GAO 

United States Government Accountability Office

Report to Congressional Requesters

ELDERLY VOTERS

Information on 

Promising Practices 

Could Strengthen the 

Integrity of the Voting 

Process in Long-term 

Care Facilities 

November 2009 

GAO-10-6 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

November 2009

ELDERLY VOTERS

Information on Promising Practices Could Strengthen 

the Integrity of the Voting Process in Long-term Care 

Highlights of GAO-10-6, a report to Facilities

congressional requesters 

Voting is fundamental to the U.S. 

democratic system and federal law 

provides broad protections for 

people with disabilities, including 

older voters. Many long-term care 

facility residents, who often have 

physical or cognitive impairments, 

vote by absentee or early ballot. 

Concerns have been raised about 

the extent to which states and 

localities are helping the increasing 

number of facility residents 

exercise their right to vote, 

especially those requiring voting 

assistance, who may be subject to 

undue influence or unauthorized 

completion of their ballot by 

facility staff or relatives. Given 

these concerns, GAO was asked to 

identify the actions taken to 

facilitate and protect voting for 

long-term care facility residents at 

(1) the state level and (2) the local 

level. To address these objectives, 

GAO interviewed federal officials, 

national organizations, and 

researchers; reviewed Election 

Assistance Commission (EAC) 

guidance on voting in long-term 

care facilities; surveyed state and 

local election officials; and visited 

seven localities in the weeks prior 

to the November 2008 federal 

election to observe the voting 

process in long-term care facilities. 

What GAO Recommends

GAO recommends that the EAC 

collect and disseminate information 

on cost-effective promising 

practices for providing voting 

access while also ensuring voting 

integrity. EAC indicated agreement 

with our findings and 

recommendation. HHS and Justice 

did not provide formal comments. 

Most states have requirements or guidance to facilitate voting for long-term care 

facility residents, and some states also provide training and conduct oversight of 

localities’ adherence to state requirements or guidance. States reported that they 

most commonly provided requirements or guidance for accommodations for 

absentee voting for residents of long-term care facilities, followed by 

accommodations for voter registration and voter identification procedures. 

Almost one-half of the states reported providing training to local election officials 

specifically on state requirements or guidance to facilitate voting for long-term 

care facility residents. Additionally, 17 states reported that they conducted one or 

more oversight activities to ensure that localities were adhering to state long-term 

care voting requirements or guidance. According to researchers, some of these 

state requirements or guidance for voting in long-term care facilities may help to 

protect against voter fraud and undue influence. 

Localities also used a variety of actions to facilitate voting for long-term care 

facility residents, including some that may decrease the likelihood of fraud and 

undue influence. In our survey, 78 of the 92 localities reported taking actions to 

facilitate voting for long-term care facility residents. The most common actions 

included supporting facility staff in assisting residents with the absentee or early 

voting process, including providing staff with early and absentee voting 

information or guidance. Localities also reported providing services directly to 

residents. For example, close to one-half of localities we surveyed brought 

election officials to facilities to assist with the voting process. The seven localities 

we visited prior to the November 2008 federal election used a range of strategies 

to facilitate voting for long-term care facility residents, including coordination 

with facility staff and other stakeholders; the deployment of election teams to 

facilities; and implementation of procedures to protect and ensure voting 

integrity, such as requiring bipartisan voting assistance and signed affidavits to 

document voting assistance. Some local officials reported challenges to 

implementing these strategies, such as difficulty providing voting assistance to 

residents with cognitive impairments. 

Strategies Used by Selected Localities to Facilitate Voting in Long-term Care Facilities

Source: GAO site visits.

8 weeks

prior to

Election

Day

76543210

Election teams deployed

Election workers help residents

read, mark, and seal ballots.

Coordination with stakeholders

Local election officials work with stakeholders

to identify facilities and coordinate efforts. 

Procedures to

protect voting integrity

Election workers may implement

such procedures as bi-partisan teams

or collecting ballots in locked boxes.

View GAO-10-6 or key components.

For more information, contact Barbara D. 

Bovbjerg at (202) 512-7215 or 

bovbjergb@gao.gov or William O. Jenkins at 

(202) 512-8777 or jenkinswo@gao.gov. 
Page i GAO-10-6 

Contents 

Letter 1

Background 4 

Most States Have Requirements or Guidance to Facilitate Voting 

for Long-term Care Facility Residents 8 

Localities Have Taken a Variety of Actions to Facilitate and Protect 

Voting for Long-term Care Facility Residents 15 

Conclusions 28 

Recommendation for Executive Action 29 

Agency Comments and Our Evaluation 29 

Appendix I Scope and Methodology 32 

Appendix II Summary of Federal Laws Related to Voting 

Accessibility for the Elderly and People with 

Disabilities 37 

Appendix III Comments from the Election Assistance Commission 40 

Appendix IV GAO Contacts and Staff Acknowledgments 42 

Related GAO Products 43 

Tables 

Table 1: Reported State Training and Oversight of State 

Requirements or Guidance for Voting in Long-term Care 

Facilities 12 

Table 2: Selected Actions Taken Among 92 Localities to Facilitate 

Voting for Long-term Care Facility Residents 17 

Table 3: Characteristics of the Long-term Care Voting Assistance 

Efforts for the November 2008 Federal Election in the 

Seven Localities We Visited 19 

 Elderly Voters 
Table 4: Selected Approaches Taken Among the Seven Localities 

We Visited to Facilitate Voting for Long-term Care Facility 

Residents 21 

Figures 

Figure 1: Size of the Elderly Population Projected to Increase 6 

Figure 2: Most Common State Requirements and Guidance for 

Voting in Long-term Care Facilities by State 9 

Figure 3: Number of Localities Taking Actions to Facilitate Voting 

for Long-term Care Facility Residents 16 

Figure 4: Strategies Used by Localities We Visited to Facilitate 

Absentee, Early, or Election Day Mail-in Voting for Longterm Care Facility Residents 20 

Figure 5: Select Protections to Ensure Voting Integrity for Longterm Care Facility Residents 27 

Abbreviations 

ADA The Americans with Disabilities Act of 1990 

CMS Centers for Medicare and Medicaid Services 

EAC U.S. Election Assistance Commission 

EMG Election Management Guidelines 

HAVA Help America Vote Act of 2002 

HHS Department of Health and Human Services 

NASED National Association of State Election Directors 

NASS National Association of Secretaries of State 

OAA The Older Americans Act of 1965 

VAEHA Voting Accessibility for the Elderly and Handicapped Act 

VRA The Voting Rights Act of 1965 

This is a work of the U.S. government and is not subject to copyright protection in the 

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Page ii GAO-10-6 Elderly Voters
Page 1 GAO-10-6 

 to 

tation.4

 

United States Government Accountability Office

Washington, DC 20548 

 

November 30, 2009 

Congressional Requesters 

Voting is fundamental to the U.S. democratic system and, accordingly, 

federal law provides broad voting protections for people with disabilities, 

including older voters. However, questions have been raised about the 

extent to which states and local election jurisdictions are helping older 

voters and others residing in long-term care facilities exercise their right to 

vote.1

 In 2008, approximately 9 million Americans over 65 years old 

needed long-term care services.2

 Moreover, the number of adults aged 65 

and over is expected to increase by more than 23 million between 2010 

and 2025,3

 and about 70 percent of adults over age 65 are projected to 

require long-term care services at some point during their lifetime due

chronic illness or disability, including memory loss or disorien

As the proportion of older Americans in the country increases, the number 

of voters residing in long-term care facilities who may be unable to vote at 

polling places on Election Day due to their physical and mental condition 

could also increase. While the Help America Vote Act of 2002 (HAVA) 

requires each polling place to have at least one voting system for use in 

federal elections that is accessible for people with disabilities,5

 other 

federal laws provide broader protections for people with disabilities that 

may apply to alternative voting methods, such as absentee ballots. Many 

long-term care facility residents cast absentee ballots and at least one 

1

In this report, we define long-term care facilities as facilities that provide a residential 

setting and services to people with disabilities and the elderly, including nursing homes, 

assisted living facilities, and other state-defined long-term care facilities. 

2

U.S. Department of Health and Human Services, National Clearinghouse for Long-Term 

Care Information, Understanding LTC, 

http://www.longtermcare.gov/LTC/Main_Site/Understanding_Long_Term_Care/Basics/Basi

cs.aspx (accessed Aug. 19, 2009). 

3

U.S. Census Bureau, Population Division, Projections of the Population by Selected Age 

Groups and Sex for the United States: 2010 to 2050, (Washington, D.C., 2008). 

4

U.S. Department of Health and Human Services, National Clearinghouse for Long-Term 

Care Information. 

5

Pub. L. No. 107-252 (2002). 

 Elderly Voters 
 

study has recognized that absentee balloting can be vulnerable to fraud.6

Specifically, concerns have been raised that some residents may be 

subject to the undue influence of facility staff, family members, or others 

over residents’ ballot selections, or the completion of their ballot by 

someone other than the resident. These concerns arise in large part due to 

the dependency of this population on others, such as relatives and longterm care facility staff, for assistance in completing ballots. Concerns of 

alleged voter fraud in long-term care facilities have sparked debate about 

the appropriate balance between access to voting and providing 

protections to ensure voting integrity to this population. As states and 

localities take action to enhance voting access for the increasing number 

of long-term care facility residents, the integrity of the voting process 

could be at risk if proper controls are not utilized.7

 Given these concerns, 

you asked us to identify the actions taken to facilitate and protect voting 

for long-term care facility residents at (1) the state level and (2) the local 

level. 

To answer both of these objectives, we conducted interviews with officials 

at the Department of Justice (Justice), the Department of Health and 

Human Services (HHS), and two national organizations that represent 

state election officials. We also reviewed relevant federal laws, 

regulations, guidance, and other documentation. We did not analyze state 

requirements or guidance, but instead relied on states’ responses to our 

survey. In addition, we interviewed officials at the U.S. Election Assistance 

Commission (EAC) and reviewed the EAC Quick Start Management 

Guide on Elderly and Disabled Voters in Long Term Care Facilities. We 

also reviewed relevant literature and interviewed multidisciplinary 

researchers with expertise in issues of long-term care voting to identify 

practices that may facilitate voting in long-term care facilities while 

ensuring voting integrity. To gather information on state actions to 

facilitate and protect voting for long-term care facility residents, we 

administered a Web-based survey of election officials in all 50 states, the 

District of Columbia, the Commonwealth of Puerto Rico, and three 

territories between December 2008 and February 2009.8

 We received a 100 

 

6

Fay, Jessica A., “Elderly Electors Go Postal: Ensuring Absentee Ballot Integrity for Older 

Voters”, The Elder Law Journal, vol. 13, 453 (2005). 

