Prior to COVID-19, nursing and personal care home residents could access the polls in a variety of ways, occasionally even by voting at their own facility if it was a designated polling place. Residents could also more easily receive assistance from visitors on completing their absentee ballots.
But now, with the November election fast approaching, pandemic safety protocols have restricted visitation and off-site travel and moved polling places away from nursing and personal care homes. A group of a dozen community organizations across Pennsylvania, including disability, aging, health and voting advocacy groups, argue in a letter sent to state officials Monday that these restrictions threaten to disenfranchise residents of long-term care facilities.
“Inaction will bar as many as 125,000 Pennsylvanians from access to what may be the most important election in their lifetimes,” states the letter, sent to Department of Health Secretary Dr. Rachel Levine, Department of Human Services Secretary Teresa D. Miller and Department of State Secretary Kathy Boockvar.
In response, the Departments of Health, Human Services, and State wrote in an emailed statement to PublicSource that voting in Pennsylvania is now “more convenient, accessible, and secure” than ever before. The departments also wrote that residents of long-term care facilities can currently vote by absentee ballot or mail-in ballot.
“The Wolf Administration encourages every eligible Pennsylvanian to vote in the upcoming election, and we support all efforts of long-term care providers to assist and empower their residents to exercise this right,” the departments wrote. “We appreciate the concerns expressed in the letter and will consider the suggestions. We are committed to ensuring that all residents of long-term care facilities are able to vote, and are supported in that right.”
Letter author Paul O’Hanlon, who co-chairs the City of Pittsburgh-Allegheny County Task Force on Disabilities, said he wrote it after discovering long-term care facilities were limiting the entry of guests who could aid residents with voting.
Normal visitation is prohibited in facilities with outbreaks and significant COVID-19 transmission and restricted in other facilities, depending on their success at keeping out the virus. The letter states that residents in some facilities have been warned not to leave or fear being locked out as a means to control the spread of COVID-19.
Though the state has recently seen a significant increase in cases among younger Pennsylvanians, personal care and nursing homes continue to bear the brunt of the deaths, with residents constituting 67% of all COVID-related fatalities in the state. Across Pennsylvania, 977 facilities have reported having cases among residents or staff, including 102 in Allegheny County.
O’Hanlon, a retired disability rights lawyer, founded and leads an organization called Ballots for Patients that sends teams of volunteers into local hospitals to assist patients with processing emergency absentee ballots. Since its inception in 2008, Ballots for Patients has attempted to expand its reach to nursing and personal care homes.
“It's not easy in the best of times to be able to enter these facilities and offer the kind of assistance that we did with the hospitals,” O’Hanlon said. “As this presidential year was coming around, we started thinking about how we could do a better job, not expecting a pandemic. And as the pandemic hit, it increasingly became clear to me that my volunteers aren’t getting into these facilities.
“As a person with a disability, I know that all the disability groups in the world are always saying we're 20 to 25% of the population, we should be a big voting bloc, and we should be respected in the area of politics,” O’Hanlon, who uses a wheelchair, added. “But what I also know is that in order to be respected in the area of politics, you have to actually vote.”
Zachary Shamberg, president of the Pennsylvania Health Care Association President [PHCA], said Pennsylvania’s long-term care facilities have always and will continue to make concerted efforts to support residents in political participation. The organization's members include more than 400 long-term care facilities and senior service providers across the state.
Facilities are starting to reopen to certain “ancillary providers,” including therapists, X-ray technicians, hospice care providers, and beauticians, he said. But some facilities still have tighter restrictions, which presents difficulties for residents seeking to designate a visitor to assist them with marking their ballot.
“If there's any way that we can facilitate voting to make it as simple as possible for our residents, for our most vulnerable citizens, I think we should do that, whether it's allowing folks in a long-term care facility to vote there in person, whether it's ensuring that everybody has a vote by mail ballot or an absentee ballot,” Shamberg said.
Barriers beyond access
Beyond the issues of polling place access and voting assistance, residents of long-term care facilities face additional social barriers to electoral participation, according to Rutgers University professors Douglas Kruse and Lisa Schur, who research obstacles to voting for people with disabilities.
Kruse and Schur said they and other political scientists have found three major contributors to low voter turnout among individuals with disabilities: a feeling of inefficacy, a lack of economic resources and social isolation. The pandemic has especially exacerbated the latter two, according to Kruse and Schur.
