State Policies that Affect Voters in Long-Term Care Facilities
For many residents of long-term care facilities, mobility limitations or disabilities restrict their ability to access traditional, in-person voting locations. Among voters 65 and older who did not vote in the 2020 presidential election, 35.2% cited illness or disability as a reason for not voting. If residents choose to or are able to go to the polls, access to transportation, voter ID and support from family members or caregivers are all concerns. For more information on these challenges, see NCSL’s brief on voters with disabilities.
The challenges associated with traditional in-person voting mean that residents of long-term care institutions often use a different method of voting, such as absentee/mail voting or mobile voting sites.
Mobile voting locations (aka supervised absentee voting programs)
Some states and election jurisdictions bring the polling place to voters in long-term care facilities through mobile polling sites, aka supervised absentee voting programs. In this arrangement, teams of trained election workers bring ballots to residents of long-term care facilities and provide assistance as needed. This can reduce the barrier of many voters related to mobility and accessing a traditional polling site.
North Carolina’s program brings in a “multipartisan assistance team” appointed by the county board of elections to long term care facilities to assist residents with the process of absentee voting.
In Iowa, bipartisan teams of election officials deliver absentee ballots to residents of health care facilities like nursing homes and assisted living residences. Voters can request help from the team members if they desire or choose another person for assistance. The bipartisan team then returns the voted ballot to the county auditor’s office.
Absentee/mail ballot laws
Since many older voters, including those in long-term care facilities, vote an absentee/mail ballot, policies related to this form of voting have a high impact on residents’ voting access. The process of applying for an absentee/mail ballot can be difficult and cumbersome for these voters. Furthermore, residents of long-term care institutions often lack direct access to a mailbox, relying on other people to obtain and return their ballot through the mail.
Some states allow permanent absentee ballot status for residents of nursing homes and assisted living facilities specifically. These lists can ease the burden on voters who are limited by mobility issues in having reliable access to voting. Voters with permanent absentee ballot status do not need to reapply for an absentee ballot for each election.
Laws on who can assist voters
Federal law allows voters with disabilities to designate an individual to help them with their ballot, but state laws sometimes limit who can handle their ballots throughout the process of obtaining and returning the ballot. Whether states include caregivers, family members, facility staff or other individuals as acceptable parties to handle ballots of other voters impacts the voting experience of residents in long-term care facilities in the process of returning their absentee/mail ballots.
Ballot collection & delivery process
Ballot collection laws may also play a role in voting for residents of long-term care facilities. Voting does not just consist of marking a ballot—the ballot needs to be returned and processed. Facility residents may rely on others to submit their ballot to the appropriate location if they do not have direct access to a means to do so themselves.
State laws governing ballot collection are intended to preserve the integrity of the ballot but can complicate the voting process for voters who can’t cast a ballot by themselves. For example, many states permit facility staff or the voter’s immediate or extended family to return a ballot on the voter’s behalf. In some states these individuals must document their role in assisting the voter on ballot return materials. Having clear laws on who can assist a voter and how they can provide that assistance helps ensure that election officials know who has been in possession of a person’s ballot while also expanding voting options for residents of long-term care facilities.
Voter information
Residents of long-term care institutions often report a lack of knowledge about elections, including key election dates, what is on the ballot and their voting rights (including their right to assistance in voting). This problem is exacerbated for non-ambulatory residents who might not be able to see flyers posted in common areas. To expand access to this information, some states require licensed care facilities like nursing homes to post relevant voting information in a visible and accessible place in the facility.
Protecting voters from influence or coercion
Because residents often rely on other people to help them vote, concerns arise about potential influence or coercion by facility staff when they help these voters complete their ballots. Within this context, election officials work to strike a balance between supporting voting access for residents and ensuring voting integrity through protections against third party influence.
To address these concerns, some states have laws related to voter coercion with specific provisions related to long-term care facility residents. California, for instance, makes it a misdemeanor for a caregiver in a nursing home to coerce or deceive residents into voting for a candidate or measure contrary to the voter’s will. Rhode Island and Oklahoma each have similar statutes.
Training for facility staff
Because staff of long-term care facilities are likely to help at least some residents with voting, providing training to them can be beneficial for all parties. When staff are trained in regulations, laws and requirements, they can more effectively and confidently aid residents in voting. Many facilities report the need for training of staff on voting issues to enable them to support residents throughout the process.
Voter identification
For the majority of states that have some form of voter ID law in place, the type and form of acceptable ID can impact residents in long-term care. For instance, many residents may no longer have active driver’s licenses or U.S. passports as their mobility has decreased. Some states specify that documentation showing a person is in a nursing home or similar residential situation qualifies as a valid form of ID for voting. In Nebraska, for instance, a valid photo ID for voting includes a document from a nursing home or assisted living facility that shows the voter’s name and a photo or digital image of that resident.
Other considerations beyond state law
Instructions and procedures related to voting for long-term care residents are often addressed in administrative codes or agency guidance—both federally and at the state level—rather than in statute. For instance, in 2020, the Centers for Medicare and Medicaid services released a memo stating that long-term care facilities must have plans in place to enable residents to exercise their right to vote.
Some facilities and localities have even looked beyond the government and partnered with private organizations to distribute information, develop resources and train staff to expand knowledge of voting rights and relevant election laws.