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54–128 PDF 2010

S. HRG. 111–209 

EMERGENCY PREPAREDNESS, AGING AND SPECIAL 

NEEDS: PREPARED VS. SCARED! 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

JUNE 24, 2009 

Serial No. 111–9 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

BILL NELSON, Florida 

ROBERT P. CASEY, Jr., Pennsylvania 

CLAIRE McCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

MARK UDALL, Colorado 

KIRSTEN GILLIBRAND, New York 

MICHAEL BENNET, Colorado 

ARLEN SPECTER, Pennsylvania 

MEL MARTINEZ, Florida 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

BOB CORKER, Tennessee 

ORRIN HATCH, Utah 

SAM BROWNBACK, Kansas 

LINDSEY GRAHAM, South Carolina 

DEBRA WHITMAN, Majority Staff Director 

MICHAEL BASSETT, Ranking Member Staff Director 

(II) 

C O N T E N T S 

Page 

Opening Statement of Senator Mel Martinez ....................................................... 1 

Opening Statement of Senator Herb Kohl ............................................................. 3 

PANEL OF WITNESSES

Statement of Richard E. Besser, M.D., Director, Coordinator Office for Terrorism, Preparedness and Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA ........................................................................ 4 

Statement of Timothy Manning, Deputy Administrator for National Preparedness, Federal Emergency Management Agency, Washington, DC ................... 20 

Statement of Douglas Beach, Secretary, Florida Department of Elder Affairs, 

Tallahassee, FL .................................................................................................... 28 

Statement of LuMarie Polivka-West, Senior Vice President of Policy, Florida 

Health Care Association, Tallahassee, FL ......................................................... 40 

Statement of Sandy Markwood, Chief Executive Officer, National Association 

of Area Agencies on Aging, Washington, DC ..................................................... 50 

(III) 

(1) 

EMERGENCY PREPAREDNESS, AGING, AND 

SPECIAL NEEDS: PREPARED VS SCARED! 

WEDNESDAY, JUNE 24, 2009 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The Committee met, pursuant to notice, at 11:20 a.m. in room 

SD–562, Dirksen Senate Office Building, Hon. Mel Martinez presiding. 

Present: Senators Martinez [presiding] and Kohl. 

OPENING STATEMENT OF SENATOR MEL MARTINEZ, RANKING 

MEMBER 

Senator MARTINEZ. Good morning. We’ll call the hearing to order 

and thank the Chairman for allowing us to hold this hearing today. 

We are pleased to have an excellent group of witnesses with us. 

So, I want to thank all of you for joining us as we discuss how 

emergency preparedness relates to seniors, and those seniors living 

with special needs, particularly. We’re looking forward to hearing 

perspectives of some of our Federal, State, and local partners about 

the unique needs of elderly Americans to better prepare for when 

a disaster strikes. 

As we begin the 2009 hurricane season, I am reminded how older 

Americans are often the hardest hit when Mother Nature is at its 

worst. A prime example of this occurred during Hurricane Katrina, 

where nearly half of all storm-related deaths involved residents 75 

years and older, and the average age for fatalities was 69. In hurricanes and other disasters, no Americans should be in endangered 

by virtue of their age, living situation, or physical situation. As we 

have learned, threats vary from State to State, from regional to region. Whether it’s a flood, blizzard, earthquake, fire, or even a pandemic emergency, responders at every level ought to be prepared 

to assist our most vulnerable citizens. 

We know from past experiences with natural or manmade disasters that all Americans, especially those with special needs, suffer 

when there is a lack of preparation, information, and coordination. 

That’s why we as public servants, have a responsibility to help inform the general public about the value of being personally prepared. 

For seniors and seniors living with special needs, this includes 

having something as simple as a communications plan, an emergency kit, an extra pair of reading glasses, or even a hearing aid. 

Such a preparation may mean the difference between life or death. 

2 

Emergency responders in my home State of Florida have taken 

significant steps to address these unique needs of seniors. It is not 

an overstatement to say that our model can serve as a model for 

our nation. One innovation sets up the incident command center 

model in nursing homes. Those go a long way in ensuring nursing 

home employees are trained in emergency preparedness procedures 

and can coordinate a response in the event of an emergency. It will 

also help to avoid mistakes like those made during Hurricane 

Katrina, where many long-term care providers were simply untrained and unprepared. 

Another concern has been what to do for seniors in the event of 

a national pandemic. We have all read about the H1N1 swine flu 

outbreak. Although the elderly were not at great risk, we must be 

prepared for the upcoming flu season, where seniors are among the 

most vulnerable, along with the possibility of a return of a mutated 

H1N1 flu strain. 

In many instances during pandemics, caregivers may be more 

vulnerable to the flu than patients, so we must ask ourselves—how 

do we ensure that there are enough doctors, nurses, aides, and 

other medical personnel in the event that these caregivers are infected? 

Most seniors do not receive formal care in their homes, communities, or in the 24-hour facilities. For these elderly, and for those 

living at home and in need of a long-term care, the State Units on 

Aging and Area Agencies on Aging are invaluable. 

Area Agencies and State units actively seek to reach all seniors 

to help them plan and prepare for a natural disaster. They are the 

key connector to the array of government and private entities offering senior services and recovery before, during, and after a disaster. In Florida, Area Agencies are on the forefront of innovation 

and planning, preparing, and responding to disasters and emergencies. 

I’m proud to note that the Florida Department of Elder Affairs 

is seen as a model in disaster response and recovery throughout 

the country, and is often consulted by other State Units on Aging 

for guidance and experience. Florida has the highest proportion of 

elderly of any State, and also a high incidence of disasters and 

emergencies, so it is expected that Florida would have a first-rate 

preparedness and response system. But, each year, new threats 

emerge, and old threats largely remain. We must not forget the 

special needs of our seniors residing in any State facing natural, 

manmade, or public health emergencies. 

I want to thank our witnesses for joining us today. I look forward 

to hearing your thoughts and ideas on innovations and challenges 

for emergency preparedness and response for seniors across the nation. 

Now, I’d turn to Chairman Kohl for your comments, sir. 

3 

OPENING STATEMENT OF SENATOR HERB KOHL, CHAIRMAN 

The CHAIRMAN. Good morning. I’d like to thank Senator Martinez for holding today’s hearing on emergency preparedness and 

the elderly. 

This issue has been of great concern to me since we learned of 

the many tragedies that occurred when Hurricane Katrina struck, 

now nearly 4 years ago. 

