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S. HRG. 109–571

CARING FOR SENIORS IN A NATIONAL

EMERGENCY: CAN WE DO BETTER?

HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

WASHINGTON, DC

MAY 18, 2006

Serial No. 109–23

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 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

THOMAS R. CARPER, Delaware 

BILL NELSON, Florida 

HILLARY RODHAM CLINTON, New York 

KEN SALAZAR, Colorado 

CATHERINE FINLEY, Staff Director 

JULIE COHEN, Ranking Member Staff Director 

(II) 

C O N T E N T S 

Page 

Opening Statement of Senator Herb Kohl ............................................................. 1

Prepared Statement of Senator Gordon Smith ..................................................... 7

Statement of Senator Thomas Carper ................................................................... 8

PANEL I 

Maurice Frisella, New Orleans, LA ....................................................................... 3

Jean Cefalu, Slidell, LA .......................................................................................... 9

PANEL II 

Daniel W. Sutherland, officer, Office of Civil Rights and Civil Liberties and 

chair, Interagency Coordinating Council on Emergency Preparedness and 

Individuals with Disabilities, Department of Homeland Security, Washington, DC ............................................................................................................. 20

Cynthia Bascetta, director, Health Care, U.S. Government Accountability Office, Washington, DC ........................................................................................... 36

Amy B. Aiken, assistant director, Miami-Dade Office of Emergency Management, Miami, FL .................................................................................................. 56

Carmel Bitondo Dyer, M.D., associate professor of Medicine, director, Baylor 

College of Medicine Geriatrics Program at the Harris County Hospital 

District, Houston, TX ........................................................................................... 70

APPENDIX 

Prepared Statement of Senator Susan Collins ...................................................... 83

Prepared Statement of Senator Mel Martinez ...................................................... 83

Prepared Statement of Senator Ken Salazar ........................................................ 84

Letter from William Dunwiddie ............................................................................. 86

Statement and Report from AARP ......................................................................... 87

(III) 

(1)

CARING FOR SENIORS IN A NATIONAL 

EMERGENCY: CAN WE DO BETTER? 

THURSDAY, MAY 18, 2006 

U.S. SENATE, SPECIAL COMMITTEE ON AGING, Washington, DC. 

The committee met, pursuant to notice, at 10:18 a.m., in room 

SD–628, Dirksen Senate Office Building, the Hon. Herb Kohl presiding. 

Present: Senators Smith, Collins, Kohl, Carper, and Nelson. 

OPENING STATEMENT OF SENATOR HERB KOHL 

Senator KOHL. At this time, I would like to call the hearing to 

order and welcome our witnesses. 

Last September, as the Nation still reeled from the tragic and 

shameful images of seniors abandoned during the aftermath of 

Hurricane Katrina, this Committee held a hearing on how to prepare for the next disaster. 

Today, we return to that topic, determined that we never again 

leave our parents and grandparents to face an emergency alone. 

Today is not about pointing fingers for past tragedies. Today is 

about looking forward. Hurricane season is just around the corner. 

The threat of terrorism remains, and the potential for an avian flu 

pandemic looms. 

We all agree that we let our seniors down after Hurricane 

Katrina. But as sorry as we all are, are we any more ready for the 

next hurricane or attack or disaster? 

We now know that cookie-cutter emergency plans are of little use 

to seniors, especially those who depend on others for assistance in 

their daily lives. We must put in place a concrete strategy that recognizes and masters the challenges of keeping seniors out of harm’s 

way. This Committee is steadfast in its pursuit of that goal. We 

hope that we will learn today that the administration is equally 

committed. 

We will hear today from a senior who was forced to navigate 

Katrina without much assistance from the government and from a 

nurse who has helped countless seniors after hurricanes. Also with 

us today are the Government Accountability Office, the MiamiDade Office of Emergency Management, and a renowned geriatrician. We look forward to their recommendations. 

I am particularly interested in hearing testimony today from the 

Department of Homeland Security, which is the lead Federal agency for emergency preparedness. We are happy that Dan Sutherland 

is here from the Office of Civil Rights and Civil Liberties, and we 

2

look forward to hearing what that department is doing to prepare 

seniors for emergencies. 

We expect to work with the department on some common sense 

solutions. We must do a better job in telling older people what supplies and plans they need to have in place if a terrorist attack or 

flu pandemic hits. 

As a start, my office has developed a tip sheet, and the Department of Homeland Security should follow with pamphlets, public 

pronouncements, and specific directions for seniors and the agencies that serve them. DHS also should direct States and local governments to plan, train, and practice evacuations and sheltering in 

place exercises that specifically target seniors. 

DHS should also require hospitals and nursing homes to plan 

ahead for evacuations and fund training for first responders to help 

seniors who live at home and may be unable to evacuate. 

Our office will be developing a report outlining recommendations 

from our witnesses and other groups. I hope the Department of 

Homeland Security will take these ideas seriously and will turn 

them into action. 

Our lack of preparation for seniors after last summer’s hurricanes and the terrible price we paid in lives and suffering is, indeed, a national tragedy. That tragedy is compounded if we ignore 

the painful lessons of the past. 

We need specific plans, programs, and information for all seniors 

facing emergencies, and we need the commitment and energy of a 

DHS determined, as this Committee is, never again to desert our 

seniors when they need us the most. 

So we look forward to hearing from our witnesses today, and we 

will now turn to the first panel. 

Our first witness on the first panel is Maurice Frisella. Mr. 

Frisella is an 82-year-old man who survived Hurricane Katrina 

mainly on his own, with limited help from government. His journey 

has included being airlifted from New Orleans to Baton Rouge, 

stays in two nursing homes, and also a hospital. 

Mr. Frisella’s testimony will help us understand the challenges 

seniors face when the Government does not adequately prepare for 

emergencies. 

Also on the first panel is Jean Cefalu. Mrs. Cefalu is a nurse who 

volunteered her services after Hurricane Katrina. She will discuss 

how the gulf region dealt with the needs of seniors and how it continues to struggle with their needs and appropriate planning for future emergencies. 

We welcome you both, and we look forward to your testimony. 

First, Mr. Frisella.

3

STATEMENT OF MAURICE FRISELLA, NEW ORLEANS, LA 

Mr. FRISELLA. Good morning, Senator and friends. Good morning. 

I am Maurice Frisella. 

Senator KOHL. Is your mike on? 

Mr. FRISELLA. This is my testimony as best I can do it. All right. 

Orleanians have endured hurricanes in the past. Courageously, 

we decided to face this Katrina, too. Our 100-year-old house is high 

and study Victorian. We decided to remain within our own shelter, 

see Katrina to the finish. 

Slowly, the monstrous wind began to rise, blowing apart the security of our world. Rain and wind began to lash the house. The 

old place seemed to tremble, wind beneath the house. The floor 

creaked. 

Suddenly, with no warning, the electric power was cut. Candle 

power was blindly groped for in the black and eagerly sought, and 

it was found. Gas and water were soon suffered the same privation. 

No radio batteries because the batteries long lay unused. 

I ventured to look out the front door. The high wind snatched the 

door from my hand. Rain lashed, and in an instant, I was wet. The 

trees were in a fury. Flying trash seemed endless. The wind blew 

me backwards. Fear caught me. Was there no help? Was there no 

warning? But when? I had no knowledge. 

Surely, the city’s fathers must have given warning? I saw no police prowl cars, no National Guards, no lights, no neighbors. In the 

dark, I sensed that water was gathering about the house, but how 

high? 

I heard the screech of tearing timber. Something had fallen, 

something awful. I braved the beating wind. I could not see too 

well. My God, the upper bathroom was gone. The onslaught of wind 

increased more fearfully. I closed the front door, not feeling too secure. In the flickering glow of candlelight, the draperies billowed 

and trembled. 

Wind, wind, invading every chink and crack. Somewhat short of 

breath, I paused to gather my intelligence. Then for a moment, the 

wind stopped. The world was silent. The house seemed so dreary. 

A dead calm in the calamity. Peggie began to meow and cry. We 

waited for the dawn. It would not come. 

‘‘It is OK, Peg.’’ The frightened cat was in my lap. As for food, 

there was bottled water, canned food, crackers, peanut butter, and 

some candy. I tried to rest on the sofa. The candles were burning 

low, too low. I feared fire. Surely some help would come. A skiff, 

a guard? Somebody, please. 

It was still calm, cold, damp. I looked out. I knew instinctively 

water was there, but would it rise more? No humans, no sound. 

Only blackness and fear. Where was the police? Where was the militia? 

Finally, after 3 days within the house, September 3, 2005, I went 

outside. I stepped into the water up to my knees. Filth, garbage, 

branches, pieces of furniture floated. Believe it. Even a wingchair. 

Being fatigued, after prowling in the street, I dared rest in the 

floating chair. I jumped to my feet, foolishly trying to get the attention of a helicopter. I waded to St. Rock Park Avenue about 100 

yards from my own residence with heart fear. 

4

Nobody in sight, silence and water. Bedraggled trees. I waded 

back to the house for my adopted brother, Buzz. Once indoors, I demanded we have got to get out of here. Come on. Step into the 

water. It is not so deep. 

I managed to gather some valuables, stuffed in my little leather 

shaving kit. We waded and waded. Good Lord. What happened to 

our world? 

Finally, I was seized with joy. Hope. A National Guard vehicle 

came into my sight. Boy, they spotted us. Two young Guards boosted us up. I felt a hot hand on my backside. Buzz, too. 

So with soggy trousers and heartfelt thanks, we were seated on 

something like a bench, handed a sandwich and a drink, and then 

we rode wildly and roughly down St. Claude Avenue up to Canal 

Street. The young Guards, no more than boys, were in a crouched 

position with rifles paused looking for trouble. 

However, to end this winded episode, we were driven to the 

arena next to the Super Dome. Some kind medics changed our 

damp clothes. I know I was in a blue paper suit. The helicopter 

took Buzz and me to Baton Rouge and then to a nursing home in 

Gonzalez, about a half hour’s drive from the capital city. 

In the nursing home, we unhappily lived there from September 

3 to April. We missed every joyous holiday. I was cursed, hit, and 

informed by the aides, ‘‘Kiss my gluteus maximus.’’ You translate 

that yourself. I am not going to do that. 

There were other incidents, too. Food was awful. Buzz went into 

a terrible decline. I lost my place. 

