Point of View

Long-term care and dignified voting

November 5, 2012 

Among residents of long-term care facilities who want to vote – and studies estimate that on average about one-thirds and in some facilities as many as three-quarters do vote – nearly all require an absentee ballot. However, for residents of many nursing homes, state requirements for what is a valid absentee ballot mean that their vote may not count.

Nursing home residents are typically disabled to the degree that they need assistance performing many basic activities of daily living such as dressing, bathing and moving about a room. The journey from their room to an offsite voting booth is simply an undue burden. Voting by absentee ballot is among the most common methods to enfranchise the disabled.

But absentee balloting is also one of the most common methods of voter fraud, such as stealing multiple residents’ ballots or throwing away ballots. No studies have shown, but rumors persist and cases accumulate, of long-term care facilities being the prime venue to commit such fraud.

Nursing home residents are in the crosshairs of America’s ongoing debate over how big is the problem of voter fraud and how best to address it. Sadly, the problem is typically exaggerated and, as a result, the solutions are overdone. Residents of long-term care facilities in North Carolina are now experiencing this.

North Carolina strictly forbids the employees of hospitals or long-term care facilities from assisting residents to complete their absentee ballots. This is a notable barrier because studies show that most residents require assistance reading the small font and filling in the tiny dots. North Carolina also forbids those people from serving as the required witness on a ballot.

So who can assist a resident and who can serve as a witness? “The voter’s near relative or verifiable legal guardian.”

Imagine the man who lives in a Raleigh nursing home. His family resides in New Jersey. Who will be his witness? The activities director at a Raleigh-based nursing home who described this resident to me did not know the answer. The nephew would have to make a long trip.

I asked him if the requirement for a family member’s signature presents an undue burden. His reply: “Yes. It’s a hassle.”

The desire to forbid employees from proving assistance or witnessing a ballot is an extreme solution to limit the chances of voter fraud. A better solution is to bring the elections official to the nursing homes.

So-called “mobile polling” describes a process where elections officials go to a long-term care facility, provide assistance to the residents who want to vote and then take the completed ballots back to be counted. Studies show that it minimizes fraud, maximizes access and enhances residents’ sense of dignity and worth.

It’s the norm in Australia, Canada and just a few states in the U.S. Until it is the norm for nursing home residents in states like North Carolina, we the people are only the people who have a family member close by and available.

Jason Karlawish, M.D., is professor of medicine, medical ethics and health policy at the University of Pennsylvania’s Perelman School of Medicine.

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