One of today’s witnesses will tell us that, when Katrina hit, only 

15 percent of the population in New Orleans was age 60 or older, 

and yet 70 percent of the hurricane-related deaths were seniors. 

We did see then that more needed to be done to evacuate seniors 

and the disabled in the face of an impending disaster. As a result, 

I included provisions in the 9/11 Commission Act of 2007 to train 

public transportation workers to meet the evacuation needs of seniors during an emergency. While legislative steps such as these 

have been taken since 2005, more work remains ahead. 

Last year, I released a GAO report on how prepared the Government is to evacuate vulnerable populations, such as nursing-home 

residents, in the event of an emergency. The study found that the 

Department of Homeland Security needs to improve requirements 

for evacuation planning by State and local entities that receive 

DHS funding. 

Last month, I followed up with DHS Secretary Janet Napolitano, 

and, although progress has been made under the new administration, it still does not appear that emergency preparedness requirements have been strengthened. 

As we all know, disaster can strike at any time. Just last week, 

parts of Wisconsin experienced heavy flooding, leaving some of my 

constituents stranded. We cannot hope to be ready for these kinds 

of emergencies tomorrow; we have to be ready today. 

So, we thank you, Senator Martinez, once again, for holding this 

hearing, and we thank all of our witnesses for being here today. 

I think we all understand that it’s clear that there’s more work to 

be done. 

Thank you. 

Senator MARTINEZ. Thank you, Mr. Chairman. 

Let me now introduce the witnesses we have with us today. 

Again, we’re grateful that you all are here. 

First, we have Dr. Richard Besser, M.D., the Director of the Coordinating Office for Terrorism, Preparedness, and Emergency Response, at the Centers for Disease Control and Prevention. Dr. 

Besser was the Acting CDC Director during the recent H1N1 influenza outbreak. His current office is charged with protection for the 

Nation from all threats to the public’s health. 

We also have with us Timothy Manning, Deputy Director of the 

National Preparedness Directorate for the Department of Homeland Security’s Federal Emergency Management Agency, FEMA. 

Prior to FEMA, Mr. Manning served as Director of the New Mexico 

Department of Homeland Security and Emergency Management 

and homeland security advisor to the Governor. 

We, next, have Doug Beach, Secretary of Florida’s Department of 

Elder Affairs. On February 13, 2007, Governor Crist appointed Dr. 

Beach as the Secretary for the Department of Elder Affairs in Florida. He has worked on the Aging Network for more than 12 years, 

4 

most recently serving as the Chief Executive Officer of the Seniors 

Resource Alliance, the Area Agency on Aging of Central Florida, 

where we had an opportunity to work together. 

LuMarie Polivka-West is Senior Vice President of policy of Florida Health Care Association. Ms. West is responsible for the planning and implementation of long-term care related policies and programs and staffing of the Quality Credentialing Program and 

serves as the principal investigator for a John A. Hartford Foundation Disaster Preparedness Grant. 

Sandy Markwood is the Chief Executive Officer of the National 

Association of Area Agencies on Aging. She has more than 30 

years’ experience in the development and delivery of aging health, 

human services, housing, and transportation programs in counties 

and cities across the nation. 

Welcome, all. We’ll hear from you, Mr. Besser, first, your statements. 

STATEMENT OF RICHARD E. BESSER, M.D., DIRECTOR, COORDINATOR OFFICE FOR TERRORISM, PREPAREDNESS AND 

EMERGENCY RESPONSE, CENTERS FOR DISEASE CONTROL 

AND PREVENTION, ATLANTA, GA 

Dr. BESSER. Thank you. Good morning, Chairman Kohl, Ranking 

Member Martinez, and other distinguished members. 

I am Dr. Rich Besser, Director of the Coordinating Office for Terrorism, Preparedness, and Emergency Response at the Centers for 

Disease Control and Prevention. I want to thank you for the opportunity to discuss our work to better protect the health of older 

adults during emergencies, such as the current influenza pandemic. 

Many of us have parents and grandparents who rely on the help 

of families and communities during emergencies. This help is critically important at this time. 

The risk to older adults is serious. As was stated, more than 70 

percent of the people who died in Louisiana as a result of Hurricane Katrina were older than age 60. Most died in their homes, in 

hospitals, or nursing homes. The increased risk faced by older 

adults occurs for a variety of reasons, such as health status, reliance on supportive services, and the need for assistance with transportation. More than 80 percent of older adults have at least one 

chronic condition, such as diabetes or heart disease. Disruptive 

medical and supportive services during emergencies put older 

adults with chronic conditions at especially high risk. 

The Nation has made progress in protecting the health of older 

adults during emergencies. For example, during the 2008 hurricane 

season response, many nursing homes and hospitals were evacuated before hurricanes hit. A marked improvement compared to the 

evacuation that occurred during Hurricane Katrina. 

I’d also like to mention some progress at CDC. We’ve developed 

guidelines on the H1N1 influenza pandemic for vulnerable populations, including older adults, and for the clinicians who care for 

them. We’ve also engaged with tribal nations to learn from them 

how to better reach older adults in their communities to prepare 

for an influenza pandemic. We support State and local public 

health departments in their efforts to protect older adults during 

5 

emergencies, such as through the Public Health Emergency Preparedness Cooperative Agreement. 

Although we’ve made progress, more still needs to be done to improve our ability to assist older adults during emergencies. I’d like 

to highlight three main areas. 

First, we must assure that healthcare is available. Public health 

emergencies can cause disruptions in healthcare system, leaving to 

negative health effects for older adults. We need to enable older 

adults and their caregivers to have the necessary medications to 

avoid exacerbations of chronic diseases and other conditions. 

Moreover, emergency shelters need to have the necessary capabilities, supplies, and other resources to respond to the needs of 

older adults and other vulnerable evacuees. 

Implementing electronic health records nationwide could help 

greatly. This could make it easier for older adults to identify their 

medications and renew prescriptions during an emergency, even if 

they’re in a different city or State. 

We need to focus on prevention and wellness. A healthy community will be more resilient to the negative impact of public health 

emergencies. Only about one-third of older adults are up to date on 

all recommended preventive services. Increasing the use of immunizations and other key clinical preventive services will make our 

older—will make our elderly population more healthy and better 

able to withstand and recovery from the added stress of a public 

health emergency. 