He of the United States Air Force, his knowledge of botany and 

food, Buzz could not eat. The kitchen was filthy. I was simply helpless—too much? 

Senator KOHL. It is all right. 

Mr. FRISELLA. I was simply helpless in the nursing home. I 

called, called, waited, waited—FEMA. Then that Spanish. I was offended. This is an English-speaking nation. Let us keep it that 

way. 

My home has been looted. Valuable antiques gone. Pigeons have 

invaded the house. My home has been closed since September. I 

was presented today with two $500 bills from the Entergy Company. My house has been closed for seven months. Seven months, 

nothing done. The levee neglected. 

Now this is a rumor, but this was certainly overheard. Watch 

this now. ‘‘Nothing was wrong with that son of a bitching levee. It 

has been that way since I have known myself.’’ I lost my place. OK. 

Where is my place? Oh, this, sirs, is my sorrowful lamentation. Our 

elected officials are not taking care of our Nation. 

As for the Corps of Engineers, by thunder, they blunder. Does no 

one see the United States is in a decline? No one. 

Divine Father, spare our Nation. So I humbly lift my being to 

God. Pray my words are not false. The elected ones are truly only 

for one thing—privilege, prestige, possession, and power. They are 

exalted and way above the citizens. This is the end. 

Here is a quotation from Shakespeare from Richard III. ‘‘In the 

base court, come down. Come down.’’ That, sir, is the end of my 

statement. I hope I haven’t been too foolish. 

[The prepared statement of Mr. Frisella follows:]

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Senator KOHL. Thank you. You have made a beautiful statement. 

We appreciate it very much. 

Mr. FRISELLA. OK. Don’t think I haven’t been nervous. 

Senator KOHL. You did great. You did absolutely great. 

Mr. FRISELLA. Thank you. 

Senator KOHL. Before we turn to Mrs. Cefalu, I would like to ask 

our Chairman, Gordon Smith, for his statement. 

The CHAIRMAN. Well, thank you, Senator Kohl. 

Out of respect for our witnesses, and with apology for the vote 

that has delayed myself and Senator Carper for being here, I will 

put my statement in the record so we don’t hold them any longer. 

I want to hear from them. 

[The prepared statement of Senator Smith follows:] 

PREPARED STATEMENT OF SENATOR GORDON SMITH

Good morning. 

Senator Kohl, I appreciate being here today to revisit one of the most important 

topics this Committee has looked into during the past year. 

Since the tragic events on the Gulf Coast last year, we in Congress have devoted 

much of our time to helping our fellow Americans who were displaced by Hurricanes 

Katrina and Rita get back on their feet. We are continuing the long process of rebuilding those areas of the Gulf region that have been so ravaged by these terrible 

storms. 

The Baltimore Sun on Sunday examined difficulties that the 200,000 people currently living in New Orleans are facing when assessing medical care from the city’s 

devastated health care system. Damage from Hurricane Katrina has reduced the 

number of hospital beds in the city from 2,300 to 500, and Charity Hospital, the 

city’s hospital for the uninsured, is not expected to reopen for years. Meanwhile, the 

uninsured rate in the city has increased from about 20 percent to 40 percent, largely 

because many people have lost jobs that provided health insurance. In addition, out 

of 4,500 physicians who worked in New Orleans before Katrina, only about 1,200 

have returned. 

While we must continue to work to ensure New Orleans is a safe city to return 

to, the past few months have also been a time to examine the preparedness of our 

federal, state and local governments to deal with such disasters in the future. 

Last October, this Committee held a hearing entitled Preparing Early, Acting 

Quickly: Meeting the Needs of Older Americans During A Disaster. We heard from 

witnesses who described older Americans’ special needs that make them particularly 

vulnerable during an emergency. A key lesson that came out of our hearing was 

that the 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 make certain that adequate steps 

have been taken to identify those in need, evacuate seniors to a safe place and provide appropriate care once displaced. 

The October hearing also pointed out that there are other substantial issues that 

still need to be addressed. Issues of specific concern are the double-counting of emergency services, trouble identifying individuals who have special needs and making 

sure that funding is flexible for an all hazards approach to disaster preparedness. 

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

the responses to hurricanes Katrina and Rita. However we must also consider the 

myriad of other natural and man-made disasters a frail senior may face. Seniors in 

the Midwest may need to prepare for tornadoes, while in the West seniors may need 

to prepare for earthquakes. This is why during our last hearing I found the ‘‘allhazards’’ approach to disaster preparedness so valuable. 

Simply put an ‘‘all-hazards’’ approach focuses more on coordinating efforts toward 

any disaster rather than preparing for a specific disaster. By doing this, an agency 

can be prepared to provide for: 

Effective coordination of activities among the organizations having a management/response role; 

Early warning and clear instructions to all concerned organizations and individuals if a crisis occurs; and 

Continued assessment of actual and potential consequences of the crisis at hand. 

As I stated in October, there is no doubt that disaster preparedness for older 

Americans poses a daunting challenge. However, I believe hearings like this one will 

8

shed light on the difficulties we have had in the past to find solutions for future 

disasters. 

Large-scale natural disasters like the hurricanes that struck the Gulf Coast 

stretch our federal, state and local response capabilities to their absolute limits. I 

hope the testimony today from our distinguished witnesses allows this Committee 

to learn about disaster preparedness and enables us to move forward and protect 

our most vulnerable citizens during emergencies. 

I thank all of you for coming to share your expertise and look forward to your 

comments. 

Thank you.

Senator KOHL. Thank you. 

Senator Carper. 

OPENING STATEMENT OF SENATOR THOMAS CARPER 

Senator CARPER. I would like just to make a very brief statement. 

Welcome. We are delighted that you are here and happy to have 

this hearing today. 

I am a Navy veteran and have been, as my colleagues, have very, 

very active on behalf of veterans in my State and across the country. 

In the wake of Katrina, when thousands of veterans were evacuated from the gulf coast and taken to veterans nursing homes and 

VA hospitals in other States, when they arrived in those places, the 

folks who received them in the new nursing homes and hospitals 

had the medical records because of the electronic medical records 

for all the veterans. 

They knew what medicines they were taking. They knew what 

their medical histories were. They knew what their MRIs or X-rays 

or lab tests were. They were able to provide in the new homes, receive in their new homes excellent care right away. 

For a lot of folks who were civilians who were evacuated from the 

gulf coast, they ended up in other States, in other hospitals, and 

other nursing homes. They had in many cases paper medical 

records, which were largely destroyed. Those who received them 

did not know the medical histories, the prescription medicines that 

needed to be taken and so forth. 

One of the things that someone’s been working on—my colleagues and, too, our guests—is to increase the likelihood that we 

are going to have electronic medical records, health records for ourselves and for others in this country. Not just to help out in emergencies like Katrina, but also in other instances just to provide better health care. 

So this is, I think, an important hearing for the cause for which 

it is slated. But there is also another reason that we need to provide electronic health records that goes beyond emergencies. 

Thanks very much. 

Senator KOHL. Thank you very much, Senator Carper. 

The hearing is very much focused on some of the points that you 

have just made. 

Now we would like to hear from Mrs. Cefalu.

9

STATEMENT OF JEAN CEFALU, SLIDELL, LA 

Ms. CEFALU. Senator Smith, Senator Kohl, and honorable U.S. 

Special Senate Committee on Aging members, thank you for the 

opportunity to allow me to share my experiences relative to the elderly in both the community and the long-term care populations 

that were affected directly or indirectly by Hurricane Katrina. 

While I was not practicing nursing at the time of the hurricane, 

the devastation caused by Katrina produced severe labor shortages, 

especially at nursing homes in the peripheral areas of New Orleans, Baton Rouge, and Shreveport. That is why I and many other 

nurses came out of retirement to help out. 

It was at one of these nursing homes that I met and informally 

adopted ‘‘Uncle Buzzy’’ and Maurice, who is with me here today. 

Several John and Jane Does came from New Orleans area nursing homes that were unprepared for the storm. They were evacuated at the last minute without identification, health histories, or 

medications. Many couldn’t tell us who they were or where they 

were from. Many were acutely ill on arrival and had to be shipped 

to the hospital. 

As I speak to you today, hundreds of evacuees are literally 

trapped in nursing homes around the State and probably other 

States. Since it is still undetermined when or if they can return to 

their homes, the vast majority of them are now helpless and don’t 

have the physical ability and/or the financial resources to rebuild 

their lives. 

The seniors who have returned are regular targets for unscrupulous individuals who prey on their trusting ways. Other evacuated 

seniors are having to pay out of their own back pockets to finance 

their nursing home stay, using up all of their savings and rendering it impossible to get back on their feet. 

In some cases, as with Maurice, they had large sums of money 

and personal possessions stolen at the very places that they sought 

shelter and protection. The experience I had after Katrina made 

me realize how delicate and fragile this population of advanced age 

seniors really is. Unlike you and I, they don’t bounce back. 

One organization that provided tremendous support and leadership to our area nursing homes that were either evacuated or took 

in evacuees is the Louisiana Health Care Review’s Nursing Home 

Quality Improvement Committee, authorized by CMS. 

They met regularly after Katrina via teleconference and onsite to 

the nursing home staff. My personal and heartfelt thanks goes out 

to one member in particular, Debbie Serio, who made herself available to meet day and night, along with regular visits to my nursing 

home after we lost the administrator, the director of nurses, and 

the medical director. I was the only RN in the facility for several 

weeks, and I couldn’t have done it without her. 

Over the last several months, this group has formulated a series 

of workforce recommendations, which is attached to my report. 

These recommendations are the culmination of several facilities’ experiences before, during, and after Katrina. This list is intended to 

assist nursing homes relative to evacuation procedures, as well as 

nursing homes who serve as evacuation shelters. 

One recommendation that I would like to make, based on my 

personal observation, is that elderly evacuees who are placed in 

10

nursing homes outside of a disaster area be granted a waiver of determination of eligibility for a period of at least 6 months. Any personal or financial assets accompanying the evacuee be secured in 

a safe place at the accepting facility to prevent financial abuse 

until conditions stabilize. 

It is my opinion that the evacuation process for nursing home 

residents in New Orleans was not adequate. It is a known fact that 

75 percent of those who died during and after Katrina were 75 

years of age or older. Appropriate and tested evacuation plans for 

seniors is a key to the prevention of elderly deaths in any disaster. 

But the evacuation plans can only go so far if we are not educated 

relative to geriatric issues. 

