Oct 20, 2020
Voting with Alzheimer's Disease
“Just because you have a cognitive impairment doesn't automatically disqualify your right to vote.”— Melissa Batchelor, PhD, RN, FNP, FAAN (01:44-01:49)
Should a person with Alzheimer’s disease be allowed to vote?
The majority of people living with Alzheimer's disease live at home with family or have friends who help provide care. These family and friends may need to help the person living with dementia to vote, so in this week’s episode, we will review some things to think about when helping someone to vote.
Part One of ‘Voting with Alzheimer's Disease’
In a previous episode when I was talking to my mom regarding visitation in nursing homes, she mentioned that the leadership team was also trying to figure out how to get people into the nursing home to help the residents there to vote (those that could). Shortly after that, I got an email from a colleague asking me if a resident with Alzheimer’s disease should be allowed to vote, and the question was posed as an ethical dilemma. These two things and more recent news led me to do this podcast.
Less than four percent of older adults will ever end up living in a skilled nursing home. If for those who do, around sixty-percent of those residents do have some form of cognitive impairment. The right to vote is a fundamental right and privilege, and just because you have a medical diagnosis of Alzheimer’s disease doesn't automatically disqualify your right to vote.
Decision-Making Capacity vs. Competency
“When we're providing care to a person with Alzheimer's disease, they may have decision-making capacity, but not necessarily have competency.” — Melissa Batchelor, PhD, RN, FNP, FAAN (02:09-02:17)
Part Two of ‘Voting with Alzheimer's Disease’
When we're providing care to a person with Alzheimer's disease, they still may have decision-making capacity, but they may not necessarily have competency. Decision-making capacity is the ability to decide. What are you ready to eat? Are you ready to take a shower? Is there something you'd like to do today? Those are easy decisions that people with early symptoms of Alzheimer's disease can still make.
As this disease progresses, competency may become an issue, and whether or not a person is competent is determined by a judge based on individual state law. If you are the legal guardian of someone who's already been deemed incompetent. In that instance, the person living with Alzheimer's disease may or may not be able to vote - it just depends on where they are in the disease trajectory. The person may or may not have the competency to vote because people with Alzheimer's disease takes away a persons’ ability to execute the multiple steps required in many activities, such as voting.
If you think about all the different steps that it takes to vote, you have to register to vote. If you've recently moved into an assisted living facility or a skilled nursing facility, you do need to change your address because we need you to be able to verify your instate residency. The other things you have to be able to do to vote is to know who the candidates are, their backgrounds, and their positions on issues. Other issues include being able to either go through all the steps that it takes to request an absentee ballot if that's allowed in your state; being able to arrange to get to a polling station or participate in a mobile ballot program? I think that's what my mom was talking about with my grandmother’s nursing home. They were trying to figure out how to bring the mobile ballot program and make it accessible to the nursing home residents who still have the capacity and competency to vote.
If you have mild to moderate Alzheimer's disease and need help completing your ballot, you (and the person helping you) need to be aware that there is potential for coercion and how to avoid it.
“Every facility has an ombudsman that's dedicated to helping to advocate for each of the residents and their rights.” — Melissa Batchelor, PhD, RN, FNP, FAAN (08:09-08:16)
Considerations for a person living with Alzheimer’s disease and voting
- Person must be able to tell you they want to vote
If you are asked to help someone to vote or if you're the one that's asked them to help your loved one to vote, the first question is asking the person if they want to vote. If they do say yes, they need to be allowed to vote.
- What if the person can’t mark their own ballot?
If the person living with dementia cannot mark their own ballot, it's not necessarily a reason that they should not be allowed to vote. If they can't mark their ballot, you have to ask them who they would vote for. The person needs to communicate that to you verbally because if you're the one assisting that person, it's not your opinion, thoughts, ideas, or beliefs that need to be marked on that ballot.
- What if they ask you who to vote for?
If they ask you questions about the different ballots and their positions, that's something that person should have been able to obtain on their own (and it's not your place). You're there as a proxy to fill out on their behalf. Maybe they want to vote for someone that's not on the ballot. If they can tell you the name of whoever they want to vote for, you can write that for them.
- What if the person with dementia can’t remember if they voted?
Another issue could be — the person that you're asking if they want to vote, they may say, "Well, I don't know if I already voted. I can't remember if I voted already or if I did an absentee ballot." But again, you may be able to have people in the assisted living or skilled nursing facility. They may know if the person requested an absentee ballot or the person's family member may know. We only get one vote. So, that's going to be a little bit more of a trickier situation.
- Who can help me or my loved one living in a skilled nursing home?
Every facility has an ombudsman dedicated to helping advocate for each of the residents and their rights. If you witness a situation where you're not sure if the person with Alzheimer's disease has another person trying to control their ability to access the vote or their ability to vote, ombudsmen are a good neutral party to help you work through some of that. You can find more information on how to find your local ombudsman program here.
Find out what the state rules are and how voting is executed in each state. We do need to allow people with Alzheimer's disease the autonomy to vote if they have the decision-making capacity and they are competent to do so.
About Melissa
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.