Finally, we need to better address the needs of older adults in 

preparedness and response. Despite recent improvements, community healthcare delivery systems and supportive services still need 

to be better integrated into emergency planning efforts. Protecting 

the health of older adults during emergencies requires cross-sector 

partnerships, strong community engagement, and a committed 

focus on integrating the needs of older adults in all preparedness 

and response activities. Progress is difficult, because the economic 

crisis has led to job losses in public health departments and budget 

shortfalls among hospitals and healthcare systems. 

In closing, preventing illness and disease are, not only essential 

components of health reform, but are also critical to our nation’s 

overall health protection and preparedness efforts. As Dr. David 

Satcher, a former CDC director and U.S. Surgeon General, has 

noted, the same things that lead to health disparities on a day-today basis in the United States also lead to disparities in the negative impacts of public health emergencies, especially for older 

adults and other vulnerable populations. 

We’ve made progress, but we still need to do more. I believe that 

our nation is only as prepared as our ability to care—to take care 

of older adults and other vulnerable members of our community. 

We look forward to working with you to continue to prepare the 

Nation to protect older adults during emergencies. 

I want to thank you again for the opportunity to share this information with you today, and I look forward to questions. 

[The prepared statement of Dr. Besser follows:] 

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Senator MARTINEZ. Mr. Manning, we’ll hear from you now. 

STATEMENT OF TIMOTHY MANNING, DEPUTY ADMINISTRATOR FOR NATIONAL PREPAREDNESS, FEDERAL EMERGENCY MANAGEMENT AGENCY, WASHINGTON, DC 

Mr. MANNING. Thank you. Chairman Kohl, Ranking Member 

Martinez, good morning. 

I’m Tim Manning. I’m the Deputy Administrator of the Federal 

Emergency Management Agency. It’s a privilege to appear before 

you today on behalf of FEMA and the Department of Homeland Security. We appreciate your interest in, and continued support of, 

emergency management and the unique disaster planning requirements for those with unique needs. 

Throughout history, and throughout the history of emergency 

management, considerations for specific populations have been inadequate. From the 1930’s, when disaster response was largely an 

ad hoc mission focused on the repair of damaged infrastructure, 

through to the present day, special-needs populations were often 

given insufficient consideration. This fact is evident in the 2003 

California wildfires and the—when Hurricane Katrina devastated 

the Gulf Coast in 2005. During these events, a substantial number 

of individuals with special needs did not receive the appropriate 

warning, were unable to access shelters, went without medical 

intervention, or, at worst, perished. A subsequent review of emergency plans around the Nation concluded that a substantial improvement is necessary to integrate people with disabilities into 

emergency planning and readiness. Indeed, the needs of all populations of all people must be considered in planning and response. 

Numerous lessons learned reported, that followed Katrina, also 

identified a large segment of the U.S. population that may not be 

able to successfully plan for, and respond to, an emergency with resources typically accessible to the general population. Our population is one that is diverse, aging, and focused on maintaining 

independence as long as possible. The popularity of living situations that provide an as-needed level of care in the least restrictive 

manner is fast becoming the norm, and consideration must, therefore, be given to people who may not be able to function independently under normal situations, but who may need assistance in an 

emergency situation. 

FEMA’s working hard to ensure that its own basic planning addresses special-need populations and that we are supporting and 

assisting States, tribes, and localities in this regard. We are also 

reinforcing the critical and enduring need for personal preparedness, encouraging individuals to adequately prepare themselves for 

disaster events, recognizing that better individual preparedness 

translates into better community preparedness and stronger resilience. 

FEMA’s directly engaged in activities that will address specialneeds populations, including the elderly, in coordination with 

FEMA’s Office of Equal Rights, DHS’s Office for Civil Liberties and 

Civil Rights, and the National Advisory Council, as well as State, 

tribal, and local agencies. The FEMA disability coordinator has 

built a viable network to ensure that the needs of the elderly and 

persons with disabilities are addressed during and following disasVerDate Nov 24 2008 14:25 Jan 07, 2010 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 H:\DOCS\54128.TXT SAG PsN: JOYCE
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ters. We are also developing disability and special-needs subjectmatter teams to work with States during disasters in order to assure accommodation for people with disabilities and other special 

needs. 

Citizen Corps is FEMA’s grassroots initiative to actively involve 

citizens in the security of their communities through planning and 

personal preparedness. At the national level, Citizen Corps promotes inclusion and a focus on disabilities and the community by 

integrating these priorities into our homeland security policies. 

Emergency management takes into consideration planning for 

the safety of every person in the community during and following 

a disaster. Taking into consideration populations historically considered vulnerable, at risk, or special needs, ultimately improves 

the overall community’s post-disaster sustainability. FEMA assists 

States and localities with planning guidance for State and local 

preparedness efforts, and will shortly issue guidelines on these populations through its comprehensive preparedness guide number 

301, Emergency Management Planning Guides for Special Needs 

Populations. This guide, developed in collaboration with the Office 

for Civil Rights and Civil Liberties, is currently available to all of 

the Nation’s responders and communities as an interim document. 

It addresses many of the issues that will confront us in providing 

care to the elderly, ensuring that our plans and our procedures 

take all requirements, all needs into account. 

Mr. Chairman, Ranking Member Martinez, Secretary Napolitano, 

FEMA Administrator Craig Fugate, and I are committed to advancing our Nation’s preparedness. Our efforts must begin with personal preparedness and a process of individual thinking in consideration of basic steps that each of us must take to help prevent and 

prepare for the next disaster. All Americans must take responsibility for preparing themselves and their families and their communities for the next disaster. In times of crisis, government plays a 

critical role in coordinating the response-and-recovery efforts, especially in protecting and providing for our most vulnerable populations. A government’s first responsibility is to ensure the safety 

and well-being of the public. We believe that that is the cornerstone of our strategy, moving forward, and, with the continued support of Congress, we believe that considerable progress is within 

reach. 

Mr. Chairman, Ranking Member, thank you, and thank you, 

members of the committee, for allowing me to testify today, and I 

look forward to any questions you may have. 

[The prepared statement of Mr. Manning follows:] 

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Senator MARTINEZ. Thank you very much, Mr. Manning—Secretary Manning. 

Now, we hear from Secretary Beach. 

STATEMENT OF DOUGLAS BEACH, SECRETARY, FLORIDA 

DEPARTMENT OF ELDER AFFAIRS, TALLAHASSEE, FL 

Dr. BEACH. Thank you. Good morning, Chairman Kohl, Ranking 

Member Martinez. My name is Doug Beach. I’m Secretary of the 

Florida Department of Elder Affairs. 

Thank you, I was looking for the button. 

