pretty squarely, pretty quickly as I move through this presentation. 

The nation has 3,000 local health departments. Now, all those 

local health departments are at various levels of sophistication 

with respect to their ability to respond and their capacity to respond, but, fundamentally, the responsibility for that first response 

and for the health and well-being of special needs citizens, including the elderly, fall fairly straight-forwardly on the shoulders of 

local health departments. 

The CHAIRMAN. Should it be otherwise? 

Mr. GOLDHAGEN. No, it should not be otherwise. We are central 

partners with the public safety colleagues, but, in fact, it is pretty 

straightforward what the responsibilities of our public safety agencies are. It is pretty well-defined and they are fairly well-funded. 

But, in fact, for public health, that definition is not quite as welldefined nationally, and we have not had the degree of funding that 

our public safety colleagues have had. 

With respect to special needs—just a broad overview—we are responsible for identification of all special needs people, citizens in 

the community and their triage. We are responsible for ensuring 

their transportation to appropriate shelters. We are responsible for 

ensuring that, in fact, their medical needs are met, their mental 

health needs are met, their social service needs are met within the 

context of the shelters. We are responsible for post-event planning 

to make sure that they are discharged and get to a venue that is 

safe for them, ensuring, in fact, they get to those venues. 

In particular—and I think it relates to the question about double 

counting—we are responsible for ensuring that the system works. 

There are hospitals in this system, there are home health agencies 

in this system, there are ambulance companies in this system, 

there are dialysis centers in this system. There are numeral parts 

of this system that have to work. In fact, it is local health departments that are responsible that the system responds appropriately, 

and to be accountable and to intervene when, in fact, those systems 

are not, both prospectively as well as during the event. 

It is critical to understand the important role that we play because over the last several decades, in fact, the infrastructure of 

public health has been allowed to deteriorate. It may be too strong 

a word to say that it has decimated, but it has been allowed to deteriorate. The Institute of Medicine has put together two very 

poignant reports on that, and, in fact, what we see now is that if 

that infrastructure is not available and present, then we are not 

able to respond. 

46

Let me go into some more specifics, some of the challenges. We 

have to make sure that, in fact, the shelter is open. We have to 

make sure that there is medical personnel. We have to make sure 

that there is access to medication, access to oxygen, availability of 

dialysis. That is our responsibility. We are also responsible to make 

sure the hospitals are prepared. In fact, it is our responsibility to 

make sure they have generators in place, that assisted-living facilities have generators in place, that, in fact, the shelters have generators in place, so that is essentially our responsibility. 

It is our responsibility to make sure that, in fact, the equipment 

that is required in the shelters are there, whether it is lifts to 

make sure that we can lift overweight people or appropriate cots 

that fill the needs of those that are elderly, and on and on. 

Now, with respect to what we have been able to do in Duval 

County, we are very proud of what we have been able to put together. With respect to what Senator Martinez had said a moment 

ago, that, in fact, is the secret to our success, that local communities have assumed responsibility and particular local public 

health agencies have assumed responsibilities. 

In Jacksonville, as an example, at least once a year, sometimes 

twice a year, we put out a request for registration for special-needs 

in the utility bills. So we get information through the utility bills 

as well as a number of other sources of information to identify and 

register all of the people with special needs. 

All of that information goes into a searchable database. That includes extensive information, and I am going to read some of that 

information; demographics on the individual; who the person’s physician is; what pharmacy they use; what medications they have; 

what home health agency they use; who are their emergency contact persons in and out of town; permission to search their home 

after an event; again, their medications; what disabilities they 

have, what special medical needs they have or transportation requirements they have; whether they live in a surge zone; and so 

on. That is all searchable, based on what category storm is coming 

in and the type of event that might be happening. 

The CHAIRMAN. Jeff, you actually get written permission to enter 

their homes ahead of time. 

Mr. GOLDHAGEN. Right. 

The CHAIRMAN. So that, obviously, is a very significant educational tool—people understand there is one that can help, and 

you know who they are and what their needs are. 

Mr. GOLDHAGEN. Right, absolutely. 

The CHAIRMAN. Have you had an occasion to test this? Obviously, 

you had four hurricanes last year. Was Duval County affected? 

Mr. GOLDHAGEN. Yes. We were affected not to the extent that 

Southern Florida was affected. Yes, we have detract teams, which 

are teams that actually go out post-event to actually look at people’s homes to find out whether or not there is electricity, not electricity, whether it is appropriate to send the person back, and 

whether a person in fact registered to come to the shelter actually 

came. Sometimes when we arrange the transportation with the 

other emergency service function, if people refuse to actually be 

transported, we will go back after the event to make sure that, in 

fact, they are okay. 

47

We have a very interesting program called Adopt-A-Shelter program, and each of the hospitals in Jacksonville have adopted a special-needs shelter. They are responsible for assuring that there is 

personnel, not only physician nurses, but respiratory therapists. 

They are responsible for making sure that all of the material that 

is needed in the center is there. 

We have a contract with a medical supply company, and that 

contract includes maintaining an inventory over time so that if we 

need to open up a shelter, we pick up the phone. The medical supply company drops everything that is needed to run that center, 

and we then walk in with our personnel and it is all there, from 

oxygen to medications, and so on. If we have to change a venue 

after the event, they take all of that material and move it to another venue. 

We have 500 people in the Medical Reserve Corps who serve as 

a background for us to back us up. That includes physicians, 

nurses, respiratory therapists, and so on. We have ham operators 

in each of our shelters, and the community is completely connected 

by an 800 mega hertz radio system. 

My time is really, actually over. I just want to focus on several 

recommendations. The first is an all-hazards approach. There has 

been a tremendous amount of assets and resources that have come 

down to the local level. We would say that most of it has not come 

to the health departments public account, but there has been a tremendous amount of resources coming in. Unfortunately, it has been 

categorical, focused on bioterrorism. We need the ability to use the 

resources that come in, in an all-hazards approach so that we can 

be as prepared to deal with a hurricane as we are with an anthrax 

attack. That would be the first recommendation that I would have. 