Every 5 minutes, information was broadcast all over the television and the radio where and when to evacuate. All you had to 

do was pick up the phone, and someone would come and pick you 

up. That wasn’t the problem. 

Why didn’t our seniors get on the bus to leave? The reason is our 

frail elderly would rather die in familiar surroundings than spend 

days in uncertainty and fear. 

Education of geriatric health care professionals in the State of 

Louisiana and the Nation should be a priority with aging baby 

boom upon us now. My husband, Dr. Charles Cefalu, is the chief 

of geriatrics at LSU Health Science Center in New Orleans. His 

program was located at Charity Hospital, which was damaged beyond repair. 

Thanks to the immediate and generous support of the American 

Geriatrics Society, the Gerontological Society of America, and the 

John A. Hartford Foundation, he was able to relocate his program 

to another LSU teaching hospital in Lafayette, LA, to serve the 

many immediate needs our seniors faced during the aftermath of 

Katrina. 

It is a shame that our State has only one teaching facility to 

train physicians and nurses in geriatric medicine. That is not the 

case in other States, where geriatric education is the norm and not 

the exception. Louisiana’s own congressmen and senators should be 

taking note of this. 

My final recommendation is that Congress reinstate Title 7 funding of geriatric education centers across the United States to address the need for educating geriatric health care professionals. 

Such centers can serve two unique purposes. 

The first is to train geriatric health care professionals relative to 

emergency preparedness, and the second would be to serve as a 

multi-institutional consortium. Depending on the effect of a disaster in a particular area, each of the members could serve as a 

coordinating center for the evacuation, post disaster assistance, 

and safe return of our senior citizens to their communities. 

Thank you. 

[The prepared statement of Ms. Cefalu follows:]

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Senator KOHL. Thank you very much for your excellent testimony. 

Mr. Frisella, we will start with a question for you. It is very important for us to learn from seniors like yourself, who have experienced such a disaster. As a senior living independently, do you feel 

that you were given appropriate information to help you prepare 

for Hurricane Katrina before it struck? 

Mr. FRISELLA. No, I wasn’t fully aware of it. But I knew the hurricane was coming. But as I said, we survived other hurricanes, 

and I didn’t give it that much attention. 

Senator KOHL. Did you get any information in advance at all? 

Mr. FRISELLA. Some on the television or the radio, but I didn’t 

keep the television and the radio on constantly. 

Senator KOHL. So there was no preparation that was given out 

to you to be aware of the fact that disasters may happen, and when 

they happen, the following things should be done? That kind of advance preparation was not in evidence at all? 

Mr. FRISELLA. No, Senator. No, sir. 

Senator KOHL. Tell us, in the months since Hurricane Katrina, 

Mr. Frisella, have you been given direction and assistance that you 

need to get back to where you were before the storm occurred? 

Mr. FRISELLA. Well, I would like to see the old house repaired. 

It didn’t have water damage. It had wind damage. When they constructed that house, it probably had an outhouse on the side of it. 

So the bathroom was built on the side of the house and attached 

to the house. 

So when the wind came from that back alley, it blew the bathroom back this way in the downpour, and it collapsed. That is all 

I can tell you. 

Senator KOHL. All right. 

Mr. FRISELLA. That is enough. 

Senator KOHL. Thank you. 

Mrs. Cefalu, I didn’t get that percentage figure on the number 

of seniors——

Ms. CEFALU. Seventy-five. 

Senator KOHL. Who were——

Ms. CEFALU. Seventy-five percent of the people who died in Hurricane Katrina were 75 years or older, either during or in the aftermath. 

Senator KOHL. Seventy-five percent? 

Ms. CEFALU. Mm-hmm. 

Senator KOHL. Wow. In your opinion, what were the Government’s greatest shortcomings in responding to the needs of seniors 

during Katrina? 

Ms. CEFALU. Not laying blame on anybody because I am not sure 

how the Government really works, but it was too late. Next time, 

immediate help. Not waiting 3 or 4 days. That was a big thing. 

Senator KOHL. Would you say that there is an urgent need for 

advance preparation——

Mr. FRISELLA. Yes. 

Senator KOHL [continuing]. Considering that we will be having 

additional catastrophes in the future? 

Ms. CEFALU. Oh, yes. Definitely. But we also have to realize because of the ages of our older citizens, we have to prepare that they 

15

are not going to leave in the event of another disaster, and we 

must be prepared to move in quickly after the disaster and locate 

where they are. 

Just because of the reasons of not leaving their cat or——

Mr. FRISELLA. The cat, yes. 

Ms. CEFALU [continuing]. Food, medicines, clothing, doctor, their 

familiar surroundings. That is a reality. Unless we drag them out, 

they are not going to go. 

Senator KOHL. That is a good point. 

Mr. Frisella. 

Mr. FRISELLA. Could we do something about the pets? I had to 

leave my pet there. People, if you have a pet, it is like a child, and 

you love that thing. 

Senator KOHL. Very well said. 

Mr. FRISELLA. Yes. May I be so egotistical as to read my poem? 

Senator KOHL. Certainly. Go right ahead, sir. 

Mr. FRISELLA. OK. It is called the ‘‘Curve in Crisis Care.’’ The 

curve is in Mississippi. The curve is the Crescent City. 

O immortal day, let us pray. Swamp of that mighty stream. The 

suffering of that horrible dream. The matters of the wind as cruel 

as the lash before his cross, the bewailing of our loss. 

We sigh, cry with the angels. Beg powers that be, help us. Peter, 

open paradise. How that storm has cast that fatal dice. 

Our curve and that stream is holy. Holy is joyful. Joyful is no 

sin. We wait for those saints to come to begin. 

Clean up, buck up. Swagger in high style, old pal, down brightlighted canal. Dear old South land, how grand. No tears, no cheers. 

Time for jubilation. New Orleans is the doorway to our Nation. 

What do you think? 

Senator KOHL. I think that is beautiful. 

The CHAIRMAN. That is great. 

Senator KOHL. That is beautiful. We thank you. 

Now we turn to our Chairman, Senator Smith, for his questions 

and comments. 

The CHAIRMAN. Jean, you had a remarkable statement in your 

testimony that seniors would rather die than evacuate, and it is a 

shocking thing that 75 percent of the deaths in Katrina were 

among the elderly. 

Do you think that that decision that they would rather die than 

evacuate, would that change if there were better preparation, better education, better certainty that the seniors knew they had a 

place to go and that there was a home to return to? 

Ms. CEFALU. Actually, yes. But I am not an expert in that area. 

A lot of people and a lot of the seniors evacuated had the questions of the pets. They are like children. A mother wouldn’t leave 

her child. An elderly person is not going to leave their pet. 

They have medications. It was on August 29 right? 

The CHAIRMAN. Yes. 

Ms. CEFALU. On the 1st, the Social Security checks come in. 

Many disadvantaged, you know, elderly wait for those checks. If 

they don’t get them when they come in the mailbox, somebody else 

is going to take them. 

One month without a check, they can’t pay for food. They can’t 

pay their light bills. Not they couldn’t think that there is not going 

16

to be any lights any way, but they need that money. They can’t 

leave without their money. They don’t have high finances. 

Where were they going to go? A lot of seniors, you know, your 

parents, they can’t sit in cars for long periods of time. There is no 

bathrooms on school buses. If anyone has had any more than three 

children, the women in here, you will know that when you have got 

to go, you have got to go. It would be highly humiliating to people 

to have an accident on a crowded school bus. 

There are many reasons. So I am not really an expert on that, 

but these are the reasons that they are not going to go. A lot of 

them did. But most of our frailest elderly, they didn’t. 

The CHAIRMAN. But did they make, in the face of the evacuation 

order, was there a conscious decision made that ‘‘I am just going 

to ride this out?’’ Ms. Cefalu. I believe so. 

The CHAIRMAN. Maybe that question should be asked to Maurice, 

and I loved your poem. But Maurice, you made the decision to stay 

based on your previous experience in hurricanes. You had survived 

them all, and yet I suspect you decided to stay in face of an evacuation order because your experience, your place, your pet, all of 

these things, you just said, ‘‘I will—’’ Mr. Frisella. The house was 

so strong. I wasn’t aware that the storm was that severe until I 

heard the crash of the bathroom going down, and I had to investigate what is going on. 

The CHAIRMAN. Is there anything that the government at the 

local, State, and Federal level could have done to cause you to 

make a decision to evacuate? 

Mr. FRISELLA. I wouldn’t know how to answer that. Please, honestly. I wouldn’t know how to answer that. 

The CHAIRMAN. That is really, I mean, I guess our responsibility—not I guess. Our responsibility of Government is to make 

sure that you have a decision to make that is informed, and you 

have some certitude as to what is going to happen to you in the 

evacuation. How your most treasured aspects of life, maybe even 

a pet—I don’t know—can be saved in all of this. 

Mr. FRISELLA. My family lived in that house for over 60 years, 

100 years in that parish. I didn’t want to leave the house. I growed 

into the house and grow young with the house. 

The CHAIRMAN. So you might have made the decision, even if the 

Government had done everything perfectly, you would have made 

the decision to stay? 

Mr. FRISELLA. Stay put. 

The CHAIRMAN. Thank you, Mr. Chairman. 

Senator KOHL. Yes. Just to follow up on that with Mrs. Cefalu. 

If, in fact, seniors are determined to ride it out even in the face of 

catastrophe, what can the Government do? 

Ms. CEFALU. Well, I was talking with some of the other people 

that are going to be on the panel in just a little bit about ideas. 

If it wasn’t for the HIPAA laws that maybe something—I am not 

an expert. Maybe anyone on Social Security disability, their names 

could be given to local fire districts so that you would at least know 

geographically where they were located. So that after the storm, 

you could pinpoint in priority areas to search first, to check to help 

them out. I don’t know. 

17

Senator KOHL. Would you say that if we were going to make meticulous preparation, we need to pinpoint where our seniors are, 

each and every one? Then, in the immediate aftermath of a catastrophe, go to each——

Ms. CEFALU. I was thinking local fire departments. This is just 

off my head. Local fire departments in their fire districts, if they 

had the information on where the seniors were, maybe it is possible 

that once a year, there could be some contact. Do you have a place 

to go? Are you going to stay? Do you have family? 

We could locate, you know, the people like Maurice that aren’t 

going to leave. Because there was also several other people, elderly 

people in his neighborhood that didn’t leave either and are still 

there to this day, and they lived it out. 

