www.eac.gov

Serving Voters in

Long-Term

Care Facilities

October 2008
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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

The Quick Start Management Guide on 

Serving 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 to 

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.

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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Quick Facts on Aging and 

Disability:

 • 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. 

1 U.S. Census Bureau

2 U.S. Census Bureau, Voting and Registration in the Election of 

November 2006 (issued June 2008)

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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 voters and voters with 

disabilities, 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 

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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 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 voters and voters with 

 disabilities, 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 to 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 

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

 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.

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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 – 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 

 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 

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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.

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Care Facilities

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 • 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.

 • 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. 

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).”

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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 

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Care Facilities

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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.

 – Educational videos

 – Voter’s Bill of Rights poster

 – Large print voter registration 

 applications and absentee ballot 

 applications

 – “How to Mark your Ballot” posters

 – 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.

Tip: Remember to use large font and 

bulleted short sentences on posters and

informational brochures.

 • 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, 

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.

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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 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 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).

 n If it MUST be used as a polling 

 site for area residents, then it 

 must be set up in a manner that

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).
The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

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 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 voters and 

voters with disabilities:

ADA Best Practices Tool Kit for State and 

Local Government

www.ada.gov/pcatolkit/toolkitmain.htm

American Association of People with 

Disabilities

www.aapd-dc.org

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The Quick Start Management Guide on Serving Voters in LongTerm 

Care Facilities

American Foundation for the Blind

www.afb.org

Americans with Disabilities Act

www.ada.gov (homepage)

http://www.ada.gov/votingck.htm 

(ADA Checklist for Polling Places)

National Council on Aging

www.ncoa.org/index.cfm

National Disability Rights Network

www.napas.org/issues/voting/laws/

vaeha.htm

National Institute on Aging (of the 

National Institutes of Health)

www.nia.nih.gov

Online Resources for Americans with 

Disabilities

www.disabilityinfo.gov

State Provisions Regarding Voting: 

Constitutions, Election Laws, and 

Guardianship Statutes

www.abanet.org/aging/docs/state_

provisions_regarding_voting_pdf

United States Access Board

http://www.access-board.gov/

U.S. Department of Justice, Civil Rights 

Division, Disability Rights Section

http://www.usdoj.gov/crt/drs/drshome.

htm

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For information regarding this publication or to 

request additional copies at no cost, please contact:

Address

U.S. Election Assistance Commission 

1201 New York Avenue, NW, Suite 300

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.

1414

UNITED STATES OF AMERICA

ELECTION ASSISTANCE COMMISSION