The second is, frankly, that a focus needs to be put in the public 

health infrastructure nationwide. In fact, if we are able to respond, 

or the capacity to respond, we can in fact do so. Clearly, what happened in Katrina is once there was a focus off of the public safety 

issue, the focus was on public health, and this is a public health 

emergency and so on. So, ultimately, all disasters deteriorate essentially into a public health disaster and public health system. 

We need to make sure that public health departments understand that, in fact, they are responsible for the system’s response 

and coordinating the other elements of the health system. We need 

state laws that really require local jurisdictions to create these 

searchable databases, and make it very well defined. In fact, the 

public health system is responsible for these roles and responsibilities. 

Finally, let me reiterate again, we need flexibility. We need the 

ability to use the assets and resources that are coming from the 

federal level to meet the needs of our local communities. If that 

happens, then we have the capacity to actually respond to make 

sure the systems work. 

[The prepared statement of Mr. Goldhagen follows:]

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The CHAIRMAN. Well, Mr. Goldhagen and Ms. Greene, you both 

are truly to be congratulated for the work you have done in your 

communities and counties to prepare, particularly for the focus on 

the seniors, and mental health issues, and special services for people with dementia. It is actually a very remarkable kind of plan 

you have in place. I guess my question to you is, in your dealings 

and in your associations with other states and counties, do most 

have the level of preparation that you have in these Gulf state 

areas? 

Mr. GOLDHAGEN. Well, I would say most definitively in the state 

of Florida. The reason for that is, quite frankly, a history of how 

Florida’s public health system has been established. That is there 

are 67 counties. There are around 65 local health departments. The 

expectation from the state and expectation of the counties are that, 

in fact, the health departments and the local systems are going to 

respond. So, then, in the context of a system that is structured like 

that, the answer is yes. On the other hand, using another state, 

which I came from, which was Ohio, in Cuyahoga County, as an 

example, there was the county health department, there was the 

City of Cleveland’s health department, and there were multiple 

other local health departments. 

So part of the answer, recommendations, need to make sure that 

counties have a coordinated system at the local level that are going 

to work, and that the agencies responsible have the capacity and 

the resources to, in fact, do so. I sat in awe and listened to Mr. Bea 

talk about the structure at the federal level. But ultimately, if it 

is going to work, the real focus needs to be at ensuring the capacity 

at the local to respond. 

The CHAIRMAN. Florida had four tough hurricanes last year, but 

the response was—I heard Senator Martinez even speak to it——

Mr. GOLDHAGEN. Remarkable. 

The CHAIRMAN [continuing]. Pretty darn good at the local, state 

and federal level. I think you even commented that FEMA really 

showed up and got it done. I think that that is a real credit to Florida and to FEMA, and the people who were all concerned. 

Ms. Greene, are you familiar with S. 1716 that has to do with 

100 percent Medicaid reimbursement for states like yours who are 

taking in refugees? Are you aware of it, and is that important? 

Ms. GREENE. Yes, sir. Oh, it is. My understanding is that Georgia’s 1115 Medicaid waiver request has been approved, and it was 

modeled similar to Texas. I believe Georgia according to FEMA had 

40,000 plus heads of households registered from the Gulf states 

that had come to Georgia. My understanding is we will have a fivemonth, 100 percent federal matching rate for those people. Many 

of them have come either into our nursing homes and maybe never 

needed a nursing home, and now we are moving them into the 

Medicaid waiver for home and community-based services, the community care services program that we manage. We are very appreciative at that immediate assistance, and it is going to help us out 

a lot. 

The CHAIRMAN. Well, we are going to get it done. I think it is 

also fair to say, in relationship to Louisiana, that even the best 

plans can be overwhelmed by natural disasters. Would you agree 

with that? 

60

Ms. GREENE. I would agree. The advantage, at least for us, is 

that since we were not a disaster state—we actually had electricity, 

utilities, cell phone towers—it is much easier to help the displaced 

individuals. I can imagine lessons learned from the Gulf states is 

going to be 10-fold, of the ones that I mentioned today just for 

Georgia. 

The CHAIRMAN. Mr. Martinez. 

Senator MARTINEZ. Thank you, Mr. Chairman. 

I will say that Florida’s preparedness today, in great measure, is 

owed to the failures of Andrew in 1992, when things did not go 

quite as well. I think a lot was learned there, and I think a lot of 

those lessons were applied, and equally, I think we need to learn 

from Katrina, so that we can move forward in a better way. 

Dr. Goldhagen, I just want to welcome you. As a fellow Floridian, 

I am proud to have you here and proud of the work that you all 

do in Jacksonville. I know Mayor Payton is a great local leader and 

does a great job as your local leader. You have had a good heritage 

of good mayors in the City of Jacksonville, which I know makes a 

big part of your ability to do what you do in your department. 

I was going to ask you about specifically what areas where you 

feel there is need for flexibility, if you could be a little more specific 

so that I can maybe be more helpful and more responsive. I am 

very sensitive, coming from local government, about assistance that 

come from gifts with strings attached to such an extent that it, perhaps, makes it unusable for the needs that you have. Particularly 

as it relates to emergency response, we have to make sure that we 

take away constrains to the flexibility that local governments will 

need as they attempt to deal with emergencies. 

Can you be specific with that? 

Mr. GOLDHAGEN. Sure. I can give you actually a wonderful example that certainly the disaster in New Orleans identified for us. 

Jacksonville, for those of you who do not know, is just an absolutely beautiful city situated on the ocean, but also having a river 

that runs through it, the St. John’s River. We have two of our largest hospitals, actually, on the river, Baptist and St. Vincent’s hospitals. They have their generators on the level of the river, and all 

of their electrical equipment and switches, as an example are basically at that level too. So, in fact, in a situation where you want 

to evacuate vertically, or move people up as opposed to moving 

them out, that would not be possible in this situation. 

