New GAO Report Focuses on Voting Procedures at Long-Term Care Facilities

Dorian Martin Health Guide
  • Voting is one of the rights that many in the United States hold dear. However, for those living in a long-term care facility and who suffer from health issues (including dementia), casting a vote can be problematic. A new study by the United States Government Accounting Office (GAO) looked at issues related to voting by those who live in a long-term care facility.

    Noting that broad protections are provided under federal law to people with disabilities, the GAO found that long-term care facility residents face difficulty in participating in the election process. “The physical and cognitive impairments of long-term care facility residents directly affect the balance between voting participation and the integrity of the voting process. Specifically, the physical and cognitive impairments of many long-term care facility residents may make it more difficult for them to independently drive, walk, or use public transportation to get to their designated polling place,” the GAO report authors wrote. “Once at the polling place, they may face challenges finding accessible parking, reaching the ballot area, and casting a ballot privately and independently. Furthermore, they often may not have a valid driver’s license or other form of government-issued photo identification that some states may require to vote.”

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     However, there is a concern about the undue influence that may be applied by facility staff or relatives who assist some of these residents with voting. “These residents may also have limited dexterity, impaired eyesight, or cognitive impairments, such as dementia, that can make them dependent on others to read or mark a ballot, regardless of where the ballot is cast. This makes them vulnerable to fraud and undue influence from relatives, long-term care facility staff, campaign workers, or candidate supporters, who sometimes provide assistance when casting their vote,” the report authors said.  The report notes that some long-term care facility staff members may use a variety of methods, such as a formal cognitive screening test, election-related questions, or use of prior assessments of the resident’s general mental capacity, to screen residents to determine whether they are able to vote. “In addition, depending on state law, some residents with cognitive impairments may also face legal limitations to their right to vote due to court determinations of mental incompetence or appointment of a legal guardian,” the authors noted.

                    The GAO was asked by the U.S. Congress to “identify the actions taken to facilitate and protect voting for long-term care facility residents at (1) the state level and (2) the local level,” GAO researchers wrote. The researchers  interviewed numerous national, state and local officials and visited seven localities to observe the voting process during the November 2008 federal elections. Here are the findings from their research:

    -          Most states do have requirements and/or guidelines concerning voting for long-term care facility residents.

  • -          Training and oversight regarding state requirements and/or guidance are provided by some states.

    -          In 42 states, requirements or guidance are in place for accommodations for absentee voting by long-term care facility residents. For instance, Iowa election officials provide guidance to long-term care facility staff on the process of soliciting absentee ballot requests from their residents. In addition, required bipartisan election teams to deliver absentee ballots to all long-term care facilities. In Illinois, election workers are required to conduct in-person absentee voting at long-term care facilities 1-4 days before Election Day.

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    -          Many states also provide accommodations for voter registration and voter identification procedures.

    -          Approximately 50 percent of states train local election officials on state requirements or guidelines in order to facilitate voting for long-term care facility residents.

    -          Seventeen states conduct one or more oversight activities to ensure that state long-term care voting requirements are followed. Researchers believe these activities may assist in protecting against voter fraud and undue influence.

    -          Seventy-eight of 92 localities who were surveyed by GAO researchers took actions to facilitate voting for long-term care facility residents. Most commonly, facility staff members were provided support in assisting residents with absentee or the early voting process. Additionally, localities that were visited often provided services directly to residents, such as bringing election officials to facilities to assist with the voting process.

    -          Of those states and U.S. territories surveyed, American Samoa and New York were the only ones that conducted all four key oversight activities – providing training to localities, conducting visits to localities to monitor actions, requiring or requesting localities report on actions taken, and tracking the number of voters in long-term care facilities. Puerto Rico, Oregon, Oklahoma and New Mexico reported conducting three of the four oversight activities.

    -          Actions taken among 92 localities to facilitate voting by long-term care residents included:

    o   Providing early or absentee voting information or guidance to long-term care facilities – 66 localities;

    o   Delivering early or absentee ballots to long-term care facilities – 48 localities;

    o   Providing training to long-term care facility staff on absentee or early voting – 29 localities;

    o   Bringing election officials to long-term care facilities to conduct absentee or early voting – 45 localities;

    o   Designating long-term care facilities as Election Day polling places – 28 localities;

    o   Conducting voting equipment demonstrations for long-term care facilities – 15 localities;

    o   Bringing accessible voting machines to long-term facilities for absentee or early voting – 2 localities; and

  • o   Providing transportation from long-term care facility to polling places on Election Day – 1 locality.

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    Seven localities were visited during the 2008 election. Their efforts to support long-term care voting assistance efforts included:

    -          Kitsap County, Washington publicly advertised voting assistance visits and allowed non-residents to vote during those visits.

    -          Washington County, Oregon allowed residents to sign ballots using fingerprints.

    -          Multnomah County, Oregon conducted several training sessions for election workers on how to help people with disabilities vote and how to use the accessible voting system.

    -          Chicago, Illinois deployed election teams to facilities to provide voting assistance a few days before Election Day.

    -          Shelburne, Vermont collected evaluations from facility staff to inform future voting assistance efforts.

    -          Burlington, Vermont conducted voting assistance visits before the voter registration deadline, allowing new residents to register and vote.

    -          The District of Columbia used portable voting booths, which allowed some residents to vote privately and independently.


    States should be encouraged to find ways to let those who live in long-term care facilities exercise their rights as Americans to vote. I’d encourage you to contact your city’s election office to determine what the current procedures are if you have a loved one in a long-term care facility who would wants to vote in elections.

Published On: December 07, 2009