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Statement of
Josefina G. Carbonell
Assistant Secretary for Aging
U.S. Department of Health and Human Services

Before the
Special Committee on Aging
United States Senate

Field Hearing
New York City, New York

February 11, 2002

Mr. Chairman and Members of the Committee:

Thank you for this opportunity to discuss the Administration on Aging's (AoA) perspectives on emergency preparedness for the elderly and those with disabilities. We appreciate your leadership in convening this hearing on responding to the needs of at-risk populations during and following a local or national state of emergency.

Mr. Chairman, the past six months have been emotional ones for all of us. Being in New York City today -- so close to one of the worst human tragedies in American history -- brings once again into focus all the vivid pictures that many Americans only watched in horror from their living room televisions.

We have learned many lessons from September 11. First and foremost, we have proven again that Americans are the most patriotic and resilient people in the world. Second, we have learned that we are not immune to terrorist attacks, and we must do all we can to support the President's efforts to protect the freedom we enjoy as Americans. Third, we have learned that we must be better prepared to deal with the possibility of future attacks on our way of life or other such disasters that impact our citizens and our families.

The Administration on Aging is charged with providing essential home and community-based services to those most in need – older persons, those who are frail and who have disabilities, as well as their caregivers. Through the Older Americans Act, the AoA works in partnership with our national aging network of State and area agencies on aging, tribal organizations, service providers and hundreds of thousands of family caregivers and volunteers. AoA's programs touch people's lives where they live – in their homes and communities. We provide meals in senior centers, and to those who are homebound. We also provide transportation to and from medical appointments or perhaps shopping or pharmacies as well as preventive health services, such as screening for diabetes, and many other important supportive services that enable older citizens to remain at home. Thanks to your leadership, we are also able to provide assistance for the first time to family caregivers who struggle on a daily basis to care for their older loved ones.

Today, there are approximately 45.7 million people 60 years of age or older. Many of these individuals have chronic health problems, and many are homebound. These individuals are dependent upon community service systems for their day-to-day existence. And that number is growing. Estimates show that by 2003, there will be 4.7 million frail, elderly persons – 85 and older – which indicates that the need for services for the aging population will only increase with time. In an emergency, these individuals represent the most vulnerable sector of our population.

Perspectives on What We Have Learned from September 11.
The events in New York, Pennsylvania and at the Pentagon on September 11 heightened our awareness of the importance of good communication. As we all now know, communication was one of the most critical challenges experienced in the hours and days following the attacks. It was difficult assessing what areas were safe and how to communicate with others to plan the next steps to protect ourselves or those we are entrusted to serve. Telephone service, something we all take for granted, was not available. You will remember that in Washington, D.C. communication was impaired due to system overloads. Here in New York this was further compounded by power outages, especially in the areas surrounding the World Trade Center. The fact that we did not have an alternative communication system made it very difficult for us to determine the immediate needs of our seniors.

Immediately after the attacks, I was in touch with the New York State Office on Aging to assess the situation. Because the New York City Department for the Aging had lost phone service, this was a challenge. As was the case with many of my colleagues, staff were impacted due to the proximity of our offices to the World Trade Center. Upon evacuation of 26 Federal Plaza in the hours after the attack, our Regional Administrator first ensured that all staff were evacuated safely. Later, offices were reopened in temporary quarters in New York City in order to continue to serve our customers. Then, only by using a handheld personal pager system with satellite linkages was he able to communicate with us in Washington during the first few hours and days following the attacks. This connection was incredibly valuable until emergency phone systems and other communications could be arranged. Portable cell phones, battery radios, and laptop computers were essential in the early days following the attacks.

Our heavy reliance on computer data systems, which hold client data about hard-to-reach older persons who rely on our services, was also at risk. Some of the material could not be retrieved and concerns were raised about confidentiality and information security. Just as we did after Hurricane Andrew in South Florida, our network had to find out who needed help the old-fashioned way – through neighborhood teams who went door to door identifying the needs of those who were homebound. Sometimes extraordinary events call for extraordinary measures.

Many elderly people were stranded in their apartments. Others were either physically unable or afraid to leave their own residences. For example, the work of the Visiting Nurse Service of New York (VNS) was invaluable, as we will hear later in today's hearing. Following September 11, VNS was tasked with locating and assisting their frail and isolated homebound clients confined in the areas around the World Trade Center. Individuals were cut off from their doctors, grocers, and pharmacies. AoA was proud to work in partnership with the Centers for Medicare and Medicaid Services (CMS) to assist the VNS in their efforts to reach those in need of food and water. AoA worked with the New York State Office on Aging and the New York City Department for the Aging to help facilitate access for the VNS.

AoA also joined with the Centers for Medicare and Medicaid Services in the establishment of a 24-hour, rapid response, multilingual hotline for older New Yorkers living in lower Manhattan. This allowed seniors to quickly access help in filling prescriptions, receiving personal services, therapies, transportation to health care professionals, or other important daily living needs. In addition, the New York aging network was able to establish a telephone system staffed by older, visually impaired adults who provided information and assistance to other visually impaired, older New Yorkers. In response to the need for continued, seamless availability of Medicare and Medicaid services, CMS ensured that medical and benefit payments flowed despite dislocation of staff and/or the destruction of offices and systems and coordinated certain emergency help for New York City below the 14th Street disaster area.

For some, reliable caregiving systems completely disintegrated as a result of family and friends who were affected by the event. In Washington, D, C, a caregiver dropped his mother off at an adult day care center on his way to work at the Pentagon and never returned. I am deeply grateful that funds from our National Family Caregiver Support Program were able to provide the family with one week of respite for the mother at a group home so they could attend to the funeral of her son. We know that there must be many similar stories here in New York.

