Vermont Secretary of State Deb Markowitz, along with Jason Karlawish, MD, Associate Professor of Medicine and Medical Ethics, University of Pennsylvania; and Charles Sabatino, Director of the American Bar Association’s Commission on Law and Aging, released the results of a study of Vermont’s mobile polling pilot project.
During the 2008 general election, the Vermont Secretary of State’s Office joined with the University of Pennsylvania and the American Bar Association to develop a pilot program where trained election workers brought ballots to residential care facilities prior to the election to permit eligible residents to register and vote. Residents who were unable to vote independently were offered assistance from bipartisan pairs of election workers who had been trained to work with elderly voters, and in particular, voters who have cognitive impairment.
Markowitz said, “Vermont participated in this study of mobile polling because those of us who administer elections need to be prepared for the challenges of meeting the needs of an aging population.” According to the United States Census Bureau, the number of Americans who are 55 and older will nearly double between 2007 and 2030, from 20 percent of the population (60 million) to 31 percent (107.6 million). Markowitz said, “This means that as we plan for future elections we must consider the challenges presented by the aging of America and explore new ways to reach voters who are in residential care facilities to ensure that they are provided an opportunity to vote, and to prevent voter intimidation or fraud. Mobile polling is a great way to accomplish this.”
The American Bar Association adopted a policy in 2007 urging states to improve access to voting by residents of long term care facilities by use of mobile polling. “Vermont is in the forefront of states in making this policy a reality and showing that it profoundly enhances the quality of participation in the election process,” said Sabatino. “About half the states have some policy that provides for limited outreach to nursing homes by election officials, but there has not been a serious study of mobile polling as a best practice.”
Karlawish said, “The results of this study are compelling and convincing because we designed this project to compare mobile polling to usual voting using nursing homes that were well matched in terms of the number of residents and the severity of their cognitive disabilities.” Working with Dr. Karlawish and Mr. Sabatino, the Secretary of State’s Office trained local election workers and recruited residential care facilities to participate in the project. Twenty-four facilities took part - 15 facilities voted as usual and nine facilities conducted mobile polling. After the election, individual participants were surveyed to assess problems and challenges.
The findings of the study discuss both the challenges and benefits of implementing mobile polling. Key general findings include:
Absentee balloting is very common in long term care facilities. When mobile polling is not offered, residents who vote will do so using an absentee ballot. This confirms previous research and makes sense because residents of long term care facilities often are disabled so that going to the polling place to vote is difficult.
Most residents of long term care facilities need assistance voting. Typically, this means reading the ballot out loud to the voter and helping mark the ballot. This confirms the fact that residents of long term care facilities may be uniquely vulnerable to undue influence and fraud, and confirms the value of having a bi-partisan pair of trained election workers assisting voters in long term care facilities.
Voting in long term care facilities without the benefit of mobile polling opens the process up to arbitrary decision about who may vote and fraud and abuse. Although the study was not designed to uncover fraud or abuse, the study found that without mobile polling nursing home residents are more susceptible to a greater opportunity for both staff and family members to unduly influence voting by residents.
The overall findings of the study indicate that mobile polling is a beneficial alternative for reaching residents of long term care facilities.
Residents of long term care facilities like mobile polling. Nursing home staff and elections workers observed that residents liked the mobile polling experience because it respected their dignity; made them feel like full citizens because their experience is closer to the civic experience of going to a polling place; and it gives them additional contact with the community and fosters feelings of independence, pride, importance and that they are valued by the community.
Mobile polling promotes increased accessibility to voting. Residents of the long term care facilities did not have to worry about transportation to the polls or arranging for an absentee ballot.
Mobile polling was beneficial to nursing home staff. Nursing home staff reported that mobile polling made the registration and voting process easier. It relieved their discomfort about assisting residents with cognitive impairment and it increased the legitimacy of the process, reducing the threat of fraud, undue influence and coercion. They were also pleased because it reduced their workload by streamlining the voting process.
Election officials saw benefits in mobile polling. Election officials found that mobile polling was a good way to assist residents of long term care. They felt that having trained election workers assist voters in bipartisan pairs helps to minimize concerns of voter fraud and manipulation for residents of long term care facilities. Some election workers noted that mobile polling could help reduce the workload on Election Day as it permits them to serve voters in advance.
