Democracy Doesn't Retire When You Enter a Nursing Home

There comes a time in life when the world begins making decisions for you. What time you eat. When you take your medications. Whether you need help getting out of bed. And, occasionally, whether you can have another cup of coffee without someone reminding you about your blood pressure.

For many nursing home residents, surrendering a little independence is part of the difficult bargain of growing older. But there is one thing that should never be surrendered simply because someone now lives in a nursing home: the right to have a say in the future of the country.

The right to vote does not expire when someone turns 80, begins using a wheelchair, or moves into Room 217 of a skilled nursing facility. It does not disappear because a person needs help bathing, cannot remember what was served for breakfast, or occasionally mistakes the administrator for the maintenance supervisor.

Some of these residents have voted in more elections than their caregivers have celebrated birthdays. They have lived through wars, recessions, civil rights movements, presidential scandals, and campaign promises that somehow never quite made it past Election Day. They have watched politicians come and go, political parties reinvent themselves, and the price of a gallon of milk become a recurring national concern.

They have earned the right to remain part of the conversation.

Yet, when election season arrives, nursing homes can become strangely quiet about voting. There may be decorations for Halloween, a Thanksgiving luncheon on the activities calendar, and enthusiastic discussions about the upcoming Christmas party. But somewhere among the bingo schedules, medication passes, and care conferences, an important question is sometimes overlooked:

Who among our residents would like to vote, and how can we help them do it?

It is a simple question, but answering it requires more than good intentions.

Nursing homes should begin preparing well before Election Day. Social services and activities staff can help residents understand how to verify their registration, obtain voter information, and request assistance with voting when necessary. Facilities can coordinate with local election officials to learn about mail-in ballots, accessible voting options, transportation, and other lawful accommodations.

And because nursing homes have developed an extraordinary talent for creating forms, perhaps we can put that talent to particularly good use by keeping a simple, confidential record of residents who have requested voting assistance, what assistance they need, and whether it has been provided.

Not another form for the sake of having a form. One that actually helps someone exercise a fundamental right.

There should also be particular sensitivity toward residents with physical disabilities or cognitive impairments. A person who can no longer hold a pen steadily may still know exactly whom they want to vote for. Someone who needs help reading a ballot may have very firm opinions about what is printed on it.

And a diagnosis of dementia does not, by itself, automatically take away a person's voting rights. Eligibility is determined by applicable election laws, not by a nursing home's diagnosis list or someone's assumptions about the resident's abilities.

Of course, assistance must never become influence.

A staff member may help a resident understand the mechanics of voting, subject to state law, but must never decide how that resident should vote. Family members should not assume they can cast a ballot on someone's behalf simply because they hold power of attorney. Nor should a resident be pressured to participate when they would rather not.

A ballot belongs to the voter. Not the facility, not the family, and certainly not the administrator, however persuasive the administrator might believe himself to be.

Residents are entitled to their political opinions, even when those opinions are dramatically different from those of the people caring for them. If an 89-year-old woman wishes to vote for a candidate her nurse considers absolutely dreadful, that is democracy doing precisely what democracy is supposed to do.

The nurse can disagree. The resident can vote. Everyone can still be pleasant to one another at dinner.

There is something profoundly moving about the possibility of a resident casting a ballot from a nursing home bed. Perhaps the hands holding the ballot are trembling. Perhaps the voter needs reading glasses, better lighting, or someone to patiently explain the instructions. Perhaps this will be the last election in which that person participates.

We may never know.

But we do know that, for that moment, the resident is doing something that connects them to millions of other Americans. They are participating in a decision much larger than the boundaries of their room, their hallway, or their facility.

They are not merely a patient receiving care. They are a citizen exercising a voice.

We speak often in long-term care about dignity, autonomy, quality of life, and person-centered care. These are important principles, although we sometimes manage to bury them beneath enough documentation to make them practically unrecognizable.

But dignity is not limited to providing a clean bed, a warm meal, and assistance with daily activities. It also means recognizing that the person in that bed still has opinions, convictions, memories, preferences, and a place in the world beyond the nursing home's front doors.

Helping someone vote may not improve a quality measure, shorten a hospital stay, or increase a facility's reimbursement. There may be no special recognition for ensuring that a resident receives an accessible ballot or has the opportunity to participate in an election.

There should not have to be.

Some of the most meaningful things we do in nursing homes are the things that cannot be measured on a spreadsheet.

And perhaps, on Election Day, we can make room for one more activity alongside the usual schedule. Not a political rally. Not a partisan gathering. Just an opportunity for those who wish to participate to do so, freely, privately, and with whatever lawful assistance they need.

We may even consider celebrating residents who choose to participate, without asking them to reveal whom they voted for. An "I Voted" sticker can look particularly wonderful on someone who has spent the better part of nine decades watching American history unfold.

A nursing home should never become a place where citizenship quietly fades into the background simply because the body has grown frail.

Our residents may no longer be able to march in demonstrations, attend town halls, or stand in long lines at polling places. Some may no longer remember the names of every candidate or understand every proposition on the ballot. But those who remain eligible and wish to vote deserve the opportunity to do so.

Because the right to vote is not a reward for being young, healthy, independent, or convenient.

It is a right.

And if we can find the time to make sure Mrs. Johnson gets her preferred television channel, Mr. Garcia receives his afternoon coffee, and everyone makes it to bingo before the first number is called, surely we can find the time to help an eligible resident cast a ballot.

After all, growing old may change where a person lives. It should not erase their place in democracy.