# U.S. ELECTION ASSISTANCE COMMISSION

# 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)*](http://www.eac.gov/election/quick-start-management-guides).
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. These guidelines are solely designed to serve as a
source of information for election officials and not as requirements by
which they must abide.

The content of the EMG and the Quick Start Management Guides has been
developed in collaboration with State and local election officials and
other election professionals who have first-hand experience managing
elections. The EAC is grateful for their participation and ensuring the
guidelines are practical and applicable for jurisdictions regardless of
their size and resources. The EMG and the Quick Starts are available
online at [www.eac.gov](http://www.eac.gov/).

**Quick Facts on Aging and Disability:**[^1]

-   37.3 million = number of people 65 and older in the U.S. (12% of the
    total population)

-   86.7 million = projected population of people 65 and older in 2050
    (21% of the total population)

-   147% = projected percentage increase in the 65 and older population
    between 2000 and 2050

-   1.6 million = number of people 65 and older who lived in nursing
    facilities in 2006

-   41.3 million = number of people who have some level of disability
    (15% of civilian non-institutionalized population 5 and older)

-   41% = adults 65 and older that have a disability

-   14.3 million = number of people with limitations in cognitive
    functioning, or who have a mental or emotional illness that
    interferes with daily activities, including those with Alzheimer's
    disease and mental retardation

**Introduction**

In the November 2006 general elections, 63% of adults aged 65 and older
voted; this age group made up 17% of the voting age citizen population
and 23% of the population that actually voted.[^2] As noted above, this
segment of the population is projected to increase 147% between 2000 and
2050. In addition, the Congressional Research Service has reported that
"two-thirds of the people receiving long term care are over 65, an age
group expected to double by 2030. After 2030, even faster growth rates
are anticipated for people over 85, the age group most likely to need
care."

The administration of elections must, therefore, develop and implement
policies that facilitate registration and voting processes for elderly
and disabled voters, including those in long-term care facilities. These
policies must include safeguards to preserve and protect the integrity
of the voting process. Following are recommendations to consider when
developing these policies; they are based on the actual experiences of
States and local jurisdictions that have experience in this matter.
Implementation of these policies will vary according to State laws and
the local jurisdiction's resources. The recommendations contained in
this publication should be vetted with Federal, State, and local laws,
regulations, and relevant case law to ensure they are properly and
lawfully implemented; election officials should contact their State
officials when there is a question as to whether a practice is permitted
or prohibited under State law.

**Developing Your Voting Assistance Plan**

-   Research the number of long term care (LTC) facilities in your
    jurisdiction; these include nursing homes and assisted living
    facilities. Identify their location, the services they provide, and
    the number of people they serve. This will provide useful
    information for conducting a general assessment of the resources you
    would need to reach LTC voters. It would also be beneficial to learn
    if any of the facilities serve a specific disability; this will help
    you develop and provide outreach suited to those particular needs.

    -   *Tip: Your State's licensing bureau can assist you with this
        task*.

-   Contact your State's election office and find out what studies or
    activities they have conducted or are developing regarding elderly
    and disabled voters, including those in long-term care facilities.

    -   *Tip: Your State's election office may have an advisory board
        that addresses accessibility issues. If they have such a board,
        learn what they do, who their members are, what resources they
        have, and how you can directly participate or be kept updated
        about their activities.*

-   Contact the LTC facilities and ask to speak to their director or
    activities manager; if you can set up an in-person meeting. The goal
    of this meeting or conference call is to find out what has been done
    in the past at each facility to provide voting services, whether by
    community groups or the facility itself, and to learn how willing
    they are allow your office to come in and provide services.
    Questions you may want to ask during this conversation are, but not
    limited to:

    -   What successes and challenges did they experience in the past?

    -   What formal or informal procedures do they have for handling
        their clients' registration and voting needs? For example: do
        they periodically announce voting information or is it only upon
        request; do they have a dedicated staff member to handle voting
        inquiries; do they allow outside groups to conduct voter
        registration; have they ever received formal training about
        registration and voting procedures in your State and local
        jurisdiction; how do they manage absentee ballots requests; how
        do they assist voters to cast their ballots; etc.