7

The term “locality” refers to the local jurisdiction in charge of the administration of 

elections, which could be the county, township, or city. 

8

In this report, we refer to the 50 states, the District of Columbia, the Commonwealth of 

Puerto Rico, and three U.S. territories, collectively, as states. 

Page 2 GAO-10-6 Elderly Voters
 

percent response rate. We did not verify survey responses or other 

information provided by state officials. 

To gather information on local actions to facilitate and protect voting for 

long-term care facility residents, we conducted an e-mail survey of 104 

local election jurisdictions between September 2008 and February 2009. 

We received an 88 percent response rate. The sample of election 

jurisdictions was selected as part of our related study examining polling 

place accessibility for voters with disabilities.9

 The survey estimates 

calculated for this report did not have a low enough margin of error to 

allow us to generalize results to localities nationally. We did not verify 

survey responses or other information provided by local officials. In 

addition, to gather more detailed information on local actions to facilitate 

and protect voting, we conducted site visits to seven localities—

Burlington, Vermont; Chicago, Illinois; the District of Columbia; Kitsap 

County, Washington; Multnomah County, Oregon; Shelburne, Vermont; 

and Washington County, Oregon—in the weeks prior to the November 

2008 federal election. At each locality, we interviewed local election 

officials and visited one or two long-term care facilities. In total we visited 

10 long-term care facilities and at each we interviewed facility staff and 

observed voting procedures. We selected localities generally well-regarded 

in their approach to facilitate voting for long-term care facility residents 

based on interviews with agency officials, representatives of professional 

organizations, and multidisciplinary researchers. We selected long-term 

care facilities to visit based on input from local election officials. 

We conducted our work from April 2008 through November 2009, in 

accordance with all sections of GAO’s Quality Assurance Framework that 

were relevant to our objectives. The framework requires that we plan and 

perform the engagement to obtain sufficient and appropriate evidence to 

meet our stated objectives and to discuss any limitations in our work. We 

believe that the information and data obtained, and the analysis 

conducted, provide a reasonable basis for any findings and conclusions. 

 

9

Our related study used a two-stage sampling method to create a nationally representative 

random selection of polling places in the contiguous United States, with the exception of 

Oregon. Alaska and Hawaii were excluded from the sample for cost and efficiency reasons 

and Oregon was excluded because voters exclusively use mail-in ballots. See GAO, Voters 

with Disabilities: Additional Monitoring of Polling Places Could Further Improve 

Accessibility, GAO-09-941 (Washington, D.C.: Sept. 30, 2009) for a more detailed 

description of the sampling methodology. 

Page 3 GAO-10-6 Elderly Voters
 

See appendix I for more detailed information on our scope and 

methodology. 

Background 

Role of State and Federal 

Government 

The administration of federal elections is a massive enterprise, conducted 

primarily at the state and local level, under applicable state and federal 

voting laws. Responsibility for holding elections and ensuring that each 

voter has the ability to fully participate in the electoral process—including 

registering to vote, accessing polling places or alternative voting methods, 

and casting a vote—primarily rests with state and local governments, with 

regulation and oversight from states and the federal government. Each 

state establishes the requirements for conducting local, state, and federal 

elections within the state. For example, states regulate such aspects of 

elections as ballot access, absentee voting requirements, the establishment 

of voting places, provision of Election Day workers, and the counting and 

certification of the votes. The states, in turn, have typically delegated 

responsibility for administering and funding state election systems to the 

more than 10,000 local election jurisdictions nationwide. Federal laws 

have been enacted to cover several aspects of the voting process, 

including some that are designed to help ensure voting accessibility for the 

elderly and people with disabilities. The relevant provisions of these 

federal laws are primarily related to the accessibility of polling places, 

prohibitions on discrimination, and the allowance of voting assistance 

from a person of the voter’s choice. See appendix II for more detail on 

federal laws. 

Multiple federal agencies are involved with issues related to state and local 

governments’ administration of the election process for long-term care 

facilities residents, including enforcing election laws, conducting election 

research, and ensuring that residents’ rights are protected. Justice’s Civil 

Rights Division and its various sections enforce federal statutes 

prohibiting discrimination. Specifically, the Disability Rights Section 

protects the rights of persons with disabilities under the Americans with 

Disabilities Act of 1990 (ADA) and the Voting Section is responsible for 

enforcing certain federal statutes protecting voting rights, including 

certain protections of the voting rights of persons with disabilities, which 

may also include long-term care facility residents. In addition to Justice’s 

role, HHS administers certain provisions of statutes related to disabilities 

and voting. HHS’ Administration on Aging administers a long-term care 

Page 4 GAO-10-6 Elderly Voters
 

ombudsman program that assists with complaints and provides advocacy 

for long-term care residents, while the Administration on Developmental 

Disabilities administers a federal grant program that distributes HAVA 

funds to support state and local efforts to ensure that people with 

disabilities have access to the election process, including grants for 

making polling places accessible to individuals with disabilities and 

providing individuals with disabilities with information about the 

accessibility of polling places. Also, the HHS Centers for Medicare and 

Medicaid Services (CMS) sets requirements for states to conduct periodic 

studies on nursing homes that participate in Medicare, and then collects, 

analyzes, and reports on this data on nursing homes, such as complaints 

related to residents’ choices and rights, which could include the right to 

vote. 

In addition, the EAC, which was established under HAVA, has wideranging duties to help improve state and local administration of federal 

elections. Among other things, the EAC is responsible for serving as a 

national clearinghouse of election-related information and a resource for 

information with respect to the administration of federal elections; making 

HAVA grants for research and development of new voting equipment and 

technologies, and the improvement of voting systems; and periodically 

conducting and making publicly available studies regarding methods of 

ensuring accessibility of voting, polling places, and voting equipment to all 

voters. In addition, EAC reported that of the payments it has provided to 

states, states have spent over $800 million on voting systems that comply 

with HAVA’s requirements for voting system standards. In 2008, the EAC 

published the Election Management Guidelines (EMG), which provides 

information on a wide range of election related topics intended to assist 

state and local election officials in effectively managing and administering 

elections, and a series of Quick Start guides, designed to highlight and 

summarize information contained in the chapters of the EMG. 

Characteristics of Longterm Care Facility 

Residents 

In 2007, there were almost 38 million individuals aged 65 or older and the 

majority had at least one chronic health condition. By 2030, those aged 65 

and over are projected to grow to over 72 million individuals (see fig.1), 

and this group is projected to represent a quarter of the voting age 

population at that time. Older voters, who consistently vote in higher 

proportions than other voters, may face challenges exercising their right to 

vote because disability increases with age. Studies have shown, for 

example, that the risk of losing mobility doubles with every 10 years after 

reaching the age of 65. Moreover, it is estimated that 70 percent of people 

Page 5 GAO-10-6 Elderly Voters
 

over age 65 will require some long-term care services at some point in 

their lives, such as residing in a nursing home or assisted living facility. 

Figure 1: Size of the Elderly Population Projected to Increase 

0

10

20

30

40

50

60

70

80

2010 2015 2020 2025 2030

Projected population (in millions)

Age 85 or older

Age 65 to 84

Source: GAO analysis of U.S. Census data.

40.2

46.8

54.8

63.9

72.1

Long-term care facilities provide an array of health care services for 

individuals who may have difficulty caring for themselves because of a 

range of physical or mental impairments. The support long-term care 

facilities provide can range from independent living with little or no 

personal medical care to nursing homes with 24-hour a day skilled care. 

While the individuals residing in long-term care facilities are most often 

elderly, the resident population may also include younger individuals with 

a disabling chronic illness, severe injury, or disease. According to the most 

recent National Nursing Homes Survey, in 2004, approximately 88 percent 

of nearly 1.5 million nursing home residents were age 65 and older.10

Furthermore, nearly all of these older residents were dependent upon 

others for assistance with at least one activity of daily living, such as 

 

10Jones, A.L.; Dwyer, L.L.;, Bercovitz, A.R.; Strahan, G.W., The National Nursing Home 

Survey: 2004 Overview. National Center for Health Statistics. Vital Health Stat 13(167). 

2009. 

Page 6 GAO-10-6 Elderly Voters
 

bathing or dressing. Long-term care facility residents may face challenges 

not only with physical impairments, but also with cognitive impairments. 

According to CMS, in 2006, 69 percent of nursing home residents 

demonstrated some form of cognitive impairment, including various stages 

of dementia.11 These physical and cognitive impairments can make longterm care facility residents dependent on others—family, friends, facility 

staff, or election workers—for assistance in exercising the right to vote. 

The physical and cognitive impairments of long-term care facility residents 

directly affect the balance between voting participation and the integrity 

of the voting process. Specifically, the physical and cognitive impairments 

of many long-term care facility residents may make it more difficult for 

them to independently drive, walk, or use public transportation to get to 

their designated polling place. Once at the polling place, they may face 

challenges finding accessible parking, reaching the ballot area, and casting 

a ballot privately and independently.12 Furthermore, they often may not 

have a valid driver’s license or other form of government-issued photo 

identification that some states may require to vote. Consequently, the 

number of elderly people who exercise their right to vote through 

alternative voting methods,13 such as absentee, early, and Election Day 

mail-in ballots14 may grow as more elderly individuals reside in long-term 

care facilities. These residents may also have limited dexterity, impaired 

eyesight, or cognitive impairments, such as dementia, that can make them 

dependent on others to read or mark a ballot, regardless of where the 

ballot is cast. This makes them vulnerable to fraud and undue influence 

from relatives, long-term care facility staff, campaign workers, or 

candidate supporters, who sometimes provide assistance when casting 

their vote. Some long-term care facility staff may choose to screen 

residents to determine their ability to vote using a variety of methods that 

may include administering a formal cognitive screening test, asking 

 

11Centers for Medicare & Medicaid Services, Nursing Home Data Compendium, 2007. 

12For information on the accessibility of polling places in the November 2008 federal 

election, see GAO-09-941, which includes the summary of results from a national survey on 

polling place accessibility. 

13We define “alternative” voting methods as any voting method other than traditional inperson voting on Election Day at a polling place. 