I appreciate this opportunity to discuss ways we can best serve 

older Americans before, during, and after a disaster. 

As many of you know, earlier this decade Florida faced an unprecedented onslaught from nature. We had to contend with eight 

hurricanes and several additional tropical storms, all in a 14-month 

period. At that time, I served as CEO of the Senior Resource Alliance, which is the Area Agency on Aging, stretching from Orlando 

to Cape Canaveral. With communications, transportation, and just 

about everything else disrupted, our team had to scramble to address the special needs of elders. Working with Governor Crist for 

the last 21⁄2 years as Elder Affairs Secretary, I have come to appreciate that no emergency is too small, no threat too remote, to dismiss it without doing some planning and preparation. 

The latest numbers tell us that Florida is home to 4.4 million 

residents 60 years of age and older. We have the largest percentage 

of seniors of any State in the Nation. A common myth is that many 

of these Florida elders live in nursing homes, when, in fact, 95 percent of elder Floridians live in the community. 

Plans and procedures designed to support emergency operations 

for the general population are not always appropriate for seniors. 

We encourage each elder to help by taking personal responsibility 

for his or her own safety. That’s why, each year, the Department 

of Elder Affairs publishes a Disaster Preparedness Guide, which 

we’ve—I’ve given the staff, and they can hand out. The guide offers 

tips, procedures, contact numbers, and even a disaster supply 

checklist, so the elders we serve, and their caregivers, can create 

a plan for any kind of hazard. 

It is vitally important for people to understand that they must 

be prepared to survive on their own for the first 72 hours of an 

emergency. Supplies and services may not be available until first 

responders complete their search and rescue missions and the community begins restoring critical services. For seniors, being ready 

for a disaster is a key part of maintaining independence. If elders 

and vulnerable populations are prepared ahead of time, they will 

be better able to cope and recover more quickly. 

As soon as we determine that a threat is out there, the Department of Elder Affairs establishes regular contact with the 11 Area 

Agencies on Aging. The Area Agencies then work with their local 

networks, everyone working together to make sure the communities most likely to be impacted have the supplies and resources 

they need. 

Additionally, the Department of Elder Affairs is part of the State 

Emergency Response Team, with a permanent seat in our State 

Emergency Operations Center. One crucial consideration for an 

29 

elder constituency is food and nutrition. Before a disaster occurs, 

Meals on Wheels clients receive a 3-day supply of packaged meals 

that are specifically designed for seniors. If evacuations become 

necessary, they are particularly difficult for seniors. When seniors 

are forced to go without power, they are put at a far greater risk 

than the average person. For that reason, every Florida county has 

a special-needs registry and special-needs shelters are in place to 

accommodate elders. Even self-sufficient elders may require special 

assistance during an emergency. A high-rise condo may remain 

structurally sound, but a power outage could mean the elevators 

don’t function and the residents can’t access medical care, appropriate nutrition, and medicine. Florida now requires that emergency generators be available to operate public elevators in all 

high-rise multifamily dwellings, including condos. 

Once Florida enters a recovery phase, seniors will want to return 

to their homes, but will they be able to make their way to grocery 

stores, doctors’ offices, and pharmacies? For that reason, the Department of Elder Affairs has developed a Rapid-Needs Assessment 

and Discharge Planning Form to help make these determinations. 

Elders can successfully transition back into the community as soon 

as possible, and as safely as possible. 

In order to give seniors the greatest chance to come through a 

disaster, the best possible physical and emotional conditions, planners must consider their distinctive needs beforehand. Under Governor’s Crist’s leadership, Florida State agencies stand ready to assist emergency officials in each community as we constantly strive 

to improve Florida’s Disaster Emergency Management Plans for elders. 

I thank you for the opportunity to present this information today 

on behalf of Florida’s elders, and I would be glad to answer questions at any time. 

[The prepared statement of Dr. Beach follows:] 

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Senator MARTINEZ. Thank you, Secretary. 

Ms. Polivka-West, welcome, also, and we’ll hear from you now. 

STATEMENT OF LuMARIE POLIVKA-WEST, SENIOR VICE PRESIDENT OF POLICY, FLORIDA HEALTH CARE ASSOCIATION, 

TALLAHASSEE, FL 

Ms. POLIVKA-WEST. Good morning. My name is LuMarie PolivkaWest, and I’m Senior Vice President with the Florida Health Care 

Association. I also serve as Principal Investigator for the national 

effort funded by the John A. Hartford Foundation focused on hurricane and disaster preparedness and long-term care facilities. I am 

here today on behalf of the American Health Care Association, the 

National Center for Assisted Living, and the 1.5 million frail older 

Americans who reside in skilled nursing facilities, and the additional 1.2 million who reside in assisted living facilities, a group 

particularly at high risk during disasters. 

Thank you, Chairman Kohl and Ranking Member Martinez. We 

appreciate this opportunity for a national forum to discuss the 

unique challenges faced by older adults in long-term care facilities 

during disasters. 

Hurricane Katrina focused national attention on the disproportionate vulnerability and mortality of elders during disasters. 

When Hurricane Katrina hit, only 15 percent of the population at 

New Orleans were age 60 and older, yet data from Knight-Ridder 

found that 74 percent of hurricane-related deaths were in that age 

group. 

Not all died from the disastrous flooding. Many died from the 

heat, where the lack of the electricity to long-term care facilities 

spoiled medications, dehydration, or otherwise negatively impacted 

critical medical treatments and care services. Some were evacuated 

without their life-saving medications, and some very ill, aged individuals were transported to other States while their medical 

records and medications were left on the tarmac. 

In February 2006, the John A. Hartford Foundation responded to 

the events of Hurricanes Katrina, Rita, and Wilma by supporting 

a Gulf Coast Hurricane Summit that identified issues critical to 

improving future nursing home preparedness. 

The grant aimed to improve disaster preparedness through the 

development of a Disaster Planning Guide and software, and 

through the training exercises for nursing homes and assisting living facilities, and the convening of annual hurricane summits with 

national dissemination of material and findings through the American Health Care Association. 

Hurricanes Charlie, Gustav, and Ike forced nursing homes to ask 

an important question, Is total evacuation before hurricanes best 

for residents? Preliminary analyses from a National Institute on 

Aging grant with Brown University and the University of South 

Florida suggests that evacuation is difficult for nursing home residents. If the study results continue to indicate that nursing home 

residents may fare better staying in buildings that will not flood, 

the Federal and State governments should help with the hardening 

of physical plants to withstand the force of winds. 

