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Nursing home residents isolated by coronavirus now face looming challenge: Voting

Expert fears elderly could be 'systematically disenfranchised' amid COVID.

For residents of the Goodwin House Bailey’s Crossroads senior living center in Falls Church, Va., voting used to be just an elevator ride away.

“Voting is so important,” Jean Bacon, a 79-year-old resident told ABC News. “It's the backbone of our democracy.”

With strict limits still in place on the ability of elderly residents to leave facilities, and prohibitions on friends and relatives coming inside, the looming 2020 elections are presenting the nation’s 15,000 nursing homes with an unprecedented clash of priorities -- balancing between protecting public health and securing the foundational American right to vote.

And though a top government official, along with the presidential campaigns of both major parties, said they recognize the daunting challenges facing the more than one million elderly voters, experts and advocates told ABC News they're concerned that no comprehensive plan has been presented yet to ensure they can safely cast their ballots.

“I think we should be clear that there is tremendous reason to be concerned that nursing home residents will be... systematically disenfranchised in this election,” said Nina Kohn, a law professor at Syracuse University who has studied the voting-rights of older adults.

“This is a train barreling down on the right to vote and the sooner people recognize it, the sooner we'll be in a position to intervene.”

Kohn said nursing homes operators will need to tackle the looming voting challenges head on, in no small part because facilities receiving Medicare and Medicaid funding are legally required to ensure their residents are afforded all of their rights, including the right to cast a vote.

Seema Verma, who runs the federal government's Centers for Medicare and Medicaid Services, told ABC News last week the agency is in the middle of looking into efforts nursing homes are devising to ensure residents can vote in the upcoming elections.

“I think that every American who's eligible should have the right to vote,” Verma said. “We certainly don’t want to create any barriers for anybody around voting.”

Both presidential campaigns told ABC News they recognize the issue -- and the importance of making sure nursing home residents are not left without any options for voting in November. Seniors traditionally represent a sizable block of voters, and both parties have for decades devised election day strategies for mobilizing those living in long-term care, whether that has meant hiring shuttle buses or distributing and mailing absentee ballots.

Older Americans have historically voted at higher rates than younger citizens, according to data from the Census Bureau. In the last general election in 2016, Americans 65 years and older had a voter turnout of 71%, compared to 67% for 45- to 64-year-olds, and 59% for 30- to 44-year-olds, and 46% for 18- to 29-year-olds.

Rosemary Boeglin, a spokesperson for the campaign of former Vice President Joe Biden, told ABC News the Biden campaign has launched a targeted engagement effort for seniors, saying nursing home residents “should never face barriers to making their voices heard.” According to the campaign, their engagement efforts will include setting up phone banks catering to seniors to support them in voting by mail, which is their focus, or safely voting in person -- “whichever means is the smartest and fastest for them,” Boeglin said.

A spokesperson for President Trump’s campaign, Samantha Zager, said their team also has plans to make sure “every eligible voter… [can] have their vote counted – and that includes seniors in nursing homes,” but she did not elaborate. Zagar also repeated the Trump campaign's previous concerns about mail-in voting and potential voter fraud, though Kohn told ABC News instances of voter fraud in long-term care facilities have been "incredibly few and far between."

In the age of COVID-19, Kohn said it is essential to have accessible balloting procedures for nursing home residents, many of whom face challenges in voting even under normal circumstances. Some residents have physical limitations, lack of access to transportation to polling places, or lack of information on how to access an absentee ballot.

In past years, Kohn said most facilities have followed one of three approaches to election day: they transport residents to the local polling precinct, they ensure residents can submit a mail-in ballot, or they work with election officials to let voters cast ballots directly from the nursing home through supervised absentee voting.

“It's kind of a patchwork that they put together, depending on the capacity of their residents,” said Katie Smith Sloan, CEO of LeadingAge, an association of nonprofit providers of aging services that includes many nursing homes.

This year, the first option of in-person voting is especially precarious, as the coronavirus has been shown to be especially dangerous for the oldest Americans. The second two options often require outsiders, such as family member or local election officials, to come into the facility to assist in vote casting, a practice that could run afoul of current safety measures.