The HRSA dollars that are coming to Jacksonville do not allow 

us to invest putting ancillary, auxiliary generators up high enough 

to allow them then to evacuate vertically, which would eliminate 

the kind of problems that we saw happening in the hospitals in 

New Orleans. That would be one very specific example of how we 

would use the federal dollars in a different way if we were allowed 

to, in fact, use those dollars in that context. 

Now, one might say that it should be the responsibility of the 

hospitals. The hospital systems are under significant distress in 

some respects. There is not the resources necessarily in the hospitals to actually do that, or with some additional dollars, that we 

would be able to do that. 

That would be an example of how we would use the dollars that 

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bility. Most of the dollars coming through Homeland Security, 

through HRSA CDC, come with strings attached to focus very specifically on bioterrorism and terrorism events. In fact, what we 

need to do is to be able to use those dollars in an all-hazards approach so that, in fact, we are as prepared to deal with a hurricane 

again as we are to deal with whether it is a radiological or biological event. 

Senator MARTINEZ. Thank you. 

One of the really egregious examples of failures in New Orleans 

is the issue of the nursing homes that, perhaps, or obviously, were 

not timely evacuated or evacuated at all. How does Duval—and I’ll 

take it on to Georgia as well, ask both of you to address. How do 

you deal with these vulnerable populations that you know are in 

situations where they are going to be totally dependent? How do 

you deal with them in terms if evacuations are necessary and providing for a better situation if they need to be evacuated? 

Ms. GREENE. I think, obviously, the key is communication. We 

have heard several times that as much communication that you 

can do in advance is beneficial. I know we require, through our Office of Regulatory Services, that they have emergency plans. Those 

are checked on to see that they are in place. But if they do not 

heed the warnings early—because we know that with older people 

and people with disabilities, you are going to need a little bit more 

time to help them move. Helping them to move, you also have all 

of their wheelchairs, their walkers, their medicines, and their 

records that would be helpful to go with them. So time is of the 

essence in that pre-planning, and that communication is essential. 

Mr. GOLDHAGEN. I would agree. But I would like to just comment 

on the issue of double counting. I am not exactly sure what that 

meant. But, again, I think it really focuses the issue on the capacity of local government to respond. 

When we actually evacuated the beaches last year for one of the 

hurricanes, it became very clear that the ambulance companies—

if this is what you meant by double counting—had multiple contracts, all with different facilities, including the hospital and so on. 

What we were able to do was take over the system. 

We then stepped in—the health department, the ESFA, took over 

the system, took over the ambulance, triaged the ambulance, got 

the hospital—which we have one at the beaches—evacuated early, 

and then assured that the system was in place to orderly evacuate 

each of the nursing homes that needed to be evacuated. 

Without a strong local health system, nobody could have walked 

in and taken over the actual function of the ambulance services to 

ensure that, in fact, there was a coordinated approach to what 

needed to happen. So, again, it comes back to emphasize the critical role, both predictable as well as unpredictable. We had not predicted that, in fact, the local ambulance companies had multiple 

contracts with the same people to do the same thing, but because 

a system was in place, we assumed that responsibility. 

Senator MARTINEZ. In those instances, though, where the beach 

was evacuated, how far in advance was that carried out, whose decision was it to evacuate, and who executed the decision to evacuate? 

62

Mr. GOLDHAGEN. Well, the way the system works, it is the mayor’s decision. We meet as an executive group, which is probably 30 

to 40 people. 

Senator MARTINEZ. The EOC? 

Mr. GOLDHAGEN. At the Emergency Operation Center, right, 

which 12 years ago was one room with three telephones, and today 

is an extremely sophisticated, high-tech center. We meet. The 

mayor makes the decision. There is a complex set of formulas that 

go into exactly how long in advance we should be getting the evacuation. We routinely argue for starting 6 to 12 hours before the 

Emergency Operation Center is willing to start, and we go through 

that discussion and tension, and a decision is made when to do it. 

Then the emergency service functions go into place, and we work 

in a coordinated way, with all of us sitting around in the same facility. 

Senator MARTINEZ. Those are all functions of the local officials. 

Mr. GOLDHAGEN. Yes. 

Senator MARTINEZ. My experience in Orange County was that we 

pretty much made those decisions and carried them out ourselves. 

Mr. GOLDHAGEN. Yes. 

Ms. GREENE. It is similar in Georgia and also with the role of 

public health, which I value and support. We have provisions in 

Georgia statute for public health to also step up to the plate and 

take control if it is not working out, similar to how he was describing it. So my hat is off to the first responders. At times, people 

have said, should the aging network be the first responder. We are 

seeing the bulk of our work now, after the crisis. We did not necessarily need to be there with the first responders. Our work is 

more now. 

Senator MARTINEZ. It is the long-term recovery and the issues 

that come from that. 

Ms. GREENE. Absolutely. 

Senator MARTINEZ. Thank you both very much. 

Mr. GOLDHAGEN. Thank you for the opportunity. 

The CHAIRMAN. To the incident Senator Martinez raised, where 

healthcare providers and responders literally abandoned hundreds 

of elderly people to die, and they died, I wonder if part of your calculation now is to work with those providers on their own plans for 

how to take care of their individual and family needs without abandoning the vulnerable population. 

Is that a new calculation in preparedness; that you have to know 

who your responders are and what their back bone is going to be 

in the event of these kinds of catastrophes? 

Mr. GOLDHAGEN. Well, that is not an issue for us, primarily because we work extensively with the medical society, as an example. 

When we evacuate a hospital, the physician orders go with the patient. We have worked on creating actually bilateral agreements 

with nurses so, in fact, with the hospitals, to allow nurses from one 

hospital to actually follow with the patients to another hospital, 

and have worked through all the legal issues related to that, so 

that if one hospital is evacuated, the nursing staff goes at that entity. 