    -   Would they be willing to participate in a more formal meeting
        with your office, other care providers, and interested
        groups/individuals to discuss the development of
        jurisdiction-wide initiatives to provide uniform and consistent
        registration and voting services to voters in LTC facilities?

    -   Ask the director or activities manager to identify the LTC staff
        who can serve as your main point of contact for future
        communications and efforts. Having an official point of contact
        at each facility will help you build your partnerships and
        ensure receipt of any information you provide them. *Tip:
        Designate one employee in your office to serve as the direct
        communication link with each LTC facility's main point of
        contact.*

-   Establish a local advisory board to assist you in developing,
    maintaining, and evaluating your LTC voting assistance plan. Small
    and medium size jurisdictions can partner up with several adjoining
    jurisdictions to develop a regional advisory board to help manage
    the cost and time burden of managing the board.

    -   Identify organizations and volunteer agencies that would share
        your commitment to this project to serve on the board. For
        example, reach out to your area offices of aging and disability,
        nursing home and independent living center associations, ADA
        chapter, veterans associations, retired and senior volunteer
        organizations, League of Women Voters, local colleges and
        universities, and local government officials. *Tip: Consider
        hiring a project manager to identify and recruit these
        organizations, develop the board, and help administer it. They
        could also help develop additional boards/taskforces that
        address other voter populations or issues.*

    -   Establish membership criteria, including terms of no more than
        two years, with a commitment of no more than 2-4 hours for
        quarterly meetings. *Tip: Take minutes of the board meetings and
        distribute them to local media and elected officials.*

-   As you begin to design your voting assistance plan, make sure that
    your goals and objectives are clear, measurable, achievable,
    realistic, and be time-bound (always refer to the election calendar
    to identify the best time to implement the different action steps in
    your voting assistance plan). *Tip: Plan in advance! A good plan is
    one that builds in to its design ample time to implement strategies
    and correct them if necessary. This also allows care providers and
    other community partners time to make any changes necessary to their
    policies or procedures to implement your plan; the goal is to work
    as a team with the facility staff and to build your schedule to
    coincide with the activity schedule of the care facility.*

**Outreach and Implementation Strategies**

The types of services local jurisdictions will be able to provide to
voters in LTC facilities will depend on the resources available to them
(e.g. funding, staffing, volunteers, cooperation of LTC facilities and
other stakeholders, etc.).

-   Provide a calendar of voting deadlines to each LTC facility. The
    calendar should have, at a minimum, information on deadlines for:
    voter registration, absentee ballot requests, submitting absentee
    ballots, early voting (include dates and locations), special voter
    registration drives, and the date the election will be held. *Tip:
    Ask your contact at the LTC facility to share this information with
    all staff members and visibly display it in general areas and/or
    distribute it to each resident.*

-   Recommend the registration of residents as a part of each facility's
    regular intake process. Incorporate voter registration applications
    and information about the voting process into each of the LTC
    facility's resident welcome packets.

-   Establish a partnership with the LTC facilities to hold voter
    registration drives on special patriotic days (e.g. Fourth of July,
    Flag Day, Veterans Day, Presidents Day, etc). Use these occasions to
    provide hands-on demonstrations on how to complete absentee ballots
    and/or use your jurisdiction's voting equipment.[^3]

-   Provide each LTC facility a listing of all residents who are
    currently registered to vote. This list becomes the master list for
    determining if there are new residents that would like to register
    and/or request an absentee ballot.

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-   Provide individualized training to care facility staff on voter
    registration and elections. Develop a training guidebook that you
    can distribute to them as part of training. The guidebook should be
    easy to read and understand. Examples of information to include in
    the guidebook are, but not limited to:

    -   Overview of voter registration laws and requirements

    -   Suggestions on communication methods to inform residents and/or
        their family members about how to participate in the election
        process.

    -   Deadlines and requirements for registering to vote, requesting
        and/or providing assistance with voting, including how to
        request an absentee ballot. *Tip: Develop scripts for use by
        facility directors and staff to ensure that the communication is
        accurate and consistent.*

    -   Description of Federal and State laws on when and under what
        circumstances an individual can provide assistance to voters in
        casting their ballot and how to request a ballot on behalf of a
        voter.