So at least we would know where they were, where to go look for 

them. 

Senator KOHL. Very good. 

Well, we thank you both for being here today, and you provided—oh, Senator Collins is here. I am sorry. 

Before we move on, we would like to hear from Senator Collins 

for her comments and whatever thoughts, questions you have. 

Senator COLLINS. Thank you. 

I thought I showed up today in yellow, you know, so that people 

would see me. 

But first, let me thank you both for holding this hearing. The 

Homeland Security Committee, which I chair, spent 7 months looking at the preparation for and response to Hurricane Katrina, and 

we held 22 hearings. Of all those hearings, the one that bothered 

me the most was when we heard about nursing homes not being 

evacuated, and we learned that those left behind were primarily elderly and people with special needs. That troubled me so much. 

There was a real contrast between Mississippi and Louisiana in 

that regard because Mississippi forced the nursing homes to evacuate their patients. Louisiana chose not to. The result in Louisiana—and let me say I recognize that it is very difficult to evacuate fragile patients from nursing homes, and there are risks in 

that. 

But if you look at the outcome, you did not have the deaths 

among nursing home patients in Mississippi that you had in Louisiana. So, Ms. Cefalu, I wanted to start my questioning with you. 

Because you mentioned in your written statement, and I apologize 

for not being here earlier, that the evacuation process for nursing 

homes was inadequate. 

Have you seen a change post Katrina at the facility level in the 

area of emergency preparedness and response? For example, have 

there been discussions at the Ascension Care Center, and has the 

staff worked out what you think is a feasible evacuation plan for 

the facility? 

Ms. CEFALU. Absolutely not, Senator. Nothing. 

We have a book. Most nursing homes have a book. The evacuation book. When the State surveyors came in, they asked me 

where the book was. Since I was just filling in for the director of 

nurses, we found the book. Thank God. Never read the book. Embarrassing as it is, that is a reality. 

18

I live in St. Tammany Parish. St. Tammany Parish nursing 

homes have a volunteer emergency preparedness coordinator, Kim 

Harbison. We didn’t lose anyone in St. Tammany Parish. We were 

evacuated like Mississippi because St. Tammany Parish evacuated 

as a parish to one school. It was pre-prepared, and everything was 

there. 

New Orleans, however, I believe it leaves it up—I am not the expert. I believe they leave it up to the individual nursing homes. 

Senator COLLINS. They do. 

Ms. CEFALU. In a large metropolitan area, you can’t do that. You 

can’t call them 72 hours before a disaster is in the Gulf or anywhere, mudslides, anything, and say you need some help because 

everybody is busy with their own preparedness. 

Also, that quick in New Orleans, you lose your employees. Without employees, you have no manpower to move everybody. So, no, 

New Orleans is far behind. 

Senator COLLINS. One of the recommendations that we have 

made in our report is that not only should every nursing home and 

hospital be required to have an evacuation plan, but that there 

should be an audit of it by the State once a year to make sure it 

exists, to make sure that people have read it, trained for it because 

this isn’t something that does you much good if it is just on paper. 

You have to do the exercises and the training as well. 

But I think this is a huge issue. Of all the issue we looked it, 

it was the one that troubled me so much. So I am so glad you are 

doing follow-up on this issue. The more attention we can have, the 

better. 

I also want to follow up on the issue that both Senator Kohl and 

Senator Smith and our witnesses have raised about how do you 

know where those individuals with special medical needs or who 

our elderly are? We, again, have recommended exactly what you 

have instinctively suggested, and that is that there be lists of special needs patients, individuals who rely on, who need electricity——

Ms. CEFALU. Oxygen. 

Senator Collins [continuing]. For their medical needs and that 

first responder agencies—the police, the firefighters—have those 

lists, and that is a lot of work. It takes a lot of updating, obviously. 

But I think it would make a real difference so that when disaster 

strikes, we know who the vulnerable are, and we can send first responders. There has been so much discussion in the response to the 

Gulf that it was somehow race based on who got left behind. It 

wasn’t. It was age based is what it was. 

It was those who were elderly, regardless of their race, who were 

left behind. It was those with special medical needs who were left 

behind, and it was those who could not evacuate themselves, for 

whatever reason, who were left behind. 

So I don’t mean to take up too much time here, but thank you 

for holding this hearing. Thank you both for your testimony. 

I also want to say that Mr. Frisella’s point about the pets was 

another issue that we found was very important. We had a mayor 

of a town in North Dakota come before us and say that you have 

to tell people to bring their pets, their pillows, and their pills. I 

thought that was a wonderful way——

19

Ms. CEFALU. Pampers. 

Senator Collins [continuing]. To sum up, and we have got to be 

realistic about that. We have got to make sure that there are shelters that are prepared to take people with pets and to take people 

with special needs, and that wasn’t the case with Katrina. 

So thank you for the work you are doing. 

The CHAIRMAN. I think the sound bite of the day is ‘‘pets, pills, 

pillows, and pampers.’’ 

Senator KOHL. That is great. Well, we thank you, Senator Collins. 

You know, your point that it was age based and not race based 

was made dramatically by Mrs. Cefalu in her testimony. She said 

that of those who perished, 75 percent——

Ms. CEFALU. Yes, sir. 

Senator KOHL [continuing]. Were 75 years or older. 

Ms. CEFALU. My husband gave me those statistics. Don’t hold me 

to them. 

Senator COLLINS. That is stunning. It really is. 

Senator KOHL. It is stunning. 

Senator COLLINS. Thank you. 

Ms. CEFALU. Thank you very much. 

Senator KOHL. Well, we thank you both for coming. As you can 

see, you have made a big difference, and you have made an impact 

on us all. 

Ms. CEFALU. Thank you very much. 

Mr. FRISELLA. Thank you very much. 

Senator KOHL. So we turn now to our second panel. Our first witness will be Dan Sutherland of the Department of Homeland Security. Mr. Sutherland is the officer for the Office of Civil Rights and 

Civil Liberties. He also heads up DHS’s Interagency Coordinating 

Council on Emergency Preparedness and Individuals with Disabilities. 

Mr. Sutherland is here to tell us of the department’s efforts to 

prepare for the needs of seniors in the event of a national emergency. 

Second witness will be Cindy Bascetta of the Government Accountability Office. Ms. Bascetta is director of the health group at 

GAO and will be telling us about GAO’s findings and recommendations on senior emergency preparedness. 

Next we will hear from Amy Aiken, the assistant director of the 

Miami-Dade Office of Emergency Management. Ms. Aiken is here 

to tell us about the initiatives her office is conducting to meet seniors’ needs in an emergency. 

Finally, we would like to welcome Carmel Dyer of the Baylor College of Medicine. Dr. Dyer is a geriatrician and directs the geriatrics program for the Harris County Hospital District. She is here 

to tell us about her research and her recommendations on emergency preparedness for seniors. 

We thank you all for being here. Mr. Sutherland, we will hear 

from you first. 

20

STATEMENT OF DANIEL W. SUTHERLAND, OFFICER, OFFICE 

OF CIVIL RIGHTS AND CIVIL LIBERTIES AND CHAIR, INTERAGENCY COORDINATING COUNCIL ON EMERGENCY 

PREPAREDNESS AND INDIVIDUALS WITH DISABILITIES, DEPARTMENT OF HOMELAND SECURITY, WASHINGTON, DC 

Mr. SUTHERLAND. Thank you. I want to thank Senator Kohl and 

Senator Smith and the members of the Senate Special Committee 

on Aging for inviting me to testify on this extremely important 

topic today. 

The oversight in this area is very important and very welcome, 

and I just wanted to start by saying that we are enthusiastic about 

the recommendations that you outlined today. We will aggressively 

pursue them and will be very glad to sit and talk with you in the 

upcoming weeks and months so that you can be assured that we 

are really aggressively pursuing those recommendations. 

I am testifying today in my capacity as the officer for civil rights 

and civil liberties at the Department of Homeland Security. Our office is responsible for advising the leadership of our department on 

issues at the intersection of homeland security and civil rights and 

civil liberties. 

But I am also testifying in my capacity as the chair of the Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities. Our council was created by an executive 

order that the President signed in July 2004. We have over 20 Federal agencies who are working aggressively on these issues. We 

have divided our work into nine key areas, such as emergency communications issues, transportation issues, evacuation issues. 

For the purposes of our work as a council, ‘‘disability’’ applies to 

a broad range of people, including individuals who use wheelchairs, 

crutches, or walkers because of physical or mobility impairments. 

Individuals who are blind or who have low vision. Individuals who 

are deaf or hard of hearing or deaf/blind. Individuals who have arthritis and diabetes. Individuals who need oxygen because of respiratory conditions. Individuals with cognitive disabilities, dementia, including Alzheimer’s disease and other mental illnesses. Individuals who live in nursing homes and assisted living centers and 

those with other physical or mental impairments that substantially 

limit a major life activity. 

We recognize that there are certainly many seniors who don’t fall 

in these categories. However, the most vulnerable older Americans 

do fall within these categories and are a primary subject of our 

interagency council’s work. In our first 2 years of operation, almost 

2 years of operation, our council has met several significant milestones. 

For example, we are participating now in the national plan review, which is a review of the emergency preparedness plans of all 

the States and the largest urban areas in the country. We are also 

participating in a number of hurricane preparedness exercises with 

experts, specifically focused on disability and aging issues. We have 

developed a Web-based resource center of educational materials, 

which I can refer to you later. We have also published a report on 

evacuation issues. 

When the hurricanes made landfall, our council immediately became a focal point for pleas for help and offers of support. We 

21

quickly formed what we call an incident management team of a 

number of people across the Federal Government who work on 

these issues, and we met regularly day after day with people in the 

region, by telephone or in person, and as a Federal incident management team. 

So, I would just take a few minutes to identify for you what we 

saw as the major issues that resulted from the hurricanes as they 

affected seniors in the disability community. First, the availability 

of durable medical equipment was a major issue. In other words, 

people who had wheelchairs, crutches, walkers, hearing aids, even 

hearing aid batteries, these things were lost during the evacuation. 

Second, evacuation was a major issue, and we have already 

heard and discussed that. That was particularly true of those who 

lived in institutional settings. 

The third major issue we saw was access to life-sustaining medications. People had to evacuate without adequate supplies of insulin, heart medicines, drugs for epilepsy, medicine for mental illnesses, and other things. 