Again, in our database system, we have the information as to 

who the doctors are, and have worked with the hospitals, as well 

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as the medical society, to ensure that, in fact, that is not an issue 

for us. When we need the physicians, they are able to evacuate 

with their families, so that we care for the families as well as 

them, if they are involved with the emergency response. 

The CHAIRMAN. That is very good news. Duval County is lucky. 

I hope every county prepares in the future the way you have. Of 

all the tragedy in this Katrina episode, I think the most disgraceful 

was the abandonment of these elderly people to die. I mean, I do 

not know how that happens in the 21st century, but it did. 

Thank you both for your presence here. It has been wonderful, 

the contribution you have made to our hearing today. With that, 

we thank you, and we will call up our third and final panel. 

The CHAIRMAN. Panel 3 will consist of Ms. Leigh Wade, who is 

the executive director of the Area Agency on Aging in Southwest 

Florida. She will discuss the role of area agencies on aging during 

a disaster. Her experience during past hurricanes have led her to 

work more closely with communities in developing disaster preparedness plans. 

We will also have Dr. Carolyn S. Wilken. She is an associate professor in family science, and a cooperative extension specialist in 

the area of gerontology at the University of Florida. Dr. Wilken is 

here today to discuss communication and transportation issues that 

older Americans face during these disasters. 

Finally, Susan Waltman is the senior vice president and general 

counsel at the Greater New York Hospital Association. Ms. 

Waltman is here to discuss her role as a healthcare representative 

in New York City’s Emergency Operation Center, EOC, during a 

disaster, and how she identifies and coordinates responses to 

healthcare emergencies. 

We thank you all for being here. 

I suppose, Susan, maybe there is a slant you can give, not a natural disaster, but on a human cause disaster like 9/11 certainly 

presented your city with. 

Why don’t we start with Ms. Wade. 

STATEMENT OF LEIGH E. WADE, EXECUTIVE DIRECTOR, AREA 

AGENCY ON AGING OF SOUTHWEST FLORIDA, INC., FORT 

MYERS, FL 

Ms. WADE. Good morning, Chairman Smith. Thank you for this 

opportunity to present today. 

My name is Leigh Wade, and I am the executive director of the 

Area Agency on Aging for Southwest Florida, Inc., which is based 

in Fort Myers, FL. Today, I also speak on behalf of the National 

Associations of Area Agencies on Aging, or N4A, which champions 

the interest of the nation’s 650 area agencies on aging, or AAAs, 

and 240 Title VI Native American aging programs. 

The human suffering caused by Hurricanes Katrina and Rita will 

linger in the American consciousness for years to come. Older 

adults were particular hard hit by these disasters. We will not soon 

forget the images of the frail, older women, 80 and 90 years old, 

who were air lifted to safety, or diabetic seniors unable to access 

proper medical care in an overwhelmed shelter. Our hearts go out 

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ida hurricanes, I have some idea of what they are going through 

and what lies ahead. 

In 2004, the AAA of Southwest Florida had the misfortune of 

bearing the brunt of three separate hurricanes in a little over a 

month’s time when Hurricanes Charley, Frances and Jean hit in 

rapid succession. Today, more than a year later, older adults in my 

area are still struggling to recover. 

Fortunately, we had a disaster plan that we put into action early 

on. We called the local older adults to inform them of Charley’s approach, and to warn them, they may have to evacuate from their 

homes. 

During the hurricanes, our agency assessed and responded to the 

needs of affected seniors. Working side by side with aging service 

providers in the most severely affected communities, we focused on 

delivering meals, water and ice to older adults. Our agency staff 

helped arrange transportation for the older adults to the special 

needs shelters and worked at disaster recovery centers. 

We had help from some federal, state and local agencies. Assistant Secretary on Aging, Josefina Carbonell, visited the devastated 

areas within three days after the hurricanes hit, and offered the 

Administration on Aging funding, assistance, and coordination. On 

the other hand, another federal agency did not figure out that we 

could help them assist older adults until two months after the first 

hurricane hit. 

The services we provided exhausted our Older Americans Act Disaster Funding of $4.3 million. We had to cease accepting applications and have over 100 applications still pending. We are still 

receiving calls on a daily basis for more assistance. We found 

through our hurricane experiences that older adults have distinct 

needs that present challenges to community-wide emergency planning and response. Every stage of an emergency needs to be handled differently when dealing with frail, older adults during evacuation, at the emergency shelters, and when returning to the communities. 

There are many challenges in transporting older adults in providing appropriate health services and nutrition; in meeting the 

needs of people with special conditions, such as hearing loss and 

dementia; in handling emotional issues, which can be complicated 

by separation from loved ones and caregivers; and in protecting 

people from those people who would prey upon older adults. By definition, disasters and other emergencies reduce any agency’s capacity to continue business as usual. However, if properly supported, 

area agencies can plan a key role in disaster preparedness. 

I can think of at least three major areas where AAAs experiences 

and resources could be of service. 

First, organizing safe and accessible transportation is critical. 

AAAs have a wealth of experience in working with community 

transportation authorities and providers through our assisted 

transportation programs. 

Second, finding appropriate temporary housing for older adults is 

another major challenge. In Southwest Florida, many long-term 

care facilities were closed permanently or for a long period of time. 

AAAs can assist in assessing the needs of older adults for housing 

assistance as well as connecting them to other needed services. 

65

Third, providing continuity of services to older evacuees as they 

move from shelters to other temporary housing has also been a significant challenge; one of my own personal pet peeves. Our agency 

had difficulty locating older adults who needed gap-filling services 

due to regulations that prevented FEMA from disclosing their new 

location once they had moved from the shelters to the temporary 

housing in FEMA cities. AAAs need to have access to older adults 

to ensure that they get the services they need. 

To effectively assist older adults during times of crisis, I join 

with N4A in offering you the following recommendations, which are 

detailed in my written testimony. In order to succeed as a first responder to older adults, AAAs must have better access to decisionmakers; be directly involved in long-range planning; be at the table 

in order to coordinate services and have adequate resources, technology and communication tools to respond to older adults needs. 