14“Election Day mail-in ballots” refers to ballots used in Oregon and Washington. Localities 

in Oregon exclusively administer a vote-by-mail election process where all eligible voters 

are mailed a ballot prior to Election Day that must be returned by a specified time on 

Election Day. Localities in Washington administer a similar vote-by-mail election process. 

Page 7 GAO-10-6 Elderly Voters
 

election-related questions, or using prior assessments of the resident’s 

general mental capacity. In addition, depending on state law, some 

residents with cognitive impairments may also face legal limitations to 

their right to vote due to court determinations of mental incompetence or 

appointment of a legal guardian. 

Most states have requirements or guidance to facilitate voting for longterm care facility residents.15 Almost half of the states reported providing 

training to local election officials specifically on state requirements or 

guidance to facilitate voting for long-term care facility residents. 

Additionally, some states conducted one or more oversight activities to 

ensure that localities were adhering to state requirements or guidance. 

Some state requirements or guidance for voting in long-term care facilities 

may help to protect against voter fraud and undue influence, according to 

researchers. 

Most States Have 

Requirements or 

Guidance to Facilitate 

Voting for Long-term 

Care Facility 

Residents 

A Large Majority of States 

Reported Having 

Requirements or Guidance 

to Facilitate Voting for 

Long-term Care Facility 

Residents 

According to our survey, 44 states reported having at least one 

requirement or guidance to facilitate voting for long-term care facility 

residents. The most commonly reported state requirements or guidance 

were to require or provide guidance to election officials to provide longterm care facility residents with accommodations to assist them in 

absentee voting processes, provide accommodations for voter registration, 

and provide special accommodations to assist elderly voters in meeting 

voter identification requirements (see fig. 2). Eleven states reported having 

requirements or guidance for all three of these activities. According to 

researchers, without state requirements or guidelines for voting in longterm care facilities, access to voting for residents is largely determined by 

the practices and attitudes of the long-term care facility staff, which they 

noted can vary. 

 

15We did not analyze state requirements or guidance, but instead relied on states’ responses 

to our survey. 

Page 8 GAO-10-6 Elderly Voters
 

Figure 2: Most Common State Requirements and Guidance for Voting in Long-term Care Facilities by State 

Source: GAO survey of state election officials, The National Atlas of the United States ®.

State guidance,

but not requirement

No state requirement

or guidance

State requirement

Voter

identification

accommodations ■ American Samoa

■ Guam

■ Puerto Rico

■ U.S. Virgin Islands

VT

NY

PA

WV VA

NC

SC

MS AL GA

LA

TX

AR

MO

IL IN OH

MI

WI

MN

IA NE

CO

AZ

CA

AK

HI

NV

ID

MT

WY

OR

WA

UT

NM

SD

ND

KS

OK

FL

TN

KY

LA

Voter

registration

outreach

VT

NY

PA

WV VA

NC

SC

MS AL GA

LA

TX

AR

MO

IL IN OH

MI

WI

MN

IA NE

CO

AZ

CA

AK

HI

NV

ID

MT

WY

OR

WA

UT

NM

SD

ND

KS

OK

FL

TN

KY

ME

Absentee

voting

accommodations

VT

NY

PA

WV VA

NC

SC

MS AL GA

TX

AR

MO

IL IN OH

MI

WI

MN

IA NE

CO

AZ

CA

AK

HI

NV

ID

MT

WY

OR

WA

UT

NM

SD

ND

KS

OK

FL

TN

KY

LA

NH

■ MA

■ RI

■ CT

■ NJ

■ DE

■ MD

■ DC

■ American Samoa

■ Guam

■ Puerto Rico

■ U.S. Virgin Islands

NH

■ MA

■ RI

■ CT

■ NJ

■ DE

■ MD

■ DC

■ American Samoa

■ Guam

■ Puerto Rico

■ U.S. Virgin Islands

NH

■ MA

■ RI

■ CT

■ NJ

■ DE

■ MD

■ DC

ME

ME

Note: This figure does not reflect any local requirements or guidance for voting in long-term care 

facilities. 

Page 9 GAO-10-6 Elderly Voters
 

Accommodations for absentee voting for residents of long-term care 

facilities was the most commonly reported type of state requirements or 

guidance. Specifically, 42 states reported having a requirement or guidance 

for accommodations for absentee voting in long-term care facilities. Some 

of these states required election workers to deliver absentee ballots to 

long-term care facilities. For example, in Iowa, election officials reported 

that they provided guidance to long-term care facility staff on the process 

of soliciting absentee ballot requests from their residents and required 

bipartisan election teams to deliver absentee ballots to all long-term care 

facilities. Other states reported mandating that election officials conduct 

in-person absentee voting at long-term care facilities. According to state 

election officials, Illinois law requires that election workers conduct inperson absentee voting at long-term care facilities one to four days before 

Election Day. Some states reported requiring election workers to facilitate 

absentee voting at long-term care facilities if a minimum number of 

absentee ballots are requested or if the number of registered voters 

residing at a facility exceeds a state-set minimum. 

Among the states, 24 reported having requirements or guidance to 

facilitate voter registration for long-term care facility residents. For 

example, state election officials in Maryland reported that each local 

election office is required to contact nursing homes and assisted living 

facilities to offer voter registration assistance and visit facilities with more 

than 50 residents to facilitate voter registration among facility residents. 

Election officials in the District of Columbia reported that they visit longterm care facilities several times—first for voter registration and then later 

for assistance with absentee ballots. Officials from two states said that 

some long-term care facility residents may benefit from providing 

accommodations or assistance in changing their voter registration from 

their previous address, which may be in another state, county, election 

jurisdiction, or precinct, to the address of the long-term care facility. 

Also, 16 states reported requiring or allowing special accommodations to 

assist elderly voters in meeting voter identification requirements. 

According to some researchers and election officials we interviewed, longterm care facility residents may not have a valid driver’s license or utility 

bill that can typically be used for identification. Some states accept 

alternative forms of identification from long-term care facility residents. 

For example, Massachusetts offers suggestions to municipalities and longterm care facility staff on the acceptable forms of identification—such as a 

letter from the facility staff stating the individual resides in their facility. In 

addition, Massachusetts election officials reported first-time voter 

identification requirements would not apply when they conduct in-person 

Page 10 GAO-10-6 Elderly Voters
 

voter registration drives at long-term care facilities. Similarly, one South 

Dakota election official reported that voter identification and affidavit 

requirements can be waived entirely for long-term care facility residents 

receiving in-person absentee voting assistance from an election official at 

the facility. Lastly, only Puerto Rico reported requiring cognitive screening 

to assess the ability of a person to vote prior to the casting of his or her 

ballot.16

About Half of All States 

Reported Training Local 

Officials, While Fewer 

Reported Conducting 

Oversight of Local 

Adherence to State 

Requirements or Guidance 

While most states reported that they provide general training to local 

election officials on assisting voters with disabilities, about half of the 

states reported providing training to local election officials specifically on 

state requirements or guidance to facilitate voting for long-term care 

facility residents. For example, state election officials in Puerto Rico 

reported that they provided local election officials with general voting 

accessibility training to improve the interactions between the election 

officials and the voter, which included sensitivity training and simulations 

of potential scenarios. Furthermore, 23 states reported providing targeted 

training to local election officials specifically on state requirements or 

guidance for facilitating voting for long-term care facility residents. The 

training that states provided varied, but, in general, included assistance in 

adhering to state requirements or guidance on voter registration, absentee 

balloting requests, and assisted absentee voting procedures for long-term 

care facility residents. For example, in Vermont, state election officials 

provided training and distributed a handbook to local election officials on 

guidance for facilitating absentee voting in long-term care facilities, which 

included information on the role of election officials, public notification 

requirements, election supplies and forms, the set up of mobile polling 

stations, and the correct procedures for returning completed absentee 

ballots. In South Carolina, state officials, upon request, offered a one-onone training to county election office staff on absentee voting procedures. 

Connecticut provided training to local election officials on voter 

registration and absentee ballot application procedures, as well as 

absentee voting procedures. 

 

16Some researchers contend that requiring cognitive screening may increase the likelihood 

of fraud or undue influence if administered by long-term care facility staff; however, when 

screenings are administered by a bipartisan pair of local election officials they may 

decrease the risk of fraud or undue influence. Other researchers believe that requiring 

cognitive screening of long-term care facility residents, whether conducted by long-term 

care facility staff or election officials, should not be allowed because it may discriminate 

against and disenfranchise those residents. 

Page 11 GAO-10-6 Elderly Voters
 

Among the states, 17 conducted one or more oversight activities to ensure 

localities were adhering to state long-term care facility voting 

requirements or following state long-term care facility voting guidance. Of 

this group, 11 states reported conducting visits to local election 

jurisdictions or long-term care facilities to monitor local actions to meet 

state long-term care facility requirements. In Oregon, officials reported 

that they visited selected localities during an election cycle to observe 

their practices, suggest improvements, and share best practices. In 

addition, 8 states reported requiring or requesting localities to report on 

actions taken to address state requirements or guidance to facilitate voting 

for long-term care facility residents. For example, in Oklahoma, each 

county election board reported to the State Election Board after each 

election the number of voters who requested a ballot in nursing homes, the 

number of nursing homes visited, and the number of voters who voted in 

nursing homes. Then, the State Election Board aggregated the information 

at the state level and provided statistics to the state legislature, the EAC, 

and the public. In addition, county election boards in Oklahoma also 

reported to the State Election Board any problems they encountered and 

what actions they took to address them. The State Election Board may use 

this information to revise the procedures for absentee voting. Finally, 7 

states, reported requiring county officials to report the number of longterm care facility residents who voted for tracking and planning purposes 

for future elections. See table 1 for a list of the training and oversight 

activities reported by each state. 

Table 1: Reported State Training and Oversight of State Requirements or Guidance for Voting in Long-term Care Facilities 

Oversight 

State 

Provide 

training to 

localities 

Conduct visits to 

localities to monitor 

actions 

Require or request 

localities report on 

actions taken 

Track the number of 

voters in long-term care 

facilities 

American Samoa X X X X 

Arizona X 

California X 

Connecticut X 

District of Columbia X 

Georgia X 

Guam X X 

Idaho X 

Indiana X X 

Iowa X X 

Page 12 GAO-10-6 Elderly Voters
 

 Oversight 

State 

Provide 

training to 

localities 

Conduct visits to 

localities to monitor 

actions 

Require or request 

localities report on 

actions taken 

Track the number of 

voters in long-term care 

facilities 

Michigan X X 

Minnesota X 

Montana X 

Nebraska X 

New Hampshire X X 

New Mexico X X X 

New York X X X X 

Oklahoma X X X 

Oregon X X X 

Puerto Rico X X X 

Rhode Island X 

South Carolina X 

South Dakota X 

Tennessee X 

Virgin Islands X X 

Washington X X 

West Virginia X 

Wisconsin X 

Source: GAO survey of state election officials. 

