En español | In a normal election year, late summer and early fall would be a busy time for Annie Butzner. A retired nurse in Asheville, North Carolina, Butzner has for years traveled to nearby hospitals, assisted living facilities and nursing homes, helping patients and residents register to vote and request absentee ballots.
But this year the coronavirus pandemic has made that work more difficult. Butzner, 69, has had a hard time just getting into facilities to determine which residents need help registering and requesting ballots. “The fact that it's so hard to vote in care facilities is ridiculous,” she says. “All of the wisdom that these people have — it's just being wasted."
Butzner is part of a growing chorus of advocates, state officials and election experts worried about the voting roadblocks that COVID-19 presents to many of the nation's 1.3 million nursing home residents — and the specter that some won't be able to vote in this fall's general election. More than 800,000 other people live in other kinds of residential care communities, including assisted living facilities, and will likely also be affected.
"It's a bloody mess is what I would say,” Nina Kohn, a professor at the Syracuse University College of Law and a distinguished scholar in elder law at Yale Law School, says of the confusion around voting from nursing homes this year.
There isn't reliable national data for voter participation among residents of nursing homes and long-term care facilities, but they are a population that checks several boxes for high voter turnout. Nearly two-thirds are over age 65 and most are women; these are two groups who historically turn out to vote in higher numbers than the rest of the country.
With many residents cut off not just from loved ones but also election volunteers and county officials who would normally help them vote, experts fear that turnout will drop.
"Ensuring everyone can exercise their right to vote is of utmost concern to AARP,” says Elaine Ryan, the organization's vice president for state advocacy and strategy. “We must remove any barriers residents of long-term care facilities may face, especially during this pandemic."
Traditional voting upended by the virus
In a typical election year, nursing home residents generally vote in person (with the help of friends or family or by caravanning to polls), via absentee or mail-in ballot, or from the comfort of their own facility (with the help of county election officials or by simply walking down the hall, if their facility is a registered polling site).
But those traditional options have been upended by the pandemic. Few polling locations are expected to be set up in nursing homes this year, as many facilities are just beginning to emerge from a federal lockdown that began in March. In-person voting will also be more limited nationwide, especially for long-term care residents. This year many states are restricting the number of in-person polling places that they operate because larger venues are better for social distancing and because states are expecting fewer Election Day poll workers this year. Further, nursing homes are unlikely to encourage residents to go to the polls, given how susceptible they are to serious complications from the coronavirus.
Alexa Schoeman, a deputy state long-term care ombudsman in Texas, told AARP's state office during a recent Facebook Live conversation that residents can still vote in person during the pandemic, but they may then have to quarantine for 14 days if they decide to leave their facility.
Schoeman noted that curbside voting will be available in Texas and in some other states. Some long-term care facilities will be allowed to drive residents to election sites, she said, where they can cast a ballot without leaving the vehicle. But this option depends on staff availability and facility planning and is unlikely to be widely available nationally.
"We know that staff are stretched, and we know that things not in immediate jeopardy or not related to infection control have kind of been pushed to the wayside amid COVID,” Kohn says.
Many states have relaxed restrictions on voting by mail, including absentee voting, to make casting a ballot easier and safer. But in nursing homes, even voting this way is expected to be muddied by the pandemic. That's because volunteers and election officials who would normally visit with residents in the fall to do voter education and to answer questions may not be able to enter many long-term care facilities this year.
"The nursing home staff will have to do all of it this year,” says Mairead Painter, who works in Connecticut as a long-term care ombudsman, part of a national network of officials who help nursing home residents and their loved ones work through issues.
Sondra Norder, president and CEO of the St. Paul Elder Services nursing home and assisted living facilities in Kaukauna, Wisconsin, says on-site social workers will help residents cast their absentee ballots in the absence of election officials. Staffers can read ballots to applicants who need assistance, but they won't be able to answer questions about candidates’ platforms because the state doesn't want them to potentially influence residents’ votes.
"Previously, election officials went resident to resident to help them fill out their ballots, collected them and brought them to the clerk's office,” she says.
Nursing homes that accept Medicare and Medicaid payments have a legal responsibility to assist residents with voting, but the degree to which they can assist them varies. North Carolina and Louisiana, for instance, have laws that prohibit nursing home staffers from helping residents cast their ballots. In North Carolina, residents must call in a “multi-partisan assistance team” from their local election office — a tall order this year given nursing homes’ visitor restrictions.
"It's a ridiculous remedy, and it causes more problems than it solves,” says Butzner, who is assembling three-ring binders with candidates’ platforms and voter information to share with facilities to keep their residents informed.
Even in states where workers are allowed to help residents, nursing home staff have been stretched thin by added safety and sanitation responsibilities. “It is questionable whether nursing homes, already understaffed before COVID, will be able to devote the necessary staff time and attention to voting,” says Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care.
'This is so confusing to everybody'
Navigating the tapestry of state and local voting laws is difficult enough for long-term care facilities in normal times. Each state has its own rules for how to cast absentee and mail-in ballots. And many have laws about whether friends, family members or facility staffers can help residents vote.
In some states election officials have been barred from entering nursing homes. The Wisconsin Elections Commission banned voting deputies from entering facilities in March. And in Tennessee, an obscure law prevents nursing home residents from acquiring an absentee ballot if they are registered to vote in the same county where their nursing home is located. Only residents who are registered in another county can get a ballot.
"This is so confusing to everybody,” says Martin Penny, associate state director for advocacy at AARP Tennessee, who says the law means that many of the state's nursing home residents will be unable to vote via absentee ballot.
Kohn says these issues are particularly problematic for a population of voters who aren't typically on social media and often find it difficult to advocate for themselves. She says long-standing disenfranchisement and ballot-access issues in nursing homes are being laid to bare by the pandemic.
"Their institutionalization plus their underlying health conditions makes it very hard to participate in our national dialogues and discussion,” Kohn says. “This is a group, perhaps more than any other, that needs the vote to defend their interests."