Not only do AAAs need to be at the table when federal, state and 

local governments draft their emergency plans, we also need to 

take the lead in helping county and city governments adequately 

prepare for the aging of the population and the dramatic effect it 

will have on our nation. N4A has proposed establishing a new title 

in the Older Americans Act that would support AAAs and Title VI 

Native American aging programs to do just this. I hope you will 

support this new title when the Older Americans Act is up for reauthorization next year. 

The CHAIRMAN. Since you asked me to, I will. 

Ms. WADE. All right. Thank you very much. I sure do appreciate 

it. I am going to count on that. 

Thank you for holding today’s hearing to call attention to the 

special needs of America’s seniors in disaster. I would be happy to 

answer any questions you might have. 

[The prepared statement of Ms. Wade follows:]

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The CHAIRMAN. Thank you, Leigh Wade. 

Carolyn Wilken. 

STATEMENT OF CAROLYN S. WILKEN, PH.D. M.P.H., ASSOCIATE 

PROFESSOR AND COOPERATIVE EXTENSION SPECIALIST, 

UNIVERSITY OF FLORIDA, GAINESVILLE, FL 

Ms. WILKEN. Good morning, Chairman Smith. 

The CHAIRMAN. Good morning. 

Ms. WILKEN. Thank you for the opportunity to speak with you. 

I have provided detailed written testimony as well as this presentation. 

News of the hurricane, flood, wild fire, or other natural disaster 

can cause anyone to worry, but such disasters create special challenges for older adults. While some older adults can react quickly 

and independently to an emergency, others who are frail, ill, alone, 

or institutionalized are at serious risks of injury or death when disaster strikes. In fact, we know that in natural disasters, the elderly 

comprise more than 50 percent of all fatalities. We also know that 

in times of disaster, older adults respond differently than the general population. Older adults possess a very strong sense of independence and self-reliance accompanied by reluctance to accept 

help and a strong, if not overwhelming, attachment to their homes. 

A nurse who provided emergency care in Mississippi during Hurricane Katrina said it this way. ‘‘Seniors are very attached to their 

homes. Their possessions, or even the place where their possessions 

remain, often take on such a special significance that it is impossible to coax them into evacuation.’’

This is more than hanging on to things. This is about hanging 

on to memories and the accomplishments of their lives. Sometimes 

it is the substance of what they have to remind them of who they 

were and who they are. But in spite of their hesitancy to leave 

their homes, sometimes older adults must evacuate. When that 

happens, many must rely on professionals to provide transportation 

to safety, yet older adults may be afraid of the transportation process. They worry that they cannot climb on to the bus, or that it will 

not stop in time for them to get to the bathroom, or because they 

do not know where the bus is taking them or how they will get 

back home. 

Older Floridians and service providers have had too many opportunities to learn about disasters. If experience is the best teacher, 

then Florida has been an attentive student. 

Let me describe two successful programs, and there are many 

others. 

Notice how their successful transportation and evacuation relied 

on ongoing communication at all levels. In the Florida Keys, a basic 

understanding of the needs of older adults—particularly their 

needs for independence and personal responsibility—pre-planning, 

and personal communication were central to the successful evacuation of older adults. In the Keys, older adults were invited to put 

their names on a registry—and several people have discussed registries today—so that they could be contacted in the event of an 

evacuation. When they registered, their physical and transportation needs, among other things, were assessed. This information 

allowed emergency planners to prearrange transportation, and apVerDate 0ct 09 2002 12:49 Apr 04, 2006 Jkt 000000 PO 00000 Frm 00084 Fmt 6633 Sfmt 6633 H:\DOCS\26545.TXT SAGING1 PsN: JOYCE
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propriate modes of transportation; buses for the less frail, for example, and a fleet of ambulances from South Florida to transport 

those with complex medical needs, such as continuous flow oxygen, 

IVs, and critical medications. 

As the hurricane formed, older Americans on the registry were 

contacted by phone to assess their evacuation plans and transportation needs. A minimum of three follow-up phone calls were made 

to assure that each person was given the opportunity to evacuate. 

Individuals were told how they would be transported—by a bus or 

ambulance—where they could be taken, and how they would return 

to their homes. 

In Seminole County, law enforcement officers traveled door to 

door to reach people on the sheriff’s registry of persons in need of 

special assistance. At the same time, senior volunteers from RSVP 

make phone calls to reassure older adults and to answer specific 

questions concerning transportation and the evacuation process. In 

both situations, understanding and respecting the lives and the 

concerns of older adults, preplanning for appropriate and sufficient 

transportation, and personal communication were central to the 

successful evacuation of older adults. Effective disaster response requires consistent communication at the local, state, and most importantly at the individual personal level. 

Personal education at a time that is appropriate, and in a method that is appropriate, is the most powerful tool for preparation for 

disaster. Cooperative extension service, the outreach arm of the 

land grant universities, such as University of Florida, and the Department of Elder Affairs in Florida, communicate with older 

adults through written publications such as the EDIS facts sheets, 

preparing for disaster after the hurricanes have gone, and the Florida Elder Affairs Publication Disaster Preparedness Guide. Written 

materials provide elders with the information they need to make 

informed, independent decisions concerning disasters. 

Personal communications with older adults requires training. 

The fact sheet, Stop, Look and Listen, teaches communication for 

one-to-one settings, while another fact sheet, Designing Educational Programs for Older Adults, focuses on communicating with 

groups in settings such as disaster recovery centers. I have provided you with copies of these materials. 

It is time to develop a national disaster plan that reflects and responds to the specific needs and concerns of older Americans. My 

colleagues in Cooperative Extension in the Florida Department of 

Elder Affairs would like to respectfully recommend that a coastal 

states coalition of professionals and disaster-experienced adults 

conduct a best practices conference to prepare the nation to help 

older Americans prepare to act quickly in the face of disaster. 