Note: States not shown in table did not report providing training, requiring or requesting reporting, 

conducting visits to localities, or tracking voters in long-term care facilities. 

Some State Requirements 

and Guidance May Help to 

Ensure Voting Integrity 

Most states reported having requirements or guidance to provide absentee 

voting accommodations for long-term care facility residents, which 

according to researchers, may help local election officials protect voting 

integrity in long-term care settings. Because of the relatively high levels of 

cognitive impairments found in nursing home residents, this population 

requires assistance with the voting process. This assistance, however, can 

make the resident susceptible to fraud or undue influence. While the EAC 

has never completed a national study on the frequency and prevalence of 

voter fraud in long-term care facilities, there have been several high-profile 

cases and other anecdotal evidence suggesting this is an issue.17 Some 

 

17Kohn, Nina A. “Preserving Voting Rights in Long-Term Care Institutions: Facilitating 

Resident Voting While Maintaining Election Integrity”, McGeorge Law Review, vol. 38 

(2007). 

Page 13 GAO-10-6 Elderly Voters
 

researchers believe that absentee voting, especially by long-term care 

facility residents who require assistance casting their absentee ballots, is 

susceptible to voter fraud and undue influence. Researchers also believe 

that establishing requirements or providing guidance that local election 

officials conduct absentee voting in long-term care facilities would help to 

standardize efforts across facilities and protect against voter fraud. For 

example, according to researchers, requiring local election officials to 

deliver absentee ballots in person to facilities or conduct on-site absentee 

balloting at facilities—which some states require or allow—can decrease 

the likelihood of fraud and inappropriate influence by eliminating the need 

for assistance from influential third parties, such as long-term care facility 

staff, relatives, or candidate supporters. Specifically, research suggests 

that requiring bipartisan local election teams to deliver, collect, and assist 

with absentee balloting lowers the risk that election officials from a single 

party could unduly influence voters. 

In preparation for the November 2008 federal election, the EAC developed 

guidance—the Quick Start Management Guide on Elderly and Disabled 

Voters in Long Term Care Facilities—for state and local election officials 

on facilitating voting in long-term care facilities. In May 2008, the EAC 

convened a working group of academics, election officials, and other 

experts in the field, which we observed, to share information on 

facilitating voting for long-term care facility residents. The EAC developed 

the Quick Start guide based on the information discussed at the working 

group. The EAC then distributed 13,000 copies of its guidance, which 

focused on facilitating voting for elderly and disabled voters residing in 

long-term care facilities, to election officials nationally, issued a press 

release, and posted the guidance on its Web site. The guidance focused on 

the development of a plan for community outreach, coordination with 

long-term care facility staff, and implementation of voting assistance to 

long-term care facility residents; it did not address actions states or 

localities can take to ensure the integrity of the voting process. EAC 

officials told us they plan to convene a working group to develop a new 

chapter in the EMG on voting in long-term care facilities that would 

expand upon the information provided in the Quick Start guide. To date, 

the EAC has not collected information nationally nor conducted studies on 

state or local methods for identifying, deterring, and investigating fraud 

and undue influence in long-term care facilities; however, they told us that 

doing so would add value to long-term care voting nationally. According to 

the EAC, they have not conducted any studies because quantifying the 

level of voter fraud in long-term care facilities is difficult, as fraud often 

goes unreported and unprosecuted. However, EAC officials believe that 

state and local election officials could provide more education and 

Page 14 GAO-10-6 Elderly Voters
 

outreach on voting rights and voter fraud to long-term care facilities, 

including residents’ friends and family, to help reduce the likelihood of 

voter fraud or undue influence. Moreover, the EAC, which has limited 

resources—a $16.4 million budget and fewer than 50 staff members for 

fiscal year 2008—stated it has devoted much of its resources to updating 

the Voluntary Voting System Guidelines, instituting a voting system testing 

and certification program, and administering and auditing HAVA funds. 

Localities we surveyed have taken a variety of actions to facilitate voting 

access and protect voting integrity for long-term care facility residents. 

Specifically, they reported facilitating voting for long-term facility 

residents by supporting facility staff in assisting residents with the voting 

process and through direct voting services to facility residents, some of 

which may help to ensure voting integrity. Most commonly, localities we 

surveyed reported providing early or absentee voting information or 

guidance to long-term care facility staff. Similarly, the seven localities we 

visited employed a range of strategies to facilitate and protect the voting 

process. Moreover, each locality we visited used a somewhat different 

approach for applying these strategies and some reported challenges in 

doing so, such as providing assistance at a reasonable cost and assisting 

residents with cognitive disabilities. 

Localities Have Taken 

a Variety of Actions to 

Facilitate and Protect 

Voting for Long-term 

Care Facility 

Residents 

Most Localities We 

Surveyed Reported 

Providing Long-term Care 

Facilities with Voting 

Guidance or Other 

Information and Other 

Voting Assistance, Some of 

Which May Help to Ensure 

Voting Integrity 

Localities we surveyed reported taking a number of actions to facilitate 

the voting process in long-term care facilities. Specifically, 78 of the 92 

localities responding to our survey reported taking at least one action to 

facilitate the voting process for long-term care facility residents. Of the 

responding localities, close to half (45 of 92) of responding localities 

reported taking three or more actions (see fig. 3). 

Page 15 GAO-10-6 Elderly Voters
 

Figure 3: Number of Localities Taking Actions to Facilitate Voting for Long-term 

Care Facility Residents 

Number of localities

0

2

4

6

8

10

12

14

16

18

0 1 2 3 4 5 6 7 8

Source: GAO survey of local election officials.

Number of actions

1

2

4

7

14

17 17

16

14

Local officials facilitated voting for long-term facility residents through 

actions that supported facility staff in assisting residents with the voting 

process and through direct voting services to facility residents (see table 

2). Specifically, when supporting facility staff with the voting process, 

localities we surveyed reported providing support to long-term care 

facility staff in assisting residents with the absentee or early voting 

process. Over two-thirds (65 of 92) of responding localities reported 

providing early and absentee voting information or guidance to long-term 

care facility staff. For example, in Lincoln County, Kentucky, local election 

officials reported that they provide information on absentee voting 

procedures to the long-term care facility staff, including instructions on 

collecting the names of residents interested in absentee voting and 

requesting absentee voting applications to be completed and mailed back 

to the local election office. Researchers suggest that providing guidance to 

long-term care facility staff can help to ensure that residents are receiving 

voting assistance that is free of fraud and undue influence. In addition, a 

slight majority of the localities we surveyed reported delivering absentee 

ballots to facilities, which may help ensure that residents receive their 

ballots and reduce the likelihood of fraud. However, one locality reported 

that election officials were unable to deliver ballots to facilities because 

state law requires that all absentee ballots be sent by mail. Finally, close to 

Page 16 GAO-10-6 Elderly Voters
 

one-third (29 of 92) of responding localities reported that they provide 

training to long-term care facility staff which, according to researchers, 

can help to ensure that facility staff are providing voting assistance that is 

less susceptible to fraud and undue influence. 

Table 2: Selected Actions Taken Among 92 Localities to Facilitate Voting for Long-term Care Facility Residents 

Selected actions Number of localities

Supports to long-term care facility staff 

Provide early or absentee voting information or guidance to long-term care facilities 65

Deliver early or absentee ballots to long-term care facilities 48

Provide training to long-term care facility staff on absentee or early voting 29

Direct services to long-term care facility residents 

Bring election officials to long-term care facilities to conduct absentee or early voting 45

Designate long-term care facilities as Election Day polling places 28

Conduct voting equipment demonstrations for long-term care facilities 15

Bring accessible voting machines to long-term facilities for absentee or early voting 2

Provide transportation from long-term care facility to polling places on Election Day 1

Source: GAO survey of local election officials. 

Note: The survey estimates were not precise enough to generalize results to localities nationally. In 

addition, we did not contact local election officials to verify survey responses or other information 

provided by officials. 

Some localities we surveyed also reported providing voting services 

directly to long-term care facility residents. Specifically, close to half 

(45 of 92) of responding localities reported bringing election officials to 

long-term care facilities to provide voting assistance. For example, in 

Montgomery County, Maryland, local election officials reported that they 

sent trained, bipartisan teams of election workers to long-term care 

facilities to help residents complete their absentee ballots. As noted 

earlier, for state actions to facilitate voting, some researchers suggest that 

bringing trained election officials to long-term care facilities can decrease 

the likelihood that those providing the assistance to residents will unduly 

influence their votes and ensure that ballots are properly cast. In addition, 

close to one-third (29 of 92) of the localities we surveyed also reported 

designating long-term care facilities as Election Day polling places, which 

allows residents to vote in an official polling place without having to leave 

Page 17 GAO-10-6 Elderly Voters
 

their residence.18 However, local officials from one of these localities 

reported that they only designate a portion of the long-term care facilities 

in their election jurisdiction as polling places. Designating long-term care 

facilities as polling places may provide residents with increased 

opportunities to vote privately and independently, because HAVA requires 

each polling place for federal elections to have at least one voting system 

equipped for people with disabilities. While accessible voting systems 

provide opportunities for more private and independent voting, only two 

localities we surveyed—Miami-Dade County, Florida, and Travis County, 

Texas—reported bringing accessible voting systems to long-term care 

facilities for absentee or early voting. Furthermore, 15 localities we 

surveyed—including Miami-Dade County, Florida, and Travis County, 

Texas—reported providing long-term care facilities with demonstrations 

of voting systems equipped for people with disabilities, which could 

facilitate a greater use of these systems at Election Day polling places or 

for early or absentee voting at long-term care facilities by residents 

unfamiliar with electronic machinery. Finally, one locality we surveyed—

Falmouth, Maine—reported providing long-term care facility residents 

with transportation to polling places on Election Day. 

