No age limit to vote: Nursing home and all older Americans count

Amid a turbulence of anxiety and fears of voter suppression, election rigging, ballot sabotage and voter intimidation that affect all segments of society — especially as COVID-related deaths are surging specific cohort might be forgotten in their own enclosed lifeboat. 

Older adults are concerned about voting and not everyone is paying attention. They encompass a substantial segment of the voting population that votes consistently.

As a geriatrician and medical director at a not-for-profit continuing care retirement community, I see the concerns and needs of this growing segment of the population, particularly during this early voting phase and the upcoming in-person voting next month.  

One resident under my care, an 86-year-old woman with a persisting tremor shadowed by a strong gaze and stoic character, recently voiced an unrelenting desire to vote, despite a nagging feeling that “even if it does not count, at least I know I did what I had to do.”

Seniors over 65 have the highest rate of voting presence compared to other age groups. It is noteworthy that older adults had a 59 percent voter turnout in the 2014 elections and 66 percent in 2018, having demonstrated a consistently higher percentage of participation opposite to their younger counterparts:

Per Medicare, older adults are defined as 65 and older and, statistically, they have shown an unfailing interest in elections. Per U.S. Census Bureau data from 2018, the non-registered population’s rate missing a registration deadline decreases with age and is 12 percent for ages 30 to 44; 10 percent for ages 45 to 64 and 6 percent for age 65 and older.

Older Americans form a very diverse group of about 49 million aged 65 and older and they highlight the societal problems at large. According to data from the U.S Census Bureau based on the 2016 American Community Survey, the older population comprises a large society segment. They are remaining active in the labor force well past age 65, the typical retirement age.

Age also influences living arrangements. Considering that functional disability rates increase with aging, at age 85 and older, people are more likely to live in group settings, such as nursing facilities, at a rate of 11 percent.

Nursing Home settings are a microcosmos of their own. According to the Centers for Disease Control and Prevention data from 2016, an estimated 1,347,600 people were residents in roughly 15,600 nursing homes across the United States. Among the residents, 43 percent are age 85 and above and 68 percent of the total Nursing Home population are women. Hispanics are about 5 percent, Non-Hispanic white 76 percent and Non-Hispanic blacks 15 percent.

Contrary to what might be a general assumption, while many nursing homes have some degree of cognitive impairment, not everyone has dementia or lacks decision-making capacity. Data shows that fewer than 50 percent of nursing home residents carry the diagnosis of Alzheimer’s disease or other dementias.

Functional impairment is the most prevalent limitation for this population and between 87 to 97 percent of them require assistance with daily activities such as walking, toileting, bathing, dressing, and eating. Only about 88  percent of facilities provide social worker services access.

Typically, nursing home residents vote in person as often the facility itself serves as a polling site. Alternatively, loved ones in the past would typically bring and assist with mail-in ballots.

This is not possible this election year in the face of COVID raging throughout the United States, with more than 220,000 deaths and 8.26 million cases. Nursing homes across the country are in lockdown and visitation remains restricted.

Many long-term care residents have voiced concerns and disbelief about casting mail-in ballots in these uncharted waters, especially given concerns related to reported changes in the United States Postal Service.

The Centers for Medicare & Medicaid Services recently affirmed the continued Constitutional right to vote of nursing home residents even in the face of COVID-related visitation restrictions.

Given these COVID restrictions, voting by mail is a frequent option, and facilities are required to provide resources ranging from postage to pens as well as ensuring that voting is accomplished by residents expressing the desire to do so without discrimination, interference or coercion or any impediment by the facility or its staff. Nursing facilities need to facilitate these voting options as long as infection control guidelines are respected.

It is essential to ensure that all these silent voices, now further muted in isolation due to COVID, are accounted for in the November presidential election. Interestingly enough, both presidential candidates are themselves older adults in their 70s.

Dr. Fernanda Heitor-Behdad is a Geriatrician in the Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine. 

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