The final product of this conference would be an array of written 

materials and an interactive, multi-language web site that would 

be assessed by disaster planners and older Americans themselves. 

The long-term outcome of this conference would hopefully be to reduce the number of deaths and injuries suffered by older Americans during disaster. 

Thank you for the opportunity to testify at this hearing. I would 

be more than happy to answer your questions today or to follow up 

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with additional information at the completion of today’s proceedings. 

[The prepared statement of Ms. Wilken follows:]


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The CHAIRMAN. Thank you both very much. Before we go to 

Susan, I wanted to ask you a question. 

Were you living in Florida when Hurricane Andrew hit? 

Ms. WILKEN. I was not. 

Ms. WADE. I was. 

The CHAIRMAN. The poor response to Andrew, did that precipitate all the planning and preparation that has gone on since, as 

you have seen it? 

Ms. WADE. We have certainly seen an increase in the requirements for the construction industry, and we feel that there were a 

lot of lessons that were learned we were able to apply to the hurricane season of 2004. But even with Hurricane Andrew, being able 

to respond to four separate hurricanes in one season, I do not think 

Hurricane Andrew adequately prepared the state for that, but certainly there were a lot of lessons we were able to apply, but we 

have learned a lot more since then. 

The CHAIRMAN. Is there any evidence of the constructions standards being enhanced? Did they work in the subsequent storms? 

Ms. WADE. We have seen the houses that were able to withstand 

the wind. It’s really interesting. If you go through the different 

communities that were affected, some of the houses withstood the 

winds. The same construction company built another house right 

next-door to it which could have been destroyed. But we really do 

believe that those standards did help the construction industry. 

But when we look at some of the mobile home units, I do not 

know that they are currently at the level that they need to be, or 

people that live there need to understand that maybe they can only 

sustain winds of whatever that maximum is, and then take that 

into consideration and worry about your own safety when those 

winds exceed that maximum amount. 

The CHAIRMAN. Are there consumer disclosures to buyers of such 

homes? 

Ms. WADE. Yes. They do receive disclosures that tell them what 

the sustained winds are. 

The CHAIRMAN. Carolyn, you mentioned how hard it is to sometimes coax a senior emotionally away from the world they live in 

and the possessions that remind them of an earlier day. When you 

provide all the information—this is where we will take you, this is 

what will be available to you, and this is when we will return 

you—does the participation in evacuation go substantially up? 

Ms. WILKEN. It does help. There is a lot of fear of the unknown; 

where am I going to be, how will my family find me? So giving people information helps them make decisions. When people are 

stressed in the time of disaster, often times it is hard to hear what 

will happen, particularly for elderly people. It is hard to hear and 

to comprehend what is going to happen and how this is going to 

happen. So if you get that information very quickly, it makes it 

more frightening to go than to stay. On the other hand, if you can 

get that information to people in advance, and through the personal communications—for example, the RSVP phone calls that 

come in Seminole County—then people have a chance to process 

what is going to happen, and that helps them be more willing to 

go. It does not replace the possibility of losing my family pictures, 

94

which is important to everyone. But for older adults, those family 

pictures were often of people who are now gone, deceased. 

The CHAIRMAN. In the event that all the information, all the 

planning, and all the encouraging does not work and they decide 

to ride it out, what is done then as a follow up to find out if they 

are okay afterwards? 

Ms. WILKEN. I think I would have to defer on that question probably to my colleague here. But before I do that, there is something 

that I put in my regular testimony, the longer version, which is the 

whole ethical decision-making process of mandatory evacuation, 

which is something that affects older adults that I think we need 

to look at as well. 

I would like to defer to you, Leigh. 

The CHAIRMAN. Leigh, what is done after the storm? 

Ms. WADE. Well, what I can address as far as that is concerned, 

taking into consideration that the Department of Health does arrange for the transportation of many of the adults that have registered through the notice that comes out in the electric bill, our 

agencies were able to register clients based on our day-to-day interaction with them and to help them understand the necessity of getting registered and being prepared to leave to go to the shelters. 

I can remember this lady who lived in a rural county out in 

Hendry County, who shared with us that she was not leaving her 

house and literally threatened our staff with a shotgun if we came 

back. So we left her to ride out the storm. But as soon as the storm 

was able, knowing that these clients did stay behind, our staff was 

able to get right back out there and make sure they were able to 

survive the storm, and then be able to start addressing any needs 

that they may have, based on the structure that they were staying 

in. 

I just want to address your point about the shelters. What we 

found was that even after we were able to encourage those people 

to go to a shelter the first time, they were exposed—you take into 

consideration, this is an older adult who has no children around, 

no grandchildren. They have access to them, but they are not living 

with them. You put them in a shelter where they are stationed for 

days on in, weeks on in, and they are exposed to these children 

running around, screaming, yelling, not wanting to go to bed when 

they need to, and our older adults were very frustrated by that. So 

that is something that at a local level we really need to take a closer look at to see how we can address that from the local standpoint. 

The CHAIRMAN. That is very good. I appreciate so much from 

both of you. 

Now, Susan Waltman may have another take on how to deal 

with human disasters.

95

STATEMENT OF SUSAN C. WALTMAN, SENIOR VICE PRESIDENT 

AND GENERAL COUNSEL, GREATER NEW YORK HOSPITAL 

ASSOCIATION, NEW YORK, NY 

Ms. WALTMAN. Thank you very much for the opportunity to appear before you today. I am Susan Waltman. I am senior vice president and general counsel of the Greater New York Hospital Association. We represent 250 hospitals and long-term care facilities in 

the New York City region. We believe that the issues that you are 

examining today are very important. While many of us spend a lot 

of time on emergency preparedness, Hurricane Katrina in its aftermath demonstrated quite vividly and in real time how there are 

very disparate abilities and needs of various populations to participate in and gain the benefit of even the best of emergency plans, 

and evacuations in particular. 