The council’s incident management team received a lot of calls 

about pharmacies out of State that would not respect or honor requests for medicines that came from people who had cards from the 

States of Louisiana and Mississippi. 

One of the leaders in our interagency council is Dr. Peg Giannini, 

who is sitting here in the front row. She leads the Department of 

Health and Human Service Office of Disability Policy. Because she 

was involved in our council and saw the issue, she was able to go 

to the leadership of the Centers for Medicaid and Medicare Services, who immediately issued guidance instructing pharmacies to 

respect those cards and honor those cards, and that they would be 

able to reimburse for those expenses. 

The next major issue is shelters, and the final issue I wanted to 

point out was accessible housing was a major issue. We began to 

realize that mobile homes, the manufactured homes that were 

being provided were not accessible. A person with a significant mobility impairment often could not get into the front door of many 

of these types of mobile homes they were making available. Once 

there, you may not be able to reach faucets, closets, or even get 

into bathrooms or bedrooms. 

Secretary Chertoff directed us to send an expert on disability 

issues to Admiral Allen’s staff in Baton Rouge and to Admiral 

Hereth’s staff in Austin. We sent an expert there who worked for 

several weeks primarily on these accessibility issues. Along with 

colleagues from HUD and the Department of Justice, we were able 

to change the specifications that FEMA was writing for the mobile 

homes to incorporate a number of accessibility features. 

Now let me just turn to some ways that the department and our 

interagency council is trying to address some of the issues with regard to seniors. The Departments of Homeland Security and 

Health and Human Services are co-sponsoring a large, Nation-wide 

conference on emergency management and individuals with disabilities and the elderly. 

This conference is going to be held here in Washington, June 28 

through 30th. I personally have done probably 10 conferences since 

Katrina, and we are all tired of conferences. So we decided, though, 

22

what we needed to have was we needed to get the people who do 

emergency planning and the people who are responsible for the 

aging community and the disability community in the room at one 

time. 

So what we have asked each Governor to do is send a delegation—someone from the State homeland security advisor; someone 

from the emergency planning or management officials, whoever 

they would want to designate; someone from the State aging committee; and someone from the Governor’s special needs committee—and sit as a delegation. 

We have asked the Governors to expect that delegation to come 

back with concrete work products that will show that they are 

making changes. 

Second, we have included an expert on aging and emergency preparedness in our national plan review team. We expect that that 

NPR report, which will be issued to Congress and to the States, 

will be a catalyst for some very significant improvements on these 

issues. 

Third, we participated in a roundtable on seniors and emergency 

issues held by the AARP. I saw that outside they have issued a report on that conference that they held. We have contacted AARP 

in hopes of working with them. 

Senator, you referred to materials, technical assistance 

materials. We have created a resource center at 

www.disabilitypreparedness.gov. There we have tried to accumulate a lot of disability or senior aging specific documents and guides 

there. 

We have got documents from a lot of different organizations. But 

specifically on seniors, we have one page there, and there are documents from the U.S. Fire Administration, a report written by the 

International Longevity Center of the USA, and materials from 

AARP. We are anxious to find additional materials. 

The department’s ready.gov initiative focuses or includes materials on seniors, and we are working on additional materials that 

ready.gov will be preparing, focusing specifically on the aging population. 

Finally, the Citizen Corps gives training to seniors all over the 

country, and our Community Emergency Response Team (CERT) 

training includes instruction on identifying and assisting seniors. 

In conclusion, I just want to say again that the Committee’s oversight of these issues is very much welcomed. These are issues that 

Secretary Chertoff personally is very interested in and focused on 

and asked for direct reports from me on how we are making 

progress on specific items on a very regular basis. 

So, we welcome your oversight and your interest in this, and I 

appreciate the chance to testify. Thank you. 

[The prepared statement of Mr. Sutherland follows:]

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Senator KOHL. Thank you very much, Mr. Sutherland. 

Now we will hear from Ms. Bascetta. 

STATEMENT OF CYNTHIA BASCETTA, DIRECTOR, HEALTH 

CARE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE, WASHINGTON, DC 

Ms. BASCETTA. Senator Kohl and Senator Collins, thank you for 

the opportunity to discuss our ongoing work on the evacuation of 

vulnerable populations due to hurricanes and other disasters. 

As you know, Hurricane Katrina highlighted the dire situation of 

hospital patients and nursing home residents who needed to be 

evacuated, as well as the vulnerabilities of transportation-disadvantaged people living in their own homes, especially the elderly 

and persons with disabilities. 

My remarks today focus on the challenges faced by States and 

localities and hospital and nursing home administrators facing 

evacuations, as well as a limit that we identified in the design of 

the National Disaster Medical System. 

My testimony is based onsite visits to Florida, Mississippi, California, and New York; numerous interviews with local, State, and 

Federal officials; and reviews of documents such as State emergency management plans and recently issued reports on the response to Hurricane Katrina. 

Our early work shows that States and localities face challenges 

in identifying transportation-disadvantaged populations, determining their needs, and providing for and coordinating their transportation. Compared to the general population, the elderly are 

more likely to have a disability, low income, or to choose not to 

drive. Meeting their diverse needs requires additional planning, 

time, and resources. 

For example, evacuating seniors with special medical needs could 

necessitate additional pickup routes, extra time to load and unload 

vehicles, and special resources, such as buses equipped with wheelchair lifts. 

So far in our review, we have noted that some emergency management officials did not yet have a good understanding of the dimensions of their transportation-disadvantaged populations. They, 

themselves, also acknowledged the need to better integrate them 

into emergency response planning. 

On the other hand, in some locations, emergency management officials have tried to better prepare vulnerable populations through 

community outreach activities or by working with home health organizations, physicians, and the Red Cross. Notably, one location 

with a very well developed program encouraged citizens with special medical needs to voluntarily register, and they also involved 

social service providers in emergency planning. 

Hospital and nursing home administrators face challenges 

whether they decide to evacuate or to shelter in place. Because of 

the risks associated with moving sick and frail people, sheltering 

in place is their preferred alternative. But this requires ensuring 

sufficient staff and resources are available to provide care during 

and in the aftermath of the storm until help can arrive. 

Evacuation is always a last resort and requires securing sufficient and adequate transportation. In the event of widespread disVerDate 0ct 09 2002 11:19 Sep 14, 2006 Jkt 000000 PO 00000 Frm 00040 Fmt 6633 Sfmt 6633 H:\DOCS\28924.TXT SAGING1 PsN: JOYCE
37

aster, we learned that local transportation contractors would be unlikely to have adequate capacity to meet the demand or might not 

have appropriate vehicles. 

One nursing home administrator told us, for example, that its 

contractor supplied regular buses, but its residents needed power 

lifts to accommodate their wheelchairs. A particular challenge for 

nursing homes that must evacuate is finding receiving facilities 

that can take their residents for potentially very long periods of 

time. 

One Florida nursing home had to relocate its residents for over 

10 months while its facility was being repaired. We also found that 

nursing home administrators can’t reduce the number of residents 

in their facilities because these residents have no other home in the 

community, and they can’t care for themselves. In contrast, hospitals discharge as many patients as possible before an anticipated 

emergency. 

In our review, we also examined NDMS the National Disaster 

Medical System, a partnership of DOD, HHS, VA, and DHS that 

supplements State and local emergency response capabilities with 

Federal resources and services. NDMS supports the evacuations of 

patients needing hospital care by assisting in efforts to move patients from a mobilization center, such as an airport near the incident, to reception areas in other locations away from the disaster. 

NDMS agreements with participating hospitals give them the opportunity to be assured that the patients that they are moving can 

be put into an NDMS hospital and receive the continuing hospital 

care that they need. 

However, we found that NDMS was neither designed nor is it 

currently configured to assist in the evacuation of nursing home 

residents. While NDMS supported evacuation efforts that included 

nursing home residents during the recent hurricanes, it does not 

have agreements with nursing homes to receive evacuees. 

Our ongoing work will continue to examine ways to reduce the 

vulnerabilities of hospital patients, nursing home residents, and 

transportation-disadvantaged people. The need for improvement is 

obviously urgent with hurricane season just around the corner. 

I would be happy to answer any questions that you might have. 

[The prepared statement of Ms. Bascetta follows:]

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Senator KOHL. We thank you very much for your testimony. 

We would like to hear from Amy Aiken right now. 

Senator NELSON. Mr. Chairman? Before——

Senator KOHL. Senator Nelson, go right ahead. 

Senator NELSON. If I could say, because Ms. Aiken is from Florida, and we have a little bit of experience in hurricanes in Florida, 

and it is starting very shortly with the season starting June 1. I 

just want to say, before she testifies, that they have really gotten 

ahead of this down there. 

Now we had a painful experience a long time ago, 1992. A mega 

hurricane, Hurricane Andrew. There were a lot of mistakes made. 

We learned from those mistakes. Then we were hit with 4 hurricanes within a 6-weeks period just 2 years ago in 2004. 

So, Florida, of necessity, has had to get out in front of this. What 

they do is they map out where senior citizens are so that they have 

a location that by the time that they are ready to evacuate, they 

have predetermined locations to take buses to, to get senior citizens 

evacuated. 

I wanted to compliment Amy and Miami-Dade County and what 

they have been doing. That is why I wanted to come over here. I 

have got to run back to another committee meeting right now, but 

I wanted to state that for the record. 

Senator KOHL. We thank you very much, and that is a very important point in this whole question of preparedness is advance 

work, as you are pointing out, to be sure. Once the hurricane hits, 

if we haven’t prepared, it is really too late, isn’t it? 

Senator NELSON. Especially in a peninsula like Florida, where 

you have 6 million people living in south Florida, and here comes 

the hurricane. Of course, the natural tendency of people are is to 

wait until the last minute because they are so accustomed to thinking that it is suddenly going to veer and go off in a different direction, and then people wanting to get out of Dodge. Then, of course, 

it is gridlock with the few exit routes that are available. 

You know, even in north Florida back in the late 1990’s—and I 

lived through all of this because, at the time, I was a member of 

the Florida cabinet, which also, as State treasurer, was insurance 

commissioner. So I was involved in this up to my eyeballs. 

We had an evacuation with a storm headed toward north Florida, 

Jacksonville. It ultimately veered off. But in an evacuation 2 days 

before, it was total gridlock. People could not move. 