Localities We Visited Used 

a Range of Strategies to 

Facilitate and Protect 

Voting for Long-term Care 

Facility Residents and 

Faced Some 

Implementation 

Challenges 

The seven localities we visited commonly implemented targeted efforts to 

facilitate voting for long-term care facility residents for the November 2008 

federal election. However, the characteristics of each locality’s effort 

varied in a number of ways, including the number of facilities receiving 

voting assistance, the reported cost, and the number of years the effort 

had been in practice (see table 3). 

 

18We did not collect information from localities on whether long-term care facilities 

designated as polling places were open to all voters or exclusively to long-term care facility 

residents. 

Page 18 GAO-10-6 Elderly Voters
 

Table 3: Characteristics of the Long-term Care Voting Assistance Efforts for the November 2008 Federal Election in the Seven 

Localities We Visited 

Locality 

Characteristic 

Kitsap 

County, 

Washington 

Washington 

County, 

Oregon 

Multnomah 

County, Oregon 

Chicago, 

Illinois 

Shelburne, 

Vermont 

Burlington, 

Vermont 

Washington, 

District of 

Columbia 

Population 231,966 445,348 660,486 2,896,016 6,944 38,889 572,059 

Number of 

facilities 

receiving 

assistance 

18 30 14 92 4 2 18 

Number of 

residents 

assisted 

147 414 125 3,958 238 31 681 

Reported total 

cost of 

assistance 

$2,561 $10,480 $2,935 $105,988 $2,000 $600 n/a 

Reported cost 

per resident 

assisted 

$17.42 $25.31 $23.48 $26.78 $8.40 $19.35 n/a 

Were HAVA 

funds used? 

Yes Yes No No No No No 

Number of 

years voting 

assistance 

provided 

2 2 5 20+ 1 1 1 

Selected 

approaches 

Publicly 

advertised 

voting 

assistance 

visits and 

allowed nonresidents to 

vote during 

those visits 

Allowed 

residents to 

sign ballots 

using 

fingerprint 

Conducted 

several training 

sessions for 

election workers 

on how to help 

people with 

disabilities vote 

and how to use 

the accessible 

voting system 

Deployed 

election 

teams to 

facilities to 

provide voting 

assistance a 

few days 

before 

Election Day 

Collected 

evaluations 

from facility 

staff to 

inform future 

voting 

assistance 

efforts 

Conducted 

voting 

assistance 

visits before 

the voter 

registration 

deadline, 

allowing new 

residents to 

register and 

vote 

Used portable 

voting booths, 

which allowed 

some residents 

to vote privately 

and 

independently 

Source: GAO site visits. 

Note: We calculated cost per resident assisted using information provided to us by local election 

officials. As mentioned previously, grant funds are available under HAVA to support state and local 

efforts to ensure that people with disabilities have access to the election process. 

Localities we visited employed a range of strategies to facilitate and 

protect the voting process—from voter registration to casting ballots—for 

long-term care facility residents. Specifically, these strategies included 

coordination with stakeholders, such as long-term care facility staff and 

Page 19 GAO-10-6 Elderly Voters
 

others, deployment of election teams, and implementation of procedures 

to protect and ensure voting integrity. As figure 4 indicates, these 

strategies are generally used in conjunction with one another over a twomonth period to facilitate the entire voting process—including casting a 

ballot—for long-term care facility residents before Election Day. 

Figure 4: Strategies Used by Localities We Visited to Facilitate Absentee, Early, or Election Day Mail-in Voting for Long-term 

Care Facility Residents 

Source: GAO site visits.

8 weeks prior

to Election Day

76543210

Vote

Here

Procedures to protect 

voting integrity

Election workers may 

implement procedures

to protect voting integrity, 

such as working in 

bi-partisan teams

or collecting ballots

in locked boxes. 

Election teams deployed 

Election workers help residents read, mark, 

and seal absentee, early, or mail-in ballots.

Coordination with stakeholders

Local election officials work with stakeholders to identify long-term care 

facilities and coordinate with facility staff to facilitate the voting process.

State

agency

official

Disability

advocate

Facility

staff

Local

election

official

While all of the localities we visited employed all three of these 

strategies—coordination with stakeholders, deployment of election teams, 

and implementation of procedures to protect and ensure voting integrity—

each employed a somewhat different mix of approaches to implement its 

overall strategy. (See table 4) 

Page 20 GAO-10-6 Elderly Voters
 

Table 4: Selected Approaches Taken Among the Seven Localities We Visited to Facilitate Voting for Long-term Care Facility 

Residents 

Localities 

Selected approach 

Kitsap 

County, 

Washington 

Washington 

County, 

Oregon 

Multnomah 

County, 

Oregon 

Chicago, 

Illinois 

Shelburne, 

Vermont 

Burlington, 

Vermont 

Washington, 

District of 

Columbia 

Coordination with long-term care facility staff and other stakeholders 

Coordinated with facility 

staff to schedule voting 

assistance 

X X X X X X X 

Consulted with disability 

advocacy groups and/or 

state agencies 

X X X X X 

Provided facilities with 

voter outreach and 

registration materials 

X X X X X X 

Deployment of election teams to long-term care facilities 

Trained election workers 

or officials 

X X X X X X X 

Election workers assisted 

residents in reading, 

marking, and sealing 

ballots 

X X X X X X X 

Election workers 

provided bedside voter 

assistance to residents 

who were bedridden 

X X X X X X 

Procedures to protect and ensure voting integrity 

Privacy screens for 

voting 

X X X X X 

Bipartisan assistance X X X X X 

Ballot boxes to collect 

ballots 

X X X X X 

Affidavits documenting 

assistance 

X X X 

Accessible voting 

systems 

X X X 

Source: GAO site visits. 

Note: These approaches were observed during our site visits or reported by local election officials. 

Localities we visited coordinated with stakeholders relevant to the longterm care voting process in order to develop long-term care voting efforts. 

For example, in one locality—Kitsap County, Washington—local election 

officials coordinated with a disability advisory group, that included 

Coordination with Long-term 

Care Facility Staff and Other 

Stakeholders 

Page 21 GAO-10-6 Elderly Voters
 

representatives from disability advocacy organizations, to jointly identify 

long-term care facilities whose residents may have needed voting 

assistance. Kitsap County officials also consulted with the advisory group 

in the development of its long-term care facility voting effort, which 

recommended that local election workers bring accessible voting 

machines into facilities. In addition, four localities coordinated with state 

agencies to identify long-term care facilities to visit. For example, in 

advance of the November 2008 federal election, officials in the District of 

Columbia told us they coordinated with District of Columbia Department 

of Health to obtain a list of facilities and generated a list of registered 

voters at each facility from the District’s voter registration database. 

The localities we visited also reported coordinating with long-term care 

facility staff on pre-election voting activities, such as voter outreach and 

registration. Generally, these localities did not have election workers visit 

facilities to conduct voter outreach or voter registration activities, but 

instead relied on long-term care facility staff to facilitate the process. For 

example, election officials in Chicago, Illinois, told us that they delivered 

packets two months before Election Day to all of the long-term care 

facilities in the city, which included a letter explaining the city’s Nursing 

Home Voting Program, a list of residents who were registered to vote, new 

voter registration forms, absentee voting applications, and postage paid 

return envelopes that facility staff could use to return completed 

applications. Chicago election officials relied on facility staff to identify 

interested residents, aid residents in completing the forms, and return the 

materials. Providing long-term care facility staff with this type of detailed 

information and guidance on facilitating the voting process may help to 

ensure that residents are properly registered and receive an absentee 

ballot. Furthermore, in one locality—Washington County, Oregon—

officials told us that election teams visited long-term care facilities during 

the election registration period to conduct a two-hour voter education 

presentation on voting access for people with disabilities, including 

information on voting rights, accessible voting systems, and resources. 

Election officials and long-term care facility staff in a few localities 

reported some challenges with coordination. For example, officials from 

two localities reported that maintaining program knowledge at the facility 

level from election to election can be difficult due to high turnover among 

long-term care facility staff. Election officials in Chicago addressed this 

potential challenge by assigning one election staff person as the central 

contact for all long-term care facility staff. Long-term care facility staff and 

election officials in two localities told us that coordinating the voter 

registration process with local election officials can also be difficult 

Page 22 GAO-10-6 Elderly Voters
 

because of the transitory nature of residents. Although many long-term 

care facility residents reside in facilities for extended periods of time, one 

long-term care facility staff member explained that some residents may be 

in the hospital during the voter registration process or may reside in the 

facility during the registration process, but move before Election Day. 

Local election officials in the localities we visited deployed election teams 

before Election Day to provide individualized, in-person voting assistance 

to long-term care facility residents.19 To initiate the deployment of these 

teams, the localities we visited contacted long-term care facility staff well 

before Election Day to schedule a time to provide in-person voting 

assistance. For example, in Chicago, election officials told us that they 

contact facility staff about one month before the election to schedule a 

voting assistance visit during one of the four days prior to Election Day, as 

required by state law. In Multnomah County, Oregon, election officials told 

us they contacted facility staff to schedule a day to provide voting 

assistance once all mail-in ballots were mailed, which is 18 days before 

Election Day. To facilitate the voting process, all of the localities trained 

election workers or officials to provide voting assistance to people with 

disabilities and sent teams of election workers to selected long-term care 

facilities to assist individual residents in the reading, marking, and sealing 

of absentee, early, or other mail-in ballots. This assistance allowed 

residents to overcome visual, hearing, and dexterity impairments in 

casting their ballots. For example, in Burlington County, we observed 

election workers assisting a resident with hearing and dexterity 

impairments in completing a ballot by using a handheld white board to 

communicate. In general, these voting assistance activities took place in a 

common area in the facility, such as an activity room or library, which 

often provided limited privacy due to restricted space. In particular, 

residents often communicated ballot selections in loud voices to election 

workers, which may have compromised their voting privacy. In most of 

the localities, election teams also went to individual rooms to provide 

bedside voting assistance. For example, in Multnomah County, teams of 

election workers went to the rooms of bedridden residents to provide 

voting assistance. Similarly, election teams in Shelburne, Vermont, 

provided in-room assistance to residents living in the memory-loss unit to 

provide a more familiar and accommodating setting to facilitate the voting 

Deployment of Election Teams 

to Long-term Care Facilities 

 

19These activities are commonly referred to as “mobile voting.” Mobile voting is designed to 

facilitate voting for long-term care facility residents who may be unable to travel to a 

polling place. Mobile voting differs from Election Day polling place voting because they 

take place prior to Election Day and typically use absentee, early, or other mail-in ballots. 

