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Voting Rights for Individuals in Long-Term Care Facilities
Voting is a fundamental right. However, individuals who are in long-term care facilities1 (including those who need special care and support due to age, chronic conditions, dementias, and/or disabilities) may face various barriers during election cycles. Making voting easier is important for civil engagement by this population given the policy decision focus on health aging in the nation.
Common Voting Barriers
Ageist and Ableist Attitudes
Both types of attitudes are common. Some think that individuals who are in long-term care facilities no longer have any interest in voting. Statistics prove otherwise since Americans aged 65 to 70 years represent the largest number of registered voters followed by those over 75 years. (See https://www.statista.com/statistics/999919/share-people-registered-vote-age.) As to ableist attitudes, others question whether participation in elections through absentee and mail-in ballots by individuals with disabilities increases the risk of voter fraud. Extensive research reveals that fraud rarely mars elections although there are instances of problems within the election administration system. See https://www.brennancenter.org/our-work/research-reports/truth-about-voter-fraud.
A Lack of Timely Assistance
Individuals who are in long-term care facilities often require additional assistance to exercise their right to vote. The issues run a gamut – gathering election-related information about processes, candidates, and ballot measures; dealing with cognition, dexterity, mobility, and/or vision disabilities which make it more challenging to register to vote, access a polling place, understand the ballot, and physically cast their vote; and addressing matters relating to communication, including, illiteracy and language access needs.
Logistical Issues
Seemingly simple logistical issues to reach election officials and polling places by mail, telephone, email, or in-person visits are often difficult for individuals who live in long-term care facilities. They may not have ready access to affordable and reliable technology or transportation but must instead schedule matters in advance as other residents may have higher priority needs for such services. Arranging for privacy given a shared residence is still another matter for consideration.
Laws Protecting Voting Rights
Advocacy efforts over time have led to the enactment of various laws to help protect voting rights in our nation (see https://www.usa.gov/voting-rights), including those of individuals who are in long-term care facilities. For example:
- Voting Rights Act of 1965 (52 U.S.C. § 10508)
Establishes that individuals with disabilities have a right to receive assistance from a person of their choice in voting.
- Section 504 of the Rehabilitation Act of 1973 (Section 504) 29 U.S.C. § 794 and regulations at 28 C.F.R. § 41.51
States programs or activities receiving federal financial assistance must ensure accessibility for individuals with disabilities and prohibit discrimination in denial of benefits or participation in such opportunities.
- Voting Accessibility for the Elderly and Handicapped Act of 1984 (VAEHA) (52 U.S.C. § 20101 et seq.)
Requires that States provide accessible registration facilities and polling places.
- Federal Nursing Home Reform Act (in the Omnibus Budget Reconciliation Act of 1987 (OBRA ‘87)) (42 U.S. Code § 1395i–3)
Prescribes extensive requirements for issues about administration, quality care, and surveying process in skilled nursing facilities, including specific listing of resident rights and enforcement measures.2
- Americans with Disabilities Act of 1990 (ADA) (42 U.S.C. §§12101 et seq.)
Provides that mandate of the nation is the elimination of discrimination against individuals with disabilities to assure equality of opportunity, full participation, independent living, and economic self-sufficiency.
- National Voter Registration Act of 1993 (NVRA) (52 U.S.C. § 20501 et seq.)
Directs that various State agencies offer various registration options and assistance to individuals with disabilities in effort to increase voter participation in elections.
- Help America Vote Act of 2002 (HAVA) (52 U.S.C. § 21081)
Specifies that voting systems afford individuals with disabilities the same opportunity for access and participation as other voters.
Long-term Care Facility Responsibilities
Under the preceding laws, it becomes clear that support must be provided to residents who wish to vote by long-term care facilities that accept Medicaid or Medicare funds. (See 42 C.F.R. § 483.10.) Such support includes obtaining information about voting, helping fill out and mailing any applications, satisfying requirements to qualify for available alternatives to in-person voting, getting to the polls, assisting with reading and marking ballots, and ensuring that ballots are submitted in compliance with state laws. Clarification about responsibilities owed by nursing facilities regarding resident voting rights is also set forth in Memorandums sent to State Survey Agency Directors by the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services. See https://www.cms.gov/files/document/qso-21-02-nh.pdf and QSO-24-21-NH (cms.gov).
Resources:
Here are some useful links to help individuals who are in long-term care facilities exercise their right to vote:
- to check on voter registration status: https://ova.elections.il.gov/Status.aspx
- to register to vote or to update voter registration information: https://ova.elections.il.gov/
- to request a ballot by mail: https://www.elections.il.gov/ElectionOperations/VotingByMail.aspx
- to explore alternative options to in-person voting (i.e., absentee voting, early voting, military and overseas voting, provisional voting, voting by mail, and permanent voting by mail): https://www.elections.il.gov/InformationForVoters.aspx?MID=I0cuvBFuZRw%3d
- to learn about candidates: https://illinoisvoterguide.org/
- to find a polling place: https://ova.elections.il.gov/PollingPlaceLookup.aspx?Name=Jj8LeKA7il5RZ0L11%2fRsfl%2brWDzEE5awHlVA%2f04u5OOffbunYO7x4nRtY2XrA4JAErmwTGlPT%2bk%3d&T=637166797092771287
- to report complaints of possible violations of the federal voting rights laws: www.justice.gov/crt/about/vot/misc/contact.php
For more information:
https://www.aclu.org/know-your-rights/voting-rights
https://capitolnewsillinois.com/elections/election-guide/
https://theconsumervoice.org/issues/other-issues-and-resources/voting-rights
https://nursinghome411.org/wp-content/uploads/2024/04/Fact-Sheet-Right-to-Vote.pdf
https://www.usvotefoundation.org/disabled-voter-guide/illinois
Conclusion
Our democracy works best when all eligible voters can participate and have their voices heard.
Karen Alice Kloppe is a graduate of Illinois State University (BA) and the University of Illinois College of Law (JD). She is employed as the Legal Assistance Developer at the Illinois Department on Aging in Springfield, Illinois.
This message has been written by the author in her personal capacity for informational purposes only. It is not an official document of the Illinois Department on Aging or the State of Illinois.
1. Long-term care facilities include Skilled Nursing Care Facilities, Intermediate Care Facilities, Intermediate Care Facilities for the Developmentally Disabled, State Operated Developmental Centers, Illinois Veterans’ Homes, Life Care Facilities/Continuing Care Retirement Communities, Assisted Living and Shared Housing Establishments, Supportive Living Facilities, Sheltered Care Facilities, Specialized Mental Health Rehabilitation Facilities, Community Integrated Living Arrangement, and Medically Complex Facilities for the Developmentally Disabled. Independent Living Facilities are not licensed in Illinois.
2. The related state law is the Nursing Home Care Act (210 ILCS 45 et seq. at the following link: https://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1225&ChapterID=21.