Mr. Chairman, the importance of providing funding as quickly as possible to aid in recovery and relief efforts for older persons is paramount during these types of situations. The Administration on Aging was able to immediately provide almost $1.8 million in emergency funding to the State of New York following the September 11 attacks. These funds were provided to ensure that services would continue to be provided to those who needed them the most. Additionally, we were able to provide $25,000 to Virginia to assist seniors and caregivers who were impacted by the Pentagon attack.

Recommendations for Emergency Preparedness Plans - Where Do We Go From Here?
In the mid-1990's, AoA developed detailed technical assistance materials and provided training to key persons in the aging network in the event of a disaster. As a result of the events of September 11, we are currently in the process of updating these materials and plan to conduct more intensive training. One of my priorities is to ensure that our State and area agencies and tribal organizations have emergency and back-up plans for natural or man-made disasters in place, timetables for updating and revising plans, and training programs on an ongoing and regular basis. It is important too for plans at all levels to be available for use on short notice when the unexpected occurs. In addition to these plans, I recommend the following:

First, as I have stated, the need for alternative and back up communication systems is paramount at all levels of government. Battery-powered radios and other such devices need to be made available in the event of land line and cell phone failure;
Second, up-to-date information needs to be available about who and how to contact key aging officials when a disaster occurs and how to reach these individuals after hours and on weekends. State agencies need to have contacts for all of the area agencies which, in turn, need contacts for each service provider. Consistent emergency protocols must be available;
Third, up-to-date knowledge about who needs special assistance should be readily available. For example, information about clients is currently kept almost entirely at the community level and is likely to be inaccessible in or immediately following a disaster, which hampers the network and others' ability to locate seniors who may need immediate assistance or have special needs. We should develop a special needs client data base accessible to States, area agencies on aging and network providers. The aging network must develop a strong working partnership with State and local emergency management agencies to make sure that the names of frail and at-risk older persons are on their list of individuals with special needs. In times of disasters, elders with special needs, such as those who have disabilities, those who are electricity-dependent – on ventilators or oxygen, those with limited ability to speak English, and those who are afraid must have their needs immediately addressed.
Fourth, aging network resources need to be coordinated and integrated with and among larger Federal, State, and local emergency management operations so as to avoid duplication of efforts, and most importantly, to ensure that the special needs of elders are incorporated into overall community preparedness response action plans. We will be working with the State and area agencies on aging to determine how the current program can be shape to respond to these new challenges.

Additionally, it is important for everyone who is involved in an emergency to be sensitive to the fact that some older persons and individuals with disabilities may become disoriented, may take longer to evacuate, may need special equipment or may depend on others to help them evacuate.

Mr. Chairman, I also want to call to your attention the need for mental health counseling to provide individuals impacted by disasters an opportunity to react to and talk about what they have experienced. Shortly following September 11, the Department of Health and Human Services held a Mental Health and Substance Abuse Summit here in New York City. While it did not address concerns specific to the elderly, it did raise some key points that warrant attention. We know the elderly experience the same grief, anger, fear and sense of loss as others, but the disruption to their daily routine can be overwhelming. For younger persons, the possibility of recovering to a point they experienced before the disaster has greater probability. For older persons, their losses are more likely to be permanent losses, be it their home, possessions, their caregivers, or other important aspects of their daily life.

The most important item to note in terms of post-traumatic recovery is that for older persons, their day-to-day existence is often more fragile; meaning that even the most modest changes such as a neighbor moving or a meal site closing, such as was experienced in Chinatown at the City Hall Senior Center, may trigger a series of events that threaten or even destroy their ability to continue independent living. The need to make new living arrangements is much more complicated, and the ability to recover from various losses can be very difficult. We cannot let these frail individuals live in isolation or in fear. We must do our best to provide continuity and normalcy to their already fragile existence.

Preparing our workforce to respond
If we have learned anything from September 11, it is that we cannot predict the future. We can, however, be better prepared. As an agency, and certainly within the Department, we are now taking action to update our own disaster assistance and training efforts rather than talking about it as a "future" event.

One of the first steps we took was to update our employee roster for both central and regional office staff with more detailed information about ways to contact staff and their families. We implemented some back-up communication arrangements with hand-held communication and other portable devices.

A second step was to greatly tighten up our in-house emergency plans. These events have heightened our awareness for the need to educate our staff and to improve employee evacuation and safety concerns. We have had training sessions on fire safety and CPR. More training is planned.

Finally, in order to better prepare our own network to address unexpected disasters, such as bio- terrorism, the Administration on Aging is revising our Disaster Preparedness Training Manual utilizing the experience gained from this incident and other disasters. We are working with States, area agencies on aging and local communities to use this material to train staff at all levels for the development of preparedness plans. In these uncertain times, everyone should know what to do if a disaster occurs.

In closing, we are very proud of the continued commitment of Secretary Thompson to help our seniors and their families. His philosophy that the Department of Health and Human Services is "one department" increased the capacity of all agencies to provide much needed assistance during this crisis. We applaud the dedication of so many of our Federal partners, such as the Centers for Disease Control and Prevention, the Federal Emergency Management Agency and others who answered the call that day and in the weeks and months to follow. And again, we are very proud of the heroic work of the New York aging network. I would like to give special acknowledgment to Igal Jellinek, the Executive Director of the Council on Senior Centers and Services of New York, which has focused much of its energy on emergency preparedness at the local level.

I want to again commend you for calling today's hearing. As responsible public officials, we must do everything in our power to help our communities to be prepared. Most areas around the country have emergency plans in place. However, I cannot speak with confidence that these plans cover all the needs of the elderly. Today's hearing is a very important step. Mr. Chairman, thank you for this opportunity and for your continued concern for our nation's older Americans and their caregivers. I would be happy to respond to any questions.

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Last revised: February 11, 2002