That finally prompted the Florida Highway Patrol to work out a 

plan where they could make the interstate all one way. But you 

can imagine the frustration of sitting in gridlock not going anywhere for 12 hours on 2 lanes of the interstate while the other 2 

lanes, there is no traffic whatsoever. 

So, there are a lot of things that we have had to confront but, 

fortunately, are finally getting our arms around it. 

I would just say, Mr. Chairman, as we approach June 1 of this 

year, hurricane season, thank goodness I am not insurance commissioner anymore. [Laughter.] 

Senator KOHL. Great. Thank you so much, Senator Nelson. 

Amy, we would like to hear from you. 

56

STATEMENT OF AMY B. AIKEN, ASSISTANT DIRECTOR, MIAMIDADE OFFICE OF EMERGENCY MANAGEMENT, MIAMI, FL 

Ms. AIKEN. Thank you, Senator. 

Good morning, Mr. Chairman and members of the Committee. I 

would like to thank you for this opportunity to share some of 

Miami-Dade County’s disaster preparedness initiatives, particularly as they relate to our seniors. 

I would also like to commend you, Senator Kohl and Senator 

Smith, and the members of this Committee for convening this hearing that is seeking to move forward disaster preparedness for seniors. 

During the 2004 hurricane season, Miami-Dade County activated 

its emergency operations center four times for hurricanes. We did 

it again four more times in 2005. So we have had some practice. 

While many of the initiatives about which I will speak today 

were developed because of our experience with hurricanes, MiamiDade County utilizes an all-hazards approach for emergency management. It must be ready for any disaster, not just hurricanes. 

One of the principal lessons learned from the 2005 hurricane season was that no matter what happens in the county, it is and will 

ultimately be the county’s responsibility to respond to and recover 

from any disaster that affects its most vulnerable residents. 

Back-to-back storms within a matter of weeks and widespread 

extended power outages in 2005 raised our awareness that the programs Miami-Dade County already had in place were inadequate 

to care for our most vulnerable residents, particularly our seniors 

during a disaster. 

Many nongovernmental agencies and individuals seek to assist, 

but if this assistance is not well coordinated, it may lead to duplication of efforts and gaps in services. Volunteer Organizations Active in Disaster, or VOAD, a national program, exists to coordinate 

such efforts. Miami-Dade County is reestablishing its VOAD program. 

Many of the calls received by our 311 call center during activation came from residents, particularly seniors who simply needed 

reassurance. Miami-Dade County has since established a telephone 

reassurance program, letting individuals know that they are not 

alone during times of disaster. 

Florida law mandates that all assisted living facilities and nursing homes have disaster plans in place that are reviewed by their 

respective county’s office of emergency management and are enforced by the Agency for Health Care Administration. 

Florida law also mandates that each county maintains a special 

needs registry. These are data bases of homebound seniors who 

may need assistance with daily living, require skilled nursing care, 

or need life-saving medical equipment dependent upon electricity. 

Realizing that many residents, in particular seniors, will not 

evacuate without their pets, Miami-Dade County opened its first 

pet-friendly shelter last year and is working with Miami-Dade 

County Public Schools to identify additional locations for petfriendly shelters throughout the county. 

Low-income elderly residents in Miami-Dade County can take advantage of the county’s residential shuttering program. This proVerDate 0ct 09 2002 11:19 Sep 14, 2006 Jkt 000000 PO 00000 Frm 00060 Fmt 6633 Sfmt 6633 H:\DOCS\28924.TXT SAGING1 PsN: JOYCE
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gram enables homeowners to receive custom-made shutters at no 

cost and assistance, if needed, to put up and take down the panels. 

South Florida has the most stringent building codes in the Nation for wind storm protection. Other hurricane-prone areas should 

be encouraged to revisit their building codes and consider replicating south Florida’s. Areas prone to other types of disasters, such 

as earthquakes, wildfires, or flooding, should consider a review and 

possible strengthening of building codes specific to the disasters 

most likely to occur in that particular area. Building codes work. 

In addition to its stringent building codes, Miami-Dade County’s local mitigation strategy has completed $36 million in wind storm 

mitigation projects and another $128 million in flood mitigation. 

Hundreds more projects are already in progress or under development. 

During the 2004 and 2005 hurricane seasons, not a single facility 

mitigated through the LMS incurred any damage other than a few 

loose roof tiles or scraped paint. Mitigation works. 

Miami-Dade County has learned that the only way to ensure the 

prompt coordinated response that our community has come to expect and deserves is to continue to strengthen partnerships with 

local, State, and Federal Government agencies; public and private 

agencies; nonprofit organizations; and, most importantly, our 2.5 

million residents. Disaster preparedness is everyone’s responsibility. 

However, all cities, counties, and States are not the same, and 

these differences must be considered throughout all phases of 

emergency management from preparedness and mitigation to response and recovery. 

I invite you, Mr. Chairman, and members of this Committee to 

visit Miami-Dade’s emergency operations center. Senator Nelson 

and Senator Martinez, both from our State, have been there many 

times, and we look forward to visits from you and other members 

of this Committee. 

Miami-Dade County is ready and willing to share and learn from 

any efforts that will enhance disaster preparedness for all. 

Thank you again for this opportunity to be a part of a process 

that is seeking to move forward disaster preparedness for our seniors. 

[The prepared statement of Ms. Aiken follows:]

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Senator KOHL. Thank you. That is a very fine statement, and I 

would like to return to you after we hear now from Dr. Dyer. 

STATEMENT OF CARMEL BITONDO DYER, M.D., ASSOCIATE 

PROFESSOR OF MEDICINE, DIRECTOR, BAYLOR COLLEGE 

OF MEDICINE GERIATRICS PROGRAM AT THE HARRIS COUNTY HOSPITAL DISTRICT, HOUSTON, TX 

Dr. DYER. Good morning, Ranking Member Kohl. I appreciate the 

fact that you are holding this hearing and for the opportunity to 

testify today. 

I am Dr. Carmel Bitondo Dyer, and I am a geriatrician from 

Baylor College of Medicine, a member of the American Geriatric 

Society, and chief of geriatrics at the Harris County Hospital District. 

You may know that the American Red Cross set up the shelter 

facilities for Katrina evacuees in Houston, and the Harris County 

Hospital District set up a comprehensive MASH unit for medical 

treatment for the Katrina evacuees. 

What you may not know is that 56 percent of those seen in the 

medical MASH unit were over the age of 65. I had the privilege of 

caring for a number of senior Katrina survivors, and I would like 

to share with you today an onsite solution we developed and some 

recommendations that we have since formulated. 

In Houston, we saw confused, disoriented people who didn’t even 

know where they were, bilateral amputees and wheelchair-bound 

patients who couldn’t access the bathing facilities on the second 

floor. We saw seniors exploited when their FEMA checks were stolen, and we saw people promised suitable housing that wasn’t. 

Also, the cognitively impaired and functionally impaired people 

were just interspersed among the 20,000 other folks that were staying in the shelter. 

Now we are not critical of the valiant efforts made in Houston. 

The real mistake would be not to learn from those experiences. So, 

I would humbly like to recommend a few things. 

The first is that in any disaster shelter situation that there be 

separate sites for seniors to facilitate service delivery. 

The second recommendation is that we must build in protections 

for fraud and abuse. For instance, these special list patients that 

are being circulated, they cannot get in the hands of predators. 

The third is that we must develop a common language to use 

across jurisdictions. So how do we know that the special needs persons in Texas are defined in the same way as they are in Florida? 

We have developed such a tool called the SWIFT, and you may 

have copies of it in front of you, Seniors Without Families Triage. 

What we did onsite in Houston was to categorize the seniors that 

were impaired into three groups—mild, moderate, and markedly 

impaired—so that we could determine type of services that they 

needed. It takes only 5 minutes to administer, and it was used all 

across the State in different shelters. 

What we are recommending is that this tool be adopted Nation 

wide, and it can be used in the pre- and the post disaster period. 

The last recommendation I would like to make is that more geriatricians and gerontologists be involved in these disaster preparedness efforts. I mean, nobody would put together a public health 

71

program for children without tapping the expertise of pediatricians. 

Nor should we put together emergency care plans that involve seniors without consulting geriatricians and gerontologists. 

Geriatricians and gerontologists should be involved in every aspect of emergency care, including planning, care delivery, and 

training of the front-line workers. Of course, there is not quite 

enough of us to go around. 

These and other recommendations are going to be published by 

us in just a few weeks in conjunction with the American Medical 

Association and the AARP. We support Resolution 25 of the 2005 

White House Conference on Aging, which calls for coordinated Federal response. 

On behalf of the SWIFT team and the American Geriatric Society, I want to thank you for holding this hearing. Also we hope 

that this testimony helps the Federal effort to devise an emergency 

preparedness plan that both anticipates and meets the needs of 

America’s seniors. 

Thank you. 

[The prepared statement of Dr. Dyer follows:]

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Senator KOHL. Very good statement. We appreciate it very much, 

and we will return to you in a minute. 

Mr. Sutherland, we understand that the Department of Homeland Security includes seniors under the umbrella of individuals 

with disabilities when planning for emergencies. Surely you would 

agree that while some seniors are disabled, many older people—

like Maurice from our first panel—are not. They might and most 

probably do live alone, or they need help with transportation or 

supplies, and they are not disabled. 

So why would the DHS group all seniors into the same category 

as disabled? What steps is DHS taking to include those seniors who 

are not disabled, but obviously will be in great need in an emergency? 

Mr. SUTHERLAND. Thank you, Senator. 

The department looks at preparedness across the entire population. In our context, www.disabilitypreparedness.gov, there is a 

page that relates to seniors. It is the information that is contained 

there would not relate just to seniors with disabilities, but would 

contain information that relates to all seniors. 

So we need to make sure that that information is available in 

other contexts because a senior without a disability wouldn’t necessarily think to go to that particular place. So ready.gov has information like that—you know, that is specific to seniors—and is 

working on some additional work as well. 

I will just show you an example of some of the materials that we 

have. This is something that was prepared by a coalition of private 

disability-focused organizations, and it is just a small thing. It is 

tips for first responders. They put it like this so that it can be easily carried around, and it is in laminated cards. 

But the very first page in here is tips for seniors, how to deal 

with seniors. Not necessarily seniors with disabilities, but seniors 

in general. Then there are pages on people with service animals 

and people with mobility impairment. So it is more specific. 