Due to the very vulnerable and complex populations that we 

serve, it is essential that we work together with policymakers to 

41 

better prepare ourselves for a disaster. I would like to highlight six 

broad areas for critical review and consideration and better preparing and responding to large-scale disasters and evacuations. 

First, the National Disaster Medical System should be reconfigured to support the evacuation and care of nursing home patients, 

assisted living residents, and people residing in residential care facilities for the elderly and developmentally disabled. 

Second, it is essential that we, as a Nation, finally expedite the 

development of interoperable electronic health records. 

Third, the Stafford Act excludes for-profit nursing homes that 

provide 80 percent of the care for nursing home residents through 

publicly funded Medicare and Medicaid from receiving Federal financial assistance during and after disasters. As a result, threefourths of our Nation’s nursing facilities are not eligible for this 

critical and necessary Federal assistance, and, at many localities, 

for-profit nursing facilities may be the only long-term care provider 

available. Amending the Stafford Act through the Nursing Home 

Emergency Assistance Act of 2009 would allow all the long-term 

care providers access to disaster relief funding. 

Fourth, we must address emergency communications and faulty 

assumptions that communications in public-service infrastructure 

would still be in place in the aftermath of a disaster. 

Fifth, the Federal Government agencies need to work together in 

identifying requirements for long-term care facilities and their allhazard approaches to disaster preparedness. For example, preparedness for the H1N1 influenza pandemic involves the CDC, 

OSHA, CMS, HHS, DHS, and the State Departments of Health. 

Sixth, new protocols are necessary to improve communications 

and coordination between all providers and local State and Federal 

Governments with a national response framework as the guide for 

planned development at all levels. The long-term care community 

alone cannot protect or prepare effectively for disasters. We must 

be a part of a larger unified national response. 

I would like to thank the committee for providing this opportunity to share our thoughts. I, along with the American Health 

Care Association, National Center for Assisted Living, and the 

Florida Health Care Association, look forward to continuing a positive, constructive dialog that results in the only statistic that matters: the number of lives saved by an intelligent, well-executed disaster plan that includes the needs of older adults and persons with 

disabilities in long-term care facilities. 

Thank you. 

[The prepared statement of Ms. Polivka-West follows:] 

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Senator MARTINEZ [continuing]. Now, we hear from you, Ms. 

Markwood. 

STATEMENT OF SANDY MARKWOOD, CHIEF EXECUTIVE OFFICER, NATIONAL ASSOCIATION OF AREA AGENCIES ON 

AGING, WASHINGTON, DC 

Ms. MARKWOOD. Thank you. Good morning, Chairman Kohl, 

Ranking Member Martinez. My name—— 

Senator MARTINEZ. I don’t think your mike is on. 

Ms. MARKWOOD. Is it on now? Can you hear me? Great. It works? 

OK. 

Senator MARTINEZ. There you go. 

Ms. MARKWOOD. My name is Sandy Markwood, and I’m the Chief 

Executive Officer of the National Association of Area Agencies on 

Aging. n4a represents the 629 Area Agencies on Aging, or ‘‘tripleAs,’’ as we all them, and 246 Title 6 Native American programs 

that, today, and every day, are assisting millions of older adults 

and caregivers in communities across the country. 

I want to thank the committee for inviting n4a to testify on the 

issue of emergency preparedness and the ongoing efforts of Area 

Agencies and Aging Services Network to meet the special needs of 

older adults in advance of, during, and after a disaster or an emergency. 

As has been pointed out by the other panelists, AAAs have found 

that in disasters older adults have distinct needs that need to be 

present, and challenges that communitywide emergency planning 

and response efforts need to address. Each stage of an emergency 

during evacuations and emergency shelters or when returning to 

the community needs to be handled differently when dealing with 

frail older adults. 

During a crisis, frail seniors may need extensive health supports 

and services to survive. Many times, their needs are too complex, 

serious, and individualized to be treated with a one-size-fits-all approach that shelters and relief organizations are able to offer as 

they work to serve the needs of the broader population. Volunteers 

and workers unfamiliar with older adults’ needs may not recognize 

or know how to deal with the important signals that would indicate 

a senior’s state of mind or their body. Addressing the needs of 

those with chronic conditions and dementia become particularly difficult in a disaster situation. 

Providing continuity of services to older adults after disasters as 

they move from shelters to temporary housing also poses significant challenges. AAAs have experienced difficulty locating older 

adults who they know need gap-filling services due to regulations 

that prevent emergency response agencies from disclosing their 

new location once they’ve moved from a shelter to a temporary 

housing. AAAs have also found it difficult to assist disaster victims 

in making the transition back into the community, back into their 

home, due to lack of post-disaster resources available for such necessities as temporary housing, home repairs, and chore services. 

Pulling your life back together after a disaster is difficult for anybody of any age, but for older adults, the challenges can be as lifealtering and as life-threatening as the disaster itself. 

51 

During last year’s deadly floods in Iowa, nearly 65,000 Iowans 

age 60 and older requested assistance. Some of these older adults 

required a wide range of supports beyond what FEMA and other 

entities could offer. What we heard from our members in Iowa is 

an example of the thousands of older adults that sought AAA assistance. A typical request would come from an 88-year-old woman 

who had lost everything in the flood. She would need help securing 

replacement prescription medications and other medical devices, 

navigating the disaster relief channels and paperwork, including 

handling personal financial affairs, especially if a family member 

wasn’t present; managing her activities of daily living, particularly 

if her regular caregiver was displaced by the flood; and identifying 

appropriate affordable short-term housing until she can return 

home. Without this level of assistance, she would be forced to move 

into an unwanted and expensive institutional-care settings, many 

times located in another community, and, many times, for the rest 

of her life. 

In order to succeed as the first line of response for older adults 

in disasters, the Aging Services Network must have better access 

to decisionmakers to be directly involved in long-range planning, to 

be at the table in order to coordinate emergency services, and to 

have adequate resources, as well as the technology and communication tools necessary, to adequately respond to the needs of older 

adults. 

To strengthen national, State, and local efforts to address the 

needs of older adults in emergencies, n4a recommends that the following steps be taken: 

First, we need to promote, Federal, State, and local informationsharing. There needs to be a consistent policy to ensure that FEMA 

registration information for the age–60-and-older population is 

shared with State units and AAAs in federally declared disaster 

areas. 

Second, we need to make community-level special-needs registries a high priority. Federal grant funding should be established 

through the Administration on Aging to support community-level 

work by AAAs to develop emergency preparedness registry systems 

for older adults and special-needs populations, utilizing geographic 

mapping technology. 