As a result, some nursing home residents have taken it upon themselves to make their own plans for November.

“I think we're going to see a lot of creative solutions, but I think we'll see a lot of determination to make that happen because it's so important to older adults to cast their ballot,” Sloan said. “This is a generation of people who believes in voting. They believe that that is their right and that's their responsibility.”

Seniors in Virginia take charge

The hurdles facing voters are clear in places like Goodwin House Bailey’s Crossroads. Officials there told ABC News that residents who need assistance are unlikely to be able to rely on outside visitors, such as family members.

Bacon, who has been in independent living there for seven years, told ABC News residents there are well aware of the challenges, and have been working on a plan to ensure they are not disenfranchised.

Don Gurney, 77, said he is intent on doing whatever it takes to cast a vote, adding he has not used an absentee ballot since he was in the Air Force decades ago. One of the most important tasks, he said, was to get the right information to the residents, like the new location of their polling place and about the evolving election laws in Virginia.

“There is an awful lot of misinformation around and information that's changing all the time,” Gurney said.

Gurney and Bacon helped form a group to mobilize residents to apply early for their ballots. They started by placing application forms, pre-addressed envelopes, and signs with information in common areas. They hosted two events to help residents fill out the necessary forms – even providing large-print versions.

In addition to in-person events, the self-declared voting aides are finding ways to help the skilled nursing residents that typically require outside assistance by working with the staff and social workers and providing them with training, forms, and envelopes.

As the election draws nearer, they said they plan to help residents use the facility's computers to confirm that their application has been received by the Fairfax County Office of Elections. And once the ballots arrive, they will hold sessions to assist the residents with completing the ballots and getting them in the mail. Gurney said that is especially important since Virginia requires a witness for mail-in ballots and they want to make sure the residents do this properly.

“We have a very active group here at Bailey's Crossroads,” Justin Carwile, the facility's executive director, told ABC News. “Our residents are very passionate, they're engaged, they have a good sense of responsibility and they want to be involved in the greater community.”

'Still figuring this out'

At facilities like Goodwin House Bailey’s Crossroads, the pandemic has limited residents' ability to rely on relatives who can help them fill out ballots, and more responsibility has fallen to the staff. But even that is not always an option, said Robyn Grant, Director of Public Policy and Advocacy at the National Consumer Voice for Quality Long Term Care, a group pushing for improved quality in long-term care.

Grant said many nursing homes are facing acute staffing shortages, a problem exacerbated by the pandemic.

And when there are enough staffers, some states have imposed restrictions that prohibit them from helping residents complete their ballots. In North Carolina, for instance, nursing facility owners and staff are prohibited from assisting residents with voting.

Many facilities typically ask the county board of elections to send a multi-partisan assistance team to come to the facility -- another measure that will be much more challenging during a pandemic.

Tom Akins, CEO of LeadingAge North Carolina, said the state is facing a tough balancing act.

“To be frank, North Carolina is still figuring this out,” Akins said.

This month, North Carolina elections officials sent a memo to state lawmakers laying out their plan for having assistance teams work with nursing homes during special outdoor visits, or less preferable indoor visits according to specific guidelines when outdoor visits are not an option. But at the moment, Akins said, the state remains on lockdown -- both outdoor and indoor visitation is not allowed at skilled nursing facilities.

Akins said the memo wound up creating “confusion for everybody involved in terms of how are we supposed to make these visits happen when they're prohibited by the state.”

In an email, a public information officer for the North Carolina State Board of Elections told ABC News they “continue to discuss options and best practices with the N.C. Department of Health and Human Resources, the foremost authority on COVID-19 in our state.”

States across the country are facing similar issues as they continue to adapt to the evolving threat of coronavirus. Voting assistance programs for nursing homes in Florida and Wisconsin have been suspended, according to a ProPublica report.

Akins said unless a safe approach emerges, there is potential that nursing home residents around the country could find it difficult to request, complete, and return an absentee ballot. And that is a deep concern, he said.

“You don't disenfranchise a person from exercising that most basic right that they have,” he said, “and that is the right to vote.”

ABC News’ Will Steakin and John Verhovek contributed to this report.

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