Implementing mobile polling presents challenges. The principal challenge is the time it takes for election workers to conduct the mobile polling. Although, on average the mobile polling itself took only an hour or two, setting up mobile polling, and finding and training election workers can be time consuming at a time when the clerks are already busy preparing for an election and serving early voters.
The results of this study will be delivered to the United States Elections Assistance Commission, the U.S. Senate Special Committee on Aging, the National Association of Secretaries of State, and the National Association of Election Administrators.
Publication of the full report is expected in the coming year. To learn more about facilitating voting as people age and addressing the challenges of cognitive impairment, visit www.pennadc.org.
Bringing voting to long term care facilities:
Assessing the benefits of mobile polling
Jason Karlawish, University of Pennsylvania, Departments of Medicine and Medical Ethics
Deborah Markowitz, Vermont Secretary of State
Charlie Sabatino, American Bar Association, Commission on Law and Aging
The research reported herein was supported by the Greenwall Foundation and the Borchard Foundation.
Failures to ensure proper access to voting and to protect against manipulation of the vote of disabled citizens compromise the integrity of elections.
In 2008, Vermont enacted mobile polling. Mobile polling brings election officials into a long term care setting so they can assist residents to vote.
To assess the impact of mobile polling on voter turnout, voter rights, and voter fraud.
24 long term care facilities, matched according to size and residents’ cognitive status, were randomized to conduct mobile polling or voting as usual (absentee or polling booth).
Because some sites were unable or unwilling to conduct mobile polling, 15 facilities voted as usual, and 9 facilities conducted mobile polling, resulting in 9 matched pairs and 6 additional control sites.
Surveys of activities directors and election officials assessed problems or challenges with each voting method and voting outcomes.
Facility staff and election officials reported that mobile polling made voting more convenient and accessible for residents, increased legitimacy, relieved staff discomfort in assisting cognitively impaired voters, reduced the threat of fraud and coercion, and decreased workload for residents and staff.
By staff estimates, the overall proportion of residents who voted at matched sites was 30.1% ± 16.9%.
Although there were significant qualitative differences in the voting experience, there were no significant differences between matched control and intervention sites in proportion of residents who voted (t = -1.7, p = .11) or between-site variance in voting rates (variance ratio test f = 0.33, p = .14).
These findings were consistent when all sites were included in analysis.
Advantages of Mobile Polling
Beneficial for the residents’ feelings of self worth
“I think it’s very good for the residents’ self-esteem; it makes them continue to feel like a worthy part of the community and in the political system.”
Less threat of fraud and coercion
“We felt there was less coercion, it would be the cleanest way of voting. No one would influence them, because we know the justices of the peace wouldn’t do that and it also gave a real feeling of participating in democracy.”
Protects/ensures the residents’ right to vote
“They need to vote, they need to make their vote count. Just because they are in a nursing home they shouldn’t be cut off from doing things they want to do. We have pretty good people here, people are very vocal and get into discussion groups. They all felt good having to vote.”
Relieves discomfort of staff assisting the cognitively impaired
“We really cannot even read the ballot to them but you know in the past residents would say what do you think, who do you think I should vote for, so with these two officials there representing both parties it was, it took the load off us. It took the uncomfortableness out of it for us. As much as we want to help people do the right thing or what we think they would think is the right thing, this was not an area that we could get into. So it took a lot of pressure off us.”
Made voting more accessible and convenient
“Mobile Polling was convenient, it assured more people would vote with no influence and they really enjoyed it! Most people here would be too scared to just go out and go to the polling place in the confusion.”
Reduced workload for election officials
“It really helps us on the day of elections because…it helps us with not having so many people with you know those kinds of problems coming through the day of elections. I think it’s a great idea and I think it’s the wave of the future.”
Although mobile polling did not affect turnout, it does provide substantial benefits to maximize voter rights and minimize concerns of voter fraud and manipulation.
Facilities where voting occurred as usual had difficulty judging capacity to vote; staff members worried about potential persuasion and fraud; and voting was time consuming for nursing home staff.