Page 23 GAO-10-6 Elderly Voters
 

process. In some of the localities we visited, election workers providing 

bedside voting assistance were accompanied by facility staff to help meet 

resident needs during the voting process. Long-term care facility staff in 

some localities we visited noted that, without assistance from election 

teams, many of the residents in the facilities would have had to rely on 

facility staff, relatives, or volunteers to read, mark, and seal their ballots. 

In some localities we visited, local election workers and facility staff faced 

challenges in providing voting assistance to residents with cognitive 

limitations. During our observations, none of the localities we visited 

conducted cognitive screenings—assessing a resident’s ability to vote 

prior to casting a ballot by asking election-related questions or based on 

an assessment of a resident’s general mental capacity. Generally, election 

workers gave any resident registered to vote the opportunity to cast a 

ballot if they showed willingness and the intent to vote. Despite this 

approach, in some cases, residents who were registered to vote may have 

been unable to do so, apparently due to cognitive impairments. For 

example, election workers in one locality attempted to provide voting 

assistance to a resident who was registered to vote, but after 20 minutes 

the resident was unable to articulate any ballot selections. Election 

workers observed that she was unable to vote, but encouraged her to vote 

in the next election. The fluidity of residents’ health may inhibit their 

ability to make a choice at a specific time. While we did not observe 

cognitive screenings being performed during our site visits, long-term care 

facility staff in some of the localities performed cognitive screenings of 

residents before asking them to register to vote or assisting them in 

applying for early or absentee ballots. For example, one long-term care 

facility staff member explained that she did not ask residents who she 

deemed were cognitively unable to vote if they were interested in 

registering to vote. In order to determine each resident’s cognition, she 

tested the residents’ ability to articulate their name and awareness of their 

surroundings. According to researchers, if long-term care facility staff are 

not trained to address some of the unique issues of voting by the elderly, 

such as determining cognitive ability to vote, they may inadvertently 

disenfranchise some residents who are actually able to vote. 

Election officials in some localities told us that providing individual voting 

assistance to long-term care facility residents is resource intensive. Some 

local election officials told us that it was difficult to provide individualized 

Page 24 GAO-10-6 Elderly Voters
 

voting assistance at a reasonable cost.20 For example, local election 

officials in one locality told us that their voting assistance funding and 

scope had been cut to reduce the locality’s costs. As a result, the locality 

no longer conducts as much voter outreach to long-term care facilities as it 

used to. In two other localities, election officials supplemented the cost of 

providing long-term care voting assistance with HAVA funds.21 In addition 

to requiring significant monetary costs per individual served, election 

officials and long-term care facility staff from a few localities told us that 

providing individual voting assistance is a very time-consuming process. 

Most localities brought several election teams to each facility to provide 

voting assistance, which generally took most of the morning or afternoon. 

Part of the time commitment relates to election workers having to read 

each ballot aloud multiple times to residents who may have hearing and/or 

cognitive impairments. Moreover, this process is more resource intensive 

for localities that require bipartisan voting assistance. For example, in one 

locality two election officials spent an hour with one resident reading and 

marking a lengthy ballot with a number of ballot measures. 

Officials in all seven of the localities we visited implemented various 

procedures to protect long-term care facility residents against fraud and 

undue influence. Figure 5 provides examples of protections that can help 

to ensure voting integrity. Most of the localities we visited provided 

residents with bipartisan voting assistance when deploying election teams, 

which consisted of teams of two election workers with different political 

party affiliations providing voting assistance to each resident. According 

to some researchers, this practice can lower the risk of one political party 

unduly influencing the resident. However, residents may face undue 

influence from others, such as facility staff and family members. For 

example, at one long-term care facility, a resident told the bipartisan team 

of election workers assisting her that she was not sure whether she could 

vote for the candidate she preferred because her child told her to vote for 

an opposing candidate. Most localities we visited also set up privacy 

screens on tables to shield residents’ ballots from the view of others. In 

addition, most localities collected completed ballots in a ballot box, and in 

a few cases, the boxes were locked with padlocks. Also, four localities we 

visited required residents to sign affidavits documenting that voting 

Implementation of Procedures 

to Protect and Ensure Voting 

Integrity 

 

20In the majority of localities we visited election workers were paid; however, in some 

localities election workers may be unpaid volunteers. 

21HAVA grants are awarded through HHS and EAC. See the background section of this 

report for more detail. 

Page 25 GAO-10-6 Elderly Voters
 

assistance was requested and noting who provided the assistance. In 

Chicago, the election teams included election observers from law 

enforcement agencies such as the U.S. Attorney’s Office or Cook County 

State’s Attorney’s Office. These observers generally handle and inspect 

affidavits for voting assistance and check poll watcher credentials. While 

none of the localities required residents to provide identification, in 

Washington County, some residents with physical impairments were able 

to sign their ballots using a fingerprint, which was on file at the election 

office. In addition, in one locality, election teams sometimes asked 

residents for their Social Security numbers to verify that the correct 

resident was receiving the ballot. 

Page 26 GAO-10-6 Elderly Voters
 

Figure 5: Select Protections to Ensure Voting Integrity for Long-term Care Facility 

Residents 

Source: GAO survey of local election officials and GAO site visits.

Voting integrity

protections

Privacy

screens

Bipartisan

voting

assistance

Election

observers

Accessible

voting

systems

Sample

ballots

Portable

voting

booths Locked

ballot

boxes

Affidavit

of voting

assistance

Delivery

of ballots

Ballot

fingerprint

signature 

Make facility 

an official

polling place

Training

for facility

staff

Note: State and localities may also help to ensure voting integrity through the development of 

requirements or guidance to implement these protections. 

Some localities implemented additional procedures, which may have 

helped ensure voting integrity by promoting independent voting. Election 

teams in Kitsap County and Washington County brought electronic 

accessible voting systems to long-term facilities, which provided residents 

with disabilities the opportunity to complete a ballot independently 

without election worker assistance. Chicago election teams provided 

residents with sample ballots to demonstrate how to complete the official 

ballot. We observed that this practice allowed residents and election 

Page 27 GAO-10-6 Elderly Voters
 

workers to assess whether voting assistance was needed to complete the 

ballot. Additionally, the election team in the District of Columbia brought 

portable voting booths to each facility, which allowed residents to attempt 

to vote independently. We observed election teams in this locality allowing 

residents to choose whether to complete a ballot independently in the 

portable voting booths or with assistance from an election worker at a 

table. 

A few localities faced challenges fully implementing procedures to protect 

and ensure voting integrity and independence. Specifically, some local 

election officials told us that residents were reluctant to use unfamiliar 

voting methods, such as an accessible voting system. For example, we 

observed only one resident use an accessible voting system in the three 

localities we visited that reported using accessible voting systems in 

facilities. Election workers in two of these localities told us that the 

accessible voting system was seldom used by residents, who preferred 

one-on-one voting assistance using a paper ballot. In one instance, local 

election workers faced difficulties providing bipartisan assistance. In this 

locality, we observed election workers providing assistance to residents 

individually rather than in bipartisan teams in order to provide assistance 

more quickly to the growing number of residents waiting to vote. 

Many states and local jurisdictions appear to be moving in the direction of 

facilitating voting for long-term care facility residents, primarily older 

voters, by providing alternative voting methods, such as absentee or early 

ballots and, in some cases, Election Day mail-in ballots. However, at the 

same time, states and localities vary in the extent to which they ensure 

that the ballots of these voters in long-term care facilities are not 

fraudulently completed by someone else, or that these voters are not 

subjected to undue influence by facility staff or family members. The 

EAC’s plans to develop a new chapter in the EMG on voting in long-term 

care facilities is a step in the right direction, but remains a work in 

progress. For the future, state and local accommodations to address 

physical and cognitive disabilities of long-term care facility residents will 

directly affect the balance between voting access and the integrity of the 

voting process. That is, providing accommodations to facilitate voting for 

long-term care facility residents has advantages for these residents by 

increasing their access to vote, but can also present challenges for election 

officials. Officials must balance providing increased access to voting with 

ensuring that ballots are cast by the appropriate voter, and completed 

without undue influence from long-term care facility staff, relatives, or 

Conclusions 

Page 28 GAO-10-6 Elderly Voters
 

other politically interested parties. A number of localities we visited have 

taken some actions that attempt to strike this balance. We acknowledge 

that facilitating voting for long-term care facility residents can be a costly 

and challenging undertaking, but given the increasing size of the elderly 

population, it will become progressively more important to implement 

cost-effective approaches to meet the growing demand for voting 

accommodations and assistance outside of traditional polling places. 

Further guidance on how to cost-effectively provide greater voting access 

for long-term care facility residents, while also ensuring voting integrity, 

may assist some states and localities in providing voting access and 

reducing opportunities for fraud and undue influence of a vulnerable and 

dependent population. However, to the extent that states and localities do 

not have the opportunity or resources to learn from each other’s success 

and challenges, progress across the nation could be hampered. 

We recommend that, as the EAC works with stakeholders to develop 

guidance on voting in long-term care facilities, the EAC also collect and 

disseminate information on cost-effective promising practices for 

providing voting access while also ensuring voting integrity. 

Recommendation for 

Executive Action 

We provided a draft of this report to EAC, HHS, and Justice for review and 

comment. In its comments, EAC indicated agreement with our findings 

and recommendation. Specifically, EAC stated that it shared our concern 

that current voting practices in long-term care facilities must be improved 

and enhanced, and indicated that it plans to produce a full chapter on this 

topic for its EMG on serving voters in long-term care facilities. HHS and 

Justice provided no formal comments. HHS provided technical comments, 

which we incorporated into the report as appropriate. EAC’s comments 

are reproduced in appendix III. 

Agency Comments 

and Our Evaluation 

We are sending copies of this report to the EAC, HHS, Justice, relevant 

congressional committees, and other interested parties. In addition, the 

report will be made available at no charge on GAO’s Web site at 

http://www.gao.gov. 

Page 29 GAO-10-6 Elderly Voters
 

If you or your staffs have any questions about this report, please contact 

Barbara D. Bovbjerg at (202) 512-7215 or bovbjergb@gao.gov, or William 

O. Jenkins at (202) 512-8777 or jenkinswo@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on the 

last page of this report. GAO staff who made major contributions to this 

Barbara D. Bovbjerg 

report are listed in appendix VI. 