Third, we need to reinforce existing Federal policies to formalize 

coordination plans. Using the great experience of Florida as a national model, Congress should build on the emergency preparedness provisions added to the Older Americans Act in 2006 by requiring that the FEMA and other State and local emergency preparedness agencies formalize coordination plans with the Aging 

Services Network. 

Fourth, create a DHS-AOA interagency education program. We 

need to encourage the Department of Homeland Security and AOA 

establish an interagency program that would facilitate cross-agency 

training opportunities and provide the on-the-ground orientation to 

both networks on how they can more effectively work together and 

better utilize each other’s resources during disaster planning, response, and recovery efforts. 

Also, finally, we need to urge Congress to fulfill the promise of 

the Older Americans Act by funding its emergency planning proviVerDate Nov 24 2008 14:25 Jan 07, 2010 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6633 H:\DOCS\54128.TXT SAG PsN: JOYCE
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sions, directing resources to the Administration on Aging, State 

Units on Aging, and AAAs to support these critical efforts. After the floods in Iowa, AOA only had $50,000 of disaster aid 

to distribute to 11 flood-ravaged AAAs, out of the total disaster allocation of AOA of $300,000. This just isn’t enough resources to 

meet the need. 

As Congress looks ahead to the reauthorization of the Older 

Americans Act in 2011, we encourage policymakers to strengthen 

the Older Americans Act Disaster Assistance Program. 

Thank you, Chairman Kohl, Ranking Member Martinez, for holding today’s hearing and for calling the necessary attention to the 

special needs of older Americans during times of disasters. I’d be 

happy to answer any questions. 

[The prepared statement of Ms. Markwood follows:] 

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Senator MARTINEZ. Thank you all very, very much for your enlightening testimony. We will have some questions now. 

I want to begin with Dr. Besser. If we could ask you, where are 

we on the H1N1? What are the prospects for the fall? I think, in 

general, we would all, since we have you here, like to know about 

this, for general population. Then if you could, more specifically, 

speak to the potential for it to impact seniors since the virus didn’t 

seem to be affecting seniors particularly, what are the prospects 

that it might come back in a different form? Just where are we 

with the whole thing? 

Dr. BESSER. Thanks very much for that question. 

Yeah, each Friday we report our domestic case totals, and, as of 

June 19, there were more than 21,000 cases reported here in the 

United States, and 87 deaths. I mean, as you know, on June 11, 

the World Health Organization put us into phase 6 and declared 

a global pandemic, which was really not an indication that this is 

any more severe, but an indication that this is a virus that is 

spreading easily, it’s a virus for which people don’t have much in 

the way of immunity, and it’s a virus that we expect to continue 

to cause disease around the world. 

We base a lot of our assumptions on what’s taken place in 

pandemics in the past, but it seems that the influenza virus is extremely cagey and tends to outsmart us when we think we understand what’s happening. We would have predicted that, as the 

weather has gotten hotter now, that the virus would have gone 

away and that we would—that we’d be looking toward the fall for 

a return of this virus. In actuality, we are still seeing a fair amount 

of influenza activity around the country. As you’ve been reading in 

the press, there have been a number of outbreaks at summer 

camps that are causing a lot of difficulty in those institutions. 

There is some promising information in the area of elderly individuals, and that is that it appears that there is some protection. 

As we look at who has been most impacted by this strain, we are 

seeing the—primarily, disease in younger individuals. Only 1 percent of the cases are in persons 65 years and older; 4 percent of 

the hospitalizations have been in that age. We don’t know if it’s 

from repeated immunizations over people’s lives or exposure to 

strains of influenza over the course of their lives, but there is some 

degree of protection. 

What we’ve seen from previous pandemics is that viruses can 

change. An influenza virus is—the reason we need a shot every 

year is that there tends to be some change in the virus each year, 

and we need to be protected in that manner. We’re working with 

the World Health Organization and other international organizations to try and see what is happening to this virus during the flu 

season that’s taking place now in the Southern Hemisphere. That 

will help guide a lot of what we recommend for the fall. 

There are a couple of things that we clearly recommend for seniors for the fall. That’s to get their annual flu shot, to make sure, 

as well, that they have their pneumonia shot. Each year, only twothirds of seniors get their flu shot, and slightly more than half get 

their pneumonia shot, or have had a pneumonia shot. Those are 

things that, regardless of whether there’s a pandemic, are very important to do. Each year, on average, 35—36,000 Americans die 

69 

from influenza, and that’s primarily an issue in those with underlying medical conditions and the elderly. So, even if this pandemic 

does not affect the elderly disproportionally, it’s very important 

that the elderly are protected against seasonal flu. 

Senator MARTINEZ. So, at a minimum, if we can take a message 

from your comments for seniors specifically, get a flu shot and get 

a pneumonia shot, particularly this season. 

Dr. BESSER. Yes, sir. Yeah, those are very important. Then, understand where you need to get your information. Because it may 

be that this virus changes in the Southern Hemisphere, and it may 

be that seniors are one of the groups for whom the new vaccine 

might be recommended. At this point, studies are going to be done 

to look at a new vaccine, and then the administration will determine whether or not to recommend vaccination for either high-risk 

individuals or others. 

Senator MARTINEZ. Thank you. 

Secretary Beach, if we can turn to other types of disasters, I 

know we’ve, in Florida, as you testified, dealt with the hurricane 

problem, also—I believe it was Ms. Markwood—talked about the 

floods. Can we focus on those issues now and what level of preparedness you think exists across Florida that the Nation could 

also look to as a model, or benefit from? 

Dr. BEACH. I think one of the things that we do in Florida that’s 

particularly unique is, we do a lot of practicing. We bring together 

folks—tend to be two or three times a year, typically led by county 

Emergency Operations Centers, bringing—make sure that all the 

partners for disability groups, senior groups, and the like, have a 

plan in place, can identify who the special-needs folks are on their 

registry, and, most importantly, have a way to coordinate with 

some of the outreach organizations. 

When you were mayor in Orlando, Orange County, you put together an Interim Commission on Aging, and one of the things that 

came out of that Interim Commission on Aging was a 2–1–1 system 

for Brevard, Orange, Osceola Counties. The advantage of 2–1–1 

was how we could disseminate that information over a broad number of people very, very quickly. I think once you coordinate the 2– 

1–1 system with aging and disability resource centers, which are 

funded at the Federal level, which we have in each Area Agency 

on Aging in Florida, it enables us to get the process jumpstarted 

and at least have a plan in place before anything happens. 