We have, obviously, approached preparedness from the standpoint of hospitals, as those facilities that we represent and those 

we think would be most called upon to prepare for disasters. But 

we also recognize that what we do—and we are hopeful that that 

is the case—can apply to many other regions of the country as well 

as to how we can better care for special needs populations as well. 

I would like to just review what our framework has been. It is 

one that we believe is billed upon an already very strong regional 

framework for preparedness that exists in the New York City region. It is one that we think focuses very heavily on ongoing preparedness, where we really pay attention to and we learn from 

every event alert in an emergency. It is a very collaborative approach, one where we are preparing everyday with what we call 

our ‘‘partners in preparedness,’’ and all other kinds of providers, as 

well as local, state and federal governmental agencies. 

I will go through very quickly what we view as our guiding principles in that regard. 

We view ourselves as being in a very high-risk region. That is 

true for other areas of the country as well, for different reasons. We 

have experienced, as you well know, two separate attacks on the 

World Trade Center. We went through four different anthrax attacks, and we are very aware, very cognizant, everyday that we are 

on the list of other high-risk targets as well. 

We also recognize that we can experience natural disasters as 

well. We experience hurricanes and plan for them as well, and we 

know that we, as somewhat the gateway to the rest of the world, 

can experience infectious diseases as being the front line, for example, and we prepare for pandemic influenza, which we are spending 

a lot of time on right now. 

So we live everyday and we try to do it with a sound mental 

health approach as well, as though we could experience an emergency at any time. We do that through what we refer to as a very 

strong three-way partnership among providers. In our case, it 

might be human service agencies for another circumstance. But 

there is a three-way partnership among providers, the health and 

public health agencies, and the emergency management agencies. 

We cannot prepare in isolation or we would end up really not 

knowing what the other party can do for us or what we can do for 

them. 

96

I think the two ways that gets demonstrated in the New York 

City region is that we, for many years, have actually had a seat 

at the New York City Office of Emergency Management’s Emergency Operation Center. We, Greater New York Hospital Association, sit there as though we are a public agency, and we are 

grouped with the other health and medical agencies, such as the 

city and state health departments, the EPA, et cetera, so that we 

can interact with them, give them assistance, and they can give our 

own members and other healthcare providers assistance as well. 

We also have put together since September 11, what is referred 

to as an Emergency Preparedness Coordinating Council. There are 

many task forces that bring together these three partners that different groups have put together. Ours is obviously from the provider prospective, but we have forced, so to speak, the issue of 

bringing everybody to the table. We have literally met, or had a 

work group, or had a conference call, every single week I would say 

since 9/11, all with the aim of improving and enhancing preparedness among these three parties. I do suggest that it could differ for 

human services. For example, the replacement in terms of providers would be human service agencies with the relevant local 

agencies and emergency management agencies. 

We subscribe, as you have heard today, to an all-hazards approach. We to, after 9/11, looked very hard at anthrax and smallpox, but then we took a very quick deep breath, and we said let’s 

have an all hazards approach, so that we can respond to any type 

of emergency, and then fit in the hurricane plan, the pandemic influenza pan, et. cetera. As part of that, we subscribe very heavily 

to incident command systems, so that we can better prepare internally, talk to other providers, as well as other agencies, so we are 

talking the same language as we respond, and everybody has a better sense of their role. 

There is very heavy emphasis, as you have heard, on communications. We look at that from two perspectives. We need to know very 

clearly with whom, how, and for what? We need to communicate 

before a disaster so that we have all the information we need. The 

partners, our patients, our clients would be the translation before 

that disaster occurs, so we do not need to—as the Deputy Commission of OEM says—change carts in the midst of a disaster. We also, 

obviously, have built in redundant communications as well; how 

does that get demonstrated? We have an extensive emergency contact directory about all of our members, how to reach the chair of 

the disaster committee, the administrator on call, the Emergency 

Operation Center, and every single one of our members from basic 

phone lines to ham operators. It goes all the way down. 

We have very extensive ways to communicate with members 

through e-mail alerts. We have 800 mega hertz radios that connect 

the hospitals and the nursing homes with us and the Office of 

Emergency Management. We have a web site that is opened to the 

public—it is not something that is just for members only—that 

gives extensive information, focusing particular on services and information for the community at large, for the public, in terms of 

their own preparedness. 

What we have also developed, and we needed—and I just want 

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thing that you are hearing in terms of what we have put in place 

is because we learned lessons. We paid attention to what we 

needed and what we recognized that we needed during the course 

of 9/11 and the months afterwards. It was a good way to identify 

common elements that we needed, data elements, information 

about an emergency, so we can manage an emergency better—data 

elements—as well as an efficacious way of collecting that information. 

So we worked with our state health department, and we have 

created the Health Emergency Response Data System, which is 

housed on the state’s health provider network in a secure Internet 

site, that allows us to communicate information about our needs, 

as well as what we can offer during a disaster. It has many different templates that can be used in terms of beds, staffing, availability, and what is being experienced during a particular event. 

We also build in—because we needed it on 9/11—a patient location 

system. We practice and we use it weekly. We have drills, and it 

is able to be used for many types of providers, and I think it has 

become a very valuable tool for managing emergencies. 

We really feel very strongly that we have to understand each 

other’s roles and responsibilities again. That is all a part of this 

three-way partnership. In order to do that, we plan and we drill 

together as we develop a plan on threat-alert guidelines, on hurricanes, on pandemic influenza. We have all of the parties at the 

table, so we make sure that it works. We might spend two meetings on the first step because we need to understand better who 

takes charge, who is on the site, who will communicate with whom, 

and the rest does flow from that, but we undertake very collaborative planning. Training and education is very important as well. 

Interestingly, on the issue of providers, first responders’ families, 

we just undertook a survey of what training our members still 

needs. It is very much on household preparedness, so that our own 

healthcare workers will feel comfortable showing up for work during an emergency. 