So I think it is, your point is excellent. We have to recognize that 

there are overlaps between seniors and disability, but there are differences as well, and we have to recognize that. 

Senator KOHL. Mr. Sutherland, if a catastrophe like Katrina occurred next week or 2 weeks or 3 weeks from now, what would be 

different in terms of your response from a year ago? 

Mr. SUTHERLAND. Well, Senator, I have been thinking about that 

myself, and we are really focused on June 1, the beginning of the 

hurricane season, to make sure that we have a number of 

deliverables in place. I think a lot of the issues that have been 

raised today, in all honesty, are complex and require long-term solutions. 

I can tell you some things would definitely be different. For example, we have an incident management team that is set up that 

is across the Federal Government that will work on and respond 

to these issues. 

We have the National Response Plan review that is a report that 

will be coming to Congress in the first part of June that we have 

gone through. As I said earlier in my testimony, about 10, maybe 

11 large States and 10 or 11 large cities, and we have come up 

with an assessment tool. How do we assess the emergency operVerDate 0ct 09 2002 11:19 Sep 14, 2006 Jkt 000000 PO 00000 Frm 00081 Fmt 6633 Sfmt 6633 H:\DOCS\28924.TXT SAGING1 PsN: JOYCE
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ations plan for the State of X to decide whether it is really adequate or sufficient as it relates to people with disabilities or people 

from the aging community in a variety of subcategories there? 

We believe the kind of guidance that is going to come out of that 

report will really influence the debate and influence how State and 

local emergency planners are writing their plans and are assessing 

how to change their plans so that they accurately react to emergencies. 

We created a disability resource center that we think is going to 

really significantly help on the preparedness side of things in terms 

of both emergency responders and senior citizens. 

I know, just anecdotally, there is quite a bit of thought, interest, 

and energy on these issues. For example, the National Hurricane 

Conference was just held, and they invited me to come down and 

give a keynote address at the National Hurricane Conference, 

which they have never done. They have never focused in the plenary session on emergency preparedness and the aging community 

and people with disabilities. 

We have meetings on these issues all the time, experts like these 

folks who are now focused on these issues. So there is quite a bit 

of energy and interest, and I am optimistic that we would see some 

dramatic changes in the short run. But this is a long-term problem 

that we really have to stay focused on for many years. 

Senator KOHL. Ms. Aiken, you particularize things that have 

been done in Miami-Dade County area, and I was very impressed 

to hear about all of the things in detail that you put in place that 

you fully expect to really mitigate the effect of any hurricane. 

Are you asserting that while nothing is perfect, and certainly 

there is no way of avoiding tragedy when hurricanes like Katrina 

strike, that within those parameters, do you feel that you have or 

you apparently do feel that you have put in place several things 

that will make a big difference if and when a hurricane strikes? 

Ms. AIKEN. Yes, Senator. Miami-Dade County, as Senator Nelson 

mentioned, we have been forced to kind of get good at this because 

we are subjected to many hurricanes. 

Every hurricane that comes through, every disaster, every exercise or drill that we do, we learn from it. No matter how many 

times we do it, there are always things that we will continue to 

work on to improve. 

So, yes, we are hoping that the systems we have in place are better than the systems last year, but we are not there yet, and we 

will continue to move forward. 

Senator KOHL. When you look at Katrina, as I am sure you have, 

and you have thought about it in great detail, would you say that 

they were really totally unprepared to deal with the disaster? 

Ms. AIKEN. I can only speak about Katrina from a Miami-Dade 

County standpoint. I wasn’t in New Orleans. I wasn’t in the Gulf 

States. So it is unfair of me to take a look at that and not actually 

being there. I know that when something major is impending upon 

your community, if you don’t have systems in place beforehand, it 

is very difficult to get those up and running when it is kind of 

looming at your door. 

Because even when you do have systems in place, it is a disaster. 

So, those plans that you have, that you look at and you have testVerDate 0ct 09 2002 11:19 Sep 14, 2006 Jkt 000000 PO 00000 Frm 00082 Fmt 6633 Sfmt 6633 H:\DOCS\28924.TXT SAGING1 PsN: JOYCE
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ed, they don’t always go forth as well as you would like them to 

do. 

But it is very important that you do that preplanning and have 

some systems in place because when it is all going kind of haywire, 

you have to have some things that you can fall back on and know 

that your folks are trained and are prepared to deal with. 

Senator KOHL. For the three of you, do you feel that these issues 

must be dealt with to a considerable extent at the local level. That 

preparedness, in particular, must be tailored to, and you follow positions that are national in terms of knowing what the major issues 

are. But that each community, each county, each State must take 

into consideration their situation and be certain that they have 

plans in place to deal with these disasters when they occur. 

Ms. Bascetta. 

Ms. BASCETTA. Yes, I certainly would agree with that and I think 

that emergency managers would agree that the first responders are 

the locals. Even under the best-laid plans, it would take a certain 

amount of time for the State and the Federal Government to be 

able to arrive and assist. 

But as we pointed out in testimony earlier this year for Senator 

Collins, you know, probably the single most important thing is to 

have clearly defined and communicated leadership and lines of authority well in advance of an event, especially an event that is catastrophic. 

Defining that point at which we have a catastrophe, where the 

States are overwhelmed, also needs much more attention because 

we don’t want to be in a position again where we are waiting for 

the States to ask for assistance when, in fact, the Federal Government should be better positioned to lean forward with its assets. 

Senator KOHL. Dr. Dyer. 

Dr. DYER. Well, I agree that some things have to be done at the 

local level just depending on the number of people, and how many 

are rural, how dense the urban areas are. However, I think the 

Federal Government can set standards. 

I mean, before Katrina, there was a standard that all nursing 

homes had to have—and this was a Medicare requirement—had to 

have an evacuation plan. But what did that mean? What were the 

specifics of that plan? It was vague. 

So, I think it behooves the Federal Government to set the minimum standards that would provide safety for all residents and 

then the individual sites to tailor those requirements, but at least 

meet the minimum standards. 

Senator KOHL. What is the most important single thing that the 

Federal Government must do in order to prepare our seniors for 

the next disaster? What would you suggest, Ms. Aiken? 

Ms. AIKEN. I think it is very important that the Federal Government continue to support the State and local. Your earlier question 

saying do you believe that the locals—all disasters are local. I 

mean, when you talk to the locals, they begin they are all local. 

However, it needs to continue with a partnership with the States 

and with the Federal Government. 

As I stated earlier in my testimony about the mitigation, mitigation does work. So if the Federal Government can continue to support programs such as those, the local mitigation strategies that 

80

have been proven to make a difference, obviously, it is going to 

take funding dollars to do that. But if the dollars are well spent 

in advance, they are better spent dollars than they are spent post 

event. 

Senator KOHL. Mm-hmm. Ms. Bascetta? 

Ms. BASCETTA. With regard to the elderly living in their own 

communities, our ongoing work is identifying best practices in some 

communities, such as Florida, which is known as the gold standard. Getting the word out to other communities about those best 

practices is very important. 

For those in hospitals and nursing homes, paying more attention 

to the role of the NDMS and ensuring that the NDMS is adequately resourced and able to meet the demands of evacuation is 

very important. 

I might point out that in the national plan review that Mr. Sutherland referred to, by far, the evacuation annex was what both 

States and cities were still considering most problematic. I believe 

that the numbers were 11 percent of States and 9 percent of cities 

were confident that they would be able to handle an evacuation, 

and the rest were not comfortable yet. 

Senator KOHL. Hmm, very interesting. 

Dr. Dyer. 

Dr. DYER. Well, I think that we need to focus on the most frail 

because people that have mental capacity, like Mr. Frisella, they 

can make their own decisions. But we have to help those who cannot fully take care of themselves. Either they are not able because 

of functional impairment to evacuate, or they don’t have the cognitive ability to plan and take all the steps in sequence to get out. 

We have to focus attention on those ultra most vulnerable group. 

Senator KOHL. Ms. Aiken, how successful is your county’s special 

needs registry, and do you believe that we could or should attempt 

to replicate it in other places? 

Ms. AIKEN. Yes, I do believe that it can be replicated in other 

places, and I believe that it should be. The special needs registry 

is a registry for the homebound seniors that may need that special 

assistance in daily living, electricity dependent, or skilled nursing 

care, the most frail and vulnerable of our population. 

But if you don’t know where they are and who they are, we are 

not going to be able to get to them. With our registry, we know exactly who these people are. We know exactly where they are, and 

we have very specific plans in place to be able to evacuate them 

well in advance of a general evacuation because it is time consuming to get them out of there. 

They know where they are going in advance. Nobody really 

wants to leave their home, but it is incumbent upon them to actually get out of there because it becomes a life safety issue. 

If they know in advance what type of transportation is going to 

show up, that the transportation is actually going to show up at 

their door, they are going to be called in advance. They know it is 

coming. They know the facility that they are going to. While it is 

not ideal, at least it gives them some assurance that they are just 

not going to be thrown on an inappropriate bus and stuck somewhere where they are not comfortable. 

So, yes, I do believe that it can be and it should be replicated. 

81

Senator KOHL. How many people are in that registry? Do you 

have an idea? 

Ms. AIKEN. Right now, we have about 1,500 people in that registry, which we are continuing to add numbers to it all the time. 

It is incumbent upon the individual, though, to register. 

FP&L, Florida Power and Light, sends out every year in its billing at the beginning of June information about the special needs 

program. So everybody that is receiving an electric bill is receiving 

information about that program, and it says to call your local office 

of emergency management to register. 

Miami-Dade Office of Emergency Management has a full-time 

community preparedness person whose primary function is getting 

out there and educating the community, particularly our more vulnerable population, such as our seniors and those with special 

needs, about the initiatives that the county has in place and about 

the programs that are out there and available for them to take advantage of. 

So we try to get the information out. But again, it is incumbent 

upon that individual sign up for that registry. 

Senator KOHL. Any other comments any of you would like to 

make? 

Mr. Sutherland, you would like to say something? 

Mr. SUTHERLAND. Senator, you had asked about the Federal response, and I wanted to echo that I think this whole area is a 

shared responsibility. 

We looked back at Katrina and tried to come up with lessons 

learned. As we did, we started to note, started on a legal pad on 

my desk, and we have turned it into a document that eventually 

we will publish publicly, but what needs to change here? 