Director, Education, Workforce, and Income Security Issues 

stice Issues 

William O. Jenkins, Jr. 

Director, Homeland Security and Ju

Page 30 GAO-10-6 Elderly Voters
 

List of Requesters 

The Honorable Tom Harkin 

Chairman 

Committee on Health, Education, Labor, 

 and Pensions 

United States Senate 

The Honorable Herbert Kohl 

Chairman 

Special Committee on Aging 

United States Senate 

The Honorable Charles E. Schumer 

Chairman 

The Honorable Robert Bennett 

Ranking Member 

Committee on Rules and Administration 

United States Senate 

The Honorable Dianne Feinstein 

United States Senate 

Page 31 GAO-10-6 Elderly Voters
Appendix I: Scope and Methodology 

Page 32 GAO-10-6 

Appendix I: Scope and Methodology 

Our objectives were to identify the actions taken to facilitate and protect 

voting for long-term care facility residents at (1) the state level and (2) the 

local level. For both of our objectives, we interviewed officials of the 

Department of Justice (Justice), the Department of Health and Human 

Services (HHS), national organizations that represent election officials, 

and multidisciplinary researchers. We also reviewed relevant federal laws, 

regulations, guidance, and other documentation. We did not analyze state 

requirements or guidance, but instead relied on states’ responses to our 

survey. In addition, we interviewed officials at the Election Assistance 

Commission (EAC) and reviewed EAC guidance on facilitating voting in 

long-term care facilities. We interviewed multidisciplinary researchers in 

the area of long-term care voting and reviewed relevant literature to 

identify practices at the state and local level that may facilitate voting in 

long-term care facilities while ensuring voting integrity. To obtain 

information on state actions, we administered a Web-based survey of 

election officials in all 50 states, the District of Columbia, the 

Commonwealth of Puerto Rico, and three U.S. territories (American 

Samoa, Guam, and the U.S. Virgin Islands). To obtain information on local 

actions, we administered a survey of local election officials in 104 local 

election jurisdictions and conducted site visits to seven localities. We 

conducted our work from April 2008 through November 2009 in 

accordance with all sections of GAO’s Quality Assurance Framework that 

were relevant to our objectives. The framework requires that we plan and 

perform the engagement to obtain sufficient and appropriate evidence to

meet our stated objectives and to discuss any limitations in our work. We 

believe that the information and data obtained, and the analysis 

conducted, provide a reasonable basis for any findings and conclusions. 

Review of Documentation 

and Interviews with 

Federal Officials, 

Researchers, and 

Organizations 

To gather information on the actions states and localities are taking to 

facilitate and protect voting in long-term care facilities, we interviewed 

federal officials, multidisciplinary experts, representatives of national 

organizations, and reviewed relevant documentation. Specifically, we 

spoke with officials in the Voting and Disability Rights Sections of the Civil 

Rights Division from Justice and in the Administration on Aging and the 

Centers for Medicare and Medicaid Services from HHS to better 

understand the federal government’s role in facilitating voting for longterm care facility residents. To examine available guidance to state and 

local election officials on facilitating and protecting voting in long-term 

care facilities, we interviewed EAC officials, observed an EAC working 

group meeting on facilitating voting in long-term care facilities, and 

reviewed the EAC Quick Start Management Guide on Elderly and 

Disabled Voters in Long Term Care Facilities. To gain perspectives of 

 Elderly Voters 
Appendix I: Scope and Methodology 

management, improvement, and challenges to the facilitation of voting to 

long-term care residents, we spoke with representatives of the National 

Association of Secretaries of State (NASS) and National Association of 

State Election Directors (NASED). We also reviewed relevant research 

literature and interviewed principal, multidisciplinary researchers in the 

area of long-term care voting, including researchers from the American 

Association of People with Disabilities, the American Association of 

Retired Persons, the American Bar Association Commission on Law and 

Aging, the University of Pennsylvania Institute on Aging, and the National 

Academy for State Health Policy to identify practices that may facilitate 

voting in long-term care facilities and whether they may protect against 

fraud and undue influence. We found this research literature to be 

sufficiently reliable for the purposes of this report. 

Survey of States, the 

District of Columbia, the 

Commonwealth of Puerto 

Rico, and Territories 

To gather information on state actions to facilitate and protect voting for 

long-term care facility residents, we administered a Web-based survey of 

officials responsible for overseeing elections from the 50 states, the 

District of Columbia, the Commonwealth of Puerto Rico, and three U.S. 

territories (American Samoa, Guam, and the U.S. Virgin Islands). The 

survey included questions about state and local actions to facilitate voting 

in long-term care facilities.1

 The survey was conducted using a selfadministered electronic questionnaire posted on the Web. We collected 

the survey data between December 2008 and February 2009. We received 

completed surveys from all 50 states, the District of Columbia, the 

Commonwealth of Puerto Rico, and three U.S. territories for a 100 percent 

response rate. 

Because this was not a sample survey, there are no sampling errors. 

However, the practical difficulties of conducting any survey may introduce 

nonsampling errors, such as variations in how respondents interpret 

questions and their willingness to offer accurate responses. To minimize 

nonsampling errors, we pretested draft survey instruments with state 

election officials in Kansas, Virginia, and Wisconsin to determine whether 

 

1

The survey was administered in conjunction with a related GAO study examining polling 

place accessibility. To address the objectives of that study, the survey included questions 

on (1) state requirements and policies for early voting, absentee voting, and voter 

identification; (2) state voting accommodations for people with disabilities; (3) state 

funding and experiences implementing the Help America Vote Act of 2002 (HAVA) voting 

access requirements; and (4) level of interaction with Justice officials and usefulness of 

Justice guidance. More information on that study can be found in GAO-09-941. 

Page 33 GAO-10-6 Elderly Voters
Appendix I: Scope and Methodology 

(1) the survey questions were clear, (2) the terms used were precise, 

(3) respondents were able to provide the information we were seeking, 

and (4) the questions were unbiased. We made changes to the content and 

format of the questionnaire based on pretest results. Because respondents 

entered their responses directly into our database of responses from the 

Web-based surveys, the possibility of data entry errors was greatly 

reduced. We also performed computer analyses to identify inconsistencies 

in responses and other indications of error. In addition, a second 

independent GAO analyst verified that the computer programs we used to 

analyze the data were written correctly. We contacted election officials in 

some states to gain a deeper understanding of selected survey responses, 

and obtained and reviewed relevant documentation for selected states. 

The scope of this work did not include contacting election officials from 

each state and local jurisdictions to verify all survey responses or other 

information provided by state officials. Similarly, we did not analyze 

reported state requirements to verify what they require, but instead relied 

on the states’ responses to our survey.2

Survey of Local Election 

Jurisdictions 

To gather information on local actions to facilitate and protect voting for 

long-term care facility residents, we surveyed 104 local election officials.3

The survey asked local election officials to identify whether their election 

jurisdiction was taking any action to facilitate voting in long-term care 

facilities and to identify any actions taken. We conducted the survey by 

e-mail. We collected the survey data between September 2008 and 

February 2009 and received an 88 percent response rate. 

The sample of local election jurisdictions was taken from a related GAO 

study examining polling place accessibility for voters with disabilities4

 that 

used a two-stage sampling method to create a nationally representative 

random selection of polling places in the contiguous United States, with 

the exception of those in Oregon.5

 Specifically, the local election 

 

2

For the purposes of our study, we defined requirements as requirements under state law, 

regulation, or executive order/directive, but excluding federal requirements. 

3

Local election jurisdictions were generally county or city equivalents. In Maine, 

Massachusetts, Michigan, and Minnesota local election jurisdictions were townships. 

4

GAO-09-941. 

5

We excluded Alaska and Hawaii for cost and efficiency reasons related to the other study 

and Oregon because voters exclusively use mail-in ballots. 

Page 34 GAO-10-6 Elderly Voters
Appendix I: Scope and Methodology 

jurisdictions used for the survey were those which had one or more of 

their polling places randomly selected in the sample of polling places. The 

survey estimates calculated for this report did not have a low enough 

margin of error to allow us to generalize results to localities nationally. In 

addition, the scope of this work did not include contacting election 

officials from each local jurisdiction to verify all survey responses or other 

information provided by local officials. 

Local Site Visits To obtain a more detailed understanding of local actions to facilitate 

voting in long-term care facilities, we conducted site visits to seven 

localities —Burlington, Vermont; Shelburne, Vermont; Chicago, Illinois; 

the District of Columbia; Kitsap County, Washington; Multnomah County, 

Oregon; and Washington County, Oregon. We selected localities generally 

regarded as innovative or potentially effective in their approach to 

facilitate voting for long-term care facility residents based on interviews 

with agency officials, representatives of professional organizations, and 

multidisciplinary researchers. We conducted all of the site visits in 

October and November 2008, before the federal election on 

November 4, 2008. 

In each locality, we interviewed local election officials and long-term care 

facility staff. During interviews with local election officials and long-term 

care facility staff, we used a standard interview protocol that we 

developed which enabled us to obtain detailed and comparable 

information. In each locality, we discussed with local election officials the 

process for facilitating voting for long-term care facilities, including 

program history, coordination with stakeholders, and challenges. At each 

locality, we selected one or two long-term care facilities to visit based on 

input from local election officials. In total, we visited 10 long-term care 

facilities and at each we met with facility staff responsible for coordinating 

with local election officials regarding the voting process for residents, 

which was typically the facility’s Activity Director. During these 

interviews, we discussed the voting process for facility residents, including 

coordination with local election officials and the unique voting challenges 

for residents. While we met with local election officials and long-term care 

facility staff in all the localities we visited, in a few instances, we were 

unable to complete our interviews during our site visit, but conducted 

interviews afterwards over the telephone. 

We also observed the administration of the voting process prior to 

Election Day at each of the long-term care facilities we visited. During 

these observations we used a standard protocol we developed that 

Page 35 GAO-10-6 Elderly Voters
Appendix I: Scope and Methodology 

enabled us to collect uniform and detailed information that was 

comparable across all of the long-term care facilities we visited. We 

collected information on the number of election workers, number of 

facility residents voting, and the types of voting assistance provided. 