    -   Methods for protecting the security and integrity of residents'
        ballots.

    -   Information and training on how to assist voters with special
        needs. *Tip: Engage the LTC facility staff and your local
        advisory board, if applicable, in the development of voting
        assistance guidelines that address the various cognitive and
        physical challenges faced by these voters. This will also help
        ensure staff or voting assistants do not inadvertently make
        determinations on a voter's capacity to vote.*

    -   Include details about how to change residence/voting address to
        another State and/or requesting a ballot be sent to a temporary
        address. *Tip: Familiarize yourself with the various residency
        rules pertaining to Medicare/Medicaid prior to assisting a
        resident with changing their official residence address.*

-   In addition to training LTC staff, provide training to community
    groups that provide election outreach to voters in LTC facilities to
    ensure the information they provide is consistent and uniform with
    the information provided by your office. *Tip: Let the community
    groups know the dates you will be holding training at the LTC
    facilities so they may attend as well. The goal is to build
    effective collaboration between all groups for the benefit of the
    voters that receive these services.*

-   Develop a Voter Information Toolkit for use at LTC facilities and
    independent living communities. *Tip: Remember to use large font and
    bulleted short sentences on posters and informational
    brochures*.[^4]

> Examples of contents include:

-   Educational Videos

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-   Voter's Bill of Rights poster

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-   Large print voter registration applications and absentee ballot
    applications

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-   "How to Mark your Ballot" posters

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-   Audio of your local League of Women Voters voter guide

> Consider providing this information in languages other than English
> based on the demographics of the facility and in accordance with
> Federal language assistance requirements, where applicable.

-   Send teams of your office staff or recruit volunteers to provide
    voting services ("mobile polling") to voters in LTC facilities. Each
    team should be comprised of a minimum of two staff members (of
    opposite party affiliations, if required); they must also
    successfully complete training prior to providing services. The
    training should be similar to some of the aspects of poll worker
    training and the training described previously for LTC staff. For
    example, in addition to the elements listed in the LTC training, it
    should include, but not be limited to, information on:

    -   How to complete a voter registration application, absentee
        ballot application, and other forms required by State law.

    -   Information on voter identification requirements, if applicable.
        *Note: The training should include how to assist residents with
        acquiring and/or locating acceptable identification for voting
        purposes.*

    -   Details on where to pick up ballots and supplies; managing
        supplies on-site, including security of voted ballots; and
        delivery and return of all supplies and voted ballots.

    -   Training on how to use voting equipment, if applicable. *Note:
        Election officials will have to decide if the mobile polling
        teams will use absentee ballots*[^5] *or take voting equipment
        along to assist residents to vote. This decision will impact how
        the voting assistance will be provided.*

-   If an LTC facility is used as an Election Day polling place, the
    following must be considered:

    -   The facility should only be used for voting by the LTC residents
        (i.e. it is its own precinct).

        -   If it MUST be used as a polling site for area residents,
            then it must be set up in a manner that does not interfere
            with LTC services and resident traffic patterns, and it must
            give priority to the medical needs of the residents.

    -   Will the designated voting area interfere with other resident
        services?

    -   Is the voting area laid out to accommodate voters that require
        wheelchairs or other walking assistive devices?

    -   How will the site be managed and staffed to avoid long wait
        lines?

    -   How will assistance be provided to voters that are bedridden?

    -   Electioneering and poll watching rules need to be in effect as
        they would in any other polling place.