We came up with certain ideas that FEMA needs to make some 

changes. We came up with some ideas that our Preparedness Directorate needs to make some changes. We came up with some 

ideas that my own office, we need to do better at or some of our 

Federal partners. 

But we also included or noted that there were things that needed 

to go better at the State and local level, things that needed to go 

better with Red Cross, and some things that the disability and 

aging communities need to address themselves. Things you need to 

do better. You need to take on this responsibility. 

So there is a shared responsibility there. For our purposes, I 

think the three major areas that we are focusing on is preparedness, preparedness, preparedness. We are trying to get people prepared. That would be the first area. 

Second, stimulating best practices. Identifying places where 

things are working and stimulating that and replicating that and 

letting people know about that. 

The third is getting subject matter experts on these issues institutionalized into the emergency management structure. For example, the joint field office, which is set up to respond to emergencies, 

did not have a subject matter expert on disability and aging issues. 

After Katrina, Secretary Chertoff recognized we needed somebody, and he sent a memo to me and Chief Paulison and said get 

someone there. We got someone there, and it has now been instituVerDate 0ct 09 2002 11:19 Sep 14, 2006 Jkt 000000 PO 00000 Frm 00085 Fmt 6633 Sfmt 6633 H:\DOCS\28924.TXT SAGING1 PsN: JOYCE
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tionalized in the JFO structure. There are other ways that we need 

to do that as well. 

So I appreciate the chance to just outline maybe where we are 

going over the next few months as well. 

Thank you. 

Senator KOHL. I thank you. 

Well, I believe that this panel has been very useful in many 

ways. In particular, I am impressed by what local governments are 

doing, and we all recognize how important local governments are 

in preparing for disasters. 

I have my concerns, as I think all Americans do, post Katrina 

about Federal Government’s preparedness and ability to respond 

this year. You have pointed out, Mr. Sutherland, that this is a 

long-term project, and it is. But when disaster hits, it is a shortterm catastrophe that must be dealt with. It doesn’t do any good 

to have programs that will kick in some years down the road when 

a natural disaster hits. 

I think we are all worried—I am sure you are—we all are—that 

we are even today woefully unprepared for another natural disaster. That is the purpose of this hearing as it affects our seniors. 

I am looking forward to and very hopeful that we can have not 

only an ongoing relationship, but one that is tinged with a sense 

of urgency to get prepared. So that when we do have another natural disaster, we can be proud of the response at the Federal level 

as well as at the local level. 

So let us all beware and take heed that we do not have another 

Katrina. It would be, indeed, a real tragedy if that occurred, and 

we want to do everything that we can to prevent it. 

I want to thank you all for being here. I am most impressed with 

your comments, and I think you do have a sense of urgency about 

doing what needs to be done as quickly as possible because I think 

you recognize how bad it will be if we don’t do it. So, your contributions are invaluable, much appreciated. 

We thank you all for coming, and we stand adjourned. 

[Whereupon, at 11:41 a.m., the committee was adjourned.] 

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A P P E N D I X 

PREPARED STATEMENT OF SENATOR SUSAN COLLINS

Mr. Chairman, thank you for calling this hearing to examine ways to strengthen 

our emergency preparedness and response systems so that they are more sensitive 

to the special needs of seniors. 

The question posed in the title of this morning’s hearing is clearly rhetorical. Obviously, we not only can do better, but we must do better if we are to avoid the 

horrible human suffering left in the devastating wake of Hurricane Katrina. While 

Katrina would have been a terrible national incident given its strength, size and intensity, it became a far more devastating disaster because of the failure of preparedness and response at all levels of government. And tragically, the brunt of this failure was born disproportionately by our nation’s most vulnerable citizens, including 

our seniors and the disabled. 

Just a few days after Hurricane Katrina struck, the Majority Leader asked the 

Homeland Security and Governmental Affairs Committee, which I chair, to conduct 

an investigation into the government’s preparation for an response to Hurricane 

Katrina and to make recommendations that would help ensure that America is better prepared the next time a disaster strikes—whether it be predicted, as it was in 

the case of Hurricane Katrina, or a terror attack for which we have no warning. 

The committee’s Ranking Member, Joe Lieberman, and I agreed to take on this task 

in a thorough and bipartisan manner. 

Over the past seven months, our committee held 22 hearings, where we heard 

from 85 witnesses, our staffs conducted more than 325 formal interviews, and reviewed over 838,000 pages of evidence. Our findings over these seven months of 

hard work resulted in an exhaustive report titled ‘‘Hurricane Katrina: An Nation 

Still Unprepared.’’ The findings of our investigation are reflected in the very name 

of our report. 

Throughout our investigation, we found clear evidence of failures of planning; failures in decision-making; a failure to create a coordinated national response system, 

and most of all, a failure of leadership at all levels of government. 

One of the most troubling findings of our report was the failure to evacuate nursing homes in Louisiana. This undoubtedly led to the loss of dozens of lives of an 

already vulnerable population. 

As a consequence, one of the key recommendations in our report calls on the Department of Homeland Security to ensure that State and local governments have 

evacuation plans that address the special challenges posed by hospitals, nursing 

homes, and individuals with special needs, like the elderly. The report also recommends that the State agencies responsible for licensing hospitals and nursing 

homes ensure that those facilities have evacuation plans and audit them annually, 

including an evaluation of the availability of transportation resources. 

Mr. Chairman, this morning’s hearing will help to highlight the special challenges 

that the elderly face during a national disaster. It will help us in our effort to build 

and maintain a true national emergency planning and response system that is sensitive to the needs of our most vulnerable citizens. 

PREPARED STATEMENT OF SENATOR MEL MARTINEZ

I would like to thank Ranking member Kohl for having this hearing. It is important to focus on the unique needs of the elderly in times of natural disasters. I feel 

strongly that my state of Florida and Governor Bush illustrate the way local and 

state governments most effectively prepare for crises and the proper role of the federal government. As senator from a state that has experienced seven hurricanes and 

two tropical storms in the last 2 years, I urge you to consider the successes and 

challenges Florida faces when a natural disaster occurs. 

84

Florida’s Department of Elder Affairs (DOEA) and its CARES (Comprehensive Assessment and Review for Long-Term Care Services) staff respond following hurricanes and natural disasters to assist Florida’s elders throughout the state. CARES 

staff are trained and certified in completing assessments, evaluating medical needs 

and providing placement recommendations for clients. 

CARES staff respond following natural disasters providing discharge planning 

services in Special Needs Shelters (SpNS) to ensure the safe placement of residents. 

CARES staff also aid Assisted Living Facilities, Nursing Homes and Emergency Operations Centers (EOC) with placement of elderly residents. 

CARES staff contact existing clients to ensure their safety and assist local service 

providers in the delivery of food and water. During the 2004 hurricane season, approximately 92 CARES staff completed 5,354 hours of service responding to Hurricane Charley, Frances, Ivan and Jeanne. In 2005 hurricane season, approximately 

48 CARES staff completed 1,321 hours of services responding to Hurricane Katrina 

and Wilma. 

I am especially looking forward to the testimony today from Ms. Amy Aiken, the 

Assistant Director of the Miami-Dade Office of Emergency Management, and having 

her elaborate on some of the things that the state is doing in regards to emergency 

preparedness and have been doing ever since Hurricane Andrew hit back in 1992. 

Again, I thank the committee for its time and attention to this matter and look 

forward to the testimonies before us. Thank you. 

PREPARED STATEMENT OF SENATOR KEN SALAZAR

I would like to thank Chairman Smith and Ranking Member Kohl for holding this 

important hearing. Hurricane Katrina illustrated to us all that current planning, infrastructure, and leadership in the event of a national emergency is far from where 

it needs to be to adequately protect our citizens. 

We must move forward to improve our ability to effectively prepare for future disasters, we must learn from the mistakes of the past, and we must pro-actively seek 

real solutions to those mistakes to ensure they are not repeated. This hearing is an 

important opportunity to identify the specific needs faced by seniors during a natural or manmade disaster, consider recommendations, and assess the progress that 

has been made thus far in learning from past mistakes to ensure that our seniors 

are properly taken care of in the event of future emergencies. 

As we know, the special needs of senior citizens pose distinct challenges for any 

national emergency preparedness and response plan. 

In emergency situations, seniors face a terrible risk of being injured, trapped in 

their residence or perishing as a result of disasters. Among those who did not survive Hurricane Katrina, 75% were 75 years and older, and 65% of those who died 

at the Astrodome in Houston were 65 years and older. 

Transportation is one of the difficult issues that must be addressed. In the event 

of an evacuation, transporting senior citizens in a manner that is timely and safe 

can make the difference between life and death. We know from Hurricane Katrina 

that nursing home operators were faced with making a difficult determination of 

whether to evacuate, and if so, how and when. What tools could be provided so that 

operators in similar situations in the future are better equipped to act in the best 

interest of the seniors in their care? 

Almost every year, my home state of Colorado experiences forest fires that create 

risks for our Seniors living in affected communities. 

With limited resources, it is often difficult to assist and rescue our elders living 

in remotes ranches or homes in the Rockies. However, with planning and preparation, we can ensure that the manpower, vehicles, plans, and other necessary resources are readily available to these Seniors. 

Seniors also have diverse medical needs that must continue to be met during a 

disaster. As Ms. Cefalu’s testimony will indicate, in the wake of natural disaster in 

the Gulf, nurses and doctors were called upon to treat and diagnose seniors without 

a knowledge of the patient’s medical background, current diagnoses, or what medication or treatments the patient requires. 

As the gerontologists on this panel will confirm, a one-size fits-all structure for 

medical treatment does not meet the specific medical needs of senior. 

Emergency response plans must include first responders and medical professionals who are trained in geriatric medicine. Dr. Bitondo’s testimony of treating elderly Katrina evacuees at the AstroDome in Houston is an example of how people 

with medical needs can be organized to ensure that seniors, who often require geriatric specific treatments, receive appropriate care from someone trained in geriatric 

medicine. 

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America has a duty to protect and care for ALL of its citizens in the event of a 

national disaster: rich and poor, healthy and sick, young and old. Over the next 25 

years, the number of Americans over the age of 65 is expected to double. 

As the United States continues to age, it is our responsibility to ensure that federal and local response and preparedness plans are tailored to meet the specific 

needs of our seniors. 

I look forward to hearing from today’s panel and to working with my colleagues 

to ensure our country is prepared to meet that responsibility.

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