Some state requirements or guidance for voting in long-term care facilities  may help to protect against voter fraud and undue influence, according to  researchers. A Large Majority of States Reported Having Requirements or Guidance to Facilitate Voting for Long-term Care Facility Residents

According to our survey, 44 states reported having at least one  requirement or guidance to facilitate voting for long-term care facility  residents. The most commonly reported state requirements or guidance  were to require or provide guidance to election officials to provide long- term care facility residents with accommodations to assist them in  absentee voting processes, provide accommodations for voter registration,  and provide special accommodations to assist elderly voters in meeting  voter identification requirements (see fig. About Half of All States Reported Training Local Officials, While Fewer Reported Conducting Oversight of Local Adherence to State Requirements or Guidance

While most states reported that they provide general training to local  election officials on assisting voters with disabilities, about half of the  states reported providing training to local election officials specifically on  state requirements or guidance to facilitate voting for long-term care  facility residents. Among the states, 17 conducted one or more oversight activities to ensure  localities were adhering to state long-term care facility voting  requirements or following state long-term care facility voting guidance. Some  researchers believe that absentee voting, especially by long-term care  facility residents who require assistance casting their absentee ballots, is  susceptible to voter fraud and undue influence. Specifically, they reported facilitating voting for long-term facility  residents by supporting facility staff in assisting residents with the voting  process and through direct voting services to facility residents, some of  which may help to ensure voting integrity. Most Localities We Surveyed Reported Providing Long-term Care Facilities with Voting Guidance or Other Information and Other Voting Assistance, Some of Which May Help to Ensure Voting Integrity

Localities we surveyed reported taking a number of actions to facilitate  the voting process in long-term care facilities. Localities We Visited Used a Range of Strategies to Facilitate and Protect Voting for Long-term Care Facility Residents and Faced Some Implementation Challenges

The seven localities we visited commonly implemented targeted efforts to  facilitate voting for long-term care facility residents for the November 2008  federal election. Specifically, these strategies included  coordination with stakeholders, such as long-term care facility staff and  others, deployment of election teams, and implementation of procedures  to protect and ensure voting integrity. In some localities we visited, local election workers and facility staff faced  challenges in providing voting assistance to residents with cognitive  limitations. However, at the  same time, states and localities vary in the extent to which they ensure  that the ballots of these voters in long-term care facilities are not  fraudulently completed by someone else, or that these voters are not  subjected to undue influence by facility staff or family members. Appendix I: Scope and Methodology

Our objectives were to identify the actions taken to facilitate and protect  voting for long-term care facility residents at (1) the state level and (2) the  local level. In addition, there are several federal laws that provide broad protections  of the rights of people with disabilities, which indirectly apply to voting.
Why GAO Did This Study

Voting is fundamental to the U.S. democratic system and federal law provides broad protections for people with disabilities, including older voters. Many long-term care facility residents, who often have physical or cognitive impairments, vote by absentee or early ballot. Concerns have been raised about the extent to which states and localities are helping the increasing number of facility residents exercise their right to vote, especially those requiring voting assistance, who may be subject to undue influence or unauthorized completion of their ballot by facility staff or relatives. Given these concerns, GAO was asked to identify the actions taken to facilitate and protect voting for long-term care facility residents at (1) the state level and (2) the local level. To address these objectives, GAO interviewed federal officials, national organizations, and researchers; reviewed Election Assistance Commission (EAC) guidance on voting in long-term care facilities; surveyed state and local election officials; and visited seven localities in the weeks prior to the November 2008 federal election to observe the voting process in long-term care facilities.

What GAO Found

Most states have requirements or guidance to facilitate voting for long-term care facility residents, and some states also provide training and conduct oversight of localities' adherence to state requirements or guidance. States reported that they most commonly provided requirements or guidance for accommodations for absentee voting for residents of long-term care facilities, followed by accommodations for voter registration and voter identification procedures. Almost one-half of the states reported providing training to local election officials specifically on state requirements or guidance to facilitate voting for long-term care facility residents. Additionally, 17 states reported that they conducted one or more oversight activities to ensure that localities were adhering to state long-term care voting requirements or guidance. According to researchers, some of these state requirements or guidance for voting in long-term care facilities may help to protect against voter fraud and undue influence. Localities also used a variety of actions to facilitate voting for long-term care facility residents, including some that may decrease the likelihood of fraud and undue influence. In our survey, 78 of the 92 localities reported taking actions to facilitate voting for long-term care facility residents. The most common actions included supporting facility staff in assisting residents with the absentee or early voting process, including providing staff with early and absentee voting information or guidance. Localities also reported providing services directly to residents. For example, close to one-half of localities we surveyed brought election officials to facilities to assist with the voting process. The seven localities we visited prior to the November 2008 federal election used a range of strategies to facilitate voting for long-term care facility residents, including coordination with facility staff and other stakeholders; the deployment of election teams to facilities; and implementation of procedures to protect and ensure voting integrity, such as requiring bipartisan voting assistance and signed affidavits to document voting assistance. Some local officials reported challenges to implementing these strategies, such as difficulty providing voting assistance to residents with cognitive impairments.