Nursing Home Residents Could Tip Elections, if They Find a Way to Vote

But other states offer little more than absentee ballot applications and some have tried to make that process more difficult, says Michelle Bishop, manager of voter access and engagement at the National Disability Rights Network. For example, in 2023, Ohio passed a law that included a restriction on who can help a voter with a disability cast an absentee ballot — though a U.S. district court overturned that provision in July. In Louisiana, people risk criminal charges if they help more than one non-family member with an absentee ballot. A lawsuit is challenging those Louisiana laws.

Restrictions like those violate the federal Voting Rights Act, which permits voters with disabilities, including some residents of nursing homes, to get help when voting as long as they aren’t being assisted by their employer or union representative, Bishop says. Polling places also must be accessible to those with disabilities.

But limitations have a chilling effect.

"That's going to have a disparate impact on people for whom it’s going to be more difficult to get out and get to that polling place, including people who live in nursing homes,” she says.

In some places, it’s not state law or voting procedures that present a barrier. Instead, it may come down to nursing home staff, says Nina Kohn, a law professor at Syracuse University and a distinguished scholar in elder law at Yale Law School. Without that support, it may be difficult for residents to get information about voting deadlines and requirements, get absentee ballots or a van ride to the polls, Kohn says.   

“If staff don’t see voting as something that is important for residents — whether that’s because they don’t think residents are the type of people who can or should vote, or whether because they themselves are not politically active,” Kohn says, “then they may simply not place priority on voting.”

Maurice Miller at his nursing home in Takoma Park, Maryland.

Greg Kahn

The right to cast ballots

People in long-term care and nursing homes are there for many reasons: they may have physical disabilities and need help with daily activities or require specialized care. They may have cognitive challenges or Alzheimer’s disease. So should they vote?

Yes, say advocacy organizations and legal experts. Questioning that right reflects society's unrealistic view of what nursing home residents, or even people with dementia are capable of, Mollot says.

“They’re not in a vegetative state, but that’s the implication, is that these people just don’t have value and that their voice doesn’t have value,” Mollot says. “That’s wrong, whether you have weeks to live or months to live or years to live.”

Generally, most people who are 18 or older can vote unless they have been deemed incompetent by a court or, depending on the state, convicted of a felony. 

“As long as a person can express a voting preference, they have capacity to vote. And of course, that is effectively the standard that we hold people without a diagnosis of dementia to,” Kohn says.

Mary Kohanek, 67, volunteers as an election judge and lives in Minneapolis. She helps her 93-year-old mother, who has dementia and lives in a nursing home, to vote using an absentee ballot, which is mailed to her. Kohanek says her mother considers voting her civic duty.

“She’s always done it, and still really, really wants to do it. I just help her fill out the ballots,” Kohanek says. “She can still read reasonably well. She can still see pretty well, and she can still write pretty well.”

If Kohanek’s mother has trouble reading the candidates’ names, Kohanek will read them aloud and her mother will show her where to mark the ballot. Kohanek then signs the ballot to say she helped her mother. A time may come when her mother no longer understands the voting process and Kohanek says her family will decide what to do then, but for now, her mother plans to vote.

“To me, it seems logical that if a person still understands what voting is, knows the candidates, and can make choices regarding the candidates, they are still connected enough with their surroundings to be able to participate in voting,” Kohanek says.

Residents of nursing homes and other long-term care facilities should have a say in the issues that impact their lives, Bhatia says. Voting is a big part of that.  ​​“A lot of folks in nursing homes are older and count on Social Security and want to make sure their voices are heard about keeping Social Security strong,” he says. “Many have family caregivers that help them and want to make sure they get the assistance they need to keep doing that.” ​

Kohn agrees that having the opportunity to participate in the democratic process is important.

“Most nursing home residents are not in a position to march in a protest. They're not in a position to knock on doors or show up at their elected representative’s offices. The one thing they can do is vote,” Kohn says. “It's a badge of belonging and citizenship, and it’'s, in many cases, the last source of power.”

Jim Loersch, 82, says he learned at a young age about the importance of voting.

Taylor Glascock

When things go smoothly

Voting in long-term care facilities can go well. Jim Loersch, 82, has cerebral palsy and lives in an assisted living facility in Sheboygan, Wisconsin.

Loersch’s facility, the Sheboygan Senior Community, keeps a list of residents who want to vote, and the county sends special voting deputies there to help them. With a deputy present, Loersch points to where he wants a staff member or family member to mark his ballot for him

“It’s a perfect arrangement,” says the retired hospital social worker.

If a resident doesn't need assistance, the special voting deputies step out of the room, says chief executive officer Paul Treffert.

“There's a whole process around it that’s very well articulated and executed clearly every time,” Treffert says. “For our residents, it’s an honor to vote.”

Loersch, who is especially interested in social issues related to people with disabilities or who are older, says he was taught at a young age about the importance of being involved in government.

“I would not consider not voting,” he says. “We are still citizens.”

The American Health Care Coalition/National Center for Assisted Living says long-term care providers follow rules to ensure residents can register to vote, then vote in person or by absentee ballot and receive help with their ballot while not influencing how they vote.

“Our residents have a right to make their voice heard, and providers are committed to assist them in doing so,” the organization said in a statement.

When it comes to this year’s election, Miller, of Maryland, made sure he was set to vote. He reached out to administrators at his nursing home, applied for a mail-in ballot and confirmed that his application was received for the November 5general election. In early September, volunteer poll workers came to his care facility to help residents vote. They recorded his choices on the ballot, he signed it, they sealed it and returned it for him.

“A lesson was learned,” Miller says.

Loersch says you should be able to vote “until the day you die.”

Taylor Glascock