I have gone through our guiding principles for preparedness in 

general. We have subscribed to them as a region and as a state, 

and have looked at how we can better care for our special needs 

populations. I think the city and the state have done that very well 

to date, but we recognize we need to do much more. Already we 

have participated in and have arranged for a number of meetings 

to look hard at evacuation plans. The state, city and we are looking 

at putting together templates for evacuation plans for nursing 

homes and a variety of other types of providers, as well as the type 

of information that every kind of agency should be collecting about 

its own patients and their clients, so they can all reach them, as 

you have heard, in advance and during a disaster, and understand 

their special needs and be able to share that information so people 

can be adequately cared for and evacuate. We do, obviously, subscribe to individual preparedness. I think that enables the individual, whether they are an older American or someone else, to 

avail themselves of the plans that do exist, but we do take charge. 

We do believe that the agencies have responsibility for making sure 

that their clients are well taken care of. 

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We think a lot of what we have done can be expanded to other 

regions on caring and planning for special needs populations. We 

offer, obviously, to make anything that we have done, any of these 

lessons we have learned, sometimes the hard way, available to others. 

[The prepared statement of Ms. Waltman follows:]

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The CHAIRMAN. Susan, obviously, after 9/11 and Katrina, we in 

government and in the private sector have to begin imagining the 

unimaginable. Did you see a substantial increase in your preparedness after 9/11 or was it in place after the first bombing of the 

World Trade Center? 

Ms. WALTMAN. I think we have historically had a very strong regional planning approach in New York City because of the initial 

World Trade Center attack, as well as the large events that we 

host in our small town of 8 million people. But there is no question 

that we have spent an awful lot of time since 9/11. I think we realized that we are very much a target, and that we need to do even 

more collaborative planning. 

I think, as I said, that everything that you have heard we have 

put together, we have done so with hindsight and of the experiences that we have seen. We also have tried very hard not to experience a failure of imagination, as the 9/11 Commission says, so we 

have thought very hard about things we have not yet experienced 

and that might occur, and I think that has informed us tremendously. 

I just want to say one last thing. Mayor Bloomberg has made the 

point in terms of special needs populations, that no one will be left 

behind. Certainly, that is going to be a very hard task to accomplish, but I think if we go out everyday as we prepare, I think we 

are better at making sure that we think of all the special needs 

populations, and older Americans in particular. 

The CHAIRMAN. Can the abandonment of elderly and disabled 

people cannot happen in your area? 

Ms. WALTMAN. I think it can happen. I think we are, with all deliberate speed and efforts, trying to make sure that it does not happen. I think that will mean an expansion of our collaborative planning. I know that the Office of Emergency Management plans to 

include more agencies potentially in an OEM activation so that we 

cannot have, or we are less likely to have, what occurred. Again, 

that gets back to learning lessons and paying attention to everything. 

The CHAIRMAN. I remember being in New York a few days after 

9/11, and we spent some time on a huge hospital ship that had 

come in to take care of the injured, but there were no injured. 

There were, frankly, few survivors. They were, obviously, injured, 

but not what had been planned for. 

I guess my question, then, becomes, your system is very much an 

urban system. Yet, you say you have a model that you think is 

adaptable to other areas. How is it adaptable to more rural states? 

Ms. WALTMAN. I think that the essence of the plan is collaborative planning, is making sure that the private and public agencies or authorities that are responsible for individuals come together. I think that it is so easy to engage in silo approaches, stovepipe approaches, whether you have an urban area or a rural area. 

I do say in the written testimony, it does not matter who takes 

charge in a particular community, rural or urban; you have to have 

a champion. Maybe it is going to be the private sector that comes 

forward and forces, as I said, people to come to the table. But you 

can engage in collaborative, everyday planning no matter where 

you are. I do think there are some very basic principles in terms 

116

of communications and all hazards that can apply no matter where 

you are. 

The CHAIRMAN. Well, you are all to be congratulated on the work 

that you do, the programs that you run, and the care that you provide. We really appreciate your presence here today, what you have 

done to highlight the importance of both private and public sector 

collaboration. We have to do better. Experience is a hard task master, and the lessons learned are lessons we want to highlight. 

I want to express, on behalf of the senior population of which I 

am quickly becoming a member, we appreciate your focus on the 

special needs of the elderly. Ours is an aging nation, so their needs 

are, frankly, all of our needs. With that, our heartfelt thanks. This 

hearing is adjourned. 

[Whereupon, at 12:11 p.m., the committee was adjourned.] 

(117)

A P P E N D I X 

PREPARED STATEMENT OF SENATOR HERB KOHL

We thank our Chairman, Gordon Smith, for holding this hearing on emergency 

preparedness planning for seniors, and for his leadership on this and countless 

other important issues facing older Americans. 

Emergency preparedness planning is a challenge under any circumstance. Preparing for the unique needs of the elderly requires even greater diligence and resolve. As we have seen in the aftermath of Hurricanes Katrina and Rita, disasters 

have an exaggerated effect on seniors, in particular those who depend on others for 

assistance in their daily lives. The ongoing provision of evacuation transportation, 

food, medication and shelter all become life and death matters. 

This does not even speak to the tragedies we recently witnessed in the abandonment of the disabled and elderly in nursing homes, hospitals and other care 

facilities- the institutions which we would assume would be most vigilant in emergency preparedness and caring for our most vulnerable. In this regard, I have asked 

the Inspector General of the Department of Health and Human Services to conduct 

a thorough investigation into federally mandated evacuation plans for nursing 

homes and hospitals to determine the adequacy and shortcomings of those plans in 

place. 

As we have learned from past disasters and attacks, a multidisciplinary approach 

on the federal, state and local levels is needed to properly guarantee that the needs 

of our seniors are addressed. Today, the Committee will hear from a panel of experts who will tell us just how to do this. We look forward to hearing from and 

working with them to ensure that in the face of future disasters, our seniors remain 

healthy, safe and secure. 

Thank you Mr. Chairman.

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