Senator MARTINEZ. Ms. Polivka-West, if we can ask you—fit into 

the picture of both the potential for a flu pandemic situation that 

could impact seniors, as well as just plain natural disasters, how 

are we doing? The whole issue of command management for nursing homes, and how are those going to impact our preparedness in 

the future? 

Ms. POLIVKA-WEST. Well, again, I would use the model of Florida, in terms of an all-hazards approach to disaster preparedness 

planning and response and recovery. At the heart of that is the inclusion of long-term care in the State’s emergency response system. 

This is what we recommend for the national—the Federal system 

to include—long-term care, the vulnerable populations that reside 

in skilled nursing facilities and assisted living facilities, as a part 

70 

of the national response framework. They are not included, at this 

time. 

So, I go back to how we’re doing—our disaster preparedness 

planning in Florida—for example, for the hurricane season, that 

we’ve now begun. We have started our drills. We work with our 

local Emergency Operations Centers at the—each local level. We 

have a seat at the table with the EOC. At the State level, we have 

a desk. That’s Florida Health Care Association’s desk—at the 

Emergency Operations Center. This started with Craig Fugate, 

when he was at—with the Emergency Management Operations. We 

work very closely with our Emergency Support Function 8, the 

Health Desk, and we coordinate with other parts of the emergency 

management system. 

But, what we’ve learned, after the hurricane season of 2004 and 

2005, is that we had to be there, because that was the way we got 

to the power companies for power restoration. Long-term care is 

not a prioritization for power restoration. We have the same priority as the convenience store. So—unlike hospitals—and so, we 

have to be there. We have to tell them what kind of vulnerable 

populations we have on ventilators, on oxygen. They have—our 

frail, vulnerable elders have to be served. So, we know we can do 

it in Florida, we know we can do it at the rest—with the rest of 

the country, but we have to do it State by State at this point, because we are not a part of that national response framework, at 

this time. 

Although I would like to give credit to HHS’s Assistant Secretary 

for Preparedness and Response, because they have included us 

through the American Health Care Association in their gap analysis and planning. 

Senator MARTINEZ. That’s great. I don’t think there’s any question that having a desk at the EOC makes an incredible difference. 

I think—— 

Ms. POLIVKA-WEST. It does. 

Senator MARTINEZ [continuing]. It really has been—in my former 

experience as mayor, you can really see a difference when someone 

is at the desk and they are part of the whole operation. It makes 

a difference. 

Mr. Chairman, I think I’ll cede to you and maybe come back for 

a question or two. 

The CHAIRMAN. Mr. Manning, you spoke about the importance of 

personal preparedness among seniors prior to a disaster. Can you 

describe some of the things that seniors living at home need to do 

to be prepared? 

Mr. MANNING. Thank you, Mr. Chairman. Certainly. 

Having a prepared and—having a population that is expecting a 

disaster, that has taken those steps around their home and in their 

community and working with their neighbors to ready themselves 

for a disaster can lead to a community that is more resilient and 

may not require the assistance of government in the first place. If 

we can prevent a disaster from becoming—a bad event from becoming a disaster, then we’ve solved the problem before we even gotten 

there. 

Some of the specific things that can be done around the home include having a—having—something as simple as having commuVerDate Nov 24 2008 14:25 Jan 07, 2010 Jkt 000000 PO 00000 Frm 00074 Fmt 6633 Sfmt 6633 H:\DOCS\54128.TXT SAG PsN: JOYCE
71 

nication plans among homeowners—I mean, among the household 

members, among neighbors in a higher density living environment, 

where people understand that, once they’ve assured that they 

themselves are OK and that their spouses, their family members 

are OK, that their first responsibility should be: check on their 

neighbors. As we can develop planning and a capacity of community within a neighborhood, that is something that will go a long 

way toward providing a more robust community resilience. 

Other things that could be done in a home is having—we’ve said 

over and over again, having 3 days of food and water, having supplies prepared in your home, in your facility, so that you don’t need 

to require—you don’t require the assistance of government, in the 

short term, which may not be able to get there. But, it’s important 

to also recognize that many people aren’t able to do that, that having—saying having food and water for 3 days is a good thing, but 

many individuals aren’t exactly sure where they’re going to get dinner tonight, much less where—having 3 days on hand. We have to 

keep—we, those that plan for disasters, have to keep that in mind, 

as well. 

The CHAIRMAN. Thank you. 

Ms. Markwood, whether it’s providing a ride to the pharmacy or 

delivering meals, local aging service providers are on the front line, 

meeting the needs of seniors. You recommend that DHS and the 

Administration on Aging work together to include local entities in 

planning for emergencies. Can you speak a little bit more about 

that? 

Ms. MARKWOOD. Senator Kohl, what we see is the need for all 

of the coordination—and I do believe that Florida is a terrific 

model, because you’ve had to be, because you’ve experienced so 

many disasters—it’s bringing together Homeland Security, bringing 

together emergency planning and preparedness with Health and 

Human Services to make sure that those critical needs are met. 

Oftentimes, that takes cross-training. 

Again, in looking at emergency preparedness organizations, they 

have to meet the needs of the broader-based population. What 

you’ve heard today in the panel is the needs of older adults, especially those frail older adults, is different, and it needs to be—there 

needs to be cross-training to make sure that they can recognize the 

needs of older adults, not only those physical needs, but also recognizing the dementia, and there other issues, cognitive needs, that 

are there, as well, and also to do the cross-training and coordination so that those needs get met. In looking at that, it is important 

to make sure, as well, that resources are shared among those agencies at the local level. 

Ultimately, it comes down to what happens on the ground at the 

local level, and there needs to be cross-training and coordination to 

make sure that the needs of older adults are met in those situations. 

The CHAIRMAN. Thank you. 

Ms. Polivka-West, we all understand that, during mass evacuation times, the readiness and availability of vehicles to transport 

seniors is critical, and, without it, we can’t get the job done. Would 

you talk about that and what your thoughts are on whether we’re 

prepared and how we deal with that? 

72 

Ms. POLIVKA-WEST. We consider transportation to be our Achilles 

heel in disaster preparedness for long-term care. In fact, we’ve 

helped two transportation summits at the national level with the 

motor carriers—the American Bus Company, Trailways—the major 

carriers with the American Health Care Association and National 

Center for Assisted Living—to address the problems, in terms of 

the lack of transportation when it’s needed. Because of competing 

priorities with populations to be served, we know, through Hurricane Charlie, what happened when that went through Port Charlotte. All of the ambulances were taken by the hospitals; there were 

none left for other assisted living facilities or nursing homes. So, 

we had to pull in transportation from the northern part of the 

State, and it took many hours to get them down into South Florida. 