**National Resources**

If you are interested in learning about jurisdictions that have
experience in providing services to voters in LTC facilities, please
contact the EAC's Election Management Guidelines Program at
1-866-747-1471 (toll free) or via email at <HAVAinfo@eac.gov>. The EAC
will be happy to connect you with election officials with expertise in
this area. Furthermore, please refer to the resources listed below for
additional resources and information on matters that impact elderly and
disabled voters:

**ADA Best Practices Tool Kit for State and Local Government**
[[www.ada.gov/pcatolkit/toolkitmain.htm]{.underline}](http://www.ada.gov/pcatolkit/toolkitmain.htm)

**American Association of People with Disabilities**

[[www.aapd-dc.org](http://www.aapd-dc.org/)]{.underline}

**American Foundation for the Blind**

[[www.afb.org](http://www.afb.org/)]{.underline}

**Americans with Disabilities Act**

[[www.ada.gov](http://www.ada.gov/)]{.underline} (homepage)

<http://www.ada.gov/votingck.htm> (ADA Checklist for Polling Places)

**DisabilityInfo.gov**

<http://www.disabilityinfo.gov/digov-public/public/DisplayPage.do?parentFolderId=500>

**National Council on Aging**

[[www.ncoa.org/index.cfm]{.underline}](http://www.ncoa.org/index.cfm)

**National Disability Rights Network**

[[www.napas.org/issues/voting/laws/vaeha.htm]{.underline}](http://www.napas.org/issues/voting/laws/vaeha.htm)

**National Institute on Aging (of the National Institutes of Health)**

[[www.nia.nih.gov]{.underline}](http://www.nia.nih.gov/)

**Online Resources for Americans with Disabilities**

[[www.disabilityinfo.gov]{.underline}](http://www.disabilityinfo.gov/)

**State Provisions Regarding Voting: Constitutions, Election Laws, and
Guardianship Statutes**

[[www.abanet.org/aging/docs/state_provisions_regarding_voting_pdf]{.underline}](http://www.abanet.org/aging/docs/state_provisions_regarding_voting_pdf)

**United States Access Board**

[[http://www.access-board.gov/]{.underline}](http://www.access-board.gov/)

**U.S. Department of Justice, Civil Rights Division, Disability Rights
Section**

<http://www.usdoj.gov/crt/drs/drshome.htm>

**For information regarding this publication or to request additional
copies at no cost, please contact:**

**Address**

U.S. Election Assistance Commission\
1225 New York Avenue, NW, Suite 1100\
Washington, DC 20005\
Attn: Election Management Guidelines

**Telephone**

\(202\) 566-3100\
(866) 747-1471 (toll free)

**Fax**

\(202\) 566-3127

**E-mail Address**

HAVAinfo@eac.gov

**Website**

www.eac.gov

*The EAC is an independent bipartisan commission created by the Help
America Vote Act of 2002 (HAVA). It is charged with administering
payments to states and developing guidance to meet HAVA requirements,
implementing election administration improvements, adopting voluntary
voting system guidelines, accrediting voting system test laboratories
and certifying voting equipment, and serving as a national clearinghouse
and resource of information regarding election administration.*

[^1]: U.S. Census Bureau

[^2]: U.S. Census Bureau, *Voting and Registration in the Election of
    November 2006* (issued June 2008)

[^3]: HAVA §301(a)(3) requires that each voting system used in an
    election for Federal office shall *"(A) be accessible for
    individuals with disabilities, including nonvisual accessibility for
    the blind and visually impaired, in a manner that provides the same
    opportunity for access and participation (including privacy and
    independence) as for other voters; (B) satisfy the requirement of
    subparagraph (A) through the use of at least one direct recording
    electronic voting system or other voting system equipped for
    individuals with disabilities at each polling place; and (C) if
    purchase with funds made available under Title II on or after
    January 1, 2007, meet the voting system standards for disability
    access (as outlined in this paragraph)."*

[^4]: The EAC has published guidelines for the effective design of
    ballots and polling place materials. The best practices contained in
    the report are based on based on the *2005 Voluntary Voting System
    Guidelines* (VVSG), Americans with Disabilities Act (ADA)
    guidelines, research findings, and information design principles.
    The report is available on the EAC's Web site,
    [www.eac.gov](http://www.eac.gov/).

[^5]: HAVA §301(a)(1)(B)(ii) requires jurisdictions that use a paper
    ballot system, including mail-in absentee ballots and mail-in
    ballots, to provide voters with *"instructions on how to correct the
    ballot before it is cast and counted (including instructions on how
    to correct the error through the issuance of a replacement ballot if
    the voter was otherwise unable to change the ballot or correct any
    error).*