Page 36 GAO-10-6 Elderly Voters
Appendix II: Summar

Related to Voti

and Pe

y of Federal Laws 

ng Accessibility for the Elderly

ople with Disabilities 

Page 37 GAO-10-6 

Appendix II: Summary of Federal Laws 

Related to Voting Accessibility for the Elderly 

and People with Disabilities 

Although state and local governments are responsible for administering 

elections, several federal laws set forth requirements that must be met 

during the federal election process. Specifically, federal laws have been 

enacted in major areas of the voting process, including several that are 

designed to help ensure that voting is accessible for the elderly and people 

with disabilities. 

The Voting Rights Act of 

1965 

The Voting Rights Act of 1965 (VRA)1

, as amended, provides for voting 

assistance to voters with disabilities. Specifically, the VRA, among other 

things, authorizes voters who require assistance to vote by reason of 

blindness, disability, or inability to read or write to be given assistance by 

a person of the voter’s choice, other than the voter’s employer or agent of 

that employer or officer or agent of the voter’s union. 

Voting Accessibility for the 

Elderly and Handicapped 

Act 

In 1984 Congress enacted the Voting Accessibility for the Elderly and 

Handicapped Act (VAEHA),2

 which requires that political subdivisions 

responsible for conducting elections assure that all polling places for 

federal elections are accessible to elderly voters and voters with 

disabilities, with limited exceptions. One such exception occurs when the 

chief election officer of the state determines that no accessible polling 

places are available in a political subdivision, and that officer ensures that 

any elderly voter or voter with a disability assigned to an inaccessible 

polling place will, upon advance request, either be assigned to an 

accessible polling place or will be provided with an alternative means to 

cast a ballot on the day of the election. Under the VAEHA, the definition of 

“accessible” is determined under guidelines established by the state’s chief 

election officer, but the law does not specify standards or minimum 

requirements for those guidelines. Additionally, the Act requires states to 

make available voting aids for elderly and disabled voters, including 

instructions printed in large type at each polling place, and information by 

telecommunications devices for the hearing impaired. The VAEHA also 

contains a provision requiring public notice, designed to reach elderly and 

disabled voters, of absentee voting procedures. The VAEHA also contains 

provisions that make absentee voting more accessible by prohibiting, with 

limited exceptions, the requirement of a notarization or medical 

certification of disability when granting an absentee ballot. 

 

1

Pub. L. No. 89-110 (1965). 

2

Pub. L. No. 98-435 (1984). 

 Elderly Voters 
Appendix II: Summary of Federal Laws 

Related to Voting Accessibility for the Elderly 

and People with Disabilities 

The Help America Vote Act of 2002 (HAVA)3 contains a number of 

provisions designed to help increase the accessibility of polling place 

voting for individuals with disabilities. In particular, Section 301(a) 4

outlines minimum standards for voting systems for federal elections. The 

provision states that the voting system must be accessible for people with 

disabilities, including nonvisual accessibility for the blind and visually 

impaired, in a manner that provides the same opportunity for access and 

participation as for other voters. To satisfy this requirement, each polling 

place must have at least one direct recording electronic device or other 

voting system equipped for people with disabilities. HAVA may apply to 

assisted voting provided to long-term care facility residents, if the longterm care facility is considered a “polling place,” which is generally 

designated at the state and local level. 

Help America Vote Act of 

2002 

In addition, there are several federal laws that provide broad protections 

of the rights of people with disabilities, which indirectly apply to voting. 

Older Americans Act of 

1965 

The Older Americans Act of 1965 (OAA),5

 as amended, supports a wide 

range of social services and programs for older persons. The OAA 

authorizes grants to agencies on aging to serve as advocates of, and 

coordinate programs for, the older population. Such programs cover areas 

such as caregiver support, nutrition services, and disease prevention. 

Importantly, the OAA also provides assistance to improve transportation 

services for older individuals, which may include transportation to polling 

places. 

The Americans with 

Disabilities Act of 1990 

Title II of the Americans with Disabilities Act of 1990 (ADA)6

 and its 

implementing regulations7

 require that people with disabilities have access 

to basic public services, including the right to vote. However, it does not 

strictly require that all polling place sites be accessible. Under the ADA, 

public entities must make reasonable modifications in policies, practices, 

 

3

Pub. L. No. 107-252 (2002). 

4

42 U.S.C. § 15481(a). 

5

Pub. L. No. 89-73 (1965). 

6

Pub. L. No. 101-336 (1990). 

7

28 C.F.R. Parts 35, 36. 

Page 38 GAO-10-6 Elderly Voters
Appendix II: Summary of Federal Laws 

Related to Voting Accessibility for the Elderly 

and People with Disabilities 

or procedures to avoid discrimination against people with disabilities. 

Moreover, no individual with a disability may, by reason of the disability, 

be excluded from participating in or be denied the benefits of any public 

program, service, or activity. State and local governments may comply 

with ADA accessibility requirements in a variety of ways, such as by 

redesigning equipment, reassigning services to accessible buildings or 

alternative accessible sites, or altering existing facilities or constructing 

new ones. However, state and local governments are not required to take 

actions that would threaten or destroy the historic significance of a 

historic property, fundamentally alter the nature of a service, or impose 

undue financial and administrative burdens. In choosing between available 

methods of complying with the ADA, state and local governments must 

give priority to the choices that offer services, programs, and activities in 

the most integrated setting appropriate. 

Title III of the ADA covers commercial facilities and places of public 

accommodation. Such facilities may also be used as polling places. Under 

Title III, public accommodations must make reasonable modifications in 

policies, practices, or procedures to facilitate access for individuals with 

disabilities. They must also ensure that no individual with a disability is 

excluded or denied services because of the absence of “auxiliary aids and 

services,” which include both effective methods of making aurally and 

visually delivered materials available to individuals with impairments, and 

acquisition or modification of equipment or devices. Public 

accommodations are also required to remove physical barriers in existing 

buildings when it is “readily achievable” to do so; that is, when it can be 

done without much difficulty or expense, given the entity’s resources. In 

the event that removal of an architectural barrier cannot be accomplished 

easily, the accommodation may take alternative measures to facilitate 

accessibility. All buildings newly constructed by public accommodations 

and commercial facilities must be readily accessible; alterations to existing 

buildings are required to the maximum extent feasible to be readily 

accessible to individuals with disabilities. 

Page 39 GAO-10-6 Elderly Voters
Appendix III: Comments from the Election Appendix III: Comments from the Election Assistance Commission 

Assistance Commission 

Page 40 GAO-10-6 Elderly Voters 
Appendix III: Comments from the Election 

Assistance Commission 

Page 41 GAO-10-6 Elderly Voters
Appendix IV: 

A

GAO Contacts and Staff 

cknowledgments 

Page 42 GAO-10-6 

Appendix IV: GAO Contacts and Staff 

Acknowledgments 

Barbara D. Bovbjerg, (202) 512-7215 or bovbjergb@gao.gov

William O. Jenkins, Jr., (202) 512-8777 or jenkinswo@gao.gov

Brett Fallavollita, Assistant Director and Amber Yancey-Carroll, Analystin-Charge managed this assignment. Ryan Siegel, Katherine Bowman, 

Carolyn Blocker, and Laura Heald made significant contributions to this 

report in all aspects of the work. Josephine Perez provided assistance with 

site visit data collection. Carl Barden, Cathy Hurley, Stuart Kaufman, and 

Walter Vance provided analytical assistance; Alex Galuten and Sarah 

Cornetto provided legal support; Jessica Orr provided assistance on report 

preparation; James Bennett developed the report’s graphics; and Anna 

Bonelli verified our findings. 

GAO Contacts 

Staff 

Acknowledgments 

 Elderly Voters 
Related GAO Products Related GAO Products 

Voters with Disabilities: Additional Monitoring of Polling Places Could 

Further Improve Voting Accessibility. GAO-09-941. Washington, D.C.: 

September 30, 2009. 

Voters with Disabilities: More Polling Places Had No Potential 

Impediments Than in 2000, but Challenges Remain. GAO-09-685. 

Washington, D.C.: June 10, 2009. 

Elections: States, Territories, and the District Are Taking a Range of 

Important Steps to Manage Their Varied Voting System Environments.

GAO-08-874. Washington, D.C.: September 25, 2008. 

Elections: 2007 Survey of State Voting System Programs.

GAO-08-1147SP. Washington, D.C.: September 25, 2008. 

Elections: Federal Program for Certifying Voting Systems Needs to Be 

Further Defined, Fully Implemented, and Expanded. GAO-08-814. 

Washington, D.C.: September 16, 2008. 

Election Assistance Commission—Availability of Funds for Purchase of 

Replacement Voting Equipment. B-316107. Washington, D.C.: 

March 19, 2008. 

Elderly Voters: Some Improvements in Voting Accessibility from 2000 to 

2004 Elections, but Gaps in Policy and Implementation Remain.

GAO-08-442T. Washington, D.C.: January 31, 2008. T

Elections: All Levels of Government Are Needed to Address Electronic 

Voting System Challenges. GAO-07-741T. Washington, D.C.: April 18, 2007. 

Older Driver Safety: Knowledge Sharing Should Help States Prepare for 

Increase in Older Driver Population. GAO-07-413. Washington, D.C.: 

April 11, 2007. 

Elections: The Nation’s Evolving Election System as Reflected in the 

November 2004 General Election. GAO-06-450. Washington, D.C.: June 6, 

2006. 

Elections: Federal Efforts to Improve Security and Reliability of 

Electronic Voting Systems Are Under Way, but Key Activities Need to Be 

Completed. GAO-05-956. Washington, D.C.: September 21, 2005. 

Page 43 GAO-10-6 Elderly Voters
Related GAO Products 

Transportation-Disadvantaged Seniors: Efforts to Enhance Senior 

Mobility Could Benefit from Additional Guidance and Information.

GAO-04-971. Washington, D.C.: August 30, 2004. 

Elections: Electronic Voting Offers Opportunities and Presents 

Challenges. GAO-04-975TT. Washington, D.C.: July 20, 2004. 

Elections: Perspectives on Activities and Challenges Across the Nation.

GAO-02-3. Washington, D.C.: October 15, 2001. 

Elections: A Framework for Evaluating Reform Proposals. GAO-02-90. 

Washington, D.C.: October 15, 2001. 

Voters with Disabilities: Access to Polling Places and Alternative Voting 

Methods. GAO-02-107. Washington, D.C.: October 15, 2001. 

Elections: The Scope of Congressional Authority in Election 

Administration. GAO-01-470. Washington, D.C.: March 13, 2001. 

(130919) Page 44 GAO-10-6 Elderly Voters
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