“People who have more money and more education tend to vote more, and now a lot of people have lost their jobs,” Schur said. “We’ve found that people with disabilities tend to be often the last hired, first fired. Relatively more people with disabilities now have been hit by the pandemic and have lost their jobs.”
Kruse added that a number of studies have also found individuals who are more socially disconnected are less likely to vote.
“And it's just as simple a thing as a colleague or a neighbor saying, ‘Well, have you voted yet?’” Kruse said. “Social isolation is especially a big factor for people with disabilities who are more likely to live alone. And it's especially a big factor this year with the pandemic.”
Schur also pointed to a persistent issue of election officials regularly discarding ballots whose signatures don’t match the ones they have on file, which could disproportionately affect the elderly and disabled residents of long-term care facilities.
“If you have some sort of disability that can affect your ability to write, like cerebral palsy, or just weakness as you get older, your handwriting might not look very much like your handwriting five years ago, or even two years ago,” Schur said.
The pandemic has also limited long-term care residents’ access to candidates, according to Shamberg. During past elections, many nursing and personal care homes would often invite candidates from both parties to visit facilities and inform residents about their platforms.
“That hasn't been able to happen this year, unfortunately, so it's a shame,” Shamberg said. “It's a disservice to a lot of the residents who are unable to learn about those candidates.”
Calls for change
At the end of 2019, before the pandemic struck, Pennsylvania decided to widely implement mail-in ballots to make voting more accessible.
However, disability rights advocates in Pennsylvania like O’Hanlon and Alisa Grishman contend that many long-term care facilities throughout the state have made insufficient efforts to assist residents with participating in voting by mail.
“I think it's great that suddenly we have this as an option because Pennsylvania's voting system is usually really restrictive for absentee ballots,” said Grishman, founder of Access Mob Pittsburgh, an accessibility advocacy group that signed the letter to the state.
“On the other hand, a lot of the agencies that normally should be doing voter registration for disabled people are limited in their reach at the moment because of health restrictions,” Grishman, who uses a wheelchair, continued. “I understand that these long-term care facilities are understaffed and underfunded, so I think there should be more of a government push.”
Many nursing homes and personal care homes that are usually polling places couldn’t operate during the primary election in June and “they most likely can't be expected to do it in November,” Shamberg said. “And that's for the sheer reason that they're trying to keep residents safe, they're trying to keep staff safe,” he said.
Shamberg added that the PHCA is hoping the Department of State or county election commissions will work with long-term care facilities to remove these polling locations as a measure to protect residents.
The signatories of the letter asked that the Department of State match long-term care facility census data with existing voting records and update mailing addresses. They also called on the state to automatically mail out forms for mail-in ballot requests to voters at the facility address; to register eligible, unregistered residents; and to send out applications for mail-in ballots to voters at the facility address.
The letter further calls on the Departments of Health and Human Services, who oversee nursing homes and personal care homes respectively, to issue an All Facilities Letter [AFL] to department-licensed facilities. The letter states that the AFL should formally instruct department-licensed facilities to submit a “plan of action” to facilitate voting by residents.
This should include supporting residents in requesting mail-in or absentee ballots and in receiving assistance with voting. Grishman noted, for example, that currently there is no means by which individuals who are both deaf and blind can remotely vote without help.
Accordingly, the letter argues that facilities must permit residents to designate a person of their choice to assist them in voting, with only narrow restrictions as allowed by the Voting Rights Act, and facilitate in-person meetings with designated persons, with reasonable safety precautions. Facilities should also remind staff that they are not authorized to determine residents’ eligibility to vote, per the letter.
Kruse said that long-term care facilities must protect the idea of the “secret ballot” by guaranteeing residents a voting aide of their choosing to the fullest extent possible.
“When people need to have help with marking a mail-in ballot, it's obviously not confidential,” Kruse said. “It seems very reasonable if you need help and your vote is not going to be confidential that you choose who your vote is going to be revealed to.”
Recognizing that many facilities may lack ample staff or funding, O’Hanlon said he believes the state government must make a “special effort” to increase historically low voter turnout of long-term care residents.
“Staff of these facilities are overwhelmed, and nobody's going to get inside,” O’Hanlon said. “I frankly think that the likelihood that people in these facilities are going to be able to vote in this election looks pretty dim if something extraordinary doesn’t happen.”
Amanda Su is a PublicSource editorial intern. She can be reached at firstname.lastname@example.org.