So, we learned from those experiences, that we had to have a template for transportation providers. We have to have redundancy in 

transportation planning. We have to—we advise facilities to have 

three providers with contracts, and to ensure that they renew those 

contracts each year. But, even then, we know there could be problems, because—and you never have enough transportation potential for a huge disaster. We know this. So, that’s why we’re focusing on hardening facilities, the physical plants. We wish that you 

would get the banks to let up on some of that money that we’ve 

given so that we could have some physical plant hardening with facilities—that’s just an aside—in terms of disaster preparedness. 

But, the profit margins are very lean with long-term care providers, because they get primarily Medicare and Medicaid funding. 

But, these plants, these physical plants, need to be hardened in 

order to shelter in place as much as possible so you don’t need 

transportation for evacuation, except when you know you’ve got 

surge zones that you have to protect or during—if the—for example, if you have earthquakes and you have to move populations, 

you’re going to have to have transportation to be aware of what the 

needs are of our vulnerable elder adults. We’re doing that through 

the American Health Care Association, the transportation summits 

that started in Florida 3 years ago. 

The CHAIRMAN. Thank you. 

Mr. Chairman. 

Senator MARTINEZ. Well, I want to come back to the health issue, 

and maybe just ask you, Dr. Besser, but others on the panel, perhaps to comment. 

If a health emergency were to arise that really impacted seniors, 

how do all of these various agencies that are here today and all the 

things that we’ve done to prepare for natural disasters, how prepared are we to deal with a health emergency, as opposed to a natural disaster or—a typical natural-disaster type of emergency? 

Dr. BESSER. We have taken an all-hazards approach to preparedness, as was mentioned earlier. There has been an enormous investment over the past 5, 6 years, in public health emergency preparedness. This has led to great improvement in the ability of public health to engage with the various communities. 

We know that, in the setting of an emergency, whether it’s a natural disaster, whether it’s a new emerging infection or whether it’s 

something deliberate, the coordination that takes place at the local 

level is a key success factor. What the resources that have gone to 

73 

public health have allowed is for public health to make those introductions now, to be part of planning at the local level. We’re hearing about some planning efforts that need to be enhanced. That’s 

true across the country. 

One of my concerns, in terms of that, is that we hear from public 

health that the economy is leading to massive layoffs in public 

health. Over 11,000 people, according to the Association of State 

and Territorial Health Officers, are losing their jobs at the State 

and local level in public health. That will have consequences in the 

setting of a disaster. 

We partner with the American Red Cross. We work very closely 

with FEMA and others in DHS on planning. But, the work that we 

do at the national level is only as good as the systems that are in 

place at the local level. 

Florida is clearly a gold standard, and that’s because they have 

the opportunity to exercise every year and respond every year because of hurricanes. Other parts of the country don’t have that experience and really rely on the resources that they get to do the 

exercising, the planning, the improvements in their plans on a regular basis. 

Senator MARTINEZ. Thank you. 

Any other comments? Yes, Secretary Beach? 

Dr. BEACH. Thank you. We do a lot of tests to see how responsive 

we’ll be. As an Area Agency on Aging Director, we did a pandemic 

flu test of the EOC, Emergency Operations Center, in Brevard and 

in Orange County. As Secretary, we’ve also had a dry run on a terrorist attack in Tallahassee, as well as a pandemic flu issue in the 

State of Florida. What we find out—much of it came through Craig 

Fugate’s leadership—but, we find out, just by going through those 

tests, those dry runs, so to speak, and making sure that 

everybody’s coordinated, at the end of the day. We know that 10 

minutes into an emergency, most of our plans will go out the window. But, in any case, at least we’re—we’ve planned, and at least 

we have some sort of idea as to what we want to do and how we 

want to do it. 

Senator MARTINEZ. Well, one last thing I would say is also in 

terms of Florida’s success with natural disasters, it’s relying on the 

local situation for the first 72 hours, because, you know, Federal 

response is always going to be coming after. I know you and I 

talked yesterday about the importance of that, and I wonder if you 

might comment on that, as well. 

Dr. BEACH. Yes. During Fay, the Surgeon General and I traveled 

up and down the East Coast from Port St. Lucy all the way up to 

Jacksonville, and we went to each of the EOCs, the counties that 

it affected during that tropical storm, terrible flooding during that 

tropical storm. The EOC directors were very kind to us, but we got 

the feeling that they kind of wanted to elbow us out there, because 

they had some pretty important business to do and we were in the 

way. 

But, at the end of the day, what we find in Florida is that, during preparation, the State Unit on Aging, Federal partners, are 

very, very important in the preparation stage. But, once the 72- 

hour period comes into play, it’s all county folks and first responders, as well as local providers, in how they get out there. Then, 

74 

after the first 72 hours, then we can come in with, not only our 

State resources, but Federal resources, to try to do the cleanup and 

make sure that everybody is in the right place at that time. 

Senator MARTINEZ. Do you have anything else? 

Well, thank you all very, very much. I think one of the real 

takeaways, for me, is the fact that nursing homes are not 

prioritized in restoring power. I think that’s something that really 

ought to be highlighted as a flaw in the system, because when you 

restore hospitals, obviously they should be at the top of the list, but 

very close thereafter should be nursing homes. That ought to be 

way ahead of the convenience store down the street. 

We require generators now at our gas stations in Florida. Obviously, there are other places that also should probably have power 

to be able to take care of themselves for the first 24 hours or so. 

So, that’s another consideration, as well. 

But, this is all very important, and I appreciate all of you highlighting it to us. For us Floridians, this is the beginning of hurricane season, so this always highlights for us the need for personal 

preparedness, for people to take matters into their own hands, 

have a personal plan of how they would cope with an emergency. 

Then, beyond that, for all our governmental agencies to continue 

to do the great job that they do. 

As we talk about our national situation, I do hope that we will 

keep an eye on the H1N1 and hope that this fall we will not be 

in a bigger problem, but also preparing ahead of time, and having, 

particularly, seniors get a flu shot and a pneumonia shot sounds 

like good advice, as well. 

OK, well, thank you very much. 

This concludes the hearing. We’re adjourned. 

[Whereupon, at 12:17 p.m., the hearing was adjourned.] 

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