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Voting During the COVID-19 Pandemic for Residents of Long-Term Care Facilities

Individuals receiving long-term services and supports retain their voting rights, no matter where they live or what type of care they receive.

The ability to vote in the upcoming election presents significant difficulties for residents of long-term care facilities.  In prior years, many facilities served as polling places, making it easier for residents to vote. Additionally, residents were able to leave facilities and travel to their polling place or rely on loved ones to bring them mail-in ballots.  This year, because of the serious risk that COVID-19 poses to residents of long-term care facilities, polling stations have been moved, facilities have been locked down, and residents cannot rely on their loved ones to help them vote.  For most residents, the only way they will be able to vote is by mail. 

Fortunately, there are many resources available for residents of long-term care facilities to help them obtain mail-in ballots.  Nevertheless, many residents will need assistance filling these ballots out and returning them.  Below you will find resources to help obtain mail-in ballots, when those ballots are due, and also how to obtain help with voting.  All nursing home residents eligible to vote must be able to cast a ballot this November. 

How To Obtain Mail-In Ballots in Your State and Deadlines for Returning Ballots

In almost all states, voters can vote by mail without giving an excuse why they cannot vote in person, or they may use COVID-19 as a reason for being unable to vote. 

Long-Term Care Facilities Must Work with Their Residents to Ensure They Are Able to Vote   

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma published a letter to nursing home residents and their families highlighting that long-term care facilities may not limit residents' right to vote and providing voting resources.

On October 5, 2020, CMS issued a memo "affirming the continued right of nursing home residents to exercise their right to vote."  The memo states that facilities must "have a plan to ensure residents can exercise their right to vote, whether in-person, by mail, absentee or other authorized process."   The memo also states that facilities:

  • Should coordinate with their states to take advantage of existing programs to help residents to vote. This includes, mobile polling, and assistance in registering to vote, requesting an absentee ballot, or completing a ballot from an agent of the Resident's choosing, including family representative, LTC Ombudsman or nursing home staff. 
  • May safely choose to transport individuals to polling places, while following proper COVID-19 infection prevention practices. 
  • Must provide access to stationery, postage, writing implements, and the ability to send mail. 
  • Have a duty to help residents promptly send and receive mail. 
  • Must not interefere with a resident exercising his or her right vote, nor may a facility coerce a resident during the voting process. 

Consumer Voice joined a coalition of advocates in a letter dated September 17, 2020 to the the Secretary of Health and Human Services, Alex M. Azar II and the administrator of the Center for Medicare & Medicaid Services, Seem Verma calling on these agencies to help facilitate voting in nursing homes.  The letter makes clear that the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Voting Rights Act, and government guidance on voting applies to residents of long-term care facilities, and requires facilities to make accommodations to support residents in voting.  The letter makes several recommendations, some of which include:

  • Requiring facilities to help any resident to vote who expresses a desire to vote, and ensure staff does not make their own determinations about who is eligible to vote.
  • Requiring facilities to help resident’s register to vote, obtain ballots, and assist residents with filling out ballots and returning them.   Facilities should provide stamps and envelopes to residents to return ballots.
  • Permitting residents to designate a person to help them to vote, and facilitating meetings with the designated person in the facility and in a manner that follows infection control guidelines.

Consumer Voice calls on all long-term facilities to immediately adopt practices that ensure all residents are able to vote.  Read all of our recommendations. 

Additionally, the National Disability Rights Network and the American Civil Liberties Union have made recommendations on accommodations long-term care facilities should make to help residents vote.

Voting Rights for Residents of Long-Term Care Facilities

Individuals receiving long-term services and supports retain their voting rights no matter where they live or what type of care they receive.

The elder population accounts for a large portion of voters during elections. This population is more likely to vote in prominent elections than their younger counterparts. However, residents of long-term care facilities have a harder time accessing voting locations due to mobility, health, and other issues that inhibit their ability to vote.  

Below are resources to help raise awareness of the issue of residents' rights and guides and information to help long-term care residents vote.

Consumer Voice Resources

Residents' Right to Vote and Ombudsman Program Advocacy (2018)

Tips for Encouraging Residents' Right to Vote (for Facilities) (2012)

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Additional Resources

Assisting Cognitively Impaired Individuals with Voting: A Quick Guide (2020), American Bar Association Commission on Law and Aging

Voters Guide, Workshop on Voting Rights, and Other Voting Resources from the Maine Long-Term Care Ombudsman Program (2020)

Helping Residents Vote in 2020, American Health Care Association and National Center for Assisted Living

Voting for People with Cognitive Impairments and/or Under Guardianship, Information from Minnesota Office of the Secretary of State

Voter Assistance Program, Washington County, Oregon Elections

People with Mental Disabilities Have the Right to Vote, Fact sheet from the National Disability Rights Network provides individuals with mental disabilities with the specific laws that grant them the right to vote.

Providing Help to Voters with Disabilities: What You Should Know, Fact sheet from the National Disability Rights Network and the Bazelon Center for Mental Health Law the provides specifics on how people with disabilities can receive assistance voting.

10 Tips for Voters with Disabilities (2015)
These tips from the U.S. Election Assistance Commission examine the options available to help voters with disabilities vote privately and independently.

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Archive - Consumer Voice Resources

Archive - Consumer Voice Resources

Voter ID Requirements by State
This 2016 resource shows the current voter identification requirements for individuals by state. It includes the requirements to be met when voting in person as well as what is required when voting via absentee ballot.  Producing a valid identification can be challenging for many residents.  They may not have a current, valid driver’s license or state identification card, and important paperwork, such as a birth certificate, might not be easily accessible. Click on the resource, and call your state’s Board of Elections.

Fact Sheets for Consumers – Print these fact sheets and distribute to nursing home residents, home care consumers, family members, and any other individuals interested in this important information.

Promising Practices for Accessible Voting - A review of successful practices during previous elections, plus tips for practices to incorporate this year.  This fact sheet is geared towards advocates, facilities, volunteers, and ombudsmen.

2016 Residents' Rights Month: My Vote Matters - The 2016 theme of Residents' Rights Month focused on residents' right to vote and be engaged in the political process.  Consumer engagement, including the right to vote, is a cornerstone in our society.  Consumers receiving long-term services and supports retain their voting rights no matter where they live or what type of care they receive.  2016 Residents' Rights Month sought to support a consumer's right to vote and participate in the political process.

Common Issues Faced When Residents Vote (2012)

Cognitive Impairment & Voting (2012)


Archive - NORC Resources

Archive - NORC Resources

Involvement of Long-Term Care Ombudsmen Programs in aiding and advocating for voting rights can help residents in long-term care facilities exercise their right to vote. 

Ombudsmen Voting Briefing
A briefing prepared by the National Ombudsmen Resource Center that discusses the effects of long-term care ombudsmen programs on resident voting in long-term care facilities. The report also lists suggestions on how long-term care ombudsmen programs can become involved in advocating for resident voting in long-term care facilities.

More information for ombudsmen is listed on NORC's Voting Issue page.


Archive - Additional Resources

Archive - Additional Resources

Vote, It's your right. A Guide to the Voting Rights of People with Mental Disabilities (2008), This booklet from the National Disability Rights Network and the Bazelon Center for Mental Health Law explains the rights of voters with mental disabilities. It can be a resource for people with mental disabilities, advocates, family members, service providers, election officials, state and local mental health and aging authorities, state legislators and others.

Harris County, Texas Voting Resources (2008)

  • Voting Brochure - A brochure htat provides the steps a long-term care resident should take in order to vote as well as what facilities and families can and cannot do to help the process.
  • Harris County Voting Best Practices Guide - Suggestions of how to encourage residents in long-term care settings to vote based on results from a study prepared for the Texas Long-Term Care Ombudsman Program about the participation of residents in long-term care facilities in the 2004 and 2008 Presidential elections.
  • Harris County Resident Voter Guide - A resource that details the steps that a long-term care resident can take in order to vote including tips and suggestions for voting by mail. It also lists what residents can and cannot do when needing assistance in voting, and what family members and long-term care facility faculty can do to assist the resident.

Iowa Voter Guide for Residents/Tenants of Long-Term Care Facilities
The guide was designed to speak directly to residents/tenants and provide them with basic information about the various options they have to register and vote from the facility or in-person.

Voting Materials for Facilities (Rhode Island 2018)
Alliance for Better Long Term Care, the Office of the Rhode Island State Long Term Care Ombudsman, delivered voting rights materials to all nursing homes and assisted living facilities in the state as a part of a joint project with the Rhode Island Disability Law Center.  Materials included:

Harris County Voting Report
A study prepared for the Texas Long-Term Care Ombudsman Program focusing on the comparison of voter participation of residents in long-term care facilities in the 2004 and 2008 Presidential elections. The study lists problems and recommendations to increase participation in elections.

Communicating and Encouraging the Right to Vote
This resource contains information and tips on how to plan a voter education program at a long-term care facility

The Use of IPads for Voting in Long-Term Care Facilities
 This article reports on the use of iPad tablet notebooks to help nursing home residents vote in a Congressional special primary election. The use of iPad’s proved to be helpful especially in aiding residents with mobility difficulties.

Long-Term Care Ombudsmen Program and Voting in Long-Term Care Facilities PowerPoint 
A PowerPoint that summarizes the "Long-Term Care Ombudsmen Program and Voting in Long-Term Care Facilities report." The report also discusses the involvement levels of state and local Long-Term Care Ombudsmen programs and ways in which the programs helped residences' exercise their right to vote.

  • Long-Term Care Ombudsmen Program Survey - A survey for Long-Term Care Ombudsmen Programs to gauge their level of activity in helping residents in long-term care facilities exercise their right to vote.

Seniors and the 2012 Presidential Election Report
A report by the Henry J. Kaiser Family Foundation that discusses the importance of seniors voting in the 2012 presidential election and how health issues are effecting their decision in voting and thoughts on Medicare and Medicaid. The report found that seniors are a large portion of the population that votes and are more likely to vote then the younger population. In terms of healthcare as a voting issue, the report found that aspects Medicare including spending and the changes due to the Affordable Care Act are the most prominent issues.

Voting in Long-Term Care Facilities: The Mobile Polling Project and Clearinghouse
A presentation given at the 2009 Consumer Voice Annual Conference by Charles Sabatino of the American Bar Association that discusses the findings of a study performed at Vermont nursing homes.  The study found that mobile polling was beneficial to residents, facility staff and to elections officials.

Quick Start Management Guide on Elderly and Disabled Voters in Long Term Care Facilities
The Quick Start Management Guide on Elderly and Disabled Voters in Long Term Care Facilities is part of a series of brochures designed to highlight and summarize the information contained in the chapters of the U.S. Election Assistance Commission’s (EAC) Election Management Guidelines (EMG). Additional voting accessibility issues are explored in current and future EMG publications. The goal of the EMG is to provide a collection of election management guidelines, consolidated into one document, to assist State and local election officials effectively manage and administer elections.  This document is intended for elections officials but provides information that may be helpful to ombudsmen, advocates and facility staff.

Right to Vote: A Voter Education Program
Minnesota Alliance for Helath Care Consumers provides information on how to plan a voter education program, including a